A Mega-Ethnography of Qualitative Meta-Syntheses on Return to Work in People with Chronic Health Conditions.

PURPOSE: The aim of this study was to synthesize the findings of qualitative meta-syntheses (QMS) on return to work (RTW) of people with different chronic illnesses and to develop a generic RTW model that can provide advice on how to improve RTW interventions and strategies. METHODS: We conducted a systematic literature search in PubMed, Epistemonikos, CENTRAL, and PsycARTICLES to find relevant QMS, published in English or German between 2000 and 2021, and adapted the meta-ethnographic approach of Noblit and Hare to synthesize their findings. RESULTS: Nineteen QMS (five focusing on musculoskeletal disorders or chronic pain, four on acquired or traumatic brain injuries, four on cancer, two on mental disorders, one on spinal cord injury, and three on mixed samples) met our inclusion criteria for the meta-ethnographic synthesis. Through systematic comparison and reciprocal translation of the single QMS findings, we could identify a set of key cross-cutting themes/concepts, which formed the basis for four RTW principles and a generic RTW model. CONCLUSIONS: RTW is a multifactorial and highly interactive multistakeholder process, embedded in an individual's life and working history, as well as in a determined social and societal context. It runs parallel and interdependently to the process of coping with the disease and realigning one's own identity, thus emphasizing the significance of RTW for the person. Besides symptoms and consequences of the disease, individual coping strategies, and RTW motivation, the course and success of RTW are strongly affected by the adaptability of the person's working environment and the social support in their private and working life. Thus, RTW is not only a problem of the individual, but also a matter of the social environment, especially the workplace, requiring a holistic, person-centered, and systemic approach, coordinated by a designated body, which considers the interests of all actors involved in the RTW process.

[Forms of Use of Psychosomatic Rehabilitation by Patients - A Study on the Significance of the Moment of Entrance in the Rehabilitation Setting and the Dependence on the Individual Situation at Admission to Rehabilitation]. / Nutzungsformen psychosomatischer Rehabilitation.

BACKGROUND AND AIMS: As expectancies of patients and physicians in psychosomatic rehabilitation are not always congruent, we focused on the patients' subjective expectancies toward rehabilitation in relation to the perceived benefit of the treatment for return to work and on the individual forms of utilization of the therapeutic services in the setting of psychosomatic clinics. A special focus was given to the changes in the patients' evaluations and coping behaviours over a follow-up period of 18 months. METHODS: N=105 participants (F-3/F-4 Main-Diagnosis, specific vocational problems, under 3 months jobless) of 4 psychosomatic rehabilitation settings were asked for their situation at the end of the rehabilitation by means of a questionnaire. 33 patients out of the questionnaire-sample who consented to participate were interviewed for 3 times (6, 12 and 18 months after release from the clinic) by means of episodic-narrative interviewing technique. RESULTS: Some characteristic expectancies and modes of use of the psychosomatic rehabilitation setting by the patients could be identified. The uses of the clinics' therapeutic services by the patients are pointing to different subjective felt needs that correlate with the state of coping with the illness and other psychosocial features at the moment of entrance in the rehabilitation setting. The patients' actual situation can be identified by retrospective tracing his/her positioning on an ideal-typed trajectory of the whole illness process from the beginning of the first symptoms up to Return to work. The results give hints for more individualised and person-centred propositions in rehabilitation-settings.

[Return to Work from Vocational RetrainingA Long-Term Analysis of Individual Trajectories: Biografical and Structural Conditions of Success and Failure]. / Von der beruflichen Vollqualifizierungsmaßnahme zurück in ArbeitEine Langzeitanalyse individueller Verlaufskarrieren und ihrer biografischen und strukturellen Bedingungen.

BACKGROUND AND AIMS: The study aimed at the reconstruction of the trajectories of participants of a two-year vocational-retraining into new workplaces thereby identifying favourable and risky conditions of the return-to-work process. From a practical point of view the study identified special needs and necessities for after-care facilities. METHODS: A Mixed-Method-Design was used. Quantitatively the follow-up-study included 214 persons who participated for three times on filling out a questionnaire over a period of eighteen months after the end of the vocational retraining. In the qualitative part of the study thirty persons consented to participate in a narrative-episodic interview on their vocational biography, their illness experiences at work and their way back into work. The study focused on the experiences of the participants from within, on their decision-making, coping, and rearrangement processes as well as on the experienced support from family members and rehabilitation professionals. RESULTS: About 75% of the participants of the vocational retraining succeeded in getting a job within the range of 18 months after finishing the retraining. Indicators for successful Return to Work are a high identification with the new vocation, effective coping with the remaining health problems, and an accepted arrangement with the disabilities in the work place and in everyday-life, a positive anticipation of the health condition in the future, and last but not least a satisfying social inclusion. As specific risk constellations for Return to Work emerged a lack of partnership, unfinished mental coping with the illness, negative subjective health prognosis, and a more passive attitude to life.

[Trajectories and Biographical Constellations in a Long-Term Study on Vocational Retraining and their Effects on Return to Work and Sustainable Stay at Work]. / Verlaufskarrieren und biografische Konstellationen beruflicher Rehabilitanden und deren Einflüsse auf Rückkehr und nachhaltigen Verbleib in Arbeit.

OBJEKTIVES: Using qualitative-hermeneutical methods with a focus on biographical (risk-) constellations for conditions of success or failure of return to work - and therefore on the efficiency and sustainability of employment participation benefits - the study accompanies participants during a time span of 2 years after their vocational retraining on their way back into the first labor market. METHODS: The study applies a mixed method design which combines 30 episodical-narrative interviews of participating rehabilitants alongside with a questionnaire survey of a total of 214 participants and 19 interviews of scientists and vocational retraining experts. RESULTS: Overall approximately 80% of the participants of our sample successfully return to work within a period of 18 months. Significant barriers can be illustrated by characteristic risk constellations, which correspond to the following dimensions: occupational choice, coping with illness, the need for protective area beyond the rehabilitation scheme, lack of (typical) life course orientation, lack of acceptance of a transitional phase with lower salary, regional occupation-specific labor market as well as social inclusion and support. CONCLUSION: Qualitative-hermeneutical methods generate - apart from diagnostic attributions and theoretical hypotheses - new factors effective for return to work with importance for rehabilitants; these factors refer to their embeddedness in processes, interrelations and interactions between biography, context factors, and administrative routines. The results identify specific needs for post-rehabilitation services supporting persons with risk constellations.

[Medical rehabilitation from a lifespan perspective]. / Medizinische Rehabilitation unter einer Lifespan-Perspektive.

Lifespan research investigates the development of individuals over the course of life. As medical rehabilitation deals with primary and secondary prophylaxis, treatment, and compensation of chronic illnesses, a lifespan perspective is needed for the classification and diagnosis of chronic disorders, the assessment of course modifying factors, the identification of vulnerable life periods and critical incidents, the implementation of preventive measures, the development of methods for the evaluation of prior treatments, the selection and prioritization of interventions, including specialized inpatient rehabilitation, the coordination of therapies and therapists, and for evaluations in social and forensic medicine. Due to the variety of individual risk constellations, illness courses and treatment situations across the lifespan, personalized medicine is especially important in the context of medical rehabilitation, which takes into consideration hindering and fostering factors alike.

Family caregiver burden in mental illnesses: The case of affective disorders and schizophrenia - a qualitative exploratory study.

BACKGROUND: Caregivers of people with mental illnesses often experience a wide range of burdens. Although many studies have confirmed burdens among family caregivers of mentally ill relatives in general, specific knowledge regarding the concrete everyday hassle and existential sorrows from the caregivers subjective reasoning perspective is lacking. Furthermore, there is little evidence on the possible different effects of affective disorders and schizophrenia on the quality of burden; this is also true with regard to the role of cultural traditions and lay beliefs. AIMS: The aim of this study was to explore the specific burdens experienced by caregivers of patients with schizophrenia and affective disorders. METHODS: A qualitative study was conducted by semi-structured interviews with 45 caregivers of patients with schizophrenia and affective disorders. Data were analysed by qualitative content analysis. RESULTS: Eleven encumbering themes resulted from the interviews including incertitude, unawareness, emotional burden, stigma and blame, financial burden, physical burden, restriction in routine, disruption in routine, dissatisfaction with family, relatives, and acquaintances, troubles with patients' adherence to medication, and problems with health services and governmental support. CONCLUSIONS: Caring for a person with mental illness affects caregivers emotionally, financially, physically, and it elicits some restrictions in their routine (daily hassles). Finally, it causes conflicts in family relationships. Despite some differences regarding perceived burden among caregivers of schizophrenia and affective disorders, a common pattern of burden could be identified. Thus, authorities should provide adequate financial, educational, and psychosocial supports for caregivers of mental illnesses.

[Which information relatives of patients with cancer are searching for? Are the findings helpful for coping and care?]. / Welche Informationen suchen internetnutzende Angehörige krebskranker Frauen und Männer? Helfen die gefundenen Informationen bei der Bewältigungsarbeit?

The question of how the relatives and friends of women with breast cancer and men with prostate cancer research illness-related subjects was examined by means of an online questionnaire. The relatives and friends use the internet primarily to inform themselves, but also to convey information further to the sick person. Often, they research for the patient who is not familiar with the medium. The relatives judge the internet as a great help. Medical themes are in the first positions of the item list. Half of the respondents recommend their relatives treatment possibilities. Concerning the therapy we see, that the illness-relevant internet usage leads thus more often to a reinforcement of the decision concerned than to noncompliance. While this interest dominates the net research, within the medical consultation most of the respondents expect attention to psychosocial matters next to the sharing of medical information. However, if they accompany their relatives to medical consultations and want to discuss net information, less than half notice an interested reaction from the physician and in one third of the respondents there is the predominating impression of the physician being overwhelmed. It is evident that relatives of cancer patients play an important role in the work of no-ending care, but still it is not payed enough attention to this fact in the daily work at the hospital.