Return to work interventions for chronic pain: a systematic review.

BACKGROUND: Chronic pain (CP) remains the second commonest reason for being off work. Tertiary return to work (RTW) interventions aim to improve psychological and physical capacity amongst workers already off sick. Their effectiveness for workers with CP is unclear. AIMS: To explore which tertiary interventions effectively promote RTW for CP sufferers. METHODS: We searched eight databases for randomized controlled trials evaluating the effectiveness of tertiary RTW interventions for CP sufferers. We employed the Cochrane Risk of Bias (ROB) and methodological quality assessment tools for all included papers. We synthesized findings narratively. Meta-analysis was not possible due to heterogeneity of study characteristics. RESULTS: We included 16 papers pertaining to 13 trials. The types, delivery format and follow-up schedules of RTW interventions varied greatly. Most treatments were multidisciplinary, comprising psychological, physical and workplace elements. Five trials reported that tertiary interventions with multidisciplinary elements promoted RTW for workers with CP compared to controls. We gave a high ROB rating for one or more assessment criteria to three out of the five successful intervention trials. Two had medium- and low-risk elements across all categories. One compared different intensity multidisciplinary treatment and one comprised work-hardening with a job coach. Seven trials found treatment effects for secondary outcomes but no RTW improvement. CONCLUSIONS: There is no conclusive evidence to support any specific tertiary RTW intervention for workers with CP, but multidisciplinary efforts should be considered. Workers' compensation is an important area for RTW policymakers to consider.

The influence of work engagement in social workers in England.

BACKGROUND: Social workers help to maintain and improve the lives of children, their families and adult service users in the UK. However, while engagement is shown to be an important determinant of both patient and employee outcomes in related health care professions, the influence of engagement has not been demonstrated in social workers. AIMS: To investigate the influence of employee engagement on perceived stress, turnover intentions, job satisfaction and presenteeism. METHODS: A cross-sectional survey of members of one English social work organization including measures of engagement (Utrecht Work Engagement Scale), the Perceived Stress Scale and single-item measures of job satisfaction, turnover intentions and presenteeism. T-tests and Mann-Whitney analyses were conducted to investigate differences in these measures in high and low engagement scores. RESULTS: A total of 1049 responses were analysed; social workers with greater engagement had significantly lower stress and turnover intentions, less presenteeism and greater job satisfaction. Additionally, overall respondents had poor levels of perceived stress, turnover intentions and presenteeism. CONCLUSIONS: Employee engagement is significantly associated with a number of work-related outcomes in social workers in England. However, social workers seem to have high turnover intentions and presenteeism, and greater than average perceived stress.

Working conditions and stress in the English education system.

Background: The UK education sector has among the highest level of stress sickness absence of all occupations. However, investigations of psychosocial working conditions which contribute to stress, including behaviour of students and parents, has not been conducted. Aims: To investigate the psychosocial working conditions and prevalence of negative parental and student behaviour in a large sample of school teachers and college lecturers based in England. In addition, to assess the influence of working conditions, student behaviour and parental behaviour on perceived stress. Methods: A cross-sectional survey of teachers in England. Respondents completed the Management Standards Indicator Tool (MSIT), Perceived Stress Scale (PSS-4), Student Behaviour Scale and a two-item measure of parental behaviour. Differences in these measures across different teaching roles were assessed using analysis of variance. Regression analyses were used to evaluate the association of MSIT, student and parental behaviour on PSS outcomes. Results: Compared to UK benchmark scoring, psychosocial working conditions were at a poor level, with primary teachers in particular exposed to negative parental behaviours, and secondary teachers to poor student behaviour. Demands were consistently associated with perceived stress outcomes across job roles, although management support and relationships with peers also played a part. Conclusions: Demands faced by teachers in England played an important part in the experience of stress. Interventions to reduce these demands, and the high frequencies of negative pupil and parental behaviours, should be considered.

The influence of zero-hours contracts on care worker well-being.

BACKGROUND: Care workers have an important social role which is set to expand with the increasing age of the UK population. However, the majority of care workers are employed on zero-hours contracts. AIMS: Firstly, to investigate the relationship between working conditions and employee outcomes such as engagement and general mental well-being in a sample of UK care workers and management. Secondly, to assess whether the use of zero-hours contracts affects employee well-being. METHODS: A cross-sectional survey of domiciliary care and care home employees, undertaken using the Management Standards Indicator Tool (MSIT), Utrecht Work Engagement Scale (UWES) and General Health Questionnaire (GHQ). T-tests and multivariate linear regression evaluated the differences in scoring between those with differing contractual conditions and job roles, and associations of MSIT scores with UWES and GHQ factors. RESULTS: Employee understanding of their role and job control were found to be priority areas for improvement in the sample. Similarly, care workers reported greater occupational demands and lower levels of control than management. However, while zero-hours contracts did not significantly influence employee well-being, these employees had greater levels of engagement in their jobs. Despite this, a greater proportion of individuals with zero-hours contracts had scores above accepted mental health cut-offs. CONCLUSIONS: Individual understanding of their role as care workers appears to play an important part in determining engagement and general mental well-being. However, more research is needed on the influence of zero-hours contracts on well-being, particularly in groups with increased likelihood of developing mental health disorders.

Systematic review: complementary therapies and employee well-being.

BACKGROUND: A variety of workplace-based interventions exist to reduce stress and increase productivity. However, the efficacy of these interventions is sometimes unclear. AIMS: To determine whether complementary therapies offered in the workplace improve employee well-being. METHODS: We performed a systematic literature review which involved an electronic search of articles published between January 2000 and July 2015 from the databases Cochrane Central Register of Controlled Trials, PsycINFO, MEDLINE, AMED, CINAHL Plus, EMBASE and PubMed. We also undertook a manual search of all applicable article reference lists to ensure that no relevant studies were missed. We only selected published, full-length, English-language, peer-reviewed journal articles. Articles had to address the research objective using valid and reliable measures. We excluded articles concerning return to work or whose populations had been adversely affected by work resulting in the development of health issues. RESULTS: We included 10 articles in the review from 131 identified. Mindfulness and meditation-based interventions were most effective in improving workplace health and work performance; the latter demonstrating some evidence of maintaining gains up to 3 months later. The evidence for relaxation interventions was inconclusive. CONCLUSIONS: Mindfulness and meditation interventions may be helpful in improving both psychosocial workplace health and work performance, but long-term efficacy has yet to be fully determined.

Employee engagement and management standards: a concurrent evaluation.

BACKGROUND: The UK Health & Safety Executive's Management Standards Indicator Tool (MSIT) has been used to assess areas of work design, which may act as psychosocial hazards leading to burnout. These have not been assessed as predictors of employee engagement. AIMS: To determine the utility of the MSIT in evaluating employee engagement as measured by the Utrecht Work Engagement Scale (UWES). METHODS: A cross-sectional survey of employees from two sales organizations in London was performed using the MSIT and UWES. MSIT scores were analysed stratifying medium-high versus low engagement. Multivariate linear regression evaluated the association of all MSIT scores with UWES factors. RESULTS: Control, managerial support, peer support and employee role differed by engagement level. Demands, peer support and role exceeded MSIT benchmark guidance that would warrant urgent improvement. Role ambiguity was the only factor significantly associated with all subdomains of engagement. CONCLUSIONS: Role appears to play a major part in determining employee engagement. Assessment of the relationship between factors measured by the MSIT and UWES requires further investigation in wider organizational settings, particularly the influence of employee role on positive psychological outcomes.

Public service stress and burnout over 12 months.

BACKGROUND: Research indicates that workplace stress has the potential to harm employee health with stress and stress-related absence increasing significantly during economic recession and times of organizational change. AIMS: To explore whether psychosocial hazards and burnout changed over a 12 month period in a public sector organization during a period of severely reduced organizational finances. METHODS: The Management Standards Indicator Tool (MSIT) and the Maslach Burnout Inventory-General Scale (MBI-GS) were administered to employees of one local government department in July 2011 and July 2012. RESULTS: A total of 128 employees completed the questionnaires in July 2011 (response rate 67%) and 57 in July 2012 (response rate 54%). MSIT factor scores of demands, peer support and role worsened significantly over the period of study. Furthermore, all psychosocial hazards scored worse than the recommended level set by Health and Safety Executive. Two burnout dimensions, 'demands' and 'cynicism', significantly worsened over the 12 month period but professional efficacy increased. CONCLUSIONS: The MSIT and MBI-GS appeared to have utility in this comparison. Psychosocial hazards appeared to worsen over the 12 months of the study, as 'demands' and 'cynicism' increased. However, an increase in professional efficacy was also seen, which requires further investigation.

The Management Standards Indicator Tool and evaluation of burnout.

BACKGROUND: Psychosocial hazards in the workplace can impact upon employee health. The UK Health and Safety Executive's (HSE) Management Standards Indicator Tool (MSIT) appears to have utility in relation to health impacts but we were unable to find studies relating it to burnout. AIMS: To explore the utility of the MSIT in evaluating risk of burnout assessed by the Maslach Burnout Inventory-General Survey (MBI-GS). METHODS: This was a cross-sectional survey of 128 borough council employees. MSIT data were analysed according to MSIT and MBI-GS threshold scores and by using multivariate linear regression with MBI-GS factors as dependent variables. RESULTS: MSIT factor scores were gradated according to categories of risk of burnout according to published MBI-GS thresholds, and identified priority workplace concerns as demands, relationships, role and change. These factors also featured as significant independent variables, with control, in outcomes of the regression analysis. Exhaustion was associated with demands and control (adjusted R (2) = 0.331); cynicism was associated with change, role and demands (adjusted R (2) =0.429); and professional efficacy was associated with managerial support, role, control and demands (adjusted R (2) = 0.413). CONCLUSIONS: MSIT analysis generally has congruence with MBI-GS assessment of burnout. The identification of control within regression models but not as a priority concern in the MSIT analysis could suggest an issue of the setting of the MSIT thresholds for this factor, but verification requires a much larger study. Incorporation of relationship, role and change into the MSIT, missing from other conventional tools, appeared to add to its validity.