[Artículo traducido] Incapacidad laboral temporal tras cirugía de rizartrosis mediante trapecectomía y artroplastia de suspensión con sutura de alta resistencia.

PURPOSE: The aim of this study is to assess the time to return to work (TRW) in patients undergoing trapezial resection using the Mini TightRope® system at our center and to investigate factors that might delay return to work following this surgery. MATERIAL AND METHODS: A retrospective study was conducted on patients who underwent Trapezial resection and suspensionplasty using the Mini TightRope® system between 2015 and 2016, with a minimum one-year follow-up. Telephone interviews were conducted along with a review of medical records and radiology reports, as well as temporary work disability documents, collecting epidemiological and occupational data. Groups were compared based on age, gender, dominant hand, biomechanical occupational requirements of the patients, and whether they had experienced prior temporary work disability. RESULTS: A total of 36 patients (29 women and 7 men) with an average age of 55.7 years were included. The median time to return to work was 126 days. Self-employed workers re-entered the workforce 72 days earlier on average; workers who had experienced prior temporary work disability had a greater total temporary work disability duration and took 91 days longer to return to work compared to those who had not. CONCLUSIONS: Patients employed by others and those who had experienced prior temporary work disability before the surgery had longer temporary work disability periods. In our study, no differences were observed based on gender, dominant hand, or biomechanical work demands of the intervened patients.

Estimating vaccine effectiveness against COVID-19 using cause-specific sick leave as an indicator: a nationwide population-based cohort study, Norway, July 2021 - December 2022.

BACKGROUND: Due to changes in testing policy and increased use of rapid tests, other indicators for SARS-CoV-2 infections are needed to monitor vaccine effectiveness (VE). We aimed to estimate VE against COVID-19 sick leave (> 3 days, certified by a medical professional) among employed individuals (25-64-years-old) in Norway. METHODS: We performed a nationwide cohort study by collating data from the Emergency preparedness register for COVID-19. We used adjusted Cox proportional hazard models with vaccine status as a time-varying covariate and presented results as adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals. Separate models were run against sick leave and against SARS-CoV-2 infections during the Delta period (June-December 2021), and against sick leave during the Omicron period (January-December 2022) when SARS-CoV-2 PCR-testing was replaced by rapid self-tests and infections were underreported. RESULTS: We included 2,236,419 individuals during the Delta period, of whom 73,776 (3.3%) had a reported infection and 54,334 (2.4%) were registered with sick leave. Of the 2,206,952 included individuals in the Omicron period, 300,140 (13.6%) were registered with sick leave. During the Delta period, 55% (26,611) of individuals who had registered sick leave also had a positive test, compared to 32% (96,445) during the Omicron period. The VE against sick leave during the Delta period followed a similar waning pattern to that against SARS-CoV-2 infections. After the second and third dose, the lowest aHRs were estimated for 2-7 days after vaccination for both sick leave (0.25; 95%CI 0.24-0.26 and 0.26; 95% CI 0.24-0.29) and infection ( 0.16; 95% CI 0.15-0.17 and 0.18; 95% CI 0.16-0.19) respectively. During the Omicron period, aHRs for sick leave were higher than during the Delta period, but the lowest aHRs were still found in 2-7 weeks after receiving the second (0.61; 95% CI 0.59-0.64) or third dose (0.63; 95% CI 0.62-0.64). CONCLUSION: Our results showed that sick leave could be a relevant indicator for VE in the surveillance of COVID-19 and a finding that may be important in the surveillance of other respiratory infection.

Mental Health Stigma in the Workplace and its Association with Possible Actions of Managers to Prevent Sickness Absence of Employees with Mental Health Problems in the Swedish Private Sector: a Video Vignette Study.

PURPOSE: Mental health problems (MHPs) are subjected to workplace stigma and can deteriorate into common mental disorders (CMDs) and sickness absence (SA). Research has shown that personal stigmatizing attitudes limit managers' efforts towards employees with MHPs, but knowledge is lacking regarding stigma in social contexts (contextual stigma) and different types of possible preventive actions. This study investigates personal stigmatizing attitudes and three contextual stigma layers (employee, collegial, organizational) and different types of possible actions to prevent SA of employees with MHPs. METHOD: Survey data of 2769 Swedish managers working in the private sector were analysed. Personal stigmatizing attitudes were measured with the managerial stigma towards employee depression scale and supplemented with four additional items capturing contextual stigma. Managers watched video vignettes and assessed which preventive actions (n = 20) were possible to use in their organization. A sum score was calculated reflecting the 'number of actions'. Principal component analysis revealed three action types: adapt tasks and setting, involve experts, and social support. A score reflecting the 'possibilities to implement actions' was calculated for each type. Multiple linear regression analyses were conducted with the four stigma layers as independent variables for each of the three action variables. RESULTS: Personal stigmatizing attitudes and contextual stigma were significantly associated with both 'number of actions' and 'possibilities for implementing actions' relating to all action types. Patterns of associations with contextual stigma were significant but varied between the different action types. CONCLUSION: This study substantiated the role of personal stigmatizing attitudes and contextual stigma in relation to possible actions of managers to prevent SA of employees with MHPs. The results emphasize the role of contextual stigma. Implications for practice and research are discussed.

Predictors of return to work in people with major depression: Results from a supported employment program in Germany.

BACKGROUND: Depression is a common mental disorder and is associated with work disability. For the implementation of evidence-based interventions, such as Individual Placement and Support (IPS) for people with depression in Germany, the aim of this study was to investigate client variables that predict return to work. METHODS: The sample consisted of 129 participants, initially treated in a psychiatric hospital due to major depression, who participated in IPS as part of a German clinical trial. Baseline demographic (age, sex, education, sickness absence days, employment status), psychiatric (symptom severity, comorbidity, general physical and mental health, disability), and neuropsychological (self-rated deficits, test performance) variables were included. Return to work within one year was predicted using separate and overall binary logistic regression analyses. RESULTS: A total of 70 participants (56 %) returned to work within the one-year follow-up period. >100 days of sick leave in the year prior to study entry (vs. <100 days) and higher self-rated cognitive deficits were significantly associated with reduced odds of return to work within one year of IPS. LIMITATIONS: The sample consisted of participants with a relatively good work history who were assigned to IPS by the treatment team, thus, the generalizability of the results is limited. CONCLUSIONS: People with depression who participate in IPS interventions might benefit from specifically targeting perceived cognitive deficits. Factors associated with prolonged sick leave due to depression and their role in return to work with IPS need further investigation.

Patients' Needs Regarding Work-Focused Healthcare: A Qualitative Evidence Synthesis.

PURPOSE: To identify, appraise, and synthesize qualitative research evidence exploring patients' needs regarding work-focused healthcare. METHODS: A systematic review was conducted in accordance with the PRISMA statement guidelines to identify studies reporting patients' needs regarding work-focused healthcare. Four databases (MEDLINE, Embase, PsychInfo and Web of Science) were systematically searched from January 2000 until May 2023 and screened in duplicate by pairs of two reviewers. Inclusion criteria were qualitative data collection method, and patients' perspectives regarding healthcare focusing on work when experiencing work-related problems due to chronic medical conditions. Data extraction and synthesis was executed by means of an inductive thematic analysis approach. The quality of the included studies was assessed using the CASP Qualitative Study checklist. Confidence in the review findings was assessed through the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. RESULTS: Out of 23,677 records, 97 qualitative studies were included. Needs regarding four main themes were identified: (1) Substantive guidance, which comprises the specific content of work-focused healthcare; (2) Clear and continuous process, which comprises clarification and optimization of the work-focused healthcare process; (3) Supportive attitude and behavior, which comprises a positive and supportive attitude and behavior from professionals towards the patients; and (4) Tailored approach, which comprises the delivery of tailored care to the individuals' needs. 17 subthemes were identified. CONCLUSION: The broader insight in patients' needs in work-focused healthcare can help (occupational) healthcare professionals adopt a more patient-centred approach in practice.

Work ability and return-to-work of patients with post-COVID-19: a systematic review and meta-analysis.

BACKGROUND: In addition to several sequelae of post-COVID-19, individuals also experience significant limitations in work ability, resulting in negative consequences for the return-to-work (RTW) process. This systematic review and meta-analysis were conducted to assess the impact of post-COVID-19 on work ability and RTW of individuals previously infected with SARS-CoV-2. METHODS: Studies on the work ability and RTW of patients with post-COVID-19 (more than 12 weeks after an acute SARS-CoV-2 infection) were regarded eligible for inclusion. Systematic search of literature was performed up to March 2023 using five databases (MEDLINE, EMBASE, CINAHL, CENTRAL and WHO COVID 19). Study selection followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) Statement. A meta-analysis estimated the overall success rate of RTW. The risk of bias of the included studies was evaluated with the Newcastle Ottawa Scale (NOS). RESULTS: 19 relevant studies, published between 2021 and 2023, were included in the systematic review, involving 21.155 patients from 14 different countries. The findings indicate that a significant proportion of individuals with post-COVID-19 experience persistent symptoms and functional impairments, with fatigue being the most prominent symptom. These persistent symptoms can have a considerable (negative) impact on individuals' physical and psychological capacity to participate in work-related activities, leading to lower work ability and increased absenteeism. The RTW for post-COVID-19 patients is complex, with approximately 60.9% of patients successfully returning to work after 12 or more weeks following SARS-CoV-2 infection. Among those who successfully returning to work, a considerable number need modifications in their work duties or hours to cope with residual impairments. Factors such as workplace accommodations, supportive policies, and occupational rehabilitation programs play a crucial role in facilitating successful RTW. CONCLUSIONS: The systematic review underscores the substantial impact of post-COVID-19 on work-related outcomes. The implications of this research highlight the need for healthcare providers, employers, and policymakers to collaborate in creating inclusive work environments and implementing tailored rehabilitation programs to support individuals recovering from post-COVID-19. Further research should focus on long-term follow-up studies with mixed methods to gain a more comprehensive understanding of the long-term consequences of post-COVID-19 on work ability and RTW outcomes. PROSPERO REGISTRATION NUMBER: CRD42023385436.

Women's health at work: a qualitative study on women's health issues in relation to work participation. Experiences and perspectives from female teachers and managers in Norwegian high schools.

BACKGROUND: Public health and working life are closely related. Even though Norway is one of the world's most equality-oriented countries, working life is still divided by gender. Women have a lower rate of participation in working life than men, they work more part-time and they have a higher sickness absence. Research has mostly focused on structural and cultural reasons for gender differences, rather than on the fact that women and men have different biology and face different health challenges. The aim of this project was to explore experienced associations between women's health and female participation in working life. METHODS: Qualitative methods were chosen for investigating women's experiences. We carried out in-depth interviews with 11 female high school teachers and supplemented the material with a focus group with five managers from the same organisation. The interviews were recorded and transcribed verbatim. We used the six steps of reflexive thematic analysis for consistency in the analysis process. RESULTS: The teachers shared a variety of experienced health issues within the field of women's health and perceived barriers in the work environment. Four main themes were identified: (1) invisibility of women's health at work, (2) complexity and lack of recognition of women's health at work, (3) women's health in work environment and (4) women's health and role conflicts. There were few contradictions between the two informant groups. We found that health, work and total life intertwine and that complexity, lack of recognition and invisibility of women's health appear at different levels in a mutual influence: for the women themselves, in the organisation and in society. CONCLUSION: Lack of recognition and invisibility of women's health in the work environment is suggested to influence women's work participation. The complexity of female health is not captured by gender-neutral structures in the work environment meant to protect and promote employees' occupational health. Recognition of women's health in the work context can therefore contribute to a gender-equal, health-promoting and sustainable working life.

Joint associations of leisure time physical activity and screen sitting time with long-term sickness absence due to mental and musculoskeletal diseases: a registry linked follow-up study.

OBJECTIVES: To examine joint associations of leisure-time physical activity (LTPA) and screen sitting time with subsequent sickness absence among the adult population. STUDY DESIGN: Registry linked follow-up study. METHODS: A representative sample of Finnish adults (n = 10,300) were asked to fill out a questionnaire for the FinHealth 2017 survey. Self-reported LTPA was classified into three groups: inactive, moderately active, and active, and screen sitting time into two groups: 3 h or less and over three hours a day, yielding a six-category variable for the joint analyses. Questionnaire data were linked to the Finnish Social Insurance Institution's register data on sickness benefits (over 9 days), including diagnoses (follow-up 2.9 years). The analytical samples were restricted to working age (18-64 years), which included 5098 participants. Associations were examined using logistic regression analysis adjusting for covariates with SPSS 29. RESULTS: The inactive and high sitting time had a higher risk for sickness absence due to mental disorders (OR 2.07, 95% CI 1.03-4.18) compared with the physically active, low-sitting time group. Additionally, the inactive and low sitting time (OR 1.69 95% CI 1.12-2.55) and the moderately active and high-sitting time groups (OR 2.06 95% CI 1.15-3.67) had a higher risk. No significant associations were found for all-cause and musculoskeletal diseases sickness absence. CONCLUSION: Employers and policymakers could support reducing sitting in front of a screen and increase LTPA outside working hours to prevent mental health problems and related sickness absences.

The role of familial factors and neuroticism in the association between exposure to offensive behaviors at work and long-term sickness absence due to common mental disorders - a prospective twin study.

OBJECTIVES: The aim of this study was to investigate associations between exposure to work-related violence/threats and harassment, and future sickness absence (SA) due to common mental disorders (CMDs), taking familial factors (shared genetics and early-life environment) and neuroticism into account. METHODS: The study sample included 8795 twin individuals from the Swedish Twin Project of Disability Pension and Sickness Absence (STODS), including survey data from the Study of Twin Adults: Genes and Environment (STAGE). Self-reported work-related violence and/or threats as well as work-related harassment (including bullying) and national register data on SA due to CMDs were analyzed using standard logistic regression, and conditional logistic regression among complete twin pairs discordant on exposures. Individuals were followed for a maximum of 13 years. Interactions between neuroticism and exposures were assessed using both multiplicative and additive interaction analyses. RESULTS: Exposure to work-related violence/threats was associated with higher odds of SA due to CMDs when adjusting for age, sex, marital status, children, education, type of living area, work characteristics, and symptoms of depression and burnout (OR 2.11, 95% CI 1.52-2.95). Higher odds of SA due to CMDs were also found for exposure to harassment (OR 1.52, 95% CI 1.10-2.11) and a combined indicator of exposure to violence/threats and/or harassment (OR 1.98, 95% CI 1.52-2.59), compared with the unexposed. Analyses of twins discordant on exposure, using the unexposed co-twin as reference, showed reduced ORs. These ORs were still elevated but no longer statistically significant, potentially due to a lack of statistical power. No multiplicative interaction was found between neuroticism and exposure to work-related violence/threats, or harassment. However, a statistically significant additive interaction was found between neuroticism and exposure to violence/threats, indicating higher odds of SA due to CMDs in the group scoring lower on neuroticism. CONCLUSIONS: Exposure to work-related offensive behaviors was associated with SA due to CMDs. However, the results indicated that these associations may be partly confounded by familial factors. In addition, an interaction between exposure and neuroticism was suggested. Thus, when possible, future studies investigating associations and causality between offensive behaviors at work and mental health-related outcomes, should consider familial factors and neuroticism.

Dutch Dataset Vocational Rehabilitation for Chronic Musculoskeletal Pain: Baseline Patients' Characteristics and Program Eligibility.

PURPOSE: Vocational rehabilitation (VR) is an intervention to improve return to work for patients with chronic musculoskeletal pain (CMP). However, a systematic overview of characteristics of referred patients or eligible for VR is lacking, which hinders comparability across studies. Objectives were (1) to describe characteristics of patients with CMP referred to and eligible for VR and (2) to identify factors that contribute to VR eligibility. METHODS: This study used a multicenter, cross-sectional design. Data of self-reported questionnaires were obtained between 2013 and 2019 from care as usual of eight Dutch VR centers. Descriptive statistics were performed to describe sociodemographic, pain-related, and work-related characteristics. Logistic regression analysis was used to identify factors contributing to VR eligibility. RESULTS: Data sets of n = 2970 referred patients were included. The mean age was 46 years and 60% were female. Low back (43%), neck (37%), and shoulder pain (34%) were most reported. 82% Worked in paid employment. The absenteeism rate was 85%, and 44% was partially absent. After multidisciplinary screening, 62.2% were eligible for VR. Persons most likely to be eligible for VR (OR < 1.20) were those having back or neck pain, whereas least eligible (OR < 0.80) were persons having pain in hand/fingers or pain in other regions, unemployed workers, and those referred by a 'other' medical specialists. All other factors contributed little or none to the model. CONCLUSIONS: An extensive description of sociodemographic, pain-related, and work-related characteristics is presented for patients eligible for VR. Especially having back/neck pain and being an employee were associated with higher chance of eligibility for VR.

Experiences of rehabilitation coordination among people on sick leave with mental health problems.

PURPOSE: Return to work often requires collaboration between different stakeholders. Rehabilitation coordination is a resource in coordinating efforts during sick leave to facilitate return to work. The purpose of the present study was to describe how people at risk for sick leave or on sick leave with mental health problems experienced rehabilitation coordination. MATERIALS AND METHOD: The study had a qualitative approach using qualitative content analysis as described by Graneheim and Lundman. Eleven semi-structured interviews were conducted with persons at risk for sick leave or on sick leave due to mental health problems and with experience of rehabilitation coordination. RESULTS: The participants experience of rehabilitation coordination were described by the overarching theme Building a bridge with many bricks between the person and society. The theme was formed by four categories and eleven subcategories reflecting the complex context of rehabilitation coordination. The categories were Collaboration in a new setting, Unburdened within certain limits, The way back to work is a joint project and Recognising challenges beyond the person. CONCLUSIONS: People with mental health problems experienced rehabilitation coordination as a meaningful link between healthcare and work. However, rehabilitation coordination needs to be more recognised within healthcare to increase accessibility. It seems important that interventions are directed not only towards the person, but also include the workplace for a sustainable return to work.

It is important to make rehabilitation coordination visible within primary health care and actively inform people on sick leave with mental health problems that it is an option, as they often have difficulties finding information. It will increase their accessibility and enable autonomous decisions.A respectful interplay based on a person-centred care approach seems fundamental for rehabilitation coordination. The interplay with rehabilitation coordinators and with other stakeholders affects the sick leave process and all parties need to collaborate for a sustainable return to work.Three-party meetings with the person on sick leave, the rehabilitation coordinator and the employer, as well as teamwork, may provide better conditions for return to work as this can ensure that all stakeholders are working towards prioritised goals.Targeted interventions at the workplace seem to be important and rehabilitation coordination could be a valuable bridge between healthcare and work for creating sustainable conditions for return to work.

Association between COVID-19 and subsequent depression diagnoses-A retrospective cohort study.

BACKGROUND: The present study aimed to investigate the association between COVID-19 and the cumulative incidence of depression and the potential role of sick leave in a large representative sample of German adults. METHODS: This retrospective cohort study was based on the Disease Analyzer database (IQVIA) data. This study included individuals aged ≥16 years with a COVID-19 diagnosis in 1284 general practices in Germany between March 2020 and December 2021, and the propensity score matched cohort without COVID-19. Univariable Cox regression analysis assessed the association between COVID-19 and depression. RESULTS: The present study included 61,736 individuals with and 61,736 without COVID-19 (mean age 46.1 years; 49 % women). Patients visited their physicians about 4.3 times per year during the follow-up period. About 25.5 % of patients were diagnosed with COVID-19 in 2020 and 74.5 % in 2021. In this representative sample of German adults, COVID-19 infection was associated with a higher cumulative incidence of depression, and this cumulative incidence was greater in women than men. As compared with non-COVID-19, COVID-19 with ≤2 weeks sick leave duration was associated with 17 % higher depression risk (HR: 1.17; 95 % CI: 1.09-2.16), COVID-19 with >2-4 weeks sick leave duration with 37 % higher depression risk (HR: 1.37; 95 % CI: 1.11-1.69), and COVID-19 with >4 weeks sick leave duration with 2 times higher depression risk (HR: 2.00; 95 % CI: 1.45-2.76). CONCLUSION: COVID-19 sick leave was positively associated with a risk for depression, and the longer the duration of sick leave, the higher the cumulative incidence of depression.

Collaboration in the return-to-work process after sick leave due to common mental disorders: a qualitative study of stakeholders' views on goals and roles.

BACKGROUND: This study explores how the goals of collaboration in the return-to-work (RTW) process for people with common mental disorders are described by the stakeholders involved, and how they experience stakeholders' roles and responsibilities in relation to these goals. METHODS: Interviews were conducted with 41 participants from three Swedish regions. Nine of the participants were workers, six employer representatives, four occupational health professionals, four social insurance officers, 18 RTW coordinators and five physicians. Thematic analysis was conducted. RESULTS: Three main themes and overarching goals when collaborating on RTW were identified. In the first theme, 'creating an informative environment', all stakeholders emphasised clear roles and responsibilities. The second theme, 'striving for consensus in an environment of negotiations', addressed negotiations about when and how to collaborate, on what and with whom, and reveal different views on stakeholders' goals, roles and responsibilities in collaboration. The third theme identified goals for 'creating a supportive environment' for both workers and other stakeholders. Coordinators are found to have an important role in achieving a supportive environment, and in neutralising power imbalances between workers and their employers and social insurance officers. CONCLUSIONS: Competing goals and priorities were identified as hindering successful collaboration, contributing to a spectrum of complex versus easy RTW collaboration. This study suggests some basic conditions for achieving a collaborative arena that is neutral in terms of power balance, where all stakeholders can share their views.

Healthcare professionals' perceptions of the contributions of rehabilitation coordinators to patients in Swedish psychiatric care: a qualitative descriptive study.

BACKGROUND: Rehabilitation coordinators have gradually been introduced into Swedish psychiatric care to support individuals on sick leave to return-to-work or enter work. AIM: To explore healthcare professionals' perspectives on the contributions a rehabilitation coordinator can make to patients in psychiatric care. MATERIALS AND METHODS: A descriptive qualitative design was used, and data were collected through interviews. Twelve healthcare professionals in psychiatric care participated in individual semi-structured interviews. Data were analysed using thematic analysis. RESULTS: An overarching theme evolved: "The rehabilitation coordinator promotes security and reduces stress in the vocational rehabilitation process", based on two themes: (1) "Adaptations and support based on the patient's needs" and (2) "Rehabilitation coordinator efforts as relevant for care". The themes, in turn, consist of six subthemes. CONCLUSIONS: This study showed that healthcare professionals perceived employment as important for patients' health and well-being. Therefore, the rehabilitation coordination efforts were not only seen as beneficial for addressing patients' challenges and needs in managing the vocational rehabilitation process but also as an integral part of the patient's care.

Sickness absence and disability pension patterns before and after ischemic stroke: A Swedish longitudinal cohort study with matched references.

INTRODUCTION: The aim was to determine ischemic stroke patients' sickness absence and disability pension before and after stroke, and compare these to that of matched references. PATIENTS AND METHODS: All working-aged individuals (aged 18-61) in Sweden with incident ischemic stroke in year 2000, 2005, 2010, or 2015, respectively, and five population-based matched references to each stroke patient. Each cohort was followed 1 year prior stroke and 3 years after. We calculated rates and mean days of sickness absence and disability pension among stroke patients and references and computed trajectories of absence days with predictors of high sickness absence and disability pension. RESULTS: Number of patients with incident ischemic stroke in 2000 (N = 2728), 2005 (N = 2738), 2010 (N = 2767), and 2015 (N = 2531). Mean stroke age was 53 years and rate of men was 64%. Mortality rate within 12 months after stroke date decreased from 8.1% in 2000 to 4.8% in 2015. Sickness absence for patients was 31.1% in the year prior their stroke, versus 13.7% for references, both groups mainly due to mental and musculoskeletal diagnoses. Factors associated with future high mean number of sickness absence and disability pension days were elementary educational level; adjusted OR (CI) 3.47(2.38-5.05), being single; 1.67(1.29-2.16), female sex 1.72(1.31-2.26), diabetes; 1.86(1.18-2.92), and aged >50; 2.25(1.69-2.98). DISCUSSION AND CONCLUSION: Ischemic stroke patients have more absence days compared to matched references even before the stroke, mainly related to mental and musculoskeletal diagnoses. Future research should address the impact of efficient stroke treatment on sickness absence and disability pension.

Return to Work Following Hip or Knee Arthroplasty: A One-Year Prospective Cohort Study in Participants with Direct Referral from Hospital to Occupational Health Care Services.

PURPOSE: In a new Finnish Coordinated Return to Work (CRTW) model, patients are referred to occupational health care after hip or knee arthroplasty. This study evaluated the CRTW model's effect on return to work (RTW), activities used in occupational health care and in the workplace, and the patient- and work-related factors affecting early RTW. METHODS: 209 participants with occupational health care service underwent primary hip (THA) or total/unicondylar knee (KJA) arthroplasty and completed self-reported questionnaires after arthroplasty and at time of RTW. Factors affecting RTW, and the roles of occupational health care and the workplace in RTW were evaluated. Time to RTW was determined as days between the arthroplasty and RTW. RESULTS: Mean time to RTW was 69 days after THA and 87 days after KJA. For easing RTW, work arrangements were made for 56% of the participants. The most utilized adjustments of work were enabling remote work and arranging limitations in work tasks. Participants with earlier RTW had lower physical workload, higher professional status and motivation to work, less pre-arthroplasty sick leave, and more positive personal expectations about the time to RTW compared to participants with later RTW (p < 0.001 for all). The linear regression and dominance analyses showed participants' own expectations and pre-arthroplasty sick leave as the strongest factors affecting time to RTW. CONCLUSIONS: The CRTW model seems to shorten time to RTW after THA and KJA. Occupational health care and workplace play important roles in supporting RTW. Patients' own expectations should be noted when giving pre-arthroplasty information.

Prognostic factors for return to work in patients affected by chronic low back pain: a systematic review.

Chronic low back pain (LBP) represents a leading cause of absenteeism from work. An accurate knowledge of complex interactions is essential in understanding the difficulties of return to work (RTW) experienced by workers affected by chronic LBP. This study aims to identify factors related to chronic LBP, the worker, and the psycho-social environment that could predict and influence the duration of an episode of sick leave due to chronic LBP.Studies reporting the relation between prognostic factors and absenteeism from work in patients with LBP were included. The selected studies were grouped by prognostic factors. The results were measured in absolute terms, relative terms, survival curve, or duration of sick leave. The level of evidence was defined by examining the quality and the appropriateness of findings across studies in terms of significance and direction of relationship for each prognostic factor.A total of 20 studies were included. Prognostic factors were classified in clinical, psycho-social, and social workplace, reaching a total of 31 constructs. Global conditions with less favorable repercussions on worker's lives resulted in a delay in time to RTW. Older age, female, higher pain or disability, depression, higher physical work demands, and abuse of smoke and alcohol have shown strong level of evidence for negative outcomes.High global health well-being, great socioeconomic status, and good mental health conditions are decisive in RTW outcomes. Interventions that aim at RTW of employee's sick-listed with LBP should focus on psycho-social aspects, health behaviors, and workplace characteristics.

"Exploring job demands and resources influencing mental health and work engagement among physical therapists: a cross-sectional survey of Norwegian physical therapists."

BACKGROUND: Physical therapists play a vital role in the Norwegian health care system, and their work environment may be a significant determinant for their wellbeing and job performance. OBJECTIVE: 1) Assess differences in work environment, mental health problems, and work engagement between physical therapists working in specialist versus municipal health care services. 2) Assess the relationships between work environment factors and work engagement and mental health problems. METHODS: In this cross-sectional study, 273 physical therapists responded to the Survey for Workplace Health Promotion (response rate = 35%). Independent-sample t-tests, Pearson correlations, and multiple regression analyses were performed. RESULTS: This study did not find any significant differences between physical therapists working in Norwegian hospitals and therapists working in the municipal health care services. Analyses showed that general demands (ß = 0.21), fragmented work tasks (0.18), predictability (-0.17) and social support (-0.34) were associated with mental health problems, while meaningful work (0.41), the opportunity to use one's strengths and potential (0.14), and social support (0.25) were associated with higher work engagement. CONCLUSION: This study highlights the role of poor job design and professional isolation as hindrances to work engagement among physical therapists, whereas work related meaningfulness and peer support promote their health and wellbeing.

Process evaluation of the CO-WORK-CARE model: Collaboration and a person-centred dialogue meeting for patients with common mental disorder in primary health care.

RATIONALE: To ensure optimal patient care based on evidence, it is crucial to understand how to implement new methods in practice. However, intervention studies often overlook parts of the implementation process. A comprehensive process evaluation is necessary to understand why interventions succeed or fail in specific contexts and to integrate new knowledge into daily practice. This evaluation examines the full implementation of the Co-Work-Care model in Swedish primary healthcare to identify strengths and weaknesses. AIM: This study aimed to evaluate the process of implementing the CO-WORK-CARE model that focuses on close collaboration and the use of a person-centred dialogue meeting in primary healthcare for patients on sick leave due to common mental disorders. METHOD: The CO-WORK-CARE model emphasises collaboration among the GP, rehabilitation coordinator and care manager, along with person-centred dialogue meetings involving employers. Following UK Medical Research Council guidelines, we conducted a process evaluation. Data from previous studies were reanalysed. We also analysed field notes and meeting notes using Malterud's qualitative method. RESULTS: The evaluation identified key facilitators for model implementation, including regular visits by facilitators and guidance from the research physician. Peer support meetings also bolstered implementation. However, challenges emerged due to conflicts with existing structures and limitations in person-centred dialogue meetings. CONCLUSION: Adapting the CO-WORK-CARE model to Swedish primary care is feasible and beneficial, with collaboration among the care manager, rehabilitation coordinator and GP and person-centred dialogue meetings. Thorough preparations, ongoing facilitator and peer support and integrated information enhanced implementation efficiency, despite challenges posed by existing structures.

Cognitive flexibility is associated with sickness resilience.

Psychological constructs related to health outcomes and well-being, such as metacognitive beliefs, have been linked to executive functions in general, and cognitive flexibility more specifically. However, such effects have previously only been discussed on a theoretical level and behavioral flexibility has most often been measured through self-report, only approximating information processing capacities. Objectively measured executive functions may be a more potent predictor of health outcomes. We set out to test whether cognitive flexibility capacity was associated with sick leave in a medium sized company. We included 111 subjects of widely different occupations and assessed their executive functions using Delis-Kaplan Executive Function System test battery (D-KEFS). To assess cognitive flexibility capacity, we included Design Fluency (DF) and Verbal Fluency (VF) and computed these into an index of cognitive flexibility (DFVF). Detailed information on sick leave for the last 5 years was gathered from the company. Our results showed that there was a significant negative correlation between DFVF and sick leave [rs(109) = -0.23, p = 0.015] in the full group as well as in the group that had at least 1 day of sick leave [rs(72) = -0.25, p = 0.03]. The results withstood adjustment for sex, age, occupation, and several core executive functions as well as autistic and ADHD-traits. The results remained for separate analyses using DF or VF. Our main findings were conceptually replicated in a group of bipolar disorder patients. This study shows that objectively measured capacity of cognitive flexibility is associated with key health outcomes such as sick leave.