Women at work despite ill health: diagnoses and pain before and after personnel support. A prospective study of hospital cleaners/home-help personnel with comparison groups.

The present study sought to elicit the diagnoses behind the pain conditions causing complaints by female hospital cleaners and home-help personnel who were working despite their symptoms. We also wished to describe the prevalence of musculoskeletal diagnoses and the intensity, frequency and location of pain, and changes in the clinical picture and pain after personnel supporting interventions. A prospective study was carried out with intervention groups and non-randomized comparison groups. The hospital cleaners intervention programme comprised occupational organizational measures, competence development, physical and psychosocial working environmental measures and individual and rehabilitation measures on both an individual and a group basis. The home-help programme comprised a 2-week stay at an orthopaedic rehabilitation unit, training of supervisors, comrade massage, purchase of training equipment and stress management. Myalgia/ tendinitis occurred in 61% of shoulder girdle elevators, 18% of rotator cuffs, 16% of dorsal neck muscles and 29% of hip muscles. There was musculoskeletal pain in the lower back in 28% of cases. Referred pain from a musculoskeletal focus occurred in about one-sixth to one-third of individuals with the diagnosis in question. Neurogenic pain occurred in 6% of cases. No fibromyalgia syndrome was found. One-third of individuals felt pain all the time or almost all the time. The mean rated perceived "worst pain" was 70 mm on a visual analogue scale of 1-100 mm. Comparisons between intervention and reference groups indicated that some improvement in the clinical picture can be attained using this kind of general support programme for employees.

Factors associated with successful vocational rehabilitation in a Swedish rural area.

The objective of this study was to identify factors associated with a positive outcome of vocational rehabilitation, and to identify groups that have been successfully rehabilitated in a Swedish rural area. In this study vocational rehabilitation is defined as medical multidisciplinary, psychological, social and occupational activities aiming to re-establish, among sick or injured people with previous work history, their working capacity and prerequisites for returning to the labour market. The study was based on 732 people on registered long-term sick-leave who, in a rural area in northern Sweden during 1992-94, became objects for vocational rehabilitation. Bivariate and stepwise logistic regression analysis was used to identify factors associated with the outcome. By successful vocational rehabilitation is meant reporting well (no economical benefit) at all three time-points 6, 12 and 24 months after termination of rehabilitation, or lowered benefit levels. The results indicate that younger, male, employed persons, with an early start on rehabilitation, in a programme entailing education, and partly sick-listed before the start of this programme, had the greatest chance of successful rehabilitation. In contrast, older, female, unemployed people, with a delayed start on rehabilitation, without education, and fully sick-listed before the start, greatly risked being unsuccessful with vocational rehabilitation. The results indicate how to improve the rehabilitation process: several process-related factors shown to be connected with successful vocational rehabilitation include time before the start of rehabilitation, partial instead of full sickness benefit, and education programmes.

The effect of vocational rehabilitation on later sick leave.

PURPOSE: The aim of this study was to examine the effect of vocational rehabilitation on later sick leave for employed and unemployed people on long-term sick leave. METHOD: The study was based on long-term sick-leave cases initiated during 1992-1994 in Stockholm, Sweden. Of 1704 cases, 383 (321 employed and 62 unemployed) underwent vocational rehabilitation. These were individually matched with sick-leave cases not undergoing rehabilitation, using the variables age, sex, diagnoses and employment status. RESULTS: The hypotheses were (1) that people who underwent rehabilitation, both employed and unemployed, would have less later sick leave than those who did not, and (2) that rehabilitation would affect employed people more than unemployed people. These hypotheses were only partly supported. CONCLUSIONS: The results indicate that vocational rehabilitation has a positive effect regarding later sick leave only for unemployed men. For unemployed women the effect is negative and for those employed, both men and women, rehabilitation has no demonstrable effect.

Return to work following vocational rehabilitation for neck, back and shoulder problems: risk factors reviewed.

PURPOSE: The present aim was an overview of factors associated with return to work following vocational rehabilitation for problems in the neck, back, and shoulders. METHOD: Studies were identified through a systematic keyword search in databases. For inclusion, return to work had to be in focus and studies to have been published between 1980 and 2000. RESULTS AND CONCLUSION: A great number of demographic, psychological, social, medical, rehabilitation-related, workplace-related and benefit-system-related factors are associated with return to work. The different types of risk factor are associated in many ways. People with greater chances of job return after vocational rehabilitation are younger, native, highly educated, have a steady job and high income, are married and have stable social networks, are self-confident, happy with life, not depressed, have low level of disease severity and no pain, high work seniority, long working history and an employer that cares and wishes them back to the work place. Unfortunately, people with the above profile are seldom found among the long-term sick.

Improved cooperation in vocational rehabilitation with systematic rehabilitation group meetings.

PURPOSE: The present aim was to investigate the communicative pattern in two rehabilitation groups. The rehabilitation group consisted of the client, a supervisor, an employer representative, an occupational health physician, a rehabilitation counsellor from the national social insurance office and a support person. METHOD: Participatory observation of 22 rehabilitation meetings. The communication was tape-recorded and transcribed word for word. The transcripts were coded and analysed both qualitatively and quantitatively. RESULTS AND CONCLUSION: The client made the most utterances in the groups, but most often in the form of answers to questions from the other actors. Following the client, the physician made the next most frequent utterances, most often as questions. The subjects most discussed concerned the client's situation regarding work, health and material support. None of the "professionals" dominated the meetings, although one picture that emerged was that the physician and employer representative played more prominent roles as takers of initiative and as coordinators while the client was more passive than the other actors. The discussions were calm and much latitude was allowed for the participants to put forward their own requirements, thoughts and feelings. The rehabilitation group may be viewed as a meeting place for "experts" and clients. The further management of the rehabilitation was by the actor the client most immediately needed. In this, rehabilitation in the rehabilitation group differs from the "case management" common in the rehabilitation field.

Vocational rehabilitation and future sick-leave.

The aim of the present pretest-posttest study was to examine and compare the impact of vocational rehabilitation on future sick-leave for employed and unemployed people, respectively, on long-term sick-leave. The study is based on 416 registered long-term sick-leave cases that were initiated during 1992-94 in the city of Stockholm, and that became objects for vocational rehabilitation. The hypotheses were (1) that the number of sick-days and levels of benefit for both employed and unemployed would be less after rehabilitation than before and (2) that rehabilitation would affect employed people more than unemployed people. The hypotheses are supported in that both employed and unemployed have less sick-days and lower levels of benefits after vocational rehabilitation than before and that unemployed people have more sick-days and higher levels of benefits than employed people after rehabilitation. However, since unemployed people also have more sick-days before rehabilitation, the proportional decrease is about the same. Another finding was that men, especially among the unemployed improved more than women.

Health-related quality of life in women at work despite ill-health. A prospective, comparative study of hospital cleaners/home-help staff before and after staff support.

The aims of this prospective, non-randomized, comparative study were to elucidate how 99 female hospital cleaners and home-helps, at work despite ill-health, experienced their quality of life, and to study whether this was affected by a particular programme of staff support. The SF-36 questionnaire was used. This contains questions on physical, mental and social health status. Health status, i.e. experienced health, was assessed by the respondents themselves. Low quality of life relating to the dimensions bodily pain, general health perceptions and vitality proved to apply both to the hospital cleaners and the home-help staff, compared to a normal Swedish female population. No significant differences between the intervention group and the reference group were demonstrated among either the cleaners or the home-helps. Following the intervention/period of customary measures, experienced quality of life was somewhat changed in the groups compared with the normal Swedish female population. This may indicate a certain unspecific improvement in experienced quality of life in both the intervention groups and the reference groups.

Vocational rehabilitation--early versus delayed. The effect of early vocational rehabilitation compared to delayed vocational rehabilitation among employed and unemployed, long-term sick-listed people.

The aim of the present study was to examine whether the wait before vocational rehabilitation affected the outcome for employed and unemployed, long-term sick-listed people. The study is based on sick-leave cases 90 days or longer, which started during 1992-1994 in a rural area in Sweden. The study included all sick-leavers with non-malignant musculoskeletal diagnoses from the neck, shoulder and back regions and who had undergone vocational rehabilitation. Of these, 391 were employed and 78 unemployed. Our hypothesis was that those who undergo early vocational rehabilitation, irrespective of employment status, often get well sooner, have fewer sick days and lower benefit levels after vocational rehabilitation than those who have to wait a long time for their rehabilitation. Our hypothesis was supported only regarding the employed who mainly reported well at 6 and 12 months after vocational rehabilitation. In the longer term (24 months) the effect was however no longer evident. Earlier studies indicate that more factors than an early start to rehabilitation are important for a successful outcome. A more important factor is probably that the right measures have been initiated at the right time, that the measures are of high quality and that the sick-leaver is mentally prepared for the measure. Although early vocational rehabilitation did not prove to be a determining factor for a successful outcome there is still reason to emphasize early involvement in the case to guarantee rehabilitation of high quality.

The unemployed sick-listed and their vocational rehabilitation.

The unemployed on long-term sick-leave are many and difficult to rehabilitate. The likelihood that a period of sick leave will result in a temporary disability pension is about three times greater for the unemployed than for those with jobs. The aim of this current study was to examine the vocational rehabilitation process of the unemployed on long-term sick-leave. The study was based on 118 matched cases on long-term sick-leave, 59 employed and 59 unemployed. Data were collected at seven social insurance offices in rural areas of Jämtland, Sweden. Our hypothesis was that the unemployed were disregarded in vocational rehabilitation. The results partly confirm this. Unemployed people's potential need for rehabilitation is not investigated to the same extent as employed people's. Also the unemployed have to wait longer for an investigation. Against our hypothesis, however, no difference exists between the employed and the unemployed in rehabilitation impulse, rehabilitation plan or rehabilitation allowance. Nor do the unemployed, except for those awaiting investigation, wait longer than the employed. The major result of the study is, instead, that vocational rehabilitation in general, regardless of employment status, seems beset with problems. Rehabilitation activities seem far too few and initiated unnecessarily late. Neither the employer nor the social insurance office seem to be fulfilling their statutory duties.

Unemployed long-term sicklisted people in rural Jämtland compared with circumstances in the city of Stockholm, Sweden.

OBJECTIVES: The dual aims of this study were to investigate the unemployed sicklisted in an area of rural northern Sweden and to compare the results with results obtained earlier from the city of Stockholm. STUDY DESIGN: Data were obtained mainly from the social insurance office registers. The study covers 795 cases. RESULTS: The results show the unexpected finding that the proportion of unemployed among sicklisted people was lower in the northern rural area (15%) than in Stockholm (20%). Mental diagnoses were, as in Stockholm, more common among the unemployed, especially among the men. In Jämtland it is more common for the employed to leave the social insurance system after sick leave than is the case for the unemployed. The latter, instead, tend to start a new period of sick leave or a period on rehabilitation allowance. In Stockholm it was more common that the unemployed compared with the employed replaced a sick period with a temporary disability pension. CONCLUSIONS: The study indicates that the unemployed sicklisted people are a group with special needs concerning rehabilitation. This poses a special challenge to the rehabilitation counsellors working with the unemployed.

Desire, longing and vanity: emotions behind successful return to work for women on long-term sick leave.

OBJECTIVE: The purpose of this study is to identify situations and phenomena that have simplified returning to work for women on long-term sick leave. PARTICIPANTS: Seven women who were exposed to a relatively large number of risk factors that normally are associated with difficulties in returning to work. METHODS: In-depth interviews with qualitative content analysis. RESULTS: The analysis indicated four main categories of factors: The Individual, Interactions, Surrounding Resources, and Situations. In each of the main categories structural factors exist and it appears that these have been of significant importance to the women in their return to work. These are presented as Key Factors and they are: clarification of--and the need for--support in the personal process of change; desire, longing, and vanity; respectful interactions between the individual and people in her surroundings; the structure and content of the rehabilitation clinic; the importance of the perceived reality; and the individual's sense of control during the work related rehabilitation process. CONCLUSIONS: The results mostly revealed phenomena that have been indicated and described in earlier research studies. However, emotions such as desire, longing and vanity as motivation and driving forces behind a return to work have not been earlier described.

The process of vocational rehabilitation for employed and unemployed people on sick-leave: employed people vs unemployed people in Stockholm compared with circumstances in rural Jämtland, Sweden.

The likelihood that a period of sick-leave will result in a temporary disability pension is about three times greater for unemployed people than for those with jobs. The aim of this study was 1) to compare the vocational rehabilitation of the employed with the rehabilitation of the unemployed in the city of Stockholm and 2) to compare the results with previous results from rural Jämtland. The study was based on 156 matched cases on long-term sick-leave (90 days or more) initiated during 1992 and 1993. Two inclusion criteria were that the diagnoses should indicate low-back pain or problems in the neck/shoulders, and that the patients should be below 58 years of age. Our hypothesis was that the unemployed were disregarded in vocational rehabilitation. The results confirm this in that rehabilitation plans are not established to the same extent for the unemployed as for the employed. Against our hypothesis, however, no difference exists in rehabilitation impulse, rehabilitation investigation or rehabilitation measures received. The major finding of the study is, instead, that rehabilitation in general seems beset with problems. Rehabilitation activities seem far too few and initiated unnecessarily late. Neither the employers nor the social insurance offices seem to be fulfilling their statutory duties. The results of the study correspond well with the results previously found in rural Jämtland.