Reliability of the instrument DOA: dialogue about ability related to work

The aim of this study was to examine the reliability of the new instrument "DOA--a dialogue about ability related to work" [6]. DOA was developed using the Model of Human of Occupation as a theoretical base [12,13]. The instrument is divided into two sections; client self-assessment and professional assessment focusing on the individual's ability to perform work-related activities. Assessments are followed by a dialogue to distinguish goals for the return-to-work process based on the client's own preferences [6,14]. 34 outpatients' clients and 14 professionals from four clinics within psychiatric work rehabilitation in Sweden participated in the study. The Spearman Rank Correlation test generally showed acceptable significant correlations in test-retest (n=34). A greater part of items correlated "moderate to good" (r=0.51-0.75). In the raters' test (n=14) Percentage of agreement (PA) was good ranging between 93.1%-96.5%, which is above the acceptable criteria of 80%. There were no significance differences between the raters. The study has indicated that items in DOA work with generally good reliability to measure ability related to work. The instrument was demonstrated to be a reliable therapeutic tool in goal setting for return-to-work in a position outside of the clients' preferences.     

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.     

Case report: a work simulation program for a manual worker with a fracture injury

Work rehabilitation programs targeting different client groups are available in nearly all major hospital occupational therapy departments in Hong Kong. Clients receiving work rehabilitation are referred from various out-patient clinics and other occupational therapists. Those clients experience limitation in work after their injuries or diseases and plan to return to work after rehabilitation. Program objectives are 1) to assist clients to reach maximum work capacity as rapidly as possible 2) to ensure clients return to work safely 3) to improve clients' work readiness. This case report describes an individualized work simulation program at a general hospital in Hong Kong provided for a typical client who is preparing to return to his worker role. Specific job analysis, goals and program rationale for the client are discussed.     

The power of outcomes: FOTO Industrial Outcomes Tool -- Initial assessment

OBJECTIVE: To demonstrate how outcomes assessment can assist in describing clients receiving rehabilitation in occupational health rehabilitation clinics and to describe the preliminary assessment of internal consistency reliability and construct validity of the FOTO Industrial Outcomes Tool. METHODS: 266 adults referred for acute work rehabilitation (AWR), work conditioning/hardening (WC/WH) or a Functional Capacity Evaluation (FCE) comprised the data set. Clients were treated between July 1998 and January 1999 in 15 clinics from 6 states by 46 clinicians participating in the Focus on Therapeutic Outcomes (FOTO) national rehabilitation database beta test. For AWR and WC/WH, clients completed a health status questionnaire on intake and discharge, and health status was assessed prior to the FCE. Comprehensive demographic data were collected describing the clinics, clinicians, clients and work status collected 2 weeks following discharge. RESULTS: Internal consistency reliability coefficients for the health status scores ranged from 0.57 to 0.89. Construct validity was supported. CONCLUSION: Results demonstrate the power of collecting outcomes from a variety of constructs for clients receiving industrial rehabilitation services. Initial reliability and construct validity findings were adequate and support continuing data analyses.     

Return to work with chronic low back pain: using an evidence-based approach along with the occupational therapy framework

This paper will attempt to apply the occupational therapy framework [1] along with an evidence-based approach and an occupation-based intervention with a population of workers with chronic low back pain (CLBP) to help them return to work and maintain their work status. This paper will focus primarily on those clients with CLBP who still have a link to their employment but who do not perceive themselves as being capable to go back to their job despite conflicting opinions from other stakeholders (primary health care professionals, employer or insurer). They are being evaluated in occupational therapy shortly before return to work and followed until their optimal functional capacities are reached. This means that either all functional goals related to the actual physical demands of their job have been reached or that further treatment does not result in functional improvement.     

I'm going back to work: back injured clients' perceptions and experiences of their worker roles

This study aimed to elicit perceptions and experiences of facilitators and barriers that affected individuals who received back rehabilitation and their ability to resume their worker roles. Qualitative research methods were used in order to explore the research question. Participants were selected by means of simple random sampling and the data were collected by means of semi-structured focus groups. Some factors that were seen as facilitatory in maintaining the worker role of an individual who received back rehabilitation included injury management strategies, a positive work culture and having meaningful/satisfactory work experiences. Factors or barriers that prevented individuals from resuming their worker roles included physical and psychosocial stressors of the job, a lack of education by the employer and inadequate workplace policy. The results indicated that occupational therapists need to reassess their role within the wider context of the helping professions where they should become more involved in on-the-job evaluations, work placements and training of individuals who received back rehabilitation.     

Development of an instrument for assessing workstyle in checkout cashier work (BAsIK)

Checkout cashier work consists of handling a large number of items during a work shift, which implies repetitive movements of the shoulders, arms and hands/wrists, and a high work rate. The work is associated with a high prevalence of disorders in the neck and upper extremity. The concept of workstyle explains how ergonomic and psychosocial factors interact in the development of work-related upper extremity disorders. The aim of the project was to develop an instrument for the occupational health services to be used in the efforts to prevent upper extremity disorders in checkout cashier work. The instrument is based on the workstyle concept and is intended to be used as a tool to identify high-risk workstyle and needs for interventions, such as training and education. The instrument, BAsIK, consists of four parts; a questionnaire about workstyle, an observation protocol for work technique, a checklist about the design of the checkout and a questionnaire about work organization. The instrument was developed by selecting workstyle items developed for office work and adapting them to checkout cashier work, discussions with researchers and ergonomists, focus-group interviews with cashiers, observations of video recordings of cashiers, and studies of existing guidelines and checklists.     

Work rehabilitation programs: a 1997 survey

By adapting to the changing health care environment, legislative reforms, and consumer needs, work rehabilitation programs have experienced a metamorphosis. This study surveyed occupational therapists currently employed in work programs to ascertain a current demographic profile of work rehabilitation programs. Respondents indicated the delivery of services in the areas of prevention, assessment and rehabilitation. The majority of work rehabilitation programs in this study provide services in the form of ergonomics, education and training, and job analyses at the worksite. The area of work injury prevention services is forecasted for increased growth among work rehabilitation programs.     

A return to work program for injured workers: a reassignment model

The current workers' compensation system does not encourage permanently restricted workers who are disabled due to work related injuries to return to work. Workers are often labeled permanently disabled and are released from their positions with their employers. However, according to the Americans with Disabilities Act of 1990, these individuals may be qualified to return to productive employment. This paper will describe a Reassignment Model for occupational therapy supported by the rehabilitation frame of reference. This Model presents reassignment to a vacant position as a reasonable accommodation to return injured workers to productive employment. A case study will illustrate the successful implementation of the model. The potential benefits of using this Model will be described for clients, society, employers, and the occupational therapy profession.     

Cognitive and behavioural assessment of people with traumatic brain injury in the work place: occupational therapists' perceptions

Cognitive and behavioural impairments, in the absence of severe physical disability, are commonly related to poor return to work outcomes for people with traumatic brain injury (TBI). Along with other health professionals, occupational therapists make judgements about cognitive and behavioural dimensions of work capacity of clients with TBI during the return to work process. Unlike many physical functional capacity evaluations, there is no standard method that therapists use to assess the ability of people with TBI to perform cognitive operations required for work. Little is known about what information occupational therapists use in their assessment of cognitive and behavioural aspects of client performance within the work place. This study employed qualitative research methods to determine what information is utilised by 20 therapists who assess the work capacity of people with TBI in the workplace. Results indicated that the process of making judgements about cognitive and behavioural competence within the work place is a multifaceted process. Therapists triangulate client information from multiple sources and types of data to produce an accurate view of client work capacity. Central to this process is the relationship between the client, the job and the work environment.     

Psychometric properties of the work environment impact scale: a cross-cultural study

This study examined the psychometric properties of the Work Environment Impact Scale in the United States and Sweden. Thirteen American and four Swedish occupational therapists used the scale (in English and Swedish respectively) to rate 21 (11 American and 10 Swedish) subjects. Results of a Rasch analysis of the data, indicate that the items work well together to measure the construct of work environment impact. The scale is also suitably matched to the clients in this study and effectively discriminated different levels of work environment impact. The findings also suggest that both language versions of the scale are equivalent and that the scale is culture-free.     

Perception differences between groups of employees identifying the factors that influence a return to work after a work-related musculoskeletal injury

Employee health and productivity losses as a result of work-related injury are estimated to be US dollars 1.2 trillion annually to US companies. This is approximately 14.3% of the gross domestic product [6,8,11,35]. Workers' compensation, medical care, and short and long-term disability are a part of these costs. Controlling or eliminating these costs is a problem for US employers [3,6,14,21,29]. The study discussed in this article examined the perceptions of manufacturing employees in identifying factors that influence a return to work after a work-related musculoskeletal injury. The classification of employees who participated in this study were safety professionals, supervisors and workers from the manufacturing industry in central Kentucky. The worker group consisted of material handlers, assembly line workers and quality control inspectors. The participants completed a developed survey instrument, the Return to Work Perception Survey. This survey instrument examined the perception of the participants on factors related to return to work: company policies and procedures, job satisfaction, worker relationships and work environment. The results indicated safety professionals and supervisors perceptions differ from workers on the variables of job satisfaction, worker relationships and work environment. Their perceptions did not differ on the variable relating to company policies and procedures. In addition, the safety professional and supervisor groups rated the items addressing job satisfaction higher than did the worker group. The worker group did not differ from one another on any of the factors. Implications of this study for manufacturing companies suggest (a). identifying those issues contributing to employee job satisfaction, (b). developing a plan for achieving increased job satisfaction and employee recognition at the workplace among all workers, and (c). consider allowing employees to develop new capacities and new learning, thus fostering motivation and job satisfaction [18,20].     

Occupational health and safety issues affecting young workers: a literature review

Many overview articles, reports, book chapters and literature reviews have examined the health and safety of young workers. These sources discuss the relationships between the work conditions of young workers and the various indicators of accidents and occupational diseases. Breslin et al. [12,13] conducted two literature reviews of quantitative studies to determine which factors best predicted work accidents and occupational disorders in young people. The present article proposes a review of young people's occupational health and safety (OHS) factors (e.g., demographic, individual, professional, organizational, temporal and operational factors) in both qualitative and quantitative studies. Five types of problems were analyzed in greater depth, namely MSD symptoms, respiratory, allergy and toxicological problems, mental health and well-being, alcohol and drug consumption, and fatigue. This review likewise examines related dimensions that allow us to adopt a more global perspective on this subject by considering such elements as young people's values, their knowledge and attitudes, safety practices in companies, the safe integration of young people, and rehabilitation. A total of 189 scientific articles were selected on the basis of certain criteria. These articles came from refereed OHS journals published between 1994 and 2005.     

Walking our talk in Social Work Education: partnering with consumers of Mental Health Services

Social work education emphasizes the importance of partnership and collaboration with clients, defining clients as experts in their lives and needs. However, academic departments of social work do not usually model this concept of partnership by fully collaborating with clients in the process of educating social work students. Clients are seldom partners with academic educators in curriculum development, information dissemination, or student evaluation. The authors developed and implemented a facilitated dialogue process between consumers of mental health services and social work students as a way to begin to address this issue. Areas of discussion included consumer views on helpful social worker actions and interventions, as well as ways consumers could be, and wished to be, included in social work education. This paper reports on the strategies and recommendations generated by consumers during the dialogue, and discusses implications for social work education.     

Illuminating the Black Box From Within: Stakeholder Perspectives on Family Drug Court Best Practices

This article describes a mixed-methods, concept mapping study in an urban family drug court (FDC) designed to identify keys to FDC success from stakeholders’ perspectives. Participating FDC team members and clients developed a set of items they deemed integral to an FDC, thematically clustered the items, and then rated their relative importance. Using these data, cluster analysis and multidimensional scaling generated 6 themes perceived as contributing to positive outcomes. Resultant concept maps revealed that, compared to team members, clients view relational aspects of the FDC as more important. The findings point to implications for future research and social work practice.     

Improving work programs' delivery of information and service to workers' compensation carriers

This paper presents the results of a telephone survey of workers' compensation carriers, addressing how occupational therapy work programs can best meet these carriers' needs. Fifty percent of the market share of workers' compensation carriers in Michigan participated in the survey. Survey results indicated that workers' compensation carriers found Functional Capacity Evaluations, job analyses, and work hardening to be important work rehabilitation services. A significant portion of the respondents (88%) stated that they recognized the need for clinically successful work rehabilitation programs and indicated that if they had return to work rates for different providers, they would utilize providers that had the most successful outcome data in a specific geographical area. Occupational therapists can use these survey results to improve their services and communication with insurance to ensure that injured workers will continue to have access to the efficacious interventions occupational therapists provide in work rehabilitation.     

Item validity of the physical demands from the Dictionary of Occupational Titles for functional capacity evaluation of clients with chronic back pain

This study assessed the item validity of 15 of the physical demands from the Dictionary of Occupational Titles (DOT), as evaluated in a new approach to functional capacity evaluation (FCE) for clients with chronic back pain, the Gibson Approach to FCE (GAPP FCE). Fifty-two occupational therapists were sent the specifications of the items in the GAPP FCE procedures and were asked to rate the items in terms of item-objective congruence, relevance and difficulty. A response rate of 59.2% was obtained. The majority of the therapists agreed that most of the items were congruent with the objectives based on the definition of the physical demands from the DOT. The items evaluating Balancing and Pushing and Pulling had the lowest item-objective congruence. The evaluation of Balancing and the Lifting, Carrying and Pushing and Pulling of loads greater than light-medium weight (10-16 kg) were not considered significantly relevant. Concerns were raised about the difficulty and safety of the evaluation of Lifting, Carrying and Pushing and Pulling with clients with chronic back pain, particularly if the therapist evaluates the manual handling of medium to heavy loads. These results may have implications for other FCEs, particularly those which are based on the DOT, or when assessing clients with chronic back pain.     

Interdisciplinary staff perceptions of an occupational therapy return to work program for people living with AIDS

The purpose of this qualitative study was to identify the perception of interdisciplinary staff members regarding the impact of a model work and independent living oriented program for residents in supportive living facilities. This study used focus groups and individual interviews to collect these perceptions. Staff members identified four areas of impact: utilization of a holistic and process-oriented approach, an ability to identify and work with the strengths of clients, emphasis on the learning of practical skills, and creating an intersection for all aspects of services. These findings point to the fact that staff members found the value that occupational therapy has to offer their overall programming by improving participation of clients with HIV in learning practical skills for use in their daily lives and in developing work related skills.     

Family-of-origin expressiveness: measurement, meaning, and relationship to alexithymia

The need for research instruments to assess the impact of affective expressiveness within the family is evident, yet few appear to be adequately designed for this purpose. In this article, we present two studies addressing this need. In the first study, the original 40-item Family-of-Origin Scale was administered to 416 students to determine those items that constitute the factor structure. This instrument was designed to assess perceived levels of health in the family of origin but has unsubstantiated construct validity. Results from a confirmatory factor analysis indicated that the instrument has one major factor, and results from five other studies provide evidence supporting the construct validity. Face validity of this 22-item construct indicates that it assesses an individual's perceived level of global expressive atmosphere within his or her family of origin. In the second study, the new Family-of-Origin Expressive Atmosphere Scale and the 20-item Toronto Alexithymia Scale were administered to 295 students. Students' self-reported expressive atmospheres in their family-of-origin scores were significantly correlated with the total scores of alexithymia and each of the three factors: impaired ability to identify feelings, impaired ability to describe feelings, and externally oriented thinking processes. No significant gender differences were found.