Inability to Work Fulltime and the Association with Paid Employment One Year After the Work Disability Assessment: A Longitudinal Register-Based Cohort Study.

OBJECTIVES: Disability benefit applicants with residual work capacity are often not able to work fulltime. In Dutch work disability benefit assessments, the inability to work fulltime is an important outcome, indicating the number of hours the applicant can sustain working activities per day. This study aims to gain insight into the association between inability to work fulltime and having paid employment 1 year after the assessment. METHODS: The study is a longitudinal register-based cohort study of work disability applicants who were granted a partial disability benefit (n = 8300). Multivariable logistic regression analyses were conducted to study the association between inability to work fulltime and having paid employment 1 year after the assessment, separately for working and non-working applicants. RESULTS: For disability benefit applicants, whether working (31.9%) or not working (68.1%) at the time of the disability assessment, there was generally no association between inability to work fulltime and having paid employment 1 year later. However, for working applicants diagnosed with a musculoskeletal disease or cancer, inability to work fulltime was positively and negatively associated with having paid employment, respectively. For non-working applicants with a respiratory disease or with multimorbidity, inability to work fulltime was negatively associated with paid employment. CONCLUSIONS: Inability to work fulltime has limited association with paid employment 1 year after the disability benefit assessment, regardless of the working status at the time of assessment. However, within certain disease groups, inability to work fulltime can either increase or decrease the odds of having paid employment after the assessment.

Diverging death risks: Mortality as a corollary of economic, social, cultural and person capital.

Introduction: Diverging death risks are associated with a wide range of social factors, including not only education and income but also other economic and non-economic resources. The aim of this study was to assess the association of mortality risks with four types of resources: economic, social, cultural and person capital. Methods: We used data of 2,952 participants from the Disparities in the Netherlands survey and annual mortality data from Statistics Netherlands for the period 2014 to 2021. Economic capital was measured through education, income, occupation, home equity, and liquid assets. Social capital was measured by the strength of social ties, the size of the core discussion network, and access to people in resourceful positions; cultural capital by lifestyle, digital skills, and mastery of English, and person capital by self-rated health, impediments to climbing stairs, self-confidence, self-image, people's appearance, and body mass index. To accommodate the fact that each capital was derived from several indicators, we used Partial Least Squares (PLS) Cox Regression. Results: In multiple regression, higher economic, cultural, and person capital were associated with lower mortality (hazard ratio, 0.77; 95% confidence interval [CI, 0.65 to 0.90], 0.77 [0.64-0.93] and 0.80; [0.70-0.92]), adjusted for all capital measures and sex. Conclusion: The finding that more economic, cultural and person capital is associated with lower mortality provides empirical support for an approach that uses a broad spectrum of capital measures - hitherto rarely included simultaneously in epidemiological research - in order to understand diverging death risks. By integrating sociological concepts, cohort data, and epidemiological research methods, our study highlights the need for further research on the interplay between different forms of resources in shaping health inequalities. In designing public health interventions, we advocate the adoption of a multidimensional capital-based framework for tackling social disparities in mortality.

Return to work policies and practices after total hip or knee arthroplasty in Denmark, Germany, and the Netherlands: an exploratory study.

PURPOSE: To explore return-to-work (RTW) policies and practices for total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients in three European countries. MATERIALS AND METHODS: An exploratory study in Denmark, Germany, and the Netherlands consisting of three aspects: (1) description of the healthcare and social security systems; (2) identification of national RTW guidelines; (3) a survey to gain insight into RTW practices and perceptions of orthopaedic surgeons, including barriers, facilitators, and needs. RESULTS: Healthcare and social security systems differed (e.g. fast-track vs longer postoperative stay; coverage of rehabilitation costs). National guidelines were available in Germany (THA, TKA) and the Netherlands (TKA), containing limited RTW information. The survey was completed by 168 orthopaedic surgeons (Denmark n = 51; Germany n = 39; the Netherlands n = 78). Overall, orthopaedic surgeons reported being in need of more knowledge and better collaboration with other healthcare practitioners. CONCLUSION: We found considerable variation in healthcare and social security systems. When available, national guidelines contained limited information. In all three countries surgeons need more knowledge and better collaboration with other healthcare practitioners. We advise that RTW multidisciplinary recommendations post THA/TKA be established by the national associations of the healthcare practitioners involved.

Orthopaedic surgeons (regardless of country) need more knowledge, including "guidelines", "scientific evidence", and "expertise with work/return-to-work", to adequately support return to work.Orthopaedic surgeons need better collaboration with other healthcare practitioners to adequately support total hip arthroplasty or total knee arthroplasty patients to return to work.Multidisciplinary recommendations for returning to work after total hip arthroplasty or total knee arthroplasty should be established by the national associations of the healthcare practitioners involved.

Process evaluation of a comprehensive approach to reintegration of disability benefit recipients with multiple problems (CARm) into the labour market.

PURPOSE: As the effect evaluation of our randomized controlled trial the "Comprehensive Approach of Reintegration for clients with Multiple problems" (CARm) showed no superior effect on re-integration into paid employment of the clients when compared with clients of the care as usual, we conducted this process evaluation to gain insight into whether the intervention was conducted according to protocol. METHODS: Using questionnaires on recruitment, reach, dose delivered, dose received, fidelity, context, and satisfaction we collected data from 40 labour experts of the Public Employment Service of the Dutch Social Security Institute, and from 166 disability benefit recipients dealing with multiple problems. RESULTS: Only few of the labour experts provided the key elements of the intervention to their clients. Between the clients of both groups were no significant differences in the dose received. More than half of the labour experts of the intervention group reported organizational changes. CONCLUSION: The lack of effect of the CARm intervention was almost certainly caused by implementation failure. Once again this study showed the importance of involving all stakeholders in developing and the conduct of the intervention, and of clarifying the consequences for the organization, to ensure that it can be conducted according to protocol.

A Strength based intervention was developed to improve re-integration into paid employment of disability benefit recipients facing multiple problems and a process evaluation was carried out.Organizations should provide sufficient time to support their professionals by implementing this intervention into practice.Protocol adherence is crucial to value intervention results in practice.

A capital-based approach to better understand health inequalities: Theoretical and empirical explorations.

Background: The persistence of health inequalities may be driven by differences in education and income, but also by other economic and non-economic factors. Our aim was to explore how the association between single-dimensional health and socioeconomic status (SES) changes when including health-related person capital, economic capital, social capital, cultural capital and attractiveness and personality capital. Methods: We used a capital-based approach to understand health inequalities. It presumes intertwined relationships between broadly measured health ('health-related person capital') and embodied resources ('attractiveness and personality capital') on the one hand, and ESC capital, i.e., economic, social, and cultural resources on the other. We used cross-sectional data on 152,592 participants from the Dutch Lifelines cohort study and estimated correlations using partial least squares structural equation modelling. Results: The correlation between SES and health-related person capital (r = 0.15) was stronger than the correlations between SES and single-dimensional health (physical and mental health; r = 0.12 and r = 0.04, respectively). ESC capital, combining economic, social and cultural capital, showed a correlation of 0.34 with health-related person capital. This was stronger than the correlation between health-related person capital and economic capital alone (r = 0.19). Lastly, the correlation between health-related person capital and ESC capital increased when health related, attractiveness and personality resources were combined into a single person capital construct (from r = 0.34 to r = 0.49). Conclusions: This exploratory study shows the empirical interconnectedness of various types of resources, and their potential role in the persistence of health inequalities. Our findings corroborate the idea of considering health as a multidimensional concept, and to extend conventional SES indicators to a broader measurement of economic and non-economic resources.

Increases in symptoms of depression and anxiety in adults during the initial phases of the COVID-19 pandemic are limited to those with less resources: Results from the Lifelines Cohort Study.

BACKGROUND: The COVID-19 pandemic may have a differential impact on mental health based on an individual's capital, i.e. resources available to maintain and enhance health. We assessed trajectories of depression and anxiety symptoms, and their association with different elements of capital. METHODS: Data on 65,854 individuals (mean baseline age = 50·4 (SD = 12·0) years) from the Lifelines COVID-19 cohort were used. Baseline mental health symptoms were on average measured 4.7 (SD = 1·1) years before the first COVID-19 measurement wave, and subsequent waves were (bi)weekly (March 30─August 05, 2020). Mental health symptom trajectories were estimated using a two-part Latent Class Growth Analysis. Class membership was predicted by economic (education, income, and occupation) and person capital (neuroticism, poor health condition, and obesity) FINDINGS: Most individuals were unlikely to report symptoms of depression (80·6%) or anxiety (75·9%), but stable-high classes were identified for both conditions (1·6% and 6·7%, respectively). The stable-high depression class saw the greatest increase in symptoms after COVID, and the stable-high anxiety class reported an increase in the probability of reporting symptoms after COVID. At the first COVID-measurement, the mean number of symptoms increased compared to baseline (depression:4·7 vs 4·1; anxiety:4·3 vs 4·2); the probability of reporting symptoms also increased (depression:0·96 vs 0·65; anxiety:0·92 vs 0·70). Membership in these classes was generally predicted by less capital, especially person capital; odds ratios for person capital ranged from 1·10-2·22 for depression and 1·08-1·51 for anxiety. INTERPRETATION: A minority of individuals, possessing less capital, reported an increase in symptoms of depression or anxiety after COVID. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Prevalence, types, and combinations of multiple problems among recipients of work disability benefits.

PURPOSE: For persons on disability benefits who are facing multiple problems, active labour market policies seem less successful. Besides health problems, these people perceive personal, social, and environmental problems. Since very little is known about these "non-medical" problems our aim was to explore the prevalence of clients experiencing multiple problems, the types and number of perceived problems, combinations of perceived problems, and associated characteristics in a group of work disability benefit recipients. METHODS: We performed a cross-sectional study, using self-reported data on perceived problems and socio-demographics, and register data from the Dutch Social Security Institute on diagnosed diseases and employment status. A convenient group of labour experts recruited eligible clients on work disability benefit. RESULTS: Of the 207 persons on work disability benefit, 87% perceived having multiple problems. Most reported problems were related to physical (76%) or mental (76%) health. Health problems most frequently occurred together with a mismatch in education, financial problems, or care for family members. Clients with lower education experienced significantly more problems than clients with an intermediate or high educational level. CONCLUSIONS: Clients with multiple problems face severe and intertwined problems in different domains of life, and need tailored multi-actor work disability management.Implications for rehabilitationClients with multiple problems face severe and intertwined problems in different domains of life; therefore, interventions tailored to deal with needs related to specific problems might be more effective than traditional programs.Interventions should match experienced barriers, and involve multi-actor work disability management with all the challenges of mutual cooperation.For persons with multiple problems a focus on pure medical barriers is too narrow, because personal, social, and environmental factors might also obstruct participation in work.

Work capacity assessments and efforts to achieve a job match for claimants in a social security setting: an international inventory.

PURPOSE: Many high-income countries are witnessing a shift of focus on eligibility for disability benefits towards promotion of work reintegration. However, little is known about how countries assess work capacity, and how a job match is then obtained. The current study aims to compare work capacity assessments and available efforts to achieve a job match in eight high-income OECD countries. METHODS: A survey was conducted among key stakeholders concerning organization of work capacity assessments in social security settings, and efforts made to obtain a job, across eight OECD countries: Australia, Denmark, Finland, Iceland, Sweden, the Netherlands, the United Kingdom and the United States. RESULTS: In most countries, work capacity is assessed at several time points, with variations in moments and in information used for job matching. In countries obtaining information on personal and work levels, the search to find a job match usually begins with the persons who have disabilities. CONCLUSION: Although a shift towards a holistic focus in work capacity assessment has been recognized, medical factors still prevail. Limited emphasis is placed on the implications of functional limitations for the possibilities of work. A holistic approach to assessment needs to be coupled with holistic support measures through provision of coordinated and high quality job matching services.IMPLICATIONS FOR REHABILITATIONBesides determining eligibility for benefits the outcome of the work capacity assessment can also be used for other purposes such as reintegration and should not result in a static description of work capacity but also deliver insight in support needs.Involving multiple institutions and disciplines in work capacity assessments may result in a broader overview of the claimants' capacities, however this places high demands on cooperation and data sharing of all those involved.Incorporating the claimants own perspective on work capacity and possibilities to work might improve the legitimacy of the process and reasonably also the achievement of a good and sustainable job match. This can be achieved by using self reported questionnaires and interviews in the assessments.

Barriers to and Facilitators of Sustained Employment: A Qualitative Study of Experiences in Dutch Patients With CKD.

RATIONALE & OBJECTIVE: Although patients with chronic kidney disease (CKD) are at risk for work disability and loss of employment, not all experience work disruption. We aimed to describe the barriers to and facilitators of sustained employment experienced by Dutch patients with CKD. STUDY DESIGN: Qualitative study using semistructured interviews. SETTING & PARTICIPANTS: 27 patients with CKD glomerular filtration rate categories 3b-5 (G3b-G5) from 4 nephrology outpatient clinics in The Netherlands. ANALYTICAL APPROACH: Content analyses with constant comparison of interview data based on the International Classification of Functioning, Disability and Health framework. RESULTS: Participants were 6 patients with CKD G3b-G4, 8 patients receiving maintenance dialysis, and 13 patients with functioning kidney transplants. We identified health-related barriers (symptoms, physical toll of dialysis/transplantation, limited work capacity) and facilitators (few physical symptoms, successful posttransplantation recovery, absence of comorbidities, good physical condition), personal barriers (psychological impact, limited work experience) and facilitators (positive disposition, job satisfaction, work attitude, person-job fit), and environmental barriers and facilitators. Environmental barriers were related to nephrology care (waiting time, use of a hemodialysis catheter) and work context (reorganization, temporary contract, working hours, physical demands); environmental facilitators were related to nephrology care (personalized dialysis, preemptive transplant), work context (large employer, social climate, job requiring mental rather than physical labor, flexible working hours, adjustment of work tasks, reduced hours, remote working, support at work, peritoneal dialysis exchange facility), and support at home. Occupational health services and social security could be barriers or facilitators. LIMITATIONS: The study sample of Dutch patients may limit the transferability of these findings to other countries. CONCLUSIONS: The wide range of barriers and facilitators in all International Classification of Functioning, Disability and Health components suggests great diversity among patients and their circumstances. These findings underline the importance of personalized nephrology and occupational health care as well as the importance of individually tailored workplace accommodations to promote sustained employment for patients with CKD.

Social insurance literacy: a scoping review on how to define and measure it.

PURPOSE: Sickness insurance and workers' compensation systems decide on peoples' eligibility for benefits, and are commonly based on medical certificates and assessments of work ability. Systems differ in the extent to which they preserve clients' dignity and right to fair assessments. In this article, we define a new concept for studying interactions between individuals and systems: social insurance literacy, which concerns how well people understand the different procedures and regulations in social insurance systems, and how well systems communicate with clients in order to help them understand the system. METHODS: The concept was defined through a scoping literature review of related concepts, a conceptual re-analysis in relation to the social insurance field, and a following workshop. RESULTS: Five related concepts were reviewed for definitions and operationalizations: health literacy, financial/economic literacy, legal capability/ability, social security literacy, and insurance literacy. CONCLUSIONS: Social insurance literacy is defined as the extent to which individuals can obtain, understand and act on information in a social insurance system, related to the comprehensibility of the information provided by the system. This definition is rooted in theories from sociology, social medicine and public health. In the next step, a measure for the concept will be developed based on this review.Implications for rehabilitationSocial insurance literacy is a new concept that is based on theories in sociology, social medicine and public health.It provides conceptual orientation for analyzing factors that may influence different outcomes of peoples' contacts with social insurance systems.The concept is of relevance for rehabilitation professionals since it focuses on how interactions between individuals and systems can influence the rehabilitation process.The study will in the next step develop a measure of social insurance literacy which will have practical applications for rehabilitation professionals.

Content Validation of a Practice-Based Work Capacity Assessment Instrument Using ICF Core Sets.

PURPOSE: A shift from providing long-term disability benefits to promoting work reintegration of people with remaining work capacity in many countries requires new instruments for work capacity assessments. Recently, a practice-based instrument addressing biopsychosocial aspects of functioning, the Social Medical Work Capacity instrument (SMWC), was developed. Our aim was to examine the content validity of the SMWC using ICF core sets. METHODS: First, we conducted a systematic search to identify relevant ICF core sets for the working age population. Second the content of these core sets were mapped to assess the relevance and comprehensiveness of the SMWC. Next, we compared the content of the SMWC with the ICF-core sets. RESULTS: Two work-related core sets and 31 disease-specific core sets were identified. The SMWC and the two work-related core sets overlap on 47 categories. Compared to the work-related core sets, the Body Functions and Activities and Participation are well represented in the new instrument, while the component Environmental factors is under-represented. Compared to the disease-specific core sets, items related to the social and domestic environmental factors are under-represented, while the SMWC included work-related factors complementary to the ICF. CONCLUSION: The SMWC content seems relevant, but could be more comprehensive for the purpose of individual work capacity assessments. To improve assessing relevant biopsychosocial aspects, it is recommended to extend the instrument by adding personal and environmental (work- and social-related) factors as well as a more tailored use of the SMWC for assessing work capacity of persons with specific diseases or underlying illness.

Personality as a Resource for Labor Market Participation among Individuals with Chronic Health Conditions.

Background: The link between personality traits and employment status in individuals with chronic health conditions (CHCs) is largely unexplored. In this study, we examined this association among 21,173 individuals with CHCs and whether this association differs between individuals suffering from a heart disease, depression, anxiety, cancer, chronic obstructive pulmonary disease, musculoskeletal disease (MSD) and type 2 diabetes mellitus (T2DM). Methods: This study was conducted using baseline data from the Lifelines Cohort Study. Employment status and the presence of CHCs were determined by questionnaire data. The Revised Neuroticism-Extroversion-Openness Personality Inventory (NEO-PI-R) was used to measure eight personality facet traits. We conducted disease-generic and disease-specific logistic regression analyses. Results: Workers with higher scores on self-consciousness (OR: 1.02; 95% CI: 1.01-1.02), impulsivity (1.03; 1.02-1.04), excitement seeking (1.02; 1.01-1.02), competence (1.08; 1.07-1.10) and self-discipline (1.04; 1.03-1.05) were more often employed. Adults with higher scores on anger-hostility (0.97; 0.97-0.98), vulnerability (0.98; 0.97-0.99), and deliberation (0.96; 0.95-0.97) were least often employed. Personality facets were associated strongest with employment status among individuals suffering from MSD and weakest in individuals with T2DM. Conclusions: Personality might be a key resource to continue working despite having a CHC. This may be relevant for the development of targeted personality-focused interventions.

Development and evaluation of a strength-based method to promote employment of work-disability benefit recipients with multiple problems: a feasibility study.

BACKGROUND: For people with disabilities, chances to find or keep work are negatively affected by multiple problems like lower education, poverty and poor health. Furthermore, although active labour market policies proved to be effective for unemployed in general, success rates are poor for persons who are unemployed due to multiple problems. The present study aims to describe the development of a method as well as professional training to teach its application, and to assess the feasibility of method and training. The Strength-based method (CARm) aims to promote employment of work-disability benefit recipients with multiple problems. METHODS: The main principles of the Strength model were redesigned for better applicability in a population of work-disability beneficiaries, resulting in the CARm method. As part of the CARm method, a training module for Labour Experts (LEs) was developed. To assess the new designed method and training, a one-group, pre-post design was used. Data were collected from eight participating LEs, five female and 3 male, aged between 41and 55 years and having 2-17 years working experience. We used self-report questionnaires and a semi-structured discussion meeting after the training sessions with the LEs. RESULTS: Eight labour experts (LEs) from the Dutch Social Security Institute participated in the study. Most LEs felt an improvement in their ability to ascertain developmental needs, opportunities and threats in the client's situation. Three months after the training, LEs almost unanimously agreed on the statements 'I expect to use the CARm method more frequently in the future' and 'I use the CARm method in daily practice whenever possible'. The overall rating for the training on a scale from 1 to 10 was 7.6 (range 7-9). The overall satisfaction with the trainers was good. CONCLUSIONS: The CARm method and training was found to be a feasible approach to facilitate LEs working at the UWV reintegration service to support clients with multiple problems. Sufficient managerial support for participating LEs is a key factor for successful implementation of CARm. Results show that CARm is worth testing for efficacy in a future trial.

Feasibility of Family Group Conference to promote return-to-work of persons receiving work disability benefit.

Purpose: To investigate the feasibility of Family Group Conference for promoting return to work by clients receiving work disability benefits from the Social Security Institute in the Netherlands.Methods: We conducted a mixed-method pre- post-intervention feasibility study, using questionnaires, semi-structured interviews and return to work plans drafted in Family Group Conferences. A convenient sample of Labour experts, Clients, and Facilitators was followed for a period of six months. Feasibility outcomes were demand, acceptability, implementation and limited efficacy of perceived mental health and level of participation.Results: Fourteen labour experts and sixteen facilitators enrolled in the study. Of 28 eligible clients, nine (32%) participated in a Family Group Conference. About 78% of the Family Group Conferences were implemented as planned. Participant satisfaction about Family Group Conference was good (mean score 7). Perceived mental health and level of participation improved slightly during follow-up. Most actions in the return to work plans were work related. Most frequently chosen to take action was the participating client himself, supported by significant others in his or her social network. Six months after the Family Group Conference five participating clients returned to paid or voluntary work.Conclusions: Family Group Conference seems a feasible intervention to promote return to work by clients on work disability benefit. Involvement of the social network may have added value to support the clients in this process. An effectiveness study to further develop and test Family Group Conferences is recommended.Implications for rehabilitationFamily Group Conference may represent a promising approach to be used in activation strategies to enhance social inclusion and return to work of persons receiving disability benefits.Conventional supply-oriented activation services could be improved by providing the Family Group Conference to unemployed persons on disability benefit.Involvement of the social network may have added value for return to work of clients receiving work disability benefits.

Patients with rheumatoid arthritis facing sick leave or work disability meet varying regulations: a study among rheumatologists and patients from 44 European countries.

OBJECTIVES: To describe and explore differences in formal regulations around sick leave and work disability (WD) for patients with rheumatoid arthritis (RA), as well as perceptions by rheumatologists and patients on the system's performance, across European countries. METHODS: We conducted three cross-sectional surveys in 50 European countries: one on work (re-)integration and social security (SS) system arrangements in case of sick leave and long-term WD due to RA (one rheumatologist per country), and two among approximately 15 rheumatologists and 15 patients per country on perceptions regarding SS arrangements on work participation. Differences in regulations and perceptions were compared across categories defined by gross domestic product (GDP), type of social welfare regime, European Union (EU) membership and country RA WD rates. RESULTS: Forty-four (88%) countries provided data on regulations, 33 (75%) on perceptions of rheumatologists (n=539) and 34 (77%) on perceptions of patients (n=719). While large variation was observed across all regulations across countries, no relationship was found between most of regulations or income compensation and GDP, type of SS system or rates of WD. Regarding perceptions, rheumatologists in high GDP and EU-member countries felt less confident in their role in the decision process towards WD (ß=-0.5 (95% CI -0.9 to -0.2) and ß=-0.5 (95% CI -1.0 to -0.1), respectively). The Scandinavian and Bismarckian system scored best on patients' and rheumatologists' perceptions of regulations and system performance. CONCLUSIONS: There is large heterogeneity in rules and regulations of SS systems across Europe in relation to WD of patients with RA, and it cannot be explained by existing welfare regimes, EU membership or country's wealth.

Implementing sensor technology applications for workplace health promotion: a needs assessment among workers with physically demanding work.

BACKGROUND: Workers with physically demanding work may be at risk for injury, illness or other adverse health outcomes due to exposure to different occupational hazards, especially at higher age. Sensor technology applications may be useful in the workplace to unobtrusively measure and monitor work exposures and provide workers with real-time feedback or access to data on demand. Many aspects might impede the implementation of sensor technology applications in the workplace, which should be taken into consideration for a successful implementation. Moreover, needs and preferences of workers regarding the use of sensor technology applications during work performance need to be identified. Therefore, the aim of this study was to identify worker needs and preferences regarding the use of sensor technology applications in the workplace. METHODS: Four on-site focus group sessions were conducted in four different companies among workers with physically demanding work (n = 30). Semi-structured interview schedules were used to identify which work exposures should be measured, by which kind of sensor technology applications, under which (pre)conditions, how to motivate long-term use of sensor technology applications, and which type of feedback is preferred. For data analysis, a content-analysis with an inductive approach was performed. RESULTS: Participants mentioned that they want to use wearable sensor technology applications to measure and monitor physical job demands, occupational heat stress, noise and fatigue. Factors associated with quality, comfort and perceived ease of use were identified as potential barriers for implementation in the workplace. Long-term motivation was attributed to the ability to manage and monitor work exposures, positive feedback and data ownership. Participants indicated a need to both receive real-time feedback and access to data on demand. CONCLUSIONS: Sensor technology applications may support workers with physically demanding work to measure and monitor their work exposures. Potential barriers for implementation such as privacy aspects and quality, comfort and perceived ease of use of sensor technology applications need to be well considered to ensure successful implementation of sensor technology applications in the workplace.

Personal and Societal Impact of Low Back Pain: The Groningen Spine Cohort.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: The aim of this study was to study the personal and societal impact of low back pain (LBP) in patients admitted to a multidisciplinary spine center. SUMMARY OF BACKGROUND DATA: The socioeconomic burden of LBP is very high. A minority of patients visit secondary or tertiary care because of severe and long-lasting complaints. This subgroup may account for a major part of disability and costs, yet could potentially gain most from treatment. Currently, little is known about the personal and societal burden in patients with chronic complex LBP visiting secondary/tertiary care. METHODS: Baseline data were acquired through patient-reported questionnaires and health insurance claims. Primary outcomes were LBP impact (Impact Stratification, range 8-50), functioning (Pain Disability Index, PDI; 0-70), quality of life (EuroQol-5D, EQ5D; -0.33 to 1.00), work ability (Work Ability Score, WAS; 0-10), work participation, productivity costs (Productivity Cost Questionnaire), and healthcare costs 1 year before baseline. Healthcare costs were compared with matched primary and secondary care LBP samples. Descriptive and inferential statistics were applied. RESULTS: In total, 1502 patients (age 46.3 ±â€Š12.8 years, 57% female) were included. Impact Stratification was 35.2 ±â€Š7.5 with severe impact (≥35) for 58% of patients. PDI was 38.2 ±â€Š14.1, EQ5D 0.39 (interquartile range, IQR: 0.17-0.72); WAS 4.0 (IQR: 1.0-6.0) and 17% were permanently work-disabled. Mean total health care costs (&OV0556;4875, 95% confidence interval [CI]: 4309-5498) were higher compared to the matched primary care sample (n = 4995) (&OV0556;2365, 95% CI: 2219-2526, P < 0.001), and similar to the matched secondary care sample (n = 4993) (&OV0556;4379, 95% CI: 4180-4590). Productivity loss was estimated at &OV0556;4315 per patient (95% CI: 3898-4688) during 6 months. CONCLUSION: In patients seeking multidisciplinary spine care, the personal and societal impact of LBP is very high. Specifically, quality of life and work ability are poor and health care costs are twice as high compared to patients seeking primary LBP care. LEVEL OF EVIDENCE: 3.

The assessment of work endurance in disability evaluations across European countries.

PURPOSE: Chronic disease is often associated with a reduced energy level, which limits the capacity to work full-time. This study aims to investigate whether the construct work endurance is part of disability assessment in European countries and what assessment procedures are used. We defined work endurance as the ability to sustain working activities for a number of hours per day and per week. MATERIALS AND METHODS: We conducted a survey using two self-constructed questionnaires. We addressed 35 experts from 19 countries through the European Union of Medicine in Assurance and Social Security (EUMASS). We gathered descriptive data on various aspects of (the assessment of) work endurance. RESULTS: Experts from 16 countries responded. In most countries work endurance is assessed. We found few professional guidelines specific for the assessment of work endurance. Both somatic and mental diseases may cause limited work endurance. Methods to assess work endurance vary, objective methods rating as most suitable. Almost half of the countries report controversies on the assessment of work endurance. CONCLUSIONS: Work endurance is recognised and assessed as an aspect of work disability assessment in Europe. However, controversies exist and evidence based guidelines, including reliable and valid methods to assess work endurance, are lacking.

Effectiveness and Cost-benefit Evaluation of a Comprehensive Workers' Health Surveillance Program for Sustainable Employability of Meat Processing Workers.

Objective To evaluate the effectiveness of a comprehensive workers' health surveillance (WHS) program on aspects of sustainable employability and cost-benefit. Methods A cluster randomized stepped wedge trial was performed in a Dutch meat processing company from february 2012 until march 2015. In total 305 workers participated in the trial. Outcomes were retrieved during a WHS program, by multiple questionnaires, and from company registries. Primary outcomes were sickness absence, work ability, and productivity. Secondary outcomes were health, vitality, and psychosocial workload. Data were analyzed with linear and logistic multilevel models. Cost-benefit analyses from the employer's perspective were performed as well. Results Primary outcomes sickness absence (OR = 1.40), work ability (B = -0.63) and productivity (OR = 0.71) were better in the control condition. Secondary outcomes did not or minimally differ between conditions. Of the 12 secondary outcomes, the only outcome that scored better in the experimental condition was meaning of work (B = 0.18). Controlling for confounders did not or minimally change the results. However, our stepped wedge design did not enable adjustment for confounding in the last two periods of the trial. The WHS program resulted in higher costs for the employer on the short and middle term. Conclusions Primary outcomes did not improve after program implementation and secondary outcomes remained equal after implementation. The program was not cost-beneficial after 1-3 year follow-up. Main limitation that may have contributed to absence of positive effects may be program failure, because interventions were not deployed as intended.

Exploring participatory behaviour of disability benefit claimants from an insurance physician's perspective.

PURPOSE: In the Dutch social security system, insurance physicians (IPs) assess participatory behaviour as part of the overall disability claim assessment. This study aims to explore the views and opinions of IPs regarding participatory behaviour as well as factors related to inadequate participatory behaviour, and to incorporate these factors in the International Classification of Functioning, Disability and Health (ICF) biopsychosocial framework. METHOD: This qualitative study collected data by means of open-ended questions in 10 meetings of local peer review groups (PRGs) which included a total of 78 IPs of the Dutch Social Security Institute. In addition, a concluding discussion meeting with 8 IPs was organized. RESULTS: After qualitative data analyses, four major themes emerged: (1) participation as an outcome, (2) efforts of disability benefit claimants in the process of participatory behaviour, (3) beliefs of disability benefit claimants concerning participation, and (4) recovery behaviour. Identified factors of inadequate participatory behaviour covered all ICF domains, including activities, environmental, and personal factors, next to factors related to health condition and body functions or structures. Outcomes of the discussion meeting indicated the impossibility of formulating general applicable criteria for quantifying and qualifying participatory behaviour. CONCLUSIONS: Views of IPs on disability benefit claimants' (in)adequate participatory behaviour reflect a broad biopsychosocial perspective. IPs adopt a nuanced tailor-made approach during assessment of individual disability benefit claimants' participatory behaviour and related expected activities aimed at recovery of health and RTW. Implications for Rehabilitation Within a biopsychosocial perspective, it is not possible to formulate general criteria for the assessment of participatory behaviour for each unique case. Individual disability benefit claimant characteristics and circumstances are taken into account. To optimize the return-to-work (RTW) process, insurance physicians (IPs) assess participatory behaviour according to the International Classification of Functioning, Disability and Health, including medical, personal, and environmental factors. Some aspects within the concept of participatory behaviour extend beyond the boundaries of the domain where IPs operate because opinions in society on personal and societal responsibility influence participatory behaviour.