Barriers to returning to work for people with spinal cord injuries: a focus group study

The rate of employment for people with spinal cord injuries is relatively low, especially among Asians. To help individuals with spinal cord injuries return to work or retain employment, rehabilitation professionals must understand the barriers to employment and intervene to reduce or remove them. Hence, a focus group study was administered to 16 people with spinal cord injuries to explore return to work barriers. Various ideas, beliefs, responses, and values at different stages of work resettlement were elicited from both employed and unemployed participants, and then summarized. According to the results, several modifications of existing forms of rehabilitation intervention are necessary, as are further research directions.     

The art and science of teamwork: enacting a transdisciplinary approach in work rehabilitation

Teamwork, collaboration and interprofessional care are becoming the new standard in health care, and service delivery in work practice is no exception. Most rehabilitation professionals believe that they intuitively know how to work collaboratively with others such as workers, employers, insurers and other professionals. However, little information is available that can assist rehabilitation professionals in enacting authentic transdisciplinary approaches in work practice contexts. A qualitative study was designed using a grounded theory approach, comprised of observations and interviews, to understand the social processes among team members in enacting a transdisciplinary approach in a work rehabilitation clinic. Findings suggest that team members consciously attended to a team approach through nurturing consensus, nurturing professional synergy, and nurturing a learning culture. These processes enabled this team to work in concert with clients who had chronic disabilities in achieving solution focused goals for returning to work and improving functioning. Implications for achieving greater collaborative synergies among stakeholders in return to work settings and in the training of new rehabilitation professionals are explored.     

A Qualitative Study of the Perceptions of Individuals with Disabilities Concerning Health and Rehabilitation Professionals

This paper examined the perceptions of persons with disabilities concerning their interaction with health and rehabilitation professionals. Data were collected and analysed with grounded theory methods, and resulted in a typology and a thematic analysis that found that: (a) most persons who perceived themselves to be disadvantaged by social oppression or stigma were also dissatisfied with health and rehabilitation professionals; and (b) those persons who de-emphasised the impact of disability either reported satisfaction with health and rehabilitation professionals or perceived their own efforts as being the primary factor in their ability to live with disability. The perceptions of respondents were, in most instances, mediated by dominant gender stereotypes.     

西方残障身份发展理论述评及本土化思考

积极的残障身份认同对残障者本身具有重要意义,残障身份发展是残障者实现身份认同的路径,理解残障身份发展的过程也可以让残疾人工作者更好地为残障者提供教育、康复等相关服务。本文通过梳理较为典型的西方残障身份发展理论,结合国内残障身份相关研究及本土社会文化背景展开讨论。文章认为,在西方残障身份发展理论框架下,残障者形成积极身份认同的关键在于认同并融入一套在残障社区内共享的残障文化,而在我国社会文化背景下,目前并没有一套成体系的残障文化,残障者也难以体会残障的文化身份感,国内残障者的身份认同缺少本土残障文化依靠。     

Multi-professional vocational rehabilitation group meetings with female clients: a qualitative study

Many women require vocational rehabilitation before they can return to work. The objective with the present study was to describe female clients' situation during the rehabilitation process, as it became apparent during the rehabilitation meetings with the various actors involved. The clients' diagnoses varied, but the majority was affected with musculoskeletal disorders. The meetings were audio-taped and transcribed verbatim, after which they were analysed by qualitative content analysis. The following themes emerged: Adaptation to the rehabilitation group; client's health status; the workplace's significance for rehabilitation; and the client's decision-point. Conflict between health and work was immensely important for rehabilitation. Differences in attitude were apparent during the rehabilitation meetings, as some clients were passive and exercised less influence on the planning, than the other more active clients did.     

Multiple sclerosis and employment barriers: a systemic perspective on diagnosis and intervention

Although they have a recent work history, 70 to 80% of adults with multiple sclerosis are unemployed following their diagnosis. This high rate of unemployment constitutes a great loss of potential to the American economy. To help individuals with multiple sclerosis (MS) return to work or retain employment, rehabilitation professionals must understand the barriers resulting in unemployment and implement interventions to reduce or remove those concerns. In this article, Hershenson's systemic model of rehabilitation counseling is presented as a diagnostic scheme for identifying barriers to employment. Counselor consultation on barrier removal via reasonable accommodation is presented as one example of a rehabilitation intervention consistent with the systemic diagnostic model.     

Improving Primary Care for Persons with Disabilities: the nature of expertise

It has been well documented that persons with disabilities (PWDs) have a more vulnerable health status than persons without disabilities; yet, they often receive inadequate primary care within the US health care system. This study explores how PWDs think about the health care they receive, particularly how primary care providers facilitate or hinder quality care for PWDs. The findings from this study expand the concept of expertise in health care, suggesting it goes well beyond technical competence of health care providers. For PWDs, expertise is multi-dimensional, not solely the domain of providers and includes having knowledge and using that knowledge within the context of the provider-patient relationship. PWDs identified three distinct areas of expertise: medical/technical, medical/biographical, and systems. Expertise can be brought to health care encounters by both PWDs and providers, and it can be developed through collaboration during interactions between providers and PWDs.     

Will Australian workers' compensation insurance management get better soon?

A study of Australian experience in the state of New South Wales (NSW) suggests that private sector underwriting of workers' compensation insurance risk plus insurer competition on premium price may put downward pressure on benefits for injured workers, inhibit rehabilitation, and cause related cost increases for taxpayers and employers. Insurer underwriting also increases workers' compensation administrative costs and means an unnecessary loss of investment income for government and industry. An emerging and better alternative for the Australian community is for government and industry to underwrite a national workers' compensation scheme and to fix premium and benefit requirements which are competitively administered by insurers. In such a regulatory environment insurer inability to compete on premium price should promote competition to provide effective services to help employers prevent injury, assist rehabilitation and contain cost. National standards are necessary to enable widespread dissemination of comparable, reliable information on the outcome of health, rehabilitation, dispute resolution and return to work services. This is required to assess the competitive performance of service providers in order to ensure effective operation of the market to achieve scheme objectives. Holistic, multi-skilled and objective rehabilitation professionals are needed who can clearly demonstrate the effectiveness of their actions in assisting injury prevention, worker rehabilitation, and safe return to work across a range of industry contexts.     

Work rehabilitation for migrant workers with work injury--the magic of Chinese paper cutting

As China has gradually transformed from agricultural economy into industrial economy since 1978, occupational injuries and diseases become a serious social problem in China. For occupational rehabilitation professionals, helping workers with occupational injuries and diseases, return to work and re-integrate to community are the ultimate goals of occupational rehabilitation. This article reports a new indigenous initiative with cultural notions in occupational rehabilitation piloted by Guangdong Provincial Rehabilitation Center. Case studies reflected that by learning and practicing traditional Chinese paper cutting, workers with occupational injury and disease could regain their self confidence, identity their strengths, learn more vocational skills as well as to re-integrate into community.     

Return to work still possible after several years as a disability pensioner due to musculoskeletal disorders: a population-based study after new legislation in Sweden permitting "resting disability pension"

Different strategies have been used to stimulate a return to work (RTW) among individuals suffering from long-term ailments. In Sweden a new law on "resting disability pension" permits disability pensioners to go back to work without jeopardising their benefits. In this study different variables related to RTW during 2000 by means of this legislation were identified among disability pensioners with musculoskeletal disorders. Individuals in the study group, when compared to a control group, had more often been disability pensioners for several years, had additional education, estimated their previous job to have been physically strenuous to a lesser degree, were more satisfied with the treatment at the social insurance office and had a more positive self-image. This study shows that it may be meaningful to continue/resume rehabilitation efforts and to try to motivate an individual suffering from musculoskeletal disorders to return to work even after several years as a disability pensioner.     

Construct validity of the instrument DOA: a dialogue about ability related to work

This study examined the construct validity of the newly developed instrument A Dialogue About Ability Related To Work (DOA). DOA [18] was developed using concepts from the Model of Human Occupation [20] as theoretical framework. The instrument assumes the assessment of work ability by both the client and the occupational therapist, and is followed by a dialogue which is expected to distinguish possible goal-setting for further rehabilitation [18,19]. Twenty-one professionals and 126 clients from three clinics in Sweden participated in the study. All clients were involved as outpatients in psychiatric work rehabilitation in county councils or community services. Results of a Rasch analysis test indicated that items are well separated and generally work together in five unidimensional continuums to measure work ability. Twenty-nine of 34 items showed goodness-of-fit statistics, which means acceptable infit MnSq values from > or = 0.6 to < or = 1.4 in association with Z values from -2 to 2. The five misfit items have to be revised. The study has indicated that DOA is a valid instrument in psychiatric work rehabilitation and ought to be useful in the dialogue between occupational therapists and clients about goalsetting and treatment planning.     

The Worker Role Interview: a powerful tool in Icelandic work rehabilitation

A pilot-study using the Worker Role Interview (WRI) was conducted to gather information from clients attending a work- rehabilitation program in an Icelandic psychiatric center. The work rehabilitation program traditionally used a performance-capacity-oriented assessment (PCA) to evaluate work readiness. Clients scoring 90% or higher on the PCA were considered able to re-enter the job market. However, scoring over 90% did not result in automatic return to work for the majority of clients. As a result, many questions were proposed about the effectiveness of the PCA to predict client ability to re-enter the work force. A pilot study using the Worker Role Interview was conducted with an aim to gain insight into what barriers prevented clients from entering the work force. Ten clients scoring 90% or over on the PCA were interviewed using the WRI. Qualitative methods were used to analyze the data. Results from the WRI indicated that clients failed to join the work force due to a number of psychosocial factors, such as lack of personal causation and self-efficacy combined with environmental factors. The WRI provided clients with an opportunity to express their attitudes and opinions towards work. Information gained through the WRI also gave new direction in goal setting for the work rehabilitation program and validated the need to expand occupational therapy services.     

A new model for vocational rehabilitation at an organizational level -- a pilot study with promising results

Sick leave has negative economic consequences for companies. The aim of this study was to implement the model Organizational Rehabilitation in two departments at an industrial company in the county of J?mtland, Sweden, to see if it was possible to reduce the costs due to sick leave. The rehabilitation model consisted of three steps and combined economy and productivity with a good psychosocial work environment, measuring the result in costs. Step 1 consisted of a problem inventory among all co-workers, step 2 semi structured interviews with all co-workers regarding how they experience their work environment and step 3 individual agreements regarding rehabilitation interventions, i.e. interventions where the individual's specific needs and wishes outlined the foundation for rehabilitation measures with the objective of increasing work capacity. The costs were measured at the start and end of the project. The study showed that it is indeed possible to reduce both sick leave and costs. During the study, the organization reduced current sick leave from 12% (2003) to 3% (Nov. 2004) and the costs per employee from euro1 860 per month (2003) to euro440 per month (Nov. 2004). This will make an estimated saving for 2005 of euro470 000. It should be noted that the study is small and should not be generalized, but may be seen as a positive indication regarding the model organizational rehabilitation. Further research is needed.     

Walking small with ‘Paul’, a man with ‘severe learning difficulties’: on (not) passing in purportedly public places

This article primarily accounts for walks taken in purportedly public places with ‘Paul’, a middle-aged man who is currently diagnosed as having ‘severe learning difficulties’. These walks offer windows into the ways in which dis/ableist discourses and the powerful abstractions they produce descend to the level of practice, seeping into seemingly innocuous spaces, and the interactions and subjectivities therein. Through these encounters, persons become complicit in the production, maintenance and reinforcement of non-disabled (or abled)/disabled identities. This article nevertheless attempts to destabilize and defetishize the ontological categories that these encounters realize, and to recognize the vitality and presence set aside or concealed behind these concepts.     

Pride, empowerment, and return to work: on the significance of promoting positive social emotions among sickness absentees

Sickness absence is a great public health problem and there is a lack of knowledge concerning the hows and whys of success or failure in promoting return to work of sick-listed persons. Discussions of and research into social and psychological aspects of this problem area are in need of theoretical contextualisation. In this paper it is suggested that theories of social emotions may be useful, and that the concept of empowerment can be applied provided that it is reasonably well defined. The notions of pride/shame and empowerment are elucidated and discussed, and it is shown that they can be related in the context of research into emotional dimensions of sickness absentees' experiences of the rehabilitation process in a way that may help to guide empirical studies. A simple model of hypothetical relations between pride/shame, empowerment/disempowerment, work ability, health, and return to work is sketched.     

A critical theory of medical discourse: ideology, social control, and the processing of social context in medical encounters

The personal troubles that patients bring to doctors often have roots in social issues beyond medicine. While medical encounters involve "micro-level" interactions between individuals, these interpersonal processes occur in a social context shaped by "macro-level" structures in society. Examining prior theories pertinent to medical discourse leads to the propositions: (a) that medical encounters tend to convey ideologic messages supportive of the current social order; (b) that these encounters have repercussions for social control; and (c) that medical language generally excludes a critical appraisal of the social context. The technical structure of the medical encounter, as traditionally seen by health professionals, masks a deeper structure that may have little to do with the conscious thoughts of professionals about what they are saying and doing. Similar patterns may appear in encounters between clients and members of other "helping" professions. Expressed marginally or conveyed by absence of criticism about contextual issues, ideology and social control in medical discourse remain largely unintentional mechanisms for achieving consent.     

Assistive technology outcomes in work settings

Successfully documenting the outcomes of assistive technology (AT) interventions in the workplace benefits people with disabilities, service providers and agencies. However, no work related system currently exists that comprehensively collects the data needed to analyze such outcomes. Part of the reason for this absence of an outcome system is that, while the concept is simple, the process is complex and depends on the acquisition of data that represent many outcomes related variables. This article describes the exploratory work of the NIDRR (National Institute on Disability and Rehabilitation Research) funded ATOMS Project (Assistive Technology Outcomes Measurement System) and its efforts to identify existing data that might be used as the basis for an outcomes measurement system. Sample records from four assistive technology service programs were acquired and evaluated for the data they housed. This study discovered that AT service programs fail to collect consistent or sufficient data for outcomes analysis. However, discussions with AT programs that provided services to State vocational rehabilitation agencies revealed an interesting potential. Assistive technology service data in combination with data collected by State vocational rehabilitation departments might coalesce the needed data. The Federal Rehabilitation Services Administration (RSA) 911 Report aggregates many variables of outcomes related information including employment status and the success of the vocational rehabilitation investment. This combined database could answer a range of assistive technology outcomes related questions of interest to service providers, people with disabilities, and vocational rehabilitation State agencies. This paper describes the data needed in an outcomes system, reviews the data that appear to be available today related to AT outcomes, and projects how data from two diverse programs might be used together to create a significant outcomes database.     

Effectiveness of problem solving skills in case management on return to work for workers with injuries

The present study aims to explore the case management model by using problem solving skills in assisting workers with injuries in returning to work. A total of five workers with injuries were enrolled and there were four stages during the whole case management process including a medical rehabilitation stage (stage I), a compensation stage (stage II), a return to work stage (stage III) and a follow-up stage (stage IV) respectively. Case managers provided services by using problem solving skills to tackle the problems which workers with injuries may encounter during all four stages. Outcome measurement showed one case return to the same company same job, two returns to different companies and different jobs, the others have self employed work. This study suggested that case management using the problem solving skills of occupational rehabilitation was beneficial to workers with injuries on return to work.     

Youth leadership program for changing self-image and attitude toward people with disabilities

Society has a negative attitude toward people with intellectual disabilities or psychiatric disabilities. It is well documented that they are subjected to prejudice, stigma, and negative attitudes (Di Giulio, 2003 ; Finger, 1994 ). Professional literature indicates that information about disabilities and encounters with persons with disabilities can change negative attitudes (Carter, Hughes, Copeland, & Breen, 2001 ; Krajewski & Flaherty, 2000 ). This study accompanied 164 9th-grade students from various junior high schools throughout Israel. Half of the students participated in an integration program for changing attitudes toward persons with disabilities, and the other half served as the control group. The research examined the existence and the degree of relationship between participation in the program, changes in attitudes toward people with disabilities, and self-image. The research findings pointed to a positive change in attitudes of the participants of the program in comparison with the control group, resulting mainly from personal contact with people with disabilities. No relationship was found between levels of self-image of the research group and attitudes toward people with disabilities.