Exploring Canadian Career Firefighters' Understanding of the Return-to-Work Process After Musculoskeletal Injuries.

PURPOSE: Firefighters perform dangerous and physically demanding work, increasing their risk of musculoskeletal injuries that can lead to work absences. Return-to-work procedures can help firefighters return-to-work sooner and safely. The purpose of this study was to explore what firefighters understand about return-to-work procedures in their workplaces, and what firefighters believe the facilitators and barriers to return-to-work are. METHODS: Thirty-eight Canadian career firefighters were recruited for semi-structured interviews. Qualitative descriptive methods were used to analyze the transcripts. Two researchers performed the inductive coding and thematic analysis. RESULTS: Five themes were identified: 1. Variation in the return-to-work process knowledge among firefighters based on their experiences; 2. Accessible medical resources and treatments to support injury recovery; 3. Light duties must be meaningful and suitable; 4. Pressures to return-to-work too soon may lead to negative consequences; and 5. Heavy physical demands of firefighting may become a barrier for return-to-work. 'Factors affecting RTW depended on personal experiences and context' was the overarching theme identified, as many reported facilitators for return-to-work were also reported as barriers in different contexts. There was a variation in the experiences and understanding of return-to-work. CONCLUSION: There is a lack of knowledge of the return-to-work processes. Firefighters require access to clear return-to-work policies and procedures and treatments that are targeted to firefighting duties to support recovery from injuries and regain physical abilities after an injury. Firefighters must be able to perform all essential duties before returning to firefighting work, as returning to work too soon can lead to further injury.

Rasch analysis of the brief Michigan Hand Questionnaire in patients with thumb osteoarthritis.

BACKGROUND: The brief Michigan Hand Questionnaire (brief MHQ) is a 12-item self-reported measure of hand function for patients with hand disorders which has been validated using Classical Test Theory. Rasch analysis can provide more detailed psychometric information. The purpose of this Rasch analysis is to assess the psychometric properties of the brief MHQ for patients with thumb osteoarthritis, and to make recommendations for improvements to the questionnaire if needed.  METHODS: The Michigan Hand Questionnaire and demographic data were collected from 923 thumb osteoarthritis patients treated in specialized clinics for hand surgery and therapy in the Netherlands. Rasch analysis was performed on the 12 items of the brief MHQ using RUMM 2030 to assess the fit of the brief MHQ to the Rasch model. To determine fit, analysis of fit summary statistics, individual person fit and individual item fit were assessed. Threshold distributions were assessed to identify if any items required rescoring. The Person Separation Index was calculated to measure reliability of the questionnaire. Differential item functioning was assessed to identify item bias, and Principal Component Analysis was performed to identify unidimensionality and local dependence. RESULTS: The brief MHQ showed misfit (χ2 = 1312.5, p < 0.0001) with 6 items having disordered thresholds and 9 items requiring rescoring. After deleting 3 of the rescored items due to significant item fit residuals, the brief MHQ had an acceptable reliability (Cronbach's alpha = 0.79). Misfit to the model (χ2 = 49.6, p = 0.0001), multidimensionality (10.2% of t-tests were significant), and item bias from non-uniform differential item functioning for 7 items across many person variables were still found. CONCLUSION: Although no satisfactory solutions were found to correct the misfit to the Rasch model, it is recommended that the response options of the brief MHQ be rescored, and that items 6, 9 and 10 be removed. The lack of unidimensionality indicates that the items do not represent the singular construct of hand disability and that totalling the scores of the brief MHQ does not provide a valid measure of hand disability for people with thumb osteoarthritis. The 37-item Michigan Hand Questionnaire may provide a better assessment of hand disability for patients with thumb osteoarthritis.

Exploring patient perspectives of barriers and facilitators to participating in hospital-based stroke rehabilitation.

BACKGROUND: Patient participation is recognized as an important element of rehabilitation. However, few studies have used a qualitative lens to specifically examine factors influencing patient participation in stroke rehabilitation. AIM: The purpose of this study was to investigate patient perspectives of barriers and facilitators to participating in hospital-based stroke rehabilitation. METHODS: Semi-structured interviews were conducted with 11 patients, with confirmed diagnoses of stroke, recruited from three separate rehabilitation settings. Analysis of the interviews was guided by a process of interpretive description to identify key barriers and facilitators to participation in stroke rehabilitation. RESULTS: Four main themes and corresponding sub-themes were constructed concerning participation in rehabilitation: (i) Environmental Factors, (ii) Components of Therapy, (iii) Physical and Emotional Well-Being, and (iv) Personal Motivators. An exploratory model of personalized rehabilitation emerged, integrating the themes emerging from the data. DISCUSSION: Personalized rehabilitation can be considered in comparison to person-centred care principles. The barriers and enablers experienced by patients in this study contribute to the existing knowledge of the patient experience of stroke rehabilitation and may be used to inform clinical practices and future research.Implications for RehabilitationThe surrounding environments can facilitate participation in rehabilitation using strategies to reduce noise and disruption and also by encouraging social interactions among patients.Increasing the frequency and consistency of communication with patients about rehabilitation goals and progress could enhance participation.Designing interventions to include activities that are meaningful and focused on the resumption of valued life roles is key to participation.Therapy intensity, time spent sedentary, and the emotional impact of stroke are aspects of rehabilitation patient's feel are neglected.

Identifying predictors of return to work and the duration of time off work in first responders affected with musculoskeletal injuries or mental health issues.

PURPOSE: To identify predictors of return to work, duration of time off work, and claim closure for first responders experiencing injuries or illnesses, and summarize the claim data. METHODS: First responder claims collected between January 2012 and July 2017 were obtained from a disability management company. Known predictors of return to work were extracted from the data including age, sex, diagnosis, years of service, claim lag, medical report lag, and the return-to-work duties. Survival analyses were performed to identify predictors of return to work and claim closure using the Cox proportional regression analysis. Log-rank tests were performed to identify predictors that affected the rate of return to work and claim closure. Summary statistics were performed for the injury and return-to-work data. RESULTS: 60 of the 67 (89.6%) identified first responders returned to work within the data collection period. Musculoskeletal injuries predicted an increased likelihood of returning to work (hazard ratio = 2.0, 95%CI = 1.14-3.60) and a shorter duration of time off work (37 days on average) compared to mental health issues. Everyday of claim lag and medical report lag predicted a 2% decrease in likelihood of return to work. Returning to work was the only predictor of claim closure. 45 (67.2%) first responders returned to their pre-absence duties. 22 (32.8%) mental health claims and 45 (67.2%) injury claims were identified. CONCLUSIONS: 89.6% of first responders returned to work, although only 67.2% returned to their pre-absence duties. Predictors of return to work included injury type, as first responders with musculoskeletal injuries returned to work sooner, and claim and medical lag delayed the return to work.

Active labour market policies for people with disabilities in receipt of public income benefits: A scoping review.

BACKGROUND: Active labour market policies (ALMP) are used in advanced welfare states to support transitions to work for people who are unemployed or underemployed, including people with disabilities (PWD) in receipt of means-tested disability income support. OBJECTIVE: This study explores the nature, strength, and limitations of ALMP across advanced welfare states (ALMP) for people with disabilities (PWD) in receipt of income benefits from social assistance programs. METHODS: Following the eight steps of a scoping study, we identified 21 documents through a scan of eight databases and consultation with key informants. The majority of these documents are scholarly publications including seven literature reviews, two program evaluations, four social policy analyses, and two longitudinal studies. RESULTS: We extracted key findings related to delivery of labour (re)entry interventions for people with disabilities. Six themes are identified that discuss these ALMP features: 1) welfare ideology and the role of citizenship; 2) conditionality of benefits; 3) work capacity and the need for an appropriate definition of disability; 4) the politics of employment outcomes for PWD; 5) the missing elements of a successful ALMP; and 6) moving beyond ALMP. The findings indicate that while various approaches are used in reintegrating PWD into mainstream employment, there are significant limitations that curtail the impact of these policies. CONCLUSIONS: Regardless of welfare regime, no welfare state provides a policy mix that results in long-term employment success for PWD in receipt of means-tested income benefits.

The experiences of workers who do not successfully return to work following a work-related injury.

BACKGROUND: A minority of workers with work-related injuries experience challenges returning to work. While factors that hinder return-to-work (RTW) are well-documented, the consequences of failing to successfully return to work on the lives of workers who have experienced a workplace injury remain poorly understood. OBJECTIVE: The purpose of this study is to explore the experiences of workers who do not successfully return to work following a work-related injury. METHODS: Using an interpretive approach to qualitative research and maximal variability sampling, 11 workers who have sustained work-related injuries without a successful RTW and four service providers were recruited through community organizations. Participants were interviewed using a semi-structured interview guide. A constant comparative approach was used to identify key themes across the worker and service provider experiences. RESULTS: The findings that emerged from the analysis capture the challenging RTW experiences of workers and describe wide ranging impacts on their lives when their workers' compensation claims are denied or discontinued, including ongoing financial strain, family tensions, subsequent health concerns, and negative employment experiences. The findings also highlight the negative consequences of existing cost-cutting frameworks that can restrict entitlement and benefits for many people with disabilities. CONCLUSIONS: The findings from this study highlight the experiences of workers who might need additional supports throughout the RTW process, and begin to shed light on the impact on their lives when RTW is not successful.

Qualitative research in rehabilitation science: opportunities, challenges, and future directions.

PURPOSE: Qualitative research has had a significant impact within rehabilitation science over time. During the past 20 years the number of qualitative studies published per year in Disability and Rehabilitation has markedly increased (from 1 to 54). In addition, during this period there have been significant changes in how qualitative research is conceptualized, conducted, and utilized to advance the field of rehabilitation. The purpose of this article is to reflect upon the progress of qualitative research within rehabilitation to date, to explicate current opportunities and challenges, and to suggest future directions to continue to strengthen the contribution of qualitative research in this field. METHODS: Relevant literature searches were conducted in electronic data bases and reference lists. Pertinent literature was examined to identify current opportunities and challenges for qualitative research use in rehabilitation and to identify future directions. RESULTS: Six key areas of opportunity and challenge were identified: (a) paradigm shifts, (b) advancements in methodology, (c) emerging technology, (d) advances in quality evaluation, (e) increasing popularity of mixed methods approaches, and (f) evolving approaches to knowledge translation. Two important future directions for rehabilitation are posited: (1) advanced training in qualitative methods and (2) engaging qualitative communities of research. CONCLUSION: Qualitative research is well established in rehabilitation and has an important place in the continued growth of this field. Ongoing development of qualitative researchers and methods are essential. Implications for Rehabilitation Qualitative research has the potential to improve rehabilitation practice by addressing some of the most pervasive concerns in the field such as practitioner-client interaction, the subjective and lived experience of disability, and clinical reasoning and decision making. This will serve to better inform those providing rehabilitation services thereby benefiting patients that are utilizing these services. Changes over time in how qualitative research is conceptualized, conducted, and utilized to advance rehabilitation science have resulted in a number of unique opportunities and challenges in using qualitative research that must be considered within this field. Advances in methodology and increased expectations for evaluation must be considered to ensure quality and credibility of qualitative rehabilitation research within rehabilitation. Improved quality and credibility may increase likelihood of research dissemination and use by clinicians intervening within the rehabilitation process in order to improve clinical practice. In order to maximize opportunities and mitigate challenges there are two principal future directions for rehabilitation scientists to consider: (1) advancing training in qualitative methods to adequately prepare future rehabilitation scientists and (2) engaging qualitative communities of research.

What you do every day matters: A new direction for health promotion.

Canadian health promotion campaigns directed towards healthy living have traditionally emphasized discrete behaviours that influence health and wellbeing, such as diet, physical activity and smoking. Although this traditional approach is important and supported by evidence, it does not account for broader determinants of health. The purpose of this commentary is to propose an innovative health promotion approach that expands the healthy living discourse through a focus on patterns of daily activity. We highlight four key public health messages derived from a synthesis of existing research evidence. The messages are based on the premise that what you do every day has an important impact on health and well-being. Rather than being prescriptive or outlining minimum requirements, this approach invites reflection on various experiences and activity patterns that shape the health and well-being of individuals and communities. This broader and more inclusive approach to healthy living reflects diverse needs and experiences, making it relevant and attainable for people of all ages and abilities. Future efforts directed at operationalizing the key messages for individuals and communities hold much promise for populations that may be at risk of activity patterns believed to contribute to poor health and well-being.

Hiring people with disabilities: A scoping review.

BACKGROUND: Many people with disabilities continue to encounter challenges trying to secure employment. OBJECTIVE: The purpose of this study was to synthesize existent knowledge about the hiring process for people with disabilities and explore research priorities from the perspective of key stakeholders. METHODS: A scoping review of the literature related to hiring processes and practices as they relate to people with disabilities was undertaken. As part of the scoping review, seven key informant consultations were conducted in order to gain further insight into the key issues identified by those most involved in the hiring process for people with disabilities. RESULTS: Findings from the literature and consultations revolve around seven inter-related topics: 1) regulationsversus practice, 2) stigma, 3) disclosure, 4) accommodations, 5) relationship building and use of disability organizations,6) information and support to employers, and 7) hiring practices that invite people with disabilities. CONCLUSIONS: Although barriers to employment for people with disabilities have been examined in the literature, there remains a paucity of literature examining and evaluating strategies to improve hiring practices and employment opportunities for people with disabilities. Future research must occur in consultation with key stakeholders including employers, people with disabilities, and employment support workers.

"Do-Live-Well": a Canadian framework for promoting occupation, health, and well-being.

BACKGROUND: Occupational therapists can bring a unique and valuable perspective to the national dialogue on health promotion. Current approaches have a narrow focus on diet and exercise; a broader focus on occupation has the potential to enrich understanding regarding forces that contribute to health and well-being. PURPOSE: A new "Do-Live-Well" framework will be presented that is grounded in evidence regarding the links between what people do every day and their health and well-being. KEY ISSUES: Elements of the framework include eight different dimensions of experience and five key activity patterns that impact health and well-being outcomes. Personal and social forces that shape activity engagement also affect the links to health and well-being. IMPLICATIONS: The framework is designed to facilitate individual reflection, community advocacy, and system-level dialogue about the impact of day-to-day occupations on the health and well-being of Canadians.

How is unemployment among people with mental illness conceptualized within social policy? A case study of the Ontario Disability Support Program.

BACKGROUND: Government policy shapes and is shaped by society's views of important social issues such as employment among people with disabilities. OBJECTIVE: This article explores how unemployment among people with mental illness has been understood and characterized within social policy. METHODS: Drawing on a qualitative case study that explored the construction and implementation of policy reform within the employment support branch of the Ontario Disability Support Program, this paper examines assumptions about unemployment among people with mental illness that underlie social policy and their impact on employment services and supports. RESULTS: The most prominent messages that emerged from the data focused on unemployment among people with mental illness as a function of personal responsibility, limitations and a lack of motivation. Although there was awareness of the role of social and systemic factors, these issues were given less weight, especially when describing employment support practices. There is a lack of sufficient attention to complex and deeply-rooted social and systemic inequalities within social policy and employment services. CONCLUSIONS: There is a need to expand conceptualizations of unemployment among people with mental illness within social policy, and develop interventions that address complex social factors and systemic constraints that can limit employment opportunities.

How does outcome-based funding affect service delivery? An analysis of consequences within employment services for people living with serious mental illness.

This paper explores the impact of outcome-based funding on service delivery within employment services for people with serious mental illness. It draws on a case study of a policy change in the provincial disability support program in Ontario, Canada where funding for employment programs and services was changed from a fee-for-service to an outcome-based model. The findings highlight that the financial imperative for programs to meet employment targets in order to secure their funding has shifted the focus away from the provision of pre-employment supports to job development and job placements. However, there remains little attention to job matching and career development, and there is concern about access to services among those with complex barriers to employment. There is a need to reconcile tensions between the goals of outcome-based funding and on-the-ground service delivery to promote ongoing innovation in employment services for people with serious mental illness.

Promoting an occupational perspective in public health.

BACKGROUND: Although the value of occupation for health and well-being is fundamental to the occupational therapy profession, this view is not well recognized in the field of public health. PURPOSE: In this article, we argue that occupational therapists have a unique and valuable perspective to bring to the field of public health, particularly with respect to the importance of occupational engagement in promoting the health and well-being of Canadians. KEY ISSUES: There are many compelling reasons for public health advocacy, including the need to increase awareness of the health benefits and risks of occupational engagement for individuals and communities. Challenges that lie ahead, however, include issues related to terminology, the complexity of occupation, the need to consider multidimensional outcomes, and diversity of evidence. IMPLICATIONS: To move forward, the profession of occupational therapy in Canada needs to position health promotion messaging in a way that clearly captures the complexity and value of occupation and resonates with Canadians of all ages and abilities.

The shift to rapid job placement for people living with mental illness: an analysis of consequences.

OBJECTIVE: This article reports on the consequences of the revised policy for employment supports within the Ontario Disability Support Program, a disability benefit program administered by the provincial government in Ontario, Canada. The revised policy involves a change from a fee-for-service model to an outcome-based funding model. This revision has encouraged a shift from preemployment to job placement services, with a particular focus on rapid placement into available jobs. METHOD: Using a qualitative case study approach, 25 key informant interviews were conducted with individuals involved in developing or implementing the policy, or delivering employment services for individuals living with mental illness under the policy. Policy documents were also reviewed in order to explore the intent of the policy. Analysis focused on exploring how the policy has been implemented in practice, and its impact on employment services for individuals living with mental illness. RESULTS: The findings highlight how employment support practices have evolved under the new policy. Although there is now an increased focus on employment rather than preemployment supports, the financial imperative to place individuals into jobs as quickly as possible has decreased attention to career development. Jobs are reported to be concentrated at the entry-level with low pay and little security or benefits. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These findings raise questions about the quality of employment being achieved under the new policy, highlight problems with adopting selected components of evidence-based approaches, and begin to explicate the influence that funding structures can have on practice.