A Study Protocol for Occupational Rehabilitation in Multiple Sclerosis

Digital medical solutions can be very helpful in restorative neurology, as they allow the patients to practice their rehabilitation activities remotely. This work discloses ReMoVES, an IoMT system providing telemedicine services, in the context of Multiple Sclerosis rehabilitation, within the frame of the project STORMS. A rehabilitative protocol of exercises can be provided as ReMoVES services and integrated into the Individual Rehabilitation Project as designed by a remote multidimensional medical team. In the present manuscript, the first phase of the study is described, including the definition of the needs to be addressed, the employed technology, the design and the development of the exergames, and the possible practical/professional and academic consequences. The STORMS project has been implemented with the aim to act as a starting point for the development of digital telerehabilitation solutions that support Multiple Sclerosis patients, improving their living conditions. This paper introduces a study protocol and it addresses pre-clinical research needs, where system issues can be studied and better understood how they might be addressed. It also includes tools to favor remote patient monitoring and to support the clinical staff.

“To have and then lose the safety net” –Female cancer survivors’ experiences of the process of becoming ready to return to work

BACKGROUND: Validation studies have not been able to confirm the stage-specific understanding as operationalised in the readiness for return to work (RRTW) questionnaire. OBJECTIVE: To explore retrospectively how working female cancer survivors experienced the process of becoming ready to RTW during and beyond participation in an occupational rehabilitation intervention and thereby expand the understanding of the RRTW construct. METHODS: A qualitative research design was employed. Thirteen female cancer survivors were included for semi-structured interviews one to two years after they had completed active treatment and returned to work. The RRTW construct guided data generation and analysis. Content analysis was performed in four analytical steps that combined a concept-driven and a data-driven analytic strategy. RESULTS: Three themes were identified; “To have and then lose the safety net”, “Realise a changed life situation”, “Strive to balance work and everyday life”. In a time span of approximately one to two years (from receiving treatment, being enrolled in an intervention and to gradually returning to work); the identified themes were interdependent of each other as one theme gradually evolved to the next theme in the process of engaging in sustained work participation. CONCLUSIONS: The present study points towards continuous development of the RRTW construct and whether the addition of a preparedness dimension would improve validity.

A social-healthcare pathway to facilitate return to work of cancer survivors in Italy: The UNAMANO project

BACKGROUND: Return to work (RTW) is a major goal to promote cancer survivors’ social participation. OBJECTIVE: This study describes the multidisciplinary social-healthcare pathway called UNAMANO, conceived to support RTW in this population. METHODS: UNAMANO was developed by the Azienda USL-IRCCS di Reggio Emilia, in partnership with the local branch of the Italian Medical Association, nonprofit associations, vocational training institutions, social cooperatives, a labour union, and a chartered accounting firm. RESULTS: UNAMANO is directed towards employed individuals diagnosed with cancer living in the province of RE. It was developed through four actions: A) training healthcare professionals on work-related occupational rehabilitation; B) dissemination among community and stakeholders; C) recruitment and training of volunteers; D) cancer survivor engagement and provision of a personalized comprehensive intervention. This consists in providing information and either occupational therapy to overcome barriers and facilitate RTW or social support through re-training and tailored job search strategies based on individual risk of job loss. CONCLUSIONS: UNAMANO is the first Italian multidisciplinary social-healthcare pathway supporting RTW of cancer survivors. Addressing a wide area of cancer survivors’ needs, it provides personalized intervention to resolve work-related issues. We propose this patient-centred RTW model to promote an easier transition from hospital to community.

The nature of positive encounters between disabled workers and insurers in the return to work process

BACKGROUND: Previous research regarding interaction between disabled workers and insurers indicates that encounters between these parties are predominantly negative in nature and may result in psychosocial harm for workers. Further research is required to investigate positive interactions to foster return to work after illness or injury. OBJECTIVE: To explore and conceptualize perceived positive encounters between disabled workers and insurers in order to identify the mechanisms that support successful rehabilitation outcomes. METHODS: This qualitative study explored the experiences of twenty-four disabled workers who had undergone an occupational rehabilitation process. Data were collected with in-depth semi-structured interviews, transcribed, coded, and analyzed using inductive content analysis. RESULTS: Four main themes arose from the 24 key concepts relating to the positive encounters: (1) process flow, (2) customer orientation, (3) information and guidance, and (4) service attitude. The results also reveal that perceived positive encounters promote the return to work not only directly, but also indirectly by improving the informants’ motivation, which has previously been found to be one of the most significant factors explaining the outcomes of rehabilitation. CONCLUSIONS: The positive relationship between disabled workers and insurers during an occupational rehabilitation could be better understood through a conceptualization of perceived positive encounters. Underlining the importance of positive encounters and their ability to improve the rehabilitee’s motivation may contribute to better support methods for the return to work.

How can social insurers promote return to work in occupational rehabilitation? A quantitative, cross-sectional study

Background Earlier studies indicate a correlation between disability claims experience and return to work outcomes. Thus, the insurer’s role and actions may affect the self-rated health of the disabled worker and the outcomes of occupational rehabilitation. This study diversifies the existing empirical evidence on the role of the insurer in the rehabilitation process and reveals the critical actions that best promote success. Materials and methods Explorative factor analysis (EFA) and confirmatory factor analysis (CFA), followed by binary regression, were used to analyse survey data of disabled workers (n = 661) who had undergone an occupational rehabilitation within an earnings-related pension insurance system in Finland. Results The claimant’s perceptions of the insurer’s (1) high-quality informing and guidance, (2) customer orientation, (3) smooth process flow and (4) positive service attitude had substantial and statistically significant effects on the success of occupational rehabilitation after adjusting for all likely confounding variables. Conclusions The insurer’s actions are significant predictors of the outcome of occupational rehabilitation. The insurer can promote the health of rehabilitees most effectively by ensuring a smooth process flow and adopting a customer-oriented approach.

Comparison of Two Multidisciplinary Occupational Rehabilitation Programs Based on Multimodal Cognitive Behavior Therapy on Self-Rated Health and Work Ability

Objective: Musculoskeletal pain and common mental disorders constitute the largest proportion of people who are on sick leave. This study investigated the efficacy of two multidisciplinary occupational rehabilitation programs on self-rated health and work-related outcomes. The interventions were identical in content but differed in length. It was hypothesized that a longer inpatient program would yield greater improvements than a shorter outpatient program.Methods: Patients were sick-listed workers referred to occupational rehabilitation by the Norwegian Labor and Welfare Administration. A non-randomized 2 Condition (20 days, n = 64 versus 12 days, n = 62) × 4 repeated measures (start, end, 3 months, 12 months) between-subject design was used. Both programs were based on multimodal cognitive behavior therapy with a return-to-work focus. Health-related questionnaires were the Subjective Health Complaints inventory, Hospital Anxiety and Depression Scale, and SF-36 Bodily Pain. Work-related questionnaires were the Work Ability Index, the Fear-Avoidance Beliefs Questionnaire, Return To Work Self-Efficacy, and Return To Work expectations. Intervention effects were estimated using linear mixed models and Cohen’s d.Results: The results revealed that both groups improved on the selected outcomes. Within-group contrasts and effect sizes showed that the inpatient group showed larger effect sizes at the end of rehabilitation and 12 months post-intervention for work-related outcomes than the outpatient group.Conclusion: Both programs were efficacious in improving health- and work-related outcomes during and after rehabilitation, but the inpatient group generally displayed stronger and more rapid improvements and was more stable at one-year postintervention.

Shifting roles of Employers: At the Intersection of Employment and Social Work: A case study from Norway

Active labour market policies (ALMPs) are often seen as a panacea for dealing with labour market exclusion, especially when it comes to young people with mental health issues. Such policies demand considerable involvement from employers, placing more responsibility in their hands. Yet, there remains a notable knowledge gap concerning the actual role that employers play in processes of inclusion in the labour market. In this article, we provide knowledge about what employers do in order to include young people with mental health issues into the workforce, what roles they play in these processes, and what motivations underlie their endeavours. We argue that, due to organizational changes to occupational rehabilitation in Norway, employers must increasingly occupy a vacancy left open by social workers. While this situation has demanded further responsibility from employers, they are quite often insufficiently educated or trained to deal with such issues.We address what consequences this could have for young people with mental health issues striving to enter the labour market.

Farmers’ work-related social security in Finland, implemented by Mela

Mela is the Farmers’ Social Insurance Institution of Finland (in Finnish: Maatalousyrittäjien eläkelaitos) founded in 1969. It provides comprehensive pension cover and social security to farmers, reindeer herders, fishermen, forest owners and recipients of scientific or artistic grants and scholarships living in Finland. In addition to providing pension insurance (MYEL), Mela provides its customers: statutory occupational accident insurance, leisuretime accident insurance, Mela sickness allowance, occupational rehabilitation, group life insurance, and farm closure support for farmers and reindeer herders. It also administers the farmers’ holiday and stand-in scheme, and provides advisory services related to occupational safety and wellbeing at work. The social security provided by Mela was originally addresses to farmers, reindeer herders, fishermen, forest owners. Since 2009 also recipients of scientific and artistic grants/scholarships are Mela’s customers. This article presents the most important stages in the development of social insurance for agricultural entrepreneurs in Finland and the evolution of this system until today. It also explains different benefits offered by Mela and the rules of being subject to social insurance by Mela, as well as the financial economy of Mela, including Mela’s sources of revenue. Finally, it presents tailored programmes and actions offered by Mela to the insured.