Associations Between the Readiness for Return to Work Scale and Return to Work: A Prospective Study.

Purpose To explore the usefulness of the Readiness for return to work scale in individuals participating in occupational rehabilitation, by assessing the association between the scale and return to work (RTW), and comparing the scale to a question assessing individuals' expectations about length of sick leave. Method Prospective cohort study with 9 months follow-up. Participants took part in one of two randomized clinical trials. Associations between the Readiness for RTW scale and RTW was analyzed using linear and logistic regression, with adjustment for age, gender and education. The Readiness for RTW scale was compared to a self-reported question assessing participants' expectations about length of sick leave using adjusted/pseudo R2. Results For participants not working (n = 96), high scores on two dimensions (Prepared for action-self-evaluative and Prepared for action-behavioral) were associated with a higher probability of sustainable RTW and more working days. For those working (n = 121), high scores on the Uncertain maintenance dimension was associated with a lower probability of sustainable RTW and less working days. Generally, models including the Readiness for RTW dimensions were not as good at explaining work outcomes as models including a single expectation question. Stage allocation, allocating participants to the dimension with the highest score, was problematic due to several tied scores between (not necessarily adjacent) dimensions. Conclusions Three of the Readiness for RTW dimensions were associated with RTW. However, several weaknesses with the Readiness for RTW scale were established and we particularly do not recommend the stage allocation approach for clinical use in its current form.

Subjective health complaints, functional ability, fear avoidance beliefs, and days on sickness benefits after work rehabilitation - a mediation model.

BACKGROUND: Long-term sick leave and withdrawal from working life is a concern in western countries. In Norway, comprehensive inpatient work rehabilitation may be offered to sick listed individuals at risk of long-term absence from work. Knowledge about prognostic factors for work outcomes after long-term sick leave and work rehabilitation is still limited. The aim of this study was to test a mediation model for various hypothesized biopsychosocial predictors of continued sick leave after inpatient work rehabilitation. METHODS: One thousand one hundred fifty-five participants on long-term sick leave from eight different work rehabilitation clinics answered comprehensive questionnaires at arrival to the clinic, and were followed with official register data on sickness benefits for 3 years. Structural equation models were conducted, with days on sickness benefits after work rehabilitation as the outcome. RESULTS: Fear avoidance beliefs for work mediated the relation between both musculoskeletal complaints and education on days on sickness benefits after work rehabilitation. The relation between musculoskeletal complaints and fear avoidance beliefs for work was furthermore fully mediated by poor physical function. Previous sick leave had a strong independent effect on continued sick leave after work rehabilitation. Fear avoidance beliefs for work did not mediate the small effect of pseudoneurological complaints on continued sick leave. Poor coping/interaction ability was neither related to continued sick leave nor fear avoidance beliefs for work. CONCLUSIONS: The mediation model was partly supported by the data, and provides some possible new insight into how fear avoidance beliefs for work and functional ability may intervene with subjective health complaints and days on sickness benefits after work rehabilitation.

A prospective study of the association between the readiness for return to work scale and future work participation in Norway.

AIM: The aim of the study was to investigate the associations between the Norwegian version of the Readiness for return to work (RTW) scale and future work participation among persons in inpatient occupational rehabilitation. METHODS: A prospective cohort with one year follow up. The participants (n = 179) were persons with reduced work ability who participated in a one-week inpatient rehabilitation program. Four readiness for RTW factors were identified at baseline using explorative factor analysis: 'RTW inability' and 'RTW uncertainty' among persons not working, and 'uncertain work maintenance' and 'proactive work maintenance' among persons working. Work participation was measured as days without sickness benefits in the year following the rehabilitation program. The associations between work participation and readiness for RTW factors were analyzed in multivariate linear regression models controlling for gender, age, subjective health complaints, employment status and previous sickness benefit. RESULTS: High scores on the RTW inability factor were associated with low future work participation among persons not working before the rehabilitation program. Among persons working before the program, the proactive work maintenance factor was associated with high future work participation. Neither the RTW uncertainty factor nor the uncertain work maintenance factor was associated with future work participation. CONCLUSIONS: The associations between two readiness for RTW factors (RTW inability and proactive work maintenance) and future work participation indicate that these factors can be used as screening tools to tailor occupational rehabilitation programs.

Psychometric properties of the readiness for return to work scale in inpatient occupational rehabilitation in Norway.

AIM: To investigate internal consistency and construct validity of the Readiness for return to work (RTW) scale in a sample participating in a Norwegian inpatient occupational rehabilitation program. METHODS: A cross-sectional study was conducted on baseline measures from a prospective cohort study evaluating a 5 days inpatient occupational rehabilitation program. The participants in the program were 18-67 years, on sickness absence or at risk of sickness absence (N = 193). The Readiness for RTW scale, sociodemographic-, work- and health-related questionnaires were answered by the participants on their first day in the program. Statistical analysis included exploratory factor analyses, reliability analyses and correlations with related instruments. RESULTS: In the scale for those not working (N = 124) two factors were found, representing (1) RTW inability and (2) RTW uncertainty. These factors corresponded to the precontemplation and contemplation stages in a previous Canadian study. The original prepared for action stages were not identified in this sample. In the scale for those working shortly before the program (N = 60) two factors were identified, representing (1) Uncertain work maintenance and (2) Proactive work maintenance, comparable to the stages in the Canadian study. The factors had satisfactory internal consistency (Cronbach's alpha >0.7), except for proactive work maintenance (Cronbach's alpha = 0.59). Expected relationships were found between the readiness for RTW stages and the pain stages of change, fear avoidance beliefs for work, subjective health complaints, decision control and coping at work. CONCLUSION: Internal consistency and construct validity of the readiness for RTW stages found were satisfactory, except for proactive work maintenance. The results indicate that the construct of readiness for RTW may vary by culture and patient setting.

Cross-cultural adaptation of the Work Role Functioning Questionnaire 2.0 to Norwegian and Danish.

BACKGROUND: A healthy and productive working life has attracted attention owing to future employment and demographic challenges. OBJECTIVE: The aim was to translate and adapt the Work Role Functioning Questionnaire (WRFQ) 2.0 to Norwegian and Danish. METHODS: The WRFQ is a self-administered tool developed to identify health-related work limitations. Standardised cross-cultural adaptation procedures were followed in both countries' translation processes. Direct translation, synthesis, back translation and consolidation were carried out successfully. RESULTS: A pre-test among 78 employees who had returned to work after sickness absence found idiomatic issues requiring reformulation in the instructions, four items in the Norwegian version, and three items in the Danish version, respectively. In the final versions, seven items were adjusted in each country. Psychometric properties were analysed for the Norwegian sample (n = 40) and preliminary Cronbach's alpha coefficients were satisfactory. A final consensus process was performed to achieve similar titles and introductions. CONCLUSIONS: The WRFQ 2.0 cross-cultural adaptation to Norwegian and Danish was performed and consensus was obtained. Future validation studies will examine validity, reliability, responsiveness and differential item response. The WRFQ can be used to elucidate both individual and work environmental factors leading to a more holistic approach in work rehabilitation.

Improved work ability and return to work following vocational multidisciplinary rehabilitation of subjects on long-term sick leave.

OBJECTIVE: To evaluate a vocational multidisciplinary rehabilitation programme for patients on long-term sick leave with respect to their work ability and return to work. METHODS: A multidisciplinary rehabilitation programme was administered to an intervention group of 183 patients on long-term sick leave (mean 12.2 months). Effects of the treatment were compared with a control group (n = 96) recruited from the national sickness insurance record of patients on sick leave of 6-12 months duration (mean 11.5 months). Perceived work ability, return to work, background factors and psychosocial aspects of work were assessed on the basis of questionnaires at baseline and after 4 months. RESULTS: Perceived work ability of the intervention group improved significantly after 4 months compared with the control group (p < 0.01). In the intervention group, 80% had returned to work compared with 66% in the control group (p = 0.06). Return to work after 4 months was predicted by good work ability at baseline, improved work motivation, improved work ability at follow-up and increased rumours of change in the workplace (R2 26.1-38.6%, p < 0.05). CONCLUSION: This multidisciplinary rehabilitation programme significantly improved perceived work ability compared with treatment as usual.