Journal Of Occupational Rehabilitation[JOURNAL]
Sun
200 papers
Factors Associated with Negative Experiences and Mental Ill Health During a Workers' Compensation Claim: A Mixed Methods Study.
Sanatkar S, Pritchard E, Callaway L … +8 more , Cruickshank G, Grant G, Godic B, MacEachen E, Thompson J, Di Donato M, Gray S, Collie A
J Occup Rehabil · 2026 Jan · PMID 41563556 · Publisher ↗
PURPOSE: Prior studies demonstrate that many injured workers find involvement in workers' compensation processes complex and stressful. This study sought to identify experiences, events and interactions contributing to s...
PURPOSE: Prior studies demonstrate that many injured workers find involvement in workers' compensation processes complex and stressful. This study sought to identify experiences, events and interactions contributing to system-generated mental ill health. METHODS: Mixed methods design utilising an online survey and follow-up interviews. Eligible participants were workers employed in Australia, at least 18 years of age, proficient in English, who had submitted a compensation claim. Survey items assessed demographic and claim information, claim experiences, and impacts of interactions with claim stakeholders and processes. Between September 2023 and July 2024, the survey was distributed through community organisations, worker support groups, and social media. Qualitative interviews took place between February and July 2024. RESULTS: A total of 533 participants completed the survey, and 20 completed an interview. Most survey participants (n = 503, Median = 45-54 years, 59.2% women) reported negative mental health impacts. Of those, 279 reported negative experiences throughout the claim process, while the remainder reported more positive or mixed experiences. Hierarchical logistic regression indicated that negative interactions with insurers (OR = 5.22, 95%CI [1.89, 14.42]) and delays in claim approval (OR = 4.12, 95%CI [1.88, 8.99]) were significantly associated with negative claim experiences. The full logistic regression model accounted for 40% of the variation in claim experiences. Qualitative analysis of injured workers revealed themes around claim-related sources of stress and negative consequences from illness or injury. CONCLUSION: Findings provide insights into modifiable aspects of compensation claim processes that, if actioned, may improve worker experiences during their claim and reduce the risk of secondary psychological injury.
Inpatient or Outpatient Occupational Rehabilitation - What Works Best for Whom? A Non-randomized Clinical Trial.
Eftedal M, Jensen C
J Occup Rehabil · 2026 Jan · PMID 41543672 · Publisher ↗
PURPOSE: This study compared return-to-work (RTW) outcomes among Norwegian patients with musculoskeletal or common mental disorders participating in a 4-week inpatient or 3-month outpatient occupational rehabilitation pr...
PURPOSE: This study compared return-to-work (RTW) outcomes among Norwegian patients with musculoskeletal or common mental disorders participating in a 4-week inpatient or 3-month outpatient occupational rehabilitation program, examining associations between program type, pre-intervention sick-leave duration, and RTW. METHODS: An observational cohort (n = 857) was categorized into five pre-intervention benefit groups, including Group 1 (partial benefits for ≥ 6 weeks) and Group 2 (90-100% benefits for 6 weeks through 5 months). Primary outcome was time to stable RTW (first month without sickness benefits); secondary outcome was cumulative work participation over 24 months. RESULTS: RTW hazard varied by group and time. During the first 3 months, outpatients in Group 1 had a threefold higher hazard of stable RTW than inpatients (HR = 3.61, p = .03). Between 3 and 10 months, the pattern reversed, favoring inpatients (outpatient HR = 0.68, p = .01). After 10 months, outpatients again had higher RTW hazards, significant only in Group 1. In Group 2, no outpatients achieved RTW during the first 3 months; furthermore, between 3 and 10 months, inpatients had a significantly higher RTW hazard (outpatient HR = 0.38, p = .02). Median months worked over 24 months was 18.1 for outpatients vs. 12.8 for inpatients in Group 1 (p = .08), and 0.6 vs. 5.3 in Group 2 (p = .04). CONCLUSION: Pre-intervention sick-leave duration strongly influences RTW. Program effectiveness is time- and subgroup dependent. Patients with remaining work attachment (partial benefits) may benefit more from outpatient care, while those on full-time benefits for moderate durations benefit more from intensive inpatient programs, suggesting a need for stratified allocation. TRIAL REGISTRATION: Current controlled trials https://doi.org/10.1186/ISRCTN12033424 , 15.10.2014, retrospectively registered.
Cross-Sectional Associations Between Overall and Task-Specific Physical Work Demands and Sustainable Employability Among Dutch Firefighters: Results from the SEmFire Cohort Study.
van Delden L, Jansen NWH, van Amelsvoort LGPM … +5 more , Fleuren BPI, Stynen D, Poesen LT, Slangen JJM, Kant I
J Occup Rehabil · 2026 Jan · PMID 41528644 · Publisher ↗
PURPOSE: Firefighting is widely recognized as a physically demanding profession, in which working until the statutory retirement age is considered highly challenging. However, increasing societal pressure to extend worki...
PURPOSE: Firefighting is widely recognized as a physically demanding profession, in which working until the statutory retirement age is considered highly challenging. However, increasing societal pressure to extend working lives highlights the need to gain more insight into how sustainable employability (SE) can be supported in such occupations. This study aims to examine cross-sectional associations between overall and task-specific physical work demands and SE among Dutch career firefighters. METHODS: Data from the SEmFire Cohort Study questionnaire for Dutch career firefighters (n = 1371) were used. SE was assessed using nine indicators across three domains: health (health status, work ability, need for recovery, prolonged fatigue), well-being (job satisfaction, motivation to work), and employability (employability, skill gap, job performance). Physical work demands-overall and task-specific-were used as independent variables. Multiple logistic regression models were applied, adjusting for personal, occupational, and health-related factors. RESULTS: Dutch career firefighters reported high physical work demands and unfavorable outcomes across multiple SE indicators. Both overall and task-specific physical demands were cross-sectionally associated with adverse SE outcomes across all three domains. Statistically significant associations were observed in all three distinguished function groups-operational, hybrid, and non-operational-though patterns (i.e., which indicators and the strength of associations) varied between groups. The frequency of incident responses per month also influenced the strengths of these associations. CONCLUSION: This study shows that physical work demands are associated with multiple indicators of SE among Dutch career firefighters. These findings provide an important first step toward identifying actionable areas to enhance SE among firefighters.
Toward Measuring Cognitive Endurance Capacity: A Proof-of-Principle Study in a Healthy Population.
van Vliet FIM, Donker-Cools BHPM, Geurtsen GJ … +2 more , Ponds RWHM, Schaafsma FG
J Occup Rehabil · 2026 Jan · PMID 41528643 · Publisher ↗
PURPOSE: Occupational health professionals increasingly encounter workers who complain about a decrease in cognitive endurance, yet standardized tools to objectively assess this decrease are lacking. Cognitive endurance,...
PURPOSE: Occupational health professionals increasingly encounter workers who complain about a decrease in cognitive endurance, yet standardized tools to objectively assess this decrease are lacking. Cognitive endurance, the ability to sustain cognitive performance during prolonged mental effort, is critical for sustainable employability. METHODS: In this proof-of-principle study, 101 healthy working adults (M_age = 35.7, SD = 13.6) completed neuropsychological assessments and fatigue questionnaires at the start and end of a regular workday. Cognitive endurance was operationalized as within-day change scores across six cognitive domains. Analyses included paired t-tests, Wilcoxon signed-rank tests, Spearman correlations, and multiple regression. RESULTS: Over the course of a workday, cognitive performance improved in language, attention/executive functioning, and information processing speed (all p < 0.001), despite a significant increase in subjective fatigue (Z = -6.34, p < 0.001). Nearly half of the neuropsychological tests showed improvement. Fatigue measures explained only a small part of the variance in language change (R = 0.122), and no individual fatigue predictors were significant in that model. Higher subjective fatigue was associated with less improvement in processing speed (p = 0.040). CONCLUSION: Cognitive performance remained stable or improved over the course of the day, even as subjective fatigue levels increased. Fatigue measures showed limited predictive value for changes in cognitive outcomes, with only subjective fatigue significantly related to performance in one domain. These findings suggest that in healthy working adults, subjective complaints alone do not reliably indicate reduced cognitive functioning. Incorporating objective cognitive data may therefore be important when assessing endurance capacity and informing occupational health evaluations.
Trajectories of Work Ability After Total Hip and Knee Arthroplasty: A Latent Class Growth Analysis.
Gernert M, Schuler M, Dejonghe LAL … +1 more , Schaller A
J Occup Rehabil · 2026 Jan · PMID 41495586 · Publisher ↗
PURPOSE: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) as treatments for osteoarthritis increasingly affect working-age adults. However, little is known about the development of work ability after THA an...
PURPOSE: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) as treatments for osteoarthritis increasingly affect working-age adults. However, little is known about the development of work ability after THA and TKA. This study investigated different trajectory classes of work ability after THA and TKA. METHODS: This prospective study included 146 working patients (THA n = 51, TKA n = 95). They received THA/ TKA treatment as usual, including surgery, rehabilitation, and optional post-rehabilitation programmes. The primary outcome work ability was assessed five times (before surgery, end of rehabilitation, 3-month, 6-month, and 12-month follow-up) with the Work Ability Score. Additionally, the questionnaires included sociodemographic, health-, rehabilitation-, and work-related data. We applied a latent class growth analysis to identify distinct trajectory classes of work ability over 12 months, and examined associated factors using univariable multinominal logistic regression analyses in MPlus. RESULTS: We found three distinct trajectory classes of work ability within one year after THA/ TKA: no improvement (24.5%), delayed improvement (36.6%), and early improvement in work ability (38.9%). Preoperative predictors for work ability trajectory classes were sex, pain intensity, functional ability in everyday life, and risk of work-related disabilities. Furthermore, work ability trajectory classes were associated with participation in the T-RENA post-rehabilitation programme, and with pain intensity one year after having started rehabilitation. CONCLUSION: Despite the fact that most patients showed improvements in work ability after THA and TKA, there is a noteworthy proportion who did not. Further studies are needed to enhance identification of these individuals, and to offer targeted interventions. TRIAL REGISTRATION: The study is registered in the German Clinical Trials Register (DRKS00029630).
Associations Between Employment and Health Outcomes: A Systematic Review of Reviews.
Gerdes R, Jackson TD, Roberts R … +9 more , Lytvyak E, Deibert D, Dennett L, Burton AK, Gross DP, Els C, Doroshenko A, Hagtvedt R, Straube S
J Occup Rehabil · 2026 Jan · PMID 41493509 · Publisher ↗
PURPOSE: The subject of employment as a determinant of health has received considerable attention from researchers. To our knowledge, a comprehensive synthesis of evidence on the health effects of employment has not been...
PURPOSE: The subject of employment as a determinant of health has received considerable attention from researchers. To our knowledge, a comprehensive synthesis of evidence on the health effects of employment has not been completed in almost 20 years. This systematic review aimed to provide an up-to-date summary of the associations between employment status and any measurable domain of health. METHODS: We searched Ovid MEDLINE, Embase, CINAHL Plus with Full Text, and APA PsycINFO. We included peer-reviewed, full-text systematic reviews or overviews published in English between January 2012 and November 2024. Two reviewers independently screened resultant publications and extracted data from those found eligible for the review. RESULTS: Our search yielded 1862 reviews and meta-analyses, 49 of which were eligible for synthesis. Employment status was associated with several health domains including general health and wellbeing, mental health, alcohol and substance use disorders, cardiovascular health, systemic inflammation, sleep quality, cognitive functioning, and mortality. CONCLUSION: Being employed was almost universally associated with favourable physical and mental health outcomes, with evidence to suggest re-employment may facilitate improvements in health after a period of unemployment. Socioeconomic status was a notable factor which affected health outcomes for both employed and unemployed people, illustrative of social gradients in health. Insecure or low-quality work demonstrated the potential to override identified health benefits of work. Heterogeneity in the operationalization of employment across publications, and the influence of survivorship bias on health outcomes highlights a task for future research to establish causality in the relationship between employment status and health.
Machine Learning to Predict Return to Work After Medical Rehabilitation for Musculoskeletal Disorders: A Retrospective Cohort Study.
Elling M, Hetzel C, Streibelt M … +3 more , Sänger N, Schwarz B, Seifert N
J Occup Rehabil · 2026 Jan · PMID 41491901 · Publisher ↗
PURPOSE: This study aimed to identify and quantify the contribution of various features and their interactions to the prediction of return to work (RTW) following medical rehabilitation due to musculoskeletal disorders,...
PURPOSE: This study aimed to identify and quantify the contribution of various features and their interactions to the prediction of return to work (RTW) following medical rehabilitation due to musculoskeletal disorders, using a machine learning approach. METHODS: This retrospective cohort study used data from the Rehabilitation Statistics Database (RSD) of the German Pension Insurance. A total of 685,890 individuals who received multimodal medical rehabilitation for musculoskeletal disorders between January 2018 and December 2021 were included. A Light Gradient Boosting Machine (LightGBM) model was trained on 75% of the sample and tested on the remaining 25%. Model predictions were explained using Shapley values to determine the contributions of individual features and their interactions. RESULTS: Overall, 65.0% of individuals achieved stable RTW. On the test dataset (threshold 0.5), the model achieved an accuracy of 0.815, precision of 0.830, recall of 0.901, and an AUC-ROC of 0.867. The most important predictors of RTW were days in employment, income, incapacity for work at admission, occupational status, duration of incapacity for work, and age. The model also identified interaction effects, including an interaction between postacute rehabilitation and incapacity for work at admission, and an interaction between age and income. CONCLUSION: The machine learning model demonstrated good predictive performance for RTW after medical rehabilitation for musculoskeletal disorders and confirmed the relevance of established predictors, such as prior employment and incapacity for work. In addition, the analysis identified interactions that are difficult to detect with traditional regression approaches.
Effectiveness of Self-Help Interventions to Reduce Work Disability: A Rapid Mixed Methods Systematic Review.
Atkinson-Graham M, Yu H, Cooper L … +15 more , Weisberg J, Connell G, Allard S, Check L, Nkamtchoum AF, Flynn T, Lorca J, McIntyre V, Paterson J, Wagenaar A, Martin K, Gross DP, Straube S, Murnaghan K, Cancelliere C
J Occup Rehabil · 2026 Jan · PMID 41491900 · Publisher ↗
PURPOSE: To assess the effectiveness of self-help interventions in reducing work disability and improving work- and health-related outcomes among individuals with musculoskeletal, anxiety, and/or depressive conditions; t...
PURPOSE: To assess the effectiveness of self-help interventions in reducing work disability and improving work- and health-related outcomes among individuals with musculoskeletal, anxiety, and/or depressive conditions; to explore lived experiences with self-help interventions; and to integrate quantitative and qualitative findings to guide future research and implementation. METHODS: We conducted a rapid mixed methods systematic review following World Health Organization (WHO) and Cochrane Rapid Reviews Methods Group guidance. We included randomized controlled trials (RCTs), quasi-experimental, qualitative, and mixed methods studies published in English since 2007. Eligible studies evaluated self-help interventions targeting musculoskeletal, anxiety, and/or depressive conditions in working-age adults (18-65 years). Quantitative outcomes included functioning, return-to-work, productivity, and self-efficacy; qualitative outcomes reflected user experiences. Risk of bias was assessed using RoB 2, ROBINS-I, and CASP tools. Findings were synthesized narratively by intervention types and outcome domain. RESULTS: Eight studies met inclusion criteria: five RCTs, two quasi-experimental, and one qualitative. All seven quantitative studies were rated high risk of bias. Short-term improvements were observed in disability and physical quality of life in two exercise-based trials, but effects on work participation were inconsistent and generally below thresholds for clinical importance. Cognitive-behavioral and psychoeducational programs produced small improvements in self-efficacy and presenteeism, and relaxation and educational interventions showed no meaningful effects. The qualitative study highlighted workplace barriers such as productivity pressures and limited opportunities for movement that constrained engagement. CONCLUSION: Self-help interventions may modestly improve self-management, disability, and coping in the short term but show limited and inconsistent evidence for reducing work disability. Their effectiveness likely depends on adherence, contextual support, and integration into workplace environments. Future high-quality, co-designed, context-sensitive studies are needed to clarify effectiveness, safety, and sustainability in real-world settings. PROSPERO registration: CRD42023472934, registered on October 16, 2023; modified March 17 2025.
General Practitioner Service Use Before and After Long-Term Workplace Injury: A Retrospective Cohort Study.
Maharjan P, Griffiths D, Di Donato M … +3 more , Sheehan LR, Mazza D, Collie A
J Occup Rehabil · 2026 Jan · PMID 41483375 · Publisher ↗
PURPOSE: In Australia, general practitioner (GP) consultations for work-related injuries are funded by workers' compensation and GP care for non-work-related conditions is funded by public health insurance (Medicare Bene...
PURPOSE: In Australia, general practitioner (GP) consultations for work-related injuries are funded by workers' compensation and GP care for non-work-related conditions is funded by public health insurance (Medicare Benefits Schedule, MBS). This study aimed to measure changes in the proportion and frequency of GP consultations after a long-term work injury, including both Medicare and workers' compensation funded care, and to assess the proportion of GP services funded by each scheme. METHOD: This retrospective cohort study linked administrative GP records from MBS and workers' compensation systems in New South Wales, Australia. The study included injured workers with long-duration (2 + years) compensation claims and community comparators. Primary outcome measures included the proportion and frequency of GP services, measured in the year pre-injury, and each of the first two years post-injury. Mixed-effects negative binomial regression was used to compare outcomes between groups during all three study periods. RESULTS: The cohort included 3170 injured workers and 7636 community controls. The annual median GP services increased from 5 (Interquartile range 2-10) pre-injury to 19 (IQR 12-27) in the first-year post-injury and decreased to 16 (IQR 10-23) in the second year. Compared to the community control cohort, injured workers used 3.6 (95% CI 3.33, 3.81) and 2.7 (95% CI 2.54, 2.91) times more GP services in the first- and second-year post-injury, respectively. This increase in annual median service use was observed among those funded by workers' compensation, while services subsidised by Medicare remained similar across all three study periods. CONCLUSION: GP service use by injured workers with long-compensation claims increased substantially post-injury and remained high for two years. Workers also continued receiving Medicare-subsidised services at a similar level to pre-injury, presumably for managing non-work-related conditions. An integrated care model may provide holistic support to injured workers needing care for both workplace-injury-related and other conditions.
Claim Characteristics and Return to Work Outcomes for Ontario Public Safety Personnel with Mental Stress Injury Program Claims, 2014-2023.
Edgelow M, Oliveira L, Ataev N … +1 more , Islam N
J Occup Rehabil · 2025 Dec · PMID 41407983 · Publisher ↗
PURPOSE: In Canada, rates of psychological injury for public safety personnel (PSP), along with related workers' compensation costs, have been on the rise in the past decade. This study explored approved workers' compens...
PURPOSE: In Canada, rates of psychological injury for public safety personnel (PSP), along with related workers' compensation costs, have been on the rise in the past decade. This study explored approved workers' compensation claims filed by PSP for work-related psychological injuries through the Ontario Workplace Safety and Insurance Board (WSIB) between 2014 and 2023. Specifically, we wanted to understand the variability in demographic and claim characteristics and how return to work (RTW) outcomes compared amongst PSP occupations. METHODS: This research employed a descriptive and quantitative analysis to identify trends in claim volumes, injury categories, and patterns in RTW outcomes for communicators, correctional workers, firefighters, paramedics, and police. RESULTS: Claimants were more often male with an average age of 41.3 years and 13 years of work experience at the time of injury. Police and paramedics accounted for over 60% of all claims and significant heterogeneity was observed across all occupations. Cumulative traumatic injury claims were more common than single event claims, and PTSD was the most common category of claim. 93.3% of all claims resulted in time lost from work, the median claim length was 14.4 months (Q1 = 0.8, Q3 = 38.7), and only 35.7% of claimants had a successful RTW outcome documented. The most favorable profile for RTW success was for younger and less experienced workers, with single event or traumatic mental stress claims. CONCLUSION: Our findings can inform the development of more effective public policies and workers' compensation processes, ultimately contributing to more timely and effective support for PSP who sustain work-related psychological injuries.
Assessing the Effect of a Rehabilitation Intervention on Exhaustion Disorders, Depression, and Return to Work: A Randomized Controlled Trial.
Thunqvist E, Nygren Å, Löfman B … +2 more , Parker D, Brulin E
J Occup Rehabil · 2025 Dec · PMID 41389236 · Publisher ↗
PURPOSE: The aim was to evaluate the effect of a Rehabilitation to Work (ReTA) model on symptoms of exhaustion disorder (ED), depression, and return to work (RTW) among healthcare workers on long-term sickness absence (L...
PURPOSE: The aim was to evaluate the effect of a Rehabilitation to Work (ReTA) model on symptoms of exhaustion disorder (ED), depression, and return to work (RTW) among healthcare workers on long-term sickness absence (LTSA) for stress-related ill-health. METHODS: The ReTA was set up as a randomized control trial (RCT), including 30 in the intervention and 41 in the control group. Physicians and nurses on LTSA were recruited via a national insurance database. The degree of self-reported ED and depression was measured using the Karolinska Exhaustion Disorder Scale (KEDS), and the Montgomery Åsberg Depression Rating Scale (MADRS). Data was collected at baseline, 3-month, and 1-year follow-up. A linear mixed model and Pearson chi-square were used to examine between- and within-group differences in KEDS, MADRS, and RTW. RESULTS: At baseline, no differences in KEDS and MADRS were observed between the groups. KEDS decreased significantly at the 3-month (m = 20.28, m = 25.93; p = 0.023) and 1-year (m = 19.78, m = 24.83; p = 0.041) follow-up in the intervention group but not in the control group (Intervention*time: F (2, 132.595) = 4.126, p = .018). The effect size at both follow-ups was moderate to large (Cohen's d = 0.77 0.69, respectively). No effect was found in MADRS. Between the 3-month and 1-year follow-ups for RTW, there was a significant change for the intervention group (p = 0.029), indicating an increase in full RTW. CONCLUSION: The ReTA model is an effective treatment for ED among healthcare professionals. Further research is needed with longer follow-up periods to see the long-term effects on ED, depression, and RTW. TRIAL REGISTRY: NCT05314530.
Social Determinants of Recovery from Work-Related Psychological Injury After Sick Leave Absence: Examining Employee and Manager Perspectives.
Sanatkar S, Lipscomb R, Bower M … +6 more , Heinsch M, Taylor RF, Arena A, Deady M, Harvey SB, Boydell K
J Occup Rehabil · 2025 Dec · PMID 41389235 · Publisher ↗
BACKGROUND: National data suggest that the mental health of Australian workers has declined over recent years. Given that genetic contributors to mental health conditions generally remain stable in longitudinal observati...
BACKGROUND: National data suggest that the mental health of Australian workers has declined over recent years. Given that genetic contributors to mental health conditions generally remain stable in longitudinal observations, it is possible that social determinants, which are contextual, non-medical factors, contribute to this trend. This qualitative research investigated employee experiences of psychological injury, including social determinants as facilitators and barriers to recovery and return to work, and gathered need-based recommendations. METHODS: Between October and December 2023, 55 participants (M = 44 yrs, 80% female) completed an online survey of demographic items and questions around injury and recovery experiences. Employees who were prescribed sick leave for at least two weeks due to a work-related psychological injury and managers who supervised at least one employee with a work-related psychological injury were eligible to participate. A subset of 12 participants also completed an in-depth online interview. Thematic analysis underpinned by a critical realist/contextualist lens was used to generate themes. RESULTS: Eleven themes described common experiences, facilitators, and barriers and were ordered along three meta-themes of injury causes, responses to injury, and recovery processes. Participant recommendations based on needs assessments centred around clear reporting systems for psychological injury, ongoing support and advocacy for employees, workplace accountability, and minimisation of requirements to access treatment, salary support, and sick leave. DISCUSSION: Detrimental work factors, negative disclosure experiences, and barriers to mental health care and return to work were described by employees who reported negative functional and mental health impacts, whereas managerial support and strength-based work modifications were protective.
Update on Individual Placement and Support for New Populations: A Meta-Analytic Review.
Bond GR, Drake RE, Becker DR
J Occup Rehabil · 2026 Mar · PMID 41389234 · Publisher ↗
PURPOSE: Since individual placement and support (IPS) emerged as the premier evidence-based vocational rehabilitation for people with serious mental illness (SMI) in the early 2000s, several groups around the world have...
PURPOSE: Since individual placement and support (IPS) emerged as the premier evidence-based vocational rehabilitation for people with serious mental illness (SMI) in the early 2000s, several groups around the world have extended IPS to new disability groups. This review examines the rigorous evidence for five new populations: adults with early psychosis, common mental disorders, substance use disorders, posttraumatic stress disorders, and severe medical conditions. METHODS: This review updates the employment outcome findings from six recent systematic reviews of controlled trials of IPS for new populations using an electronic search. Using meta-analyses, the overall odds ratio (OR) and 95% confidence intervals (CI) for IPS-control differences in employment rate were calculated for RCTs of three new populations. RESULTS: The search identified 19 controlled trials of IPS for new populations, including 9 published since 2019. Meta-analyses yielded ORs of 3.39 (95% CI: 2.11-5.46, p < .0001, N = 393) for 5 studies of adults with early psychosis, 1.42 (95% CI: 0.96-2.09, p = .08, N = 1728) for 5 studies of adults with common mental disorders and 1.88 (95% CI: 1.13-3.15, p = .02, N = 1830) for 5 studies of adults with substance use disorders. Two studies each of veterans with posttraumatic stress disorders and patients with serious medical conditions had a mix of small and large ORs. CONCLUSIONS: IPS, the only vocational rehabilitation intervention with robust employment results, has been extended to several new populations with generally positive employment outcomes in controlled trials. However, poor implementation, small sample sizes, and other methodological problems limited the overall quality of this literature.
Expanding the Focus on Work Factors in an Outpatient Setting: Does a Nudge of Patients and Clinicians have an Effect on Return-to-Work and Benefits? Findings from the NSAC Nudge Multicentre Randomised Controlled Trial.
Bardal I, Aars NAP, Trichet LO … +9 more , Brandseth OL, Terjesen C, Irgens E, Hansen BO, Kristoffersen A, Höper A, Jenssen OR, Brinchmann B, Mykletun A
J Occup Rehabil · 2025 Dec · PMID 41385138 · Publisher ↗
PURPOSE: The purpose of the study was to test the effects of a nudge on patients return-to-work (RTW) and benefits in a clinical service aimed to promote RTW and prevent sickness absence in patients referred for musculos...
PURPOSE: The purpose of the study was to test the effects of a nudge on patients return-to-work (RTW) and benefits in a clinical service aimed to promote RTW and prevent sickness absence in patients referred for musculoskeletal disorders or mental illness. METHODS: The study was a multicentre, single-blinded, parallel two-arm randomised controlled trial design. The setting was five outpatient clinics in Northern Norway, offering a work-focussed treatment to patients referred for common mental- and/or musculoskeletal disorders. Patients were randomised to receive either a questionnaire mapping health factors only, or a questionnaire mapping also Motivation for work, Barriers for return-to-work and Work environment (MBW). Clinicians were also nudged by receiving patient reports based on the patient survey. Data on sickness absence and benefits was retrieved from national registries after one year of follow-up. RESULTS: Among 1171 patients consenting to participate in the study, 1091 were eligible for inclusion in the main analyses. The intervention group (n = 558) did not differ significantly from the control group (n = 533) with respect to key variables at baseline. The nudge had no effect on days of sickness absence, return to work rates, or disability benefits during follow-up. CONCLUSION: This attempt to nudge patients and clinicians on MBW factors did not influence RTW or benefits during one year of follow-up. Although MBW factors were prevalent at baseline, the results suggest that increasing work focus in a setting where clinicians already address these factors to some extent has little effect. TRIAL REGISTRATION: The trial was prospectively registered at clinicaltrials.gov on August 9th, 2021. Trial identifier NCT05006976 ( https://clinicaltrials.gov/study/NCT05006976 ). In this study we report on the primary outcome listed as "Functional recovery: sickness absence registry data".
Workplace Outcomes After Mental Health Disclosure: The Critical Influence of Supervisor Reactions.
Volkov I, Sheppard DM, Kirk-Brown A … +1 more , Van Dijk P
J Occup Rehabil · 2025 Dec · PMID 41385137 · Publisher ↗
PURPOSE: Disclosure of mental health condition to a supervisor at work can have positive and negative consequences. However, research on the association between disclosure and employee work outcomes is limited. The aim o...
PURPOSE: Disclosure of mental health condition to a supervisor at work can have positive and negative consequences. However, research on the association between disclosure and employee work outcomes is limited. The aim of this study was to investigate the association between the employee experiences during the disclosure process (positive/negative) and work ability, intent to stay, and perceived mental health stigma among Australian workers. METHODS: A mixed-methods study design was carried out with cross-sectional survey data from a nationally representative sample of Australian employees (n = 322). Qualitative analysis of open-ended survey responses categorised the perceived nature of supervisor responses from the employee perspective into positive and negative with further subcategories for each, and subsequent quantitative analyses investigated the association between immediate supervisors' reactions to employees' mental health disclosures and work outcomes. Statistical comparisons contrasted those experiencing positive and negative disclosure responses. RESULTS: The study found positive disclosure experiences to be more common than the negative. Expressing concern, listening attentively, and demonstrating empathy were the most widely reported positive experiences, while making judgmental and condescending remarks were the most common negative experiences. Positive disclosure experiences were significantly associated with higher work ability, intent to stay and lower perceived mental health stigma. CONCLUSIONS: Supervisor reactions to employee mental health condition disclosure were found to be significantly associated with work ability, intent to stay, and perceived mental health stigma at work for disclosing employees. Noting the limitations surrounding making causal inferences, these findings emphasise the pivotal role of the supervisor in facilitating a positively perceived disclosure experience that is associated with positive employee outcomes and well-being following disclosure. In particular, training to prepare for disclosure events and respond appropriately could be an effective approach to create a work environment in which employees feel safe to disclose, actively reduce mental health stigma in the workplace, and improve work outcomes.
Developing a Vocational Empowerment Model for Clients with Chronic Mental Illness: A Grounded Theory Study.
Amanollahi Z, Esfahan MM, Akkhan Z … +1 more , Moradi M
J Occup Rehabil · 2025 Dec · PMID 41364283 · Publisher ↗
PURPOSE: Clients with chronic mental illness face multiple psychological, social, and economic challenges in securing and maintaining employment. While studies have confirmed the positive role of employment in improving...
PURPOSE: Clients with chronic mental illness face multiple psychological, social, and economic challenges in securing and maintaining employment. While studies have confirmed the positive role of employment in improving their functioning, an effective vocational empowerment model tailored to their needs remains a research gap. Therefore, this study aimed to develop a vocational empowerment model for clients with chronic mental illness. METHODS: This qualitative study was conducted within the interpretive paradigm using the grounded theory approach based on Strauss and Corbin's methodology. Data were collected through semi-structured interviews with 25 chronically mentally ill clients with work experience, following the principle of theoretical saturation. The data were analyzed using open, axial, and selective coding. RESULTS: The developed model consists of five key components: (1) Causal conditions (self-management, motivation, attitude, and agency): (2) Contextual factors (social and institutional support, environmental opportunities, and challenges); (3) Intervening factors (economic and social factors); (4) Strategies (personal development, spiritual support; and (5) Outcomes (personal and occupational well-being) CONCLUSION: The findings suggest that a combination of social support and individual empowerment can significantly enhance the employment sustainability of these clients. Vocational empowerment for clients with chronic mental illness requires a multi-dimensional approach, including self-management training, creating supportive infrastructures, reforming employment policies, and implementing psychosocial interventions. The findings of this study can contribute to designing supportive programs and informing macro-level policies for vocational rehabilitation of clients with chronic mental illness.
Employment Five Years After Cancer Diagnosis Among Native and Immigrant Women in Norway.
Moradi S, Torp S, Nielsen R … +3 more , Oldervoll LM, Engan HK, Ambugo EA
J Occup Rehabil · 2025 Dec · PMID 41351748 · Publisher ↗
PURPOSE: To compare employment status 5 years post-diagnosis among native Norwegian, Western immigrant, and non-Western immigrant female cancer survivors (CSs) and their matched controls without cancer, who were employed...
PURPOSE: To compare employment status 5 years post-diagnosis among native Norwegian, Western immigrant, and non-Western immigrant female cancer survivors (CSs) and their matched controls without cancer, who were employed at the time of diagnosis. METHODS: Participants were categorized into three groups based on data from Statistics Norway: Natives (CSs = 6587, control = 6587), Western immigrants (CSs = 209, control = 209), and non-Western immigrants (CSs = 105, control = 105). Women were aged 30-55 at diagnosis, employed (salaried/self-employed) at baseline, and alive at 5-year follow-up. CSs and controls were matched on age, education, and employment at diagnosis. Associations between cancer status, immigrant background, and employment were analyzed using binary logistic regressions and Firth penalized logistic regression to account for potential bias from small subgroup sizes. RESULTS: At 5 years, female CSs had lower odds of employment compared with controls. Western immigrants did not differ from natives, whereas non-Western immigrants showed reduced employment. Higher income was positively associated with employment, while being married or cohabiting and working in the public sector were linked to higher odds. Interaction terms between cancer survivorship and immigrant background were not significant. CONCLUSION: Among women employed at baseline, cancer survivorship and non-Western immigrant background were independently associated with lower odds of employment five years later. Tailored employment support is needed for non-Western immigrants to improve long-term outcomes. Interventions should also target employers and workplaces to support employment maintenance among CSs.
Trajectories of Work Absence in England due to a Musculoskeletal or Mental Health Condition: An Electronic Health Record Cohort Study.
Legha A, Bailey J, Welsh VK … +3 more , Jordan KP, Holdsworth C, Wynne-Jones G
J Occup Rehabil · 2025 Nov · PMID 41313417 · Publisher ↗
PURPOSE: To derive common patterns (trajectories) of work absence over time due to a musculoskeletal (MSK) or mental health (MH) condition in an English population and determine associations of these absence trajectories...
PURPOSE: To derive common patterns (trajectories) of work absence over time due to a musculoskeletal (MSK) or mental health (MH) condition in an English population and determine associations of these absence trajectories with health and sociodemographic characteristics. METHODS: This retrospective cohort study used primary care data for 43,130 and 62,355 economically active individuals with an incident work absence (as measured by receipt of fit notes) due to a MSK or MH condition, respectively, between 2016 and 2018. Latent class growth analysis was used to define trajectories (through issuance of fit notes), and trajectory-covariate association analysis was performed through multivariable multinomial logistic regression. RESULTS: Five common trajectories of work absence associated with MSK and MH conditions were determined over a one-year follow-up. The two most common trajectories consisted of low absence (a 'Single' fit note and 'Short Term' absence), while the two least common trajectories were characterized by longer-term absence of six months or more ('Chronic Sustained' and 'Chronic Fast Decreasing'), and the fifth by intermittent absence. Individuals associated with the two longer-term absence trajectories were older, living in the North or Midlands or most deprived areas of England, prescribed opioids, and current smokers. CONCLUSIONS: This study has highlighted different patterns of sickness absence due to a MSK or MH condition and profiles of individuals associated with longer-term absence. Earlier and more targeted health and work intervention toward these high-risk subgroups, alongside policy interventions to reduce health inequalities, could help alleviate the rising rate of long-term sickness absence and economic inactivity.
Employers' Perspectives on Challenges and Strategies Related To Employment of People with Physical Disabilities: Findings from a National Survey in the United States.
Yang B, Dinelli EJ, Choi H … +6 more , Crown DS, Kudla A, Wong J, Trierweiler R, Capraro P, Heinemann AW
J Occup Rehabil · 2025 Nov · PMID 41310293 · Publisher ↗
PURPOSE: The objective of the study was to advance the understanding of employers' perspectives on challenges and strategies related to hiring, retaining, and promoting people with physical disabilities (PwPD). METHODS:...
PURPOSE: The objective of the study was to advance the understanding of employers' perspectives on challenges and strategies related to hiring, retaining, and promoting people with physical disabilities (PwPD). METHODS: A nationwide cross-sectional survey of 2000 employers was conducted in the US. Descriptive analysis compared disability-related support practices between companies that hired PwPD in the past year and those that did not. Multivariable logistic regression identified specific challenges and strategies associated with inclusive hiring. Additionally, open-text responses were explored using content analysis. RESULTS: Company characteristics and disability-related support practices differed significantly between companies that hired PwPD (n = 1,142) and those that did not (n = 858). Employers who reported challenges with negative attitudes of coworkers (CI: 0.73-0.94), negative attitudes of customers (CI: 0.73-0.96), not knowing accommodation costs (CI: 0.75-0.98) had decreased odds of hiring PwPD. Conversely, employers who reported implementing onsite technical assistance (CI: 1.18-1.85), ergonomics experts (CI: 1.02-1.59), visible leadership commitment (CI: 1.11-1.73), trial work periods (CI: 1.05-1.63), and universal design (CI: 1.41-2.39) had increased odds. Open-text responses highlighted challenges such as negative attitudes, limited knowledge about how to support PwPD, and concerns about PwPD's incompetence and litigation. Effective strategies included employee resource groups, skill matching, tailored accommodations, and employee appreciation. Respondents also emphasized the importance of discussing and enhancing disability inclusion. CONCLUSION: The study identified specific challenges employers face and strategies they can use when seeking to support the employment of PwPD. Understanding employers' perspectives reveals opportunities to implement practical strategies that support organizations to enhance the workplace inclusion of PwPD.
Occupational Factors and Labor Market Outcomes Among Individuals with Sickness Absence due to Common Mental Disorders: A Population-Wide Cohort Study.
Stutaite G, Mittendorfer-Rutz E, Helgesson M … +2 more , Farrants K, Gémes K
J Occup Rehabil · 2025 Nov · PMID 41310292 · Publisher ↗
PURPOSE: To investigate how job demands, control, strain, and occupational sector and branch affect labor market outcomes following sickness absence (SA) due to common mental disorders (CMDs). METHODS: This nationwide re...
PURPOSE: To investigate how job demands, control, strain, and occupational sector and branch affect labor market outcomes following sickness absence (SA) due to common mental disorders (CMDs). METHODS: This nationwide register-based cohort study included all residents in Sweden aged 25-55 who began a new > 30-day SA spell due to a CMD (ICD-10: F32-33, F40-43) in 2011-2013 (n = 79,673). Occupational sector and branch were identified through registers, and job demands, control, and strain were assessed using the Swedish Job Exposure Matrix. We used multinomial logistic regression to estimate associations between occupational factors and different unemployment and SA/disability pension (DP) durations during a three-year follow-up. RESULTS: Public sector workers were less likely to have > 180 unemployment days (OR = 0.3, 95% CI 0.31-0.35). Working in education and public administration and in health and social services was associated with a lower likelihood of > 180 unemployment days, but a higher likelihood of > 365 SA/DP days. Low-control, passive (low control/low demands), and high-strain (low control/high demand) jobs were associated with an increased likelihood of both > 180 unemployment days and > 365 SA/DP days. For > 180 unemployment days, the ORs were 1.7 (95% CI 1.62-1.82) for low-control, 1.8 (95% CI 1.70-1.98) for passive, and 1.4 (95% CI 1.23-1.54) for high-strain jobs. For > 365 SA/DP days, the ORs were 1.3 (95% CI 1.22-1.34), 1.3 (95% CI 1.22-1.41), and 1.3 (95% CI 1.15-1.39), respectively. CONCLUSION: Particularly among individuals with SA due to CMDs, job demands, control, and strain are associated with future labor market exclusion and may be important targets for intervention.
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