scholarly journals Vocational interventions to help adults with long-term health conditions or disabilities gain and maintain paid work: an overview of systematic reviews

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049522
Author(s):  
William Mark Magnus Levack ◽  
Joanna Kirstin Fadyl
Keyword(s):  
Mental Health ◽  
Systematic Reviews ◽  
Health Conditions ◽  
Paid Work ◽  
High Quality ◽  
Mental Health Conditions ◽  
Moderate Quality ◽  
Overview Of Systematic Reviews ◽  
Quality Evidence

ObjectiveTo conduct an overview of systematic reviews to examine the effectiveness of vocational interventions to help adults with long-term health conditions or disability gain and maintain new paid work and to analyse the spread and quality of evidence in this area.MethodsWe pre-published our protocol in PROSPERO (CRD42019132448). We searched Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, Proquest Dissertations and Theses database, NICE and Business Source Complete from inception to 21 August 2020. We included any systematic reviews of clinical trials on vocational interventions for adults with long-term health conditions or disability who were not in work or had recently gained work. We excluded reviews of vocational interventions for employed people on sick leave. Two researchers identified, critically appraised,using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2, and extracted data from included reviews. We used Grading of Recommendations Assessment, Development and Evaluation to evaluate strength of evidence underpinning overview findings.ResultsWe identified 26 reviews (5 high-quality and 21 critically low to moderate quality) that focused on vocational interventions for acquired brain injury, autism, intellectual disability, multiple sclerosis, mental health conditions, spinal cord injury and general disability populations. We identified moderate quality evidence that people with moderate to severe mental health conditions who participate in supported employment, particularly individual placement and support, are more likely to gain competitive employment compared with people who receive traditional vocational services (risk ratio 2.07; 95% CI 1.82 to 2.35; 27 studies, 6651 participants). We found only very low-quality to low-quality evidence on vocational intervention for people with any other health condition. We found little to no data on employer or employee satisfaction with work outcomes or the cost effectiveness of interventions.ConclusionGiven the importance placed on work opportunities for people with long-term health conditions or disability, there is urgent need for more high-quality research on vocational interventions for this population.Prospero registration numberCRD42019132448.

scholarly journals Effectiveness of vocational interventions for gaining paid work for people living with mild to moderate mental health conditions: systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039699
Author(s):  
Joanna K Fadyl ◽  
David Anstiss ◽  
Kirk Reed ◽  
Mariya Khoronzhevych ◽  
William M M Levack
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Vocational Rehabilitation ◽  
Usual Care ◽  
Meta Analysis ◽  
Health Conditions ◽  
Competitive Employment ◽  
Paid Work ◽  
Mental Health Conditions ◽  
Quality Evidence

ObjectivesTo evaluate the effectiveness of vocational interventions to help people living with mild to moderate mental health conditions gain paid work.MethodsSystematic review of international, peer-reviewed literature. Development of the prepublished protocol and search strategy was done in consultation with stakeholder reference groups consisting of people with lived experience of long-term conditions, advocates and clinicians. We searched academic databases MEDLINE, EMBASE, PsychINFO, AMED, CINAHL, Proquest Dissertations and Theses database, and Business Source Complete for controlled trials comparing a specific vocational intervention against a control intervention or usual care, published between 1 January 2004 and 1 August 2019. Two authors independently screened search results, extracted data and appraised studies using the Cochrane risk of bias tool.ResultsEleven studies met inclusion criteria. Seven studies investigated Individual Placement and Support (IPS) modified for people who were not in intensive mental health treatment services. These studies occurred settings such as community vocational rehabilitation services, a housing programme and community mental health services. The studies provided very low quality evidence that people who receive IPS-style vocational rehabilitation are more likely to gain competitive employment than people who receive usual care (risk ratio 1.70, 95% CI 1.23 to 2.34, seven studies, 1611 participants). The remaining four studies considered cognitive behavioural therapy or specific vocational rehabilitation interventions designed to fit a unique context. There was insufficient evidence from these studies to draw conclusions regarding the effectiveness of non-IPS forms of vocational rehabilitation for people with mild to moderate mental health conditions.DiscussionThe meta-analysis showed a clear intervention effect but low precision, and more high-quality studies are needed in this field. There is currently very low quality evidence that IPS-style intervention results in more participants in competitive employment compared with ‘usual care’ control groups in populations with mild to moderate mental health conditions.

scholarly journals Using the patient activation measure to examine the self-management support needs of a population of UK workers with long-term health conditions

2021 ◽  
pp. 174239532110434
Author(s):  
Sally Hemming ◽  
Fehmidah Munir
Keyword(s):  
Mental Health ◽  
Patient Activation ◽  
Health Conditions ◽  
Self Management ◽  
Support Needs ◽  
Management Support ◽  
Long Term Conditions ◽  
Mental Health Conditions ◽  
Patient Activation Measure

Objectives To examine differences in patient activation and self-management support needs in a population of UK workers with long-term health conditions. Methods Demographic, health and activation information were taken from the data of participants with long-term conditions, collected via an online cross-sectional survey of workers. The 13-item British patient activation measure measured workers knowledge, skills and confidence towards self-managing. Results Three hundred and seven workers with mental health, musculoskeletal and other conditions completed the patient activation measure. Mental health conditions were most prevalent (36.8%). Workers were higher activated, however workers with mental health conditions were significantly less activated ( p = 0.006). Differences in activation by condition severity and age were revealed. Discussion This study provides insight to the activation of UK workers with long-term conditions. Whilst workers with mental health conditions need more training and education to self-manage, workers are variably activated indicating broader support needs. There is a gap for workplace self-management support. The patient activation measure is used in healthcare to improve people’s self-management and should be considered to be included in the workplace, and could form part of interventions to support workers self-management. More rigorous studies, including the patient activation measure, are needed to identify the best approaches to identifying workers self-management support needs.

Getting back to work: Experiences of the individual placement and support model from those with mental health conditions, an interpretative phenomenological analysis

Work ◽  
2021 ◽  
pp. 1-11
Author(s):  
Claire Raeside ◽  
Jean McQueen
Keyword(s):  
Mental Health ◽  
Interpretative Phenomenological Analysis ◽  
Social Inclusion ◽  
Phenomenological Analysis ◽  
Health Conditions ◽  
Individual Placement And Support ◽  
Mental Health Conditions ◽  
Paid Employment ◽  
Individual Placement

BACKGROUND: Evidence continues to build on the value of Individual Placement and Support (IPS), enabling those with long-term mental health conditions to find mainstream employment. Many of these individuals would like to work; however, unemployment for this population remains high. IPS research thus far has targeted the effectiveness of the model, with less emphasis on how individuals perceive and experience IPS and the return to work. OBJECTIVE: This study explores the barriers, enablers, meaning and personal experience of being supported to find work through IPS, for individuals with long-term mental health conditions. Findings based on lived experiences of nine participants from two Scottish centres running IPS, should be useful to enhance and develop services. METHODS: This study involves qualitative data collection, using semi-structured interviews and Interpretative Phenomenological Analysis (IPA). RESULTS: Transcript analysis revealed three master themes: 1) “Working is good for me”: positive aspects to working; 2) “Rome wasn’t built in a day”: time-unlimited supported journey and 3) “My inner critic”: negative aspects to working. Participants praised IPS for the on-going practical and emotional support in overcoming self-identified occupational barriers. CONCLUSION: Paid employment was greatly associated with financial freedom, social inclusion, increased self-esteem and alleviation of depressive symptoms. Participants described the person-centred, time-unlimited approach taken by the employment specialists (ESs) or occupational therapists (OTs), as the main enabler to maintaining paid employment. Barriers, such as anxiety and work-related stress were identified, however, participants felt supported to overcome some of these negative symptoms.

scholarly journals Is there an indication for surgery in patients with spinal deformities? – A critical appraisal

2021 ◽  
Vol 77 (2) ◽  
Author(s):  
Hans-Rudolf Weiss ◽  
Xiaofeng Nan ◽  
Matthew A. Potts
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Spinal Surgery ◽  
Scoliosis Surgery ◽  
Spinal Deformities ◽  
Indication For Surgery ◽  
High Quality ◽  
High Quality Evidence ◽  
Quality Evidence

Background: High-quality evidence exists to support physiotherapy and brace treatment for scoliosis and other spinal deformities. However, according to previous systematic reviews, it seems that no evidence exists for surgery. Nevertheless, the number of research articles focussing on spinal surgery highly exceeds the number of articles focussing on conservative treatment.Objective: The purpose of this study is to conduct an updated search for systematic reviews providing high-quality evidence for spinal surgery in patients with spinal deformities.Method: A narrative review including PubMed and the Cochrane database was conducted on April 12, 2020, with the following search terms: (1) spinal deformities, surgery, systematic review and outcome; (2) kyphosis, surgery, systematic review and outcome; (3) Scheuermann’s disease, surgery, systematic review and outcome, and (4) scoliosis, surgery, systematic review and outcome.Results: No reviews containing prospective controlled or randomised controlled studies were found providing evidence for surgery.Conclusions: A general indication for spine surgery just based on the Cobb angle is not given. In view of the long-term unknown variables and the possible long-term complications of such treatment, a surgical indication for patients with spinal deformities must be reviewed on an individual basis and considered carefully. A current systematic review appears necessary in order to be able to draw final conclusions on the indication for surgery in patients with spinal deformities.Clinical implications: In view of the increasing number of surgeons with an affiliation to industry, the indication for surgery needs to be given by independent conservative specialists for spinal deformities in order to provide an objective recommendation.

scholarly journals Long-term risk of de novo mental health conditions after hysterectomy with ovarian conservation

Menopause ◽  
2020 ◽  
Vol 27 (1) ◽  
pp. 33-42 ◽  
Author(s):  
Shannon K. Laughlin-Tommaso ◽  
Anisha Satish ◽  
Zaraq Khan ◽  
Carin Y. Smith ◽  
Walter A. Rocca ◽  
...  
Keyword(s):  
Mental Health ◽  
De Novo ◽  
Health Conditions ◽  
Mental Health Conditions ◽  
Ovarian Conservation

scholarly journals Dismantling the social safety net: social security reforms, disability and mental health conditions

2020 ◽  
Vol 44 (5) ◽  
pp. 208-212
Author(s):  
Jed Boardman
Keyword(s):  
Mental Health ◽  
Safety Net ◽  
Health Conditions ◽  
Social Safety Net ◽  
Long Term Conditions ◽  
Mental Health Conditions ◽  
The Social ◽  
Social Policy Reform ◽  
Social Security Reforms

SummaryThis article examines the effects of UK welfare reform since 2008 on people with mental health conditions and disabilities. The results have been profound, particularly during a time of economic austerity, damaging the social safety net and pushing many vulnerable people into poverty and hardship. It has perpetuated inequalities and increased the social exclusion of disabled groups. The holes in the safety net require repair, alongside extensive social policy reform to both protect and empower people with disabilities and long-term conditions.

scholarly journals Long term economic evaluation of interventions targeting multiple mental health conditions: protocol for a rapid review of methods

2016 ◽  
Author(s):  
Alastair G Canaway ◽  
Christopher J Sampson
Keyword(s):  
Mental Health ◽  
Economic Evaluation ◽  
Mental Health Problems ◽  
Health Problems ◽  
Trial Data ◽  
Health Conditions ◽  
Rapid Review ◽  
Mental Health Conditions ◽  
Term Trial

Background. Interventions and services for people with mental health problems can have broad remits: they are often designed to treat people with a variety of diagnoses. Furthermore, addressing mental health problems can have long term implications for economic, social and health outcomes. This represents a challenge for economic evaluation, where long term trial data can be lacking. In this review we will seek to identify how analysts have sought to tackle this problem. We will review the methods used to extrapolate costs and outcomes for the purpose of economic evaluation, where long term trial data are not available. Methods/design. We will carry out a review of the medical and economic literature evaluating long-term costs and outcomes for mental health interventions and services designed to treat or prevent more than two mental health conditions. We will search the key health economic databases, including: OVID Medline, Embase, Psycinfo, CINAHL, and EconLit. The two authors will independently screen the returned results. Any discrepancies will be resolved by deliberation between the two authors. Key information will be extracted from the papers which successfully pass through the screening process. The findings will be highlighted through a narrative analysis and tabulated data. Discussion. This review will shed light on the existing methods used to model into the future when multiple mental health conditions are considered. The review will discuss the strengths and weakness within current methodologies, highlight existing flaws, and provide guidance for future economic evaluations of interventions targeting multiple mental health conditions.

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