Factors related to sustainable employment of people with acquired brain injury or spinal cord injury: The employer's perspective.

Background: Of those people with an acquired brain injury (ABI) or spinal cord injury (SCI) who initially successfully returned to paid employment, some exit the workforce before reaching official retirement age. Employers play a central role in ensuring a sustainable work situation for employees with a disability and in preventing such exits. However, the factors and mechanisms involved from the employer's perspective are still poorly understood. Purpose: The purpose was to determine factors which, from employer's perspective, have a particularly positive or negative influence on sustainable employment of people with ABI or SCI. Methods: Twenty semi-structured interviews were conducted with employers of people with ABI or SCI and thematically analyzed. Results: Identified factors could be assigned to four thematic areas for both health conditions: socio-demographic and psychological characteristics of the disabled person, their work performance, the work environment, and other social/environmental conditions. Good disability self-management and proactive communication of needs on the part of the employee are contributing factors to long-term employment from the employer's perspective. Differing expectations and assessments of work performance by employees and employers pose a challenge. Employers feel a responsibility to provide an optimal work environment to allow the employee with a disability to reach his or her full potential. This includes appropriate work tasks, development opportunities, a compassionate work team, flexible work arrangements, providing resources to address specific needs, and an inclusive culture. Employers find the support provided by occupational specialists very helpful, as they often lack the knowledge to design the work environment to meet the person's needs. Conclusions: Employers emphasize the benefits of professional support during vocational rehabilitation to prepare employers and employees for long-term, sustainable employment. Such support is often lacking when changes and problems occur at a later stage. Therefore, people with a disability should be able to communicate their work-related needs and take charge of their own health so that problems that arise can be addressed as early as possible. Continued awareness of the environment is also beneficial. In addition, the expansion of low-threshold health-specific support services for long-term problems was found to be of great importance for employers in Switzerland.

Predicting change in labour market participation of people with spinal cord injury (SCI): longitudinal evidence from the Swiss SCI community survey.

STUDY DESIGN: Longitudinal, population-based survey. OBJECTIVE: To examine change in labour market participation (LMP) of people with spinal cord injury (SCI) living in Switzerland and to identify predictors of increase, decrease and stability in LMP between 2012 and 2017. SETTING: Community. METHODS: Longitudinal information on LMP (i.e., weekly workload) was obtained from 311 gainfully employed, working-age individuals who participated in the Swiss Spinal Cord Injury Cohort Study (SwiSCI) community survey in 2012 and were still of working age at the time of completing the 2017 questionnaire. Statistical preselection of the predictors of change in LMP was carried out by implementing the least absolute shrinkage and selection operator (LASSO) in a multinomial logistic regression model. The final set of predictors was selected by comparison of several multinomial logistic regression models. RESULTS: Out of 311 participants, almost half (43%) changed their LMP between 2012 and 2017, 48 increased their weekly workload, 49 reduced and 37 participants left the labour market prematurely. Age at time of the survey, years of education, having children, intention to change weekly workload, high satisfaction with daily routine, extra-time needs for transportation and managing support were associated with change in LMP. CONCLUSIONS: Modifiable factors like education and satisfaction with daily routine should receive particular attention in the context of job retention strategies. More longitudinal research focusing on key employment transitions and trajectories over the life course of persons with SCI is needed to complement, validate and extend our findings.

Factors associated with sustaining work after an acquired brain injury: a scoping review.

PURPOSE: Maintaining work in the long term represents a major challenge for people with acquired brain injury (ABI) as evidenced by a high rate of premature labour market dropouts. The present study aimed to compile factors associated with working in the long term after sustaining an ABI. MATERIALS AND METHODS: We carried out a scoping review synthesizing quantitative and qualitative research conducted between 2000 and 2021. Databases searched comprised PubMed, CINAHL Complete, PsycINFO, Scopus, and Web of Science. RESULTS: Ten quantitative and nine qualitative studies were included, all but one from high-resource countries. Quantitative research predominantly comprised longitudinal follow-ups on individuals' work status several years post ABI onset, showing an effect of injury-related and sociodemographic factors. Qualitative studies mostly dealt with work maintenance and revealed a key role of cognitive difficulties, psychological personal factors (e.g., adequate coping strategies) and environmental factors (e.g., flexible work schedules, supportive colleagues). CONCLUSIONS: The factors identified in our review should receive particular attention in vocational integration and job retention programs to support work participation of people with ABI in the long term. There is a need for measures that regularly monitor and promote a good match between individuals and their work environment.Implications for RehabilitationPeople with acquired brain injury (ABI) often have long-lasting and invisible injury-related difficulties that hamper their labour market participation.Factors identified as positively associated with working in the long term, such as coping strategies and self-awareness, should be strengthened.Future interventions should educate affected persons, employers and health care professionals about long-lasting injury-related difficulties and promote a supportive work environment for people with ABI.Prolonged availability of vocational services could be beneficial for supporting work maintenance of people with ABI.

Factors associated with sustaining work with chronic spinal cord injury: a scoping review.

PURPOSE: Work participation remains challenging for people with spinal cord injury (SCI), as reflected in lower employment rates compared to the general population. To promote work participation for people with SCI, practitioners and policymakers need a better understanding of the factors associated with sustaining work in the long term. This study aimed to identify such factors. MATERIALS AND METHODS: Scoping review synthesizing quantitative and qualitative research published between 2000 and 2021. The databases searched were PubMed, CINAHL Complete, PsycINFO, Scopus, and Web of Science. RESULTS: Initially, 1221 articles were identified. Three quantitative studies investigating socio-demographic and injury-related factors and eight qualitative studies exploring mainly personal and environmental facilitators and barriers to working in the long term were retained. The results of the quantitative studies showed the importance of time since injury, age, and education. The qualitative findings emphasized the positive influence of self-advocacy, managing health behaviors, and a supportive work environment. Main barriers were time organization and societal attitudes. CONCLUSIONS: Future interventions should address the identified factors to promote working in the long term of people with SCI. Policymakers should adapt and enforce legal standards that address environmental and social barriers to creating supportive work environments for persons with SCI.Implications for rehabilitationPeople with spinal cord injury (SCI) experience difficulties in maintaining employment.Personal factors identified as crucial for working in the long term, such as self-advocacy and self-management of health behaviors, should be strengthened by future interventions.People with SCI should be offered a supportive work environment with work accommodations and flexible working hours to facilitate their labor market participation.

The assessment of capacity limitations in psychiatric work disability evaluations by the social functioning scale Mini-ICF-APP.

OBJECTIVE: Insurers frequently commission medical experts to estimate the degree of the remaining work capacity (RWC) in claimants for disability benefits. The social functioning scale Mini-ICF-APP allows for a rating of activity and participation limitations in thirteen capacity domains, considered as particularly relevant for work ability. The current study sought to evaluate the role of the Mini-ICF-APP ratings in psychiatric work disability evaluations, by examining how the capacity limitation ratings varied with the claimants' primary psychiatric diagnoses and how the ratings were related to RWC estimates. METHODS: Medical experts estimated the RWC of 946 claimants with mental disorders and rated their activity and participation limitations using the Mini-ICF-APP, with higher ratings reflecting more severe limitations. The ratings were compared between claimants with different psychiatric diagnoses by analyses of variance. The mean Mini-ICF-APP rating across all capacity domains as well as all capacity-specific ratings were entered in simple or multiple regression models to predict the RWC in an alternative job. RESULTS: The Mini-ICF-APP capacity limitation ratings in all domains but mobility were higher for claimants with personality and behavior disorders as compared to those with mood disorders or with neurotic, stress-related and somatoform disorders. The largest differences were observed in social capacities (e.g. group integration: F 2, 847 = 78.300, P < 0.001). In claimants with depression, all ratings increased with the severity of the diagnosis (all Fs 2, 203 > 16.393, all Ps < 0.001). In the overall sample, the mean Mini-ICF-APP rating showed a strong negative correlation with the estimated RWC (r = -.720, P < 0.001). Adding the capacity-specific ratings to the prediction model improved this prediction only marginally. DISCUSSION: The Mini-ICF-APP allows for documenting claimants' activity and participation limitations, which is likely to increase the transparency of medical experts' RWC estimates and enables them to check the plausibility of such estimates. However, our study showed that despite the strong association between RWC and Mini-ICF-APP ratings, half of the RWC variance was unrelated to the capacity limitations documented in the Mini-ICF-APP.

Pre- and post-injury job type distributions of individuals with SCI in relation to structural changes in the labor market: A comparative analysis based on findings from the Swiss Spinal Cord Injury Cohort Study.

Objective: To compare pre- and post-injury job type distributions of individuals with spinal cord injury (SCI) living in Switzerland.Design: Cross-sectional, self-report survey.Setting: Community.Participants: Two hundred sixty-three individuals reporting a pre- and 677 a post-injury job title in the Swiss SCI Cohort Study community survey.Interventions: Not applicable.Outcome Measures: Job titles were elicited by free-text questions and classified using the International Standard Classification of Occupations (ISCO-08). Frequencies across ISCO-08 major groups were calculated and compared to Swiss labor market statistics for 1995 and 2011.Results: Compared to pre-SCI, Professionals (16.3% vs 31.2%) and Clerical Support Workers (11.7% vs 19.1%) were more prevalent and Crafts and Related Workers (26.5% vs 5.4%) less common post-injury. Except for Clerical Support Workers, these results reflect recent structural changes in the Swiss labor market.Conclusion: The higher post-SCI prevalence of jobs predominantly requiring cognitive and communication skills compared to rather physically oriented jobs mirrors structural changes in the labor market, except for clerical jobs. Future return-to-work strategies should not primarily target the clerical sector with its diminishing job opportunities, but promote vocational re-training towards jobs requiring higher education and assistive technology to return individuals with limited cognitive resources to physically oriented jobs.

Current challenges in disability evaluation and the need for a goal-oriented approach based on the ICF: a qualitative stakeholder analysis in the context of the Swiss accident insurance.

PURPOSE: By using the eligibility determination process of the Swiss accident insurance (Suva) as a case in point, we aimed to examine current challenges and the need for a goal-oriented ICF-based approach in disability evaluation as experienced by different stakeholder groups. MATERIALS AND METHODS: Descriptive qualitative design involving semi-structured expert interviews with five main stakeholder groups of the eligibility determination process (i.e., Suva insurance officers, Suva insurance physicians, treating physicians, lawyers and judges). Interviews were thematically analyzed and their results reflected upon in focus groups with selected interview participants. RESULTS: Forty-three interviews and three focus groups were conducted. Participants pointed to challenges related to standardization, transparency, objectivity, efficiency and contextual factors. An ICF-based standard documenting claimant-job mismatches and their determinants was deemed promising for ensuring comprehensible and valid eligibility decisions, systematic and uniform reporting and a goal-oriented eligibility determination process. Concerns primarily addressed a potential pseudo-accuracy when using the standard for eligibility decisions. CONCLUSIONS: Implementing a goal-oriented ICF-based standard may help to approach current challenges in disability evaluation. Our findings support the development of such a standard for Suva's eligibility determination, but also point at the importance of involving key stakeholders to ensure its applicability and cross-disciplinary acceptance.IMPLICATIONS FOR REHABILITATIONPoor standardization and transparency as well as objectivity and efficiency issues represent key challenges in disability evaluation, as experienced by the different stakeholder groups involved in an eligibility determination process.A standardized ICF-based approach focusing on the documentation of claimant-job mismatches and their determinants is promising for improving transparency, validity and comparability of eligibility decisions.With its focus on claimants' ability to participate at work such an ICF-based standard has the potential to ensure a goal-oriented planning of assessments and interventions in the eligibility determination process.Our study provides specific targets for optimizing eligibility determination in disability evaluation but also for ensuring a customized and effective return to work after sustaining an injury.

An interdisciplinary approach to job matching: developing an occupation-specific job matching tool for reintegrating persons with spinal cord injury into the labor market.

Purpose: To develop and pretest a comprehensive occupation- and health condition-specific job matching tool for vocational rehabilitation of persons with spinal cord injury.Materials and methods: The study design involved qualitative and quantitative steps. First, an interdisciplinary scoping review covering return-to-work, organizational and vocational psychology research was conducted to devise a conceptual job matching framework. Then, the occupation- and health condition-specific tool content was determined based on a database analysis of jobs performed by persons with spinal cord injury and focus groups with affected persons. Finally, a tool prototype was developed and pretested in a simulation exercise with vocational rehabilitation professionals.Results: The study yielded a tool prototype with matching profiles that structure the demands and characteristics of 415 occupations as well as spinal cord injury-related needs and limitations into a stable, a modifiable, and a needs-supplies dimension of person-job match. Vocational rehabilitation professionals perceived the prototype as helpful for determining target jobs for vocational retraining and for goal-oriented intervention planning.Conclusions: By comprehensively assessing the person-job match of individuals with spinal cord injury, the tool facilitates determining suitable target jobs and interdisciplinary intervention planning in vocational rehabilitation and is thus likely to promote sustainable return to work.Implications for rehabilitationJob matching is crucial for a sustainable work reintegration of persons with disabilities. However, the majority of existing job matching tools lack applicability for return to work because they are (1) not occupation-specific or rely on outdated occupational information, (2) not health condition-specific, and (3) not comprehensive with regard to the relevant aspects for determining a person-job match.Persons with spinal cord injury are a case in point for the need of job matching tools that comprehensively address occupation- and health condition-specific information.The present study responded to the shortcomings of existing job matching tools and uses vocational rehabilitation of persons with spinal cord injury as a case in point for developing a job matching tool that is both occupation- and health condition-specific at the same time.The developed tool was perceived as promising for determining suitable target jobs for vocational retraining of persons with spinal cord injury and for goal-oriented intervention planning in an interdisciplinary vocational rehabilitation setting. The tool's underlying conceptual framework may also serve as a blueprint for developing job matching tools for other types of disabilities.

Factors associated with labor market participation of persons with traumatic SCI in Switzerland: analyzing the predictive power of social background, health, functional independence, and the environment.

STUDY DESIGN: Cross-sectional study using data from the 2012 community survey of the Swiss Spinal Cord Injury Cohort Study. OBJECTIVES: To identify associations between selected factors related to the social background, health, functional independence, and the environment of persons with spinal cord injury (SCI) and their labor market participation. SETTING: Community-based, Switzerland. METHODS: Labor market participation (i.e., involvement in paid work or not) was determined for a sample of 966 persons with traumatic SCI who were of employable age at the time of the survey. Applying an exploratory approach, potential predictors of labor market participation were selected based on the literature and using a bidirectional stepwise variable selection approach. Descriptive statistics were calculated and weighted bootstrapped multiple logistic regressions were applied to describe the associations between the selected predictor variables and labor market participation, controlling for sociodemographic and SCI-related characteristics. RESULTS: A total of 568 (58.8%) of the participants were involved in paid work at the time of the survey. From the 17 selected predictor variables, general functional independence and Swiss citizenship showed a significant positive association, and chronic pain a negative association with involvement in paid work. CONCLUSIONS: Beyond previously established sociodemographic and injury-related risk factors such as female gender, low education, and high lesion severity, functional independence, chronic pain, and nationality proved crucial for labor market participation. These factors should receive particular attention in medical and vocational strategies striving for a sustainable work integration of persons with SCI.

Factors, assessments and interventions related to job matching in the vocational rehabilitation of persons with spinal cord injury.

BACKGROUND: Matching an individual's capabilities, interests and needs with corresponding job demands and characteristics is an established procedure in vocational rehabilitation (VR). Yet, a systematic exposition of specific factors affecting the determination and attainment of a person-job match in VR practice is currently missing. OBJECTIVE: To examine factors, assessments and interventions related to job matching (JM) in VR of persons with spinal cord injury (SCI) by using a literature-based conceptual JM framework. METHODS: Applying a qualitative descriptive design, data were collected by overt non-participant observations across the VR process of two individuals with SCI, representing major return-to-work scenarios (returning to the pre-injury job and preparing for vocational retraining). RESULTS: Person-related, job-related and environmental factors were identified that either played a direct or indirect role in determining and attaining a person-job match. The factors were evaluated by different work-related and medical assessments and were targeted by a number of JM-related interventions. CONCLUSIONS: While our conceptual framework may serve as a generic blueprint to facilitate JM approaches in VR practice, the specific factors identified in our study are particularly valuable for developing JM applications aimed at promoting sustainable return to work for persons with SCI.

Prevalence of and factors associated with expressed and unmet service needs reported by persons with spinal cord injury living in the community.

STUDY DESIGN: Observational study. OBJECTIVES: To determine the prevalence, predictors, and consequences of self-reported service needs among community-dwelling persons with SCI. SETTING: Community-based, Switzerland. METHODS: Participants were 490 people who took part in the health services module of the Swiss Spinal Cord Injury Cohort Study (SwiSCI) 2012 community survey. We determined the prevalence of 20 service needs and the extent to which they were unmet. Predictors and consequences of service needs were examined with multiple regression analyses. RESULTS: High-prevalence needs (e.g., general health care, accessible housing) exhibited a high level of fulfillment. Conversely, less prevalent service needs (e.g., peer support, support for family caregivers) showed lower levels of fulfillment. Across three specific service domains (peer support, support for family caregivers, sports activities), lower household income predicted most consistently a higher likelihood of unmet needs. The total number of expressed needs was higher in non-Swiss nationals, persons with complete para- or tetraplegia and lower income individuals. Being female, French language region and lower household income predicted more total unmet needs. Increased expressed and unmet service needs were associated with lower life satisfaction. CONCLUSIONS: Service needs with a high prevalence seem to be adequately met by the current service provision system. However, rehabilitation professionals should remain alert to clients' specific and cumulative unmet needs, in particular with respect to less common ones, and their impact on successful community reintegration and life satisfaction.

Work and wellbeing-related consequences of different return-to-work pathways of persons with spinal cord injury living in Switzerland.

STUDY DESIGN: Observational study based on the 2012 community survey of the Swiss Spinal Cord Injury Cohort Study (SwiSCI). OBJECTIVES: To investigate work and wellbeing-related consequences of different return-to-work (RTW) pathways after SCI. SETTING: Community-based. METHODS: Using a subsample of 243 SwiSCI participants, we determined whether a respondent had returned to the pre-injury employer, started with a new employer or had not returned to gainful employment post-SCI. For each pathway, descriptive statistics were provided and work and wellbeing-related consequences were examined with regression analyses. RESULTS: One hundred eleven (45.7%) participants had returned to their pre-injury employer, 80 (32.9%) had changed employers and 52 (21.4%) had never returned to paid work post-SCI. Although returning to the pre-injury employer was associated with a shorter RTW time and a higher current weekly work time compared with starting work with a new employer, no significant differences were found with regard to current employment status and post-SCI work duration. Concerning wellbeing-related outcomes (i.e., income, quality of life and life satisfaction), the two pathways did not differ. CONCLUSIONS: Although lasting RTW had beneficial wellbeing outcomes, the specific pathway initially taken (i.e., pre-injury vs. new employer) appeared less crucial. Although the two pathways seem equally viable, longitudinal data are required to corroborate the present findings, and future research needs to clarify the role of the client triage system and of vocational rehabilitation practices with regard to person-job match and its impact on job satisfaction and job performance.

Employment pathways of individuals with spinal cord injury living in Switzerland: A qualitative study.

BACKGROUND: Labour market participation (LMP) represents a key goal of rehabilitation for individuals with spinal cord injury (SCI). To achieve this goal, Swiss SCI rehabilitation centres seek, together with their clients, viable follow-up solutions for returning to work after initial rehabilitation. However, the long-term outcomes of such vocational follow-up solutions have not been investigated so far, and there is a paucity of knowledge regarding the various types of employment pathways that persons with SCI living in Switzerland may experience. OBJECTIVE: To examine long-term employment pathways as experienced by individuals with SCI living in Switzerland. METHODS: A qualitative descriptive study design involving narrative interviews with individuals who completed vocational rehabilitation (VR) during their initial rehabilitation. Interviews were transcribed verbatim, and data analysed using an inductive thematic analysis approach. RESULTS: The analysis of the 15 interviews revealed four employment pathways: the pathway of no paid work, the pathway of retraining, the pathway of job adaptation and the pathway of continuing work. CONCLUSIONS: Apart from three pathways leading towards paid employment, our results revealed one pathway that was characterized by permanent unemployment. Individuals facing a pathway of no paid work may benefit from more custom-made vocational follow-up solutions and prolonged job coaching after initial VR.

Job matching: An interdisciplinary scoping study with implications for vocational rehabilitation counseling.

PURPOSE: Matching a person's capabilities and characteristics with the demands and characteristics of their job is crucial for sustainable employment, in particular for persons with disabilities. The present study aims to summarize and synthesize conceptual and empirical knowledge on job matching (JM) from industrial and organizational psychology (IOP), vocational psychology (VP), and return to work (RTW) research. RESEARCH METHOD: We conducted a scoping study applying Arksey and O'Malley's (2005) framework and using eight electronic databases from psychology, economics, and medicine. The literature search covered studies in English and German published between 1945 and 2015. RESULTS: A total of 312 studies were selected and analyzed. Of these, 205 were assigned to IOP, 45 to VP, 31 to both IOP and VP, and 17 to RTW research. Fourteen studies were allocated to both RTW and VP research, representing the field of vocational rehabilitation counseling. IOP and VP studies predominantly investigated the effects of JM on work-related outcomes, such as job satisfaction, tenure, or career development. RTW research focused on the development of mainly generic JM tools for job placement of persons with disabilities. Limited cross-fertilization between IOP and VP and the RTW context became evident. CONCLUSIONS: Unlike in IOP and VP, there is a dearth of JM research in the RTW context. Integrating the broad organizational and occupational JM knowledge from IOP and VP with the biopsychosocial framework of RTW could provide a sound basis for developing JM applications in vocational rehabilitation counseling that promote sustainable work reintegration of persons with disabilities. (PsycINFO Database Record

Labor Market Integration of People with Disabilities: Results from the Swiss Spinal Cord Injury Cohort Study.

OBJECTIVES: We aimed to describe labor market participation (LMP) of persons with spinal cord injury (SCI) in Switzerland, to examine potential determinants of LMP, and to compare LMP between SCI and the general population. METHODS: We analyzed data from 1458 participants of employable age from the cross-sectional community survey of the Swiss Spinal Cord Injury Cohort Study. Data on LMP of the Swiss general population were obtained from the Swiss Federal Statistical Office. Factors associated with employment status as well as the amount of work performed in terms of full-time equivalent (FTE) were examined with regression techniques. RESULTS: 53.4% of the participants were employed at the time of the study. Adjusted odds of being employed were increased for males (OR = 1.73, 95% CI 1.33-2.25) and participants with paraplegia (OR = 1.78, 95% CI 1.40-2.27). The likelihood of being employed showed a significant concave relationship with age, peaking at age 40. The relation of LMP with education was s-shaped, while LMP was linearly related to time since injury. On average, employment rates were 30% lower than in the general population. Males with tetraplegia aged between 40 and 54 showed the greatest difference. From the 771 employed persons, the majority (81.7%) worked part-time with a median of 50% FTE (IRQ: 40%-80%). Men, those with younger age, higher education, incomplete lesions, and non-traumatic etiology showed significantly increased odds of working more hours per week. Significantly more people worked part-time than in the general population with the greatest difference found for males with tetraplegia aged between 40 and 54. CONCLUSIONS: LMP of persons with SCI is comparatively high in Switzerland. LMP after SCI is, however, considerably lower than in the general population. Future research needs to show whether the reduced LMP in SCI reflects individual capacity adjustment, contextual constraints on higher LMP or both.

Toward standardised documentation in psychiatric evaluations: identifying functioning aspects and contextual factors in psychiatric reports of Swiss disability claimants with chronic widespread pain.

QUESTIONS UNDER STUDY: In Switzerland, psychiatric evaluations are crucial for deciding on eligibility of disability benefits for claimants with chronic widespread pain (CWP). However, the poor standardisation and low transparency of such evaluations have been criticised. Standardisation and transparency may be enhanced by comprehensive functioning documentation using the International Classification of Functioning, Disability and Health (ICF). We applied the ICF as a reference frame to determine a list of functioning aspects and contextual factors commonly reported in psychiatric work capacity evaluations of Swiss disability claimants with CWP. METHODS: We conducted a retrospective qualitative and quantitative content analysis of 24 psychiatric reports of claimants with CWP by using the ICF taxonomy and a personal factor categorisation for data coding. Coded categories were considered candidate items for standardised documentation in psychiatric evaluations involving CWP if they passed a predetermined threshold based on their relative frequency across reports. RESULTS: A total of 71 second level ICF and personal factor categories passed the threshold. In total, 21 categories referred to the ICF component personal factors, 19 to body functions, 18 to activities and participation, and 13 to environmental factors. CONCLUSIONS: The list of ICF and personal factor categories we determined in this study addresses concepts commonly reported in psychiatric evaluations of medical work capacity involving CWP. It can serve as a starting point in developing a standard for comprehensive functioning documentation in the present context.

Towards comprehensive and transparent reporting: context-specific additions to the ICF taxonomy for medical evaluations of work capacity involving claimants with chronic widespread pain and low back pain.

BACKGROUND: Medical evaluations of work capacity provide key information for decisions on a claimant's eligibility for disability benefits. In recent years, the evaluations have been increasingly criticized for low transparency and poor standardization. The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive spectrum of categories for reporting functioning and its determinants in terms of impairments and contextual factors and could facilitate transparent and standardized documentation of medical evaluations of work capacity. However, the comprehensiveness of the ICF taxonomy in this particular context has not been empirically examined. In this study, we wanted to identify potential context-specific additions to the ICF for its application in medical evaluations of work capacity involving chronic widespread pain (CWP) and low back pain (LBP). METHODS: A retrospective content analysis of Swiss medical reports was conducted by using the ICF for data coding. Concepts not appropriately classifiable with ICF categories were labeled as specification categories (i.e. context-specific additions) and were assigned to predefined specification areas (i.e. precision, coverage, personal factors, and broad concepts). Relevant specification categories for medical evaluations of work capacity involving CWP and LBP were determined by calculating their relative frequency across reports and setting a relevance threshold. RESULTS: Forty-three specification categories for CWP and fifty-two for LBP reports passed the threshold. In both groups of reports, precision was the most frequent specification area, followed by personal factors. CONCLUSIONS: The ICF taxonomy represents a universally applicable standard for reporting health and functioning information. However, when applying the ICF for comprehensive and transparent reporting in medical evaluations of work capacity involving CWP and LBP context-specific additions are needed. This is particularly true for the documentation of specific pain-related issues, work activities and personal factors. To ensure the practicability of the multidisciplinary evaluation process, the large number of ICF categories and context-specific additions necessary for comprehensive documentation could be specifically allocated to the disciplines in charge of their assessment.

Impact of legal regulations and administrative policies on persons with SCI: identifying potential research priorities through expert interviews.

PURPOSE: To identify research gaps and potential research priorities regarding the impact that legal regulations and administrative policies might have on people with spinal cord injury (SCI) living in Switzerland. METHOD: We conducted semi-structured interviews with 14 healthcare professionals working for or being associated with the largest SCI clinic in Switzerland. The transcribed interviews were content analyzed, involving qualitative description, and thematic analysis techniques. RESULTS: Four interrelated clusters of issues were corroborated: (1) social insurance, (2) caregiving, (3) work integration, and (4) aging. In addition, two overarching themes were identified: (1) fairness considerations and (2) unavailability of systematic empirical evidence. Work capacity assessment and family caregiving were deemed to be the most pressing research priority areas. CONCLUSIONS: Legal frameworks do play both a direct and an indirect role in the lives of people with SCI in Switzerland. This is particularly true with regard to various issues related to the social insurance system, such as family caregiving and work capacity assessment. The salience of these topics is closely related to major sociodemographic and political driving forces, i.e. aging and social insurance reforms. Research directly involving people with SCI is needed to further substantiate and refine the findings of this study. IMPLICATIONS FOR REHABILITATION: When dealing with issues related to work reintegration, aging, social insurance, and caregiving, rehabilitation professionals should take existing legal frameworks into account. Eligibility criteria for disability benefits may influence the therapy motivation of rehabilitation clients.

Toward transparent documentation in medical work capacity evaluations: identifying personal factors in medical reports on Swiss disability claimants with chronic widespread pain.

The aim of this study was to determine personal factors that are reported in medical work capacity evaluations of Swiss disability claimants with chronic widespread pain. A mixed-methods study, involving a retrospective qualitative and quantitative secondary analysis of the content of medical reports, was carried out. Two personal factor categorizations (the Geyh categorization and the Grotkamp categorization) were used for coding and specifying the personal factors in the reports. The most relevant personal factor categories were determined by calculating their relative frequency across reports and setting a relevance threshold. Using the Geyh categorization, 27 personal factor categories passed the relevance threshold and six of them appeared in all medical reports. Applying the Grotkamp categorization, 32 personal factor categories passed the threshold and four of them showed up in all reports. The most relevant personal factors identified in medical reports on Swiss disability claimants with chronic widespread pain refer to biographical, occupational, and educational background, behavior patterns as well as personal feelings and cognitions. The development of a standardized documentation involving these personal factors could contribute to more transparency and better comparability of medical work capacity evaluations.

Aspects of functioning and environmental factors in medical work capacity evaluations of persons with chronic widespread pain and low back pain can be represented by a combination of applicable ICF Core Sets.

BACKGROUND: Medical work capacity evaluations play a key role in social security schemes because they usually form the basis for eligibility decisions regarding disability benefits. However, the evaluations are often poorly standardized and lack transparency as decisions on work capacity are based on a claimant's disease rather than on his or her functional capacity. A comprehensive and consistent illustration of a claimant's lived experience in relation to functioning, applying the International Classification of Functioning, Disability and Health (ICF) and the ICF Core Sets (ICF-CS), potentially enhances transparency and standardization of work capacity evaluations. In our study we wanted to establish whether and how the relevant content of work capacity evaluations can be captured by ICF-CS, using disability claimants with chronic widespread pain (CWP) and low back pain (LBP) as examples. METHODS: Mixed methods study, involving a qualitative and quantitative content analysis of medical reports. The ICF was used for data coding. The coded categories were ranked according to the percentage of reports in which they were addressed. Relevance thresholds at 25% and 50% were applied. To determine the extent to which the categories above the thresholds are represented by applicable ICF-CS or combinations thereof, measures of the ICF-CS' degree of coverage (i.e. content validity) and efficiency (i.e. practicability) were defined. RESULTS: Focusing on the 25% threshold and combining the Brief ICF-CS for CWP, LBP and depression for CWP reports, the coverage ratio reached 49% and the efficiency ratio 70%. Combining the Brief ICF-CS for LBP, CWP and obesity for LBP reports led to a coverage of 47% and an efficiency of 78%. CONCLUSIONS: The relevant content of work capacity evaluations involving CWP and LBP can be represented by a combination of applicable ICF-CS. A suitable standard for documenting such evaluations could consist of the Brief ICF-CS for CWP, LBP, and depression or obesity, augmented by additional ICF categories relevant for this particular context. In addition, the unique individual experiences of claimants have to be considered in order to assess work capacity comprehensively.