Disability Phenotypes and Job Accommodations Utilization Among People with Physical Disability.

Purpose People with disabilities (PWD) are less likely to be employed than those without disabilities. Reasonable job accommodations are an essential factor for ensuring equal access to jobs for PWD. However, use of job accommodation is less than optimal among PWD with various types of disabilities. Sometimes, PWD have co-occurring impairments, which might affect accommodation use. This research aimed to explore disability phenotypes, frequently used accommodations, and employee- and job-related factors associated with the extent of job accommodation use. Methods A cross-sectional online survey of PWD was conducted in the Midwest region of the United States. Latent class analyses were used to identify disability phenotypes. Descriptive analysis and stepwise Poisson regression were used to identify factors associated with job accommodation use. Results A total of 326 PWD with work experience after acquiring a disability were included in this analysis. We identified three disability phenotypes: (1) Severe disability in cognitive, physical, emotional, communication and visual domains (32%), (2) Moderate cognitive and low physical disability (48%), and (3) High physical disability phenotypes (20%). 80% of PWD received at least one accommodation. Flexible working schedules, telework, and access to a support person in the workplace were the most common accommodations. Employee- (age, disability phenotypes, motor function) and job-related factors (job preparation, self-employment) are associated dependently with accommodation use. Conclusion This analysis identifies three disability phenotypes and highlights both employee- and job-related factors associated with accommodations used. It may be beneficial to consider multiple contextual factors, including co-occurring disability, employee- and job-related factors, when assisting people with job accommodations.

Employment Consequences of COVID-19 for People with Disabilities and Employers.

Purpose The COVID-19 pandemic has disproportionately affected the lives of people with disabilities (PWD). How the pandemic affects the employment of PWD and employers has yet to be determined. We aimed to investigate the employment consequences of the pandemic as experienced by PWD and employers. The research questions were: (1) What employment effects do PWD experience, and what business changes do employers encounter as a result of the COVID-19 pandemic? (2) What challenges have PWD encountered during the pandemic? Methods Cross-sectional online surveys of 733 PWD and 67 employers in the Midwestern United States. Results Compared to non-disabled peers, PWD encountered more challenges in employment during the pandemic. We found high percentages of both employers and PWD experiencing employment changes and business shutdown during the pandemic. For PWD whose employment was not affected, 14.6% of the participants (n = 107) expected a loss of income and worried about the economic uncertainty of the pandemic. Unemployment for PWD is high due to illness or disability, being laid-off or furloughed, business reductions, and not feeling safe to work. However, only about 18.6% of unemployed PWD (n = 16) received pay or benefits for the time they were not working even though more than half filed for unemployment benefits. Conclusions The pandemic adversely affected employment of PWD as reported by workers and employers. Findings parallel the experience of the non-disabled workforce, but reveal vulnerabilities that reflect disability consequences and the need for job accommodations. Results reveal emergent needs for policy supports to reduce the disparities experienced by PWD in the workplace.

Job Accommodations, Return to Work and Job Retention of People with Physical Disabilities: A Systematic Review.

Purpose We aimed to identify job accommodations that help persons with physical disabilities maintain or return to work and explore the barriers and facilitators that influence the provision and reception of job accommodations. Methods We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in PROSPERO (CRD42019129645). The search strategy incorporated keywords describing physical disabilities, employer-approved job accommodations, and employment retention or return to work approaches. We searched MEDLINE, the Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, and ProQuest Theses and dissertations. Reviewers independently selected studies for inclusion. We used Hawker et al.'s method to assess study quality. Results We identified 2203 articles, of which 52 met inclusion criteria, developed a table of job accommodations commonly used by persons with physical disabilities, summarized the percentages of job accommodations used by persons with disabilities, synthesized evidence of the effectiveness of job accommodations, and identified the factors that influence job accommodation use. The most frequently reported accommodations were as follows: modification of job responsibilities, change of workplace policy, supportive personnel provision, flexible scheduling, and assistive technology. We summarized four types of facilitators and barriers that affect job accommodation use: employee-related factors, accommodation-related factors, job-related factors, and social workplace-related factors. Conclusion The absence of randomized controlled trials and prevalence of cross-sectional surveys provides inconclusive evidence regarding the effectiveness of specific job accommodations for people with particular functional limitations. Our system of categorizing job accommodations provides a guide to investigators seeking to evaluate the effectiveness of job accommodations using experimental methods.

Survey of survivors' perspective on return to work after stroke.

PURPOSE: To describe the development and results of a detailed survey on return to work (RTW) after stroke completed by survivors at various stages of recovery. METHOD: This study used a multi-method qualitative and quantitative research strategy to design and implement a 39-item survey for stroke survivors. Individual interviews, focus groups, and working committees were used to conceptualize the issues and translate them into a survey format. Surveys were distributed in regular and electronic mail. Groups of rehabilitation professionals, employers, and stroke survivors were assembled to review findings and obtain feedback to aide in interpretation. RESULTS: Overall 715 surveys were completed. The respondents were on average 54 years of age, mostly white, well-educated, urban dwelling, and in skilled occupations. Results are described in seven areas: financial, stroke impairments, organizational, work and psychological issues, interpersonal support, and therapy. Several salient findings are described including the role of fatigue, under utilization of vocational rehabilitation (VR) services, and motivational factors related to finances, self-esteem, work, and workplace relationships. CONCLUSION: Although earning an income is a strong motivation to RTW, salary decreases in importance when compared with other psychological benefits. Fatigue was rated as the second highest impairment barrier to RTW and persisted as a relevant impediment over time. Attitudes of co-workers and flexibility in work schedule were viewed as most helpful to the RTW process, whereas work stress was viewed as the greatest impediment to return. Only 24% of the sample received VR counseling with more respondents receiving counseling if they returned 6 months or longer after their stroke. Other trends and clinical and research implications are discussed.

Facilitators and barriers to employment for people with physical disabilities: A cross-sectional study.

BACKGROUND: There is increasing evidence that employment, or the lack thereof, affects an individual's health. Consequently, employment provides people with physical disabilities (PWPD) with financial independence, enhances their well-being and self-worth, and facilitates a sense of purpose. People with physical disabilities often retain job skills and motivation to return to work after acquiring a disability. Their vocational rehabilitation and job accommodation needs likely differ from people with disabilities resulting from developmental, sensory, cognitive, and mental health conditions. To better target the needs of PWPD and improve vocational rehabilitation services, it is crucial to identify the modifiable factors that influence their employment outcomes. OBJECTIVE: This research aimed to examine systematically the client-, employer-, and context-related facilitators and barriers to employment experienced by PWPD. METHODS: We recruited to this cross-sectional study, PWPD from the Midwestern United States who returned to work after injury or illness. An online survey collected data on demographic characteristics and educational history; disability and functional status; supports, facilitators and barriers to employment; and job information and accommodations. RESULTS: 347 working-age PWPD completed the survey; at the time of survey completion, 270 were working and 77 were not. People with physical disabilities who reported social support and encouragement at work were more likely to be working than respondents who did not. Negative attitudes of supervisors and colleagues, inaccessible work environments, and inflexible work schedules were barriers to employment. Important reasons for working included financial needs, a sense of purpose, and self-worth. CONCLUSIONS: Results provide insights into the importance of social supports in the work environment. Novel approaches are needed to develop supportive relationships with supervisors and coworkers.

Critical factors related to return to work after stroke: a qualitative study.

Return to work (RTW) after stroke is often perceived as a critical marker of recovery and contributes to overall well-being and life satisfaction of survivors. Quantitative studies have yielded conflicting results in identifying specific predictors of successful RTW, and qualitative studies have been very limited. The current study conducted in-depth interviews with 12 stroke survivors selected by job type and extent of RTW. Seven themes were identified in an analysis of interview transcripts: financial, impairments as barriers, interpersonal support, therapy supporting RTW, organizational influences, work/job specific issues, and psychological issues. These themes confirm and expand on existing qualitative data that focus on survivors' perceptions of their work potential and efforts by emphasizing the need to focus beyond the survivors and their work to include other people and organizations to facilitate the RTW process. Implications for intervention at the individual, work, and community levels are discussed.

Barriers and facilitators of return to work for individuals with strokes: perspectives of the stroke survivor, vocational specialist, and employer.

The purpose of this study was to identify factors that facilitated or acted as a barrier to return to work (RTW) for stroke survivors. We applied 3 approaches to identify the factors. First, we conducted qualitative interviews with 10 stroke survivors about their RTW experience post stroke. Second, we surveyed 21 vocational specialists about barriers and facilitators of RTW based on their clinical practice. Last, we interviewed 7 employers who had experience in interviewing individuals with disabilities or had the authority to make hiring decisions. Descriptions of barriers and facilitators to RTW from these 3 perspectives were illustrated. Identified components were mapped based on the ICF framework. From stroke survivors' perspectives, factors affecting employment after stroke include neurological (motor, cognition, communication), social, personal, and environmental factors. Vocational specialists described similar barriers and facilitators of RTW as the stroke survivors but emphasized personal factors such as flexibility and being realistic in vocational goals. The employers explained that the candidate's disability plays no role in the hiring process and indicated that all applicants must meet the essential job requirements. Some employers described the benefits of having the support of vocational rehabilitation staff and being able to interact with the vocational rehabilitation specialists during the hiring process. The interaction allows the employer to gather initial information (consented to by the job applicant) about the applicants from the vocational rehabilitation service and to be educated about any specific needs related to the applicant's medical issues.