RESUMEN
PURPOSE: Chronic physical conditions often negatively affect work participation. The objective of this systematic review is to investigate the effectiveness and characteristics of vocational rehabilitation interventions for people with a chronic physical condition. METHODS: Searches in five databases up to April 2020 identified 30 studies meeting our inclusion criteria. Two reviewers independently assessed and extracted data. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) framework was used to evaluate quality of evidence for three outcome measures related to work participation. RESULTS: All vocational rehabilitation interventions consisted of multiple components, but their characteristics varied widely. Analysis of 22 trials yielded a moderate positive effect with moderate certainty of interventions on work status; analysis of five trials with low risk of bias showed a large positive effect with moderate certainty (risk ratio 1.33 and 1.57, respectively). In addition, in eight studies we found a moderate to small positive effect with low certainty on work attitude (standardized mean difference = 0.59 or 0.38, respectively). We found no effect on work productivity in nine studies. CONCLUSION: The systematic review of the literature showed positive effects of vocational rehabilitation interventions on work status and on work attitude; we found no effect on work productivity.Implications for rehabilitationIn rehabilitation, addressing work participation of persons with a chronic physical condition using targeted interventions is beneficial to improve or sustain work participation, irrespective of the intervention characteristics and diagnosis.Interventions that include multiple components and offer individual support, whether or not combined with group sessions, are likely to be more effective in improving work participation in persons with a chronic physical condition.The overview of vocational interventions in this systematic review may assist healthcare professionals in making informed decisions as to which intervention to provide.Vocational rehabilitation, as well as studies on work participation in chronic disease, should include a long follow-up period to explore if work participation is sustainable and contributes to health and wellbeing.
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Evaluación de Resultado en la Atención de Salud , Rehabilitación Vocacional , Adulto , Sesgo , Enfermedad Crónica , Personal de Salud , HumanosRESUMEN
OBJECTIVE: To document the development of work participation in young adults with cerebral palsy who are transitioning into adulthood, examine associated characteristics, and investigate work limitations and barriers among employed persons. DESIGN: Observational longitudinal cohort study. SUBJECTS: Seventy-four young adults with cerebral palsy of average intelligence, aged 16-20 years at baseline. METHODS: Work participation in 3 categories (employed, unemployed, studying) was assessed at baseline, 2-year and 4-year follow-ups using structured interviews. At 4-year follow-up, associations of work participation with demographic and clinical characteristics were examined using multinomial logistic regression. Work limitations and barriers among employed persons were evaluated using questionnaires. RESULTS: From age range 16-20 years to age range 20-24 years the proportions of subjects who were employed and unemployed increased from 12% to 49% and 3% to 17%, respectively; the proportion who were students decreased from 85% to 34%. In the age range 20-24 years, the employment rate of young adults with cerebral palsy was lower and the unemployment rate higher, than that of the general population. A lower level of gross motor function and younger age were associated with unemployment. Employed persons experienced few work limitations; 28% experienced situational or health barriers. CONCLUSION: Young adults with cerebral palsy and average intelligence are at risk of experiencing unfavourable developments in work participation. Rehabilitation services should offer support to prevent unemployment and occupational disability.
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Parálisis Cerebral/rehabilitación , Empleo , Adolescente , Parálisis Cerebral/fisiopatología , Estudios de Cohortes , Personas con Discapacidad , Femenino , Humanos , Estudios Longitudinales , Masculino , Países Bajos , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
PURPOSE: The purpose of this study was to investigate into more detail how occupational performance of participants of a 1-year multidisciplinary vocational rehabilitation intervention changed over time, using a broad focus on three areas of occupational performance, addressing work, as well as self-care and leisure. In addition, we explored differences between employed and unemployed persons. METHODS: In a pre-post-intervention design, changes in occupational performance, addressing work, self-care and leisure, were evaluated using the Canadian Occupational Performance Measure (COPM) and the Occupational Performance History Interview (OPHI-II). RESULTS: Eleven young adults (median 22 years) with physical disabilities participated. Post-intervention, participants experienced fewer problems and showed improved occupational performance in work, as well as self-care and leisure, and improved satisfaction with performance. Participants also showed improved occupational identity and occupational competence, and total scores on OPHI-II. Participants who did not achieve employment did not differ in demographic characteristics. They experienced problems in all three areas of occupational performance at pre-intervention, and more difficulty in interacting in occupational settings (environment). Post-intervention, their levels of occupational identity, competence and settings were similar to those of employed persons. CONCLUSIONS: Participants showed improved occupational performance after the intervention. The goal of employment and the broad integrated approach of the intervention seemed to motivate participants to resolve problems in work, as well as self-care and leisure. Unemployed persons faced problems in all three areas of occupational performance at start. Although they seemed to catch up during the intervention, they did not achieve employment within 1 year.
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Personas con Discapacidad/rehabilitación , Evaluación del Rendimiento de Empleados/estadística & datos numéricos , Empleo/psicología , Rehabilitación Vocacional/métodos , Actividades Cotidianas , Adolescente , Adulto , Canadá , Empleo/estadística & datos numéricos , Femenino , Humanos , Masculino , Terapia Ocupacional , Satisfacción del Paciente , Autocuidado , Participación Social , Resultado del Tratamiento , Adulto JovenRESUMEN
AIM: The aim of the study was to evaluate the feasibility of a new intervention to improve work participation of young adults with physical disabilities, addressing (1) implementation and costs and (2) preliminary effectiveness. METHOD: Twelve young adults with physical disabilities (six males, six females; age 19-28 y, median age 21 y 6 mo) participated in a 1-year multidisciplinary vocational rehabilitation intervention. In a pre-post intervention design, we assessed implementation and costs as well as preliminary effectiveness in terms of employment and occupational performance using questionnaires and interviews. We tested pre-post differences with the McNemar test for proportions and the Wilcoxon signed-rank test for scores on occupational performance; p-values less than 0.05 were considered statistically significant. Additionally, we assessed work participation at follow-up after 2 years and 3 years. RESULTS: The intervention was implemented in an outpatient rehabilitation clinic for young adults. The median cost per participant for 1 year was 3128, which is an equivalent to the cost of 72 contact hours per participant. Post intervention, and at 2 years and 3 years follow-up, a significantly higher proportion of participants were employed (8/12 post vs 2/12 pre-intervention; p<0.05), with the ratio of those in paid to unpaid employment being 4:4, 5:3, and 7:1 respectively. Participants showed improved occupational performance in work, self-care, and leisure. INTERPRETATION: Feasibility and preliminary effectiveness of the intervention are promising. Employed participants seemed to have achieved suitable and continuous employment.
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Personas con Discapacidad/rehabilitación , Empleo/psicología , Rehabilitación Vocacional/métodos , Adulto , Evaluación del Rendimiento de Empleados/estadística & datos numéricos , Empleo/economía , Empleo/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Entrevista Psicológica , Masculino , Rehabilitación Vocacional/economía , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To examine the intelligibility and psychometric properties of the modified Dutch language version of the Work Limitations Questionnaire (WLQ) (WLQ-mdlv). METHODS: Employed patients with a physical chronic condition completed the WLQ-mdlv, the Work Ability Index, and the 36-item short form health survey. Intelligibility, internal consistency, test-retest reliability, and external construct validity of the WLQ-mdlv were assessed. RESULTS: In 125 patients, the WLQ-mdlv showed improved intelligibility for a Dutch population. With Cronbach α coefficients more than .80, squared weighted κ of 0.63 or more (individual items), intraclass correlation coefficients of 0.83 or more (WLQ scales), a minimal detectable change of four points (WLQ index), and negative correlations with the Work Ability Index and related 36-item short form health survey scales reliability and external construct validity of the WLQ-mdlv were confirmed. CONCLUSION: The WLQ-mdlv is an intelligible, reliable, and valid instrument for evaluating work limitations in employees with a chronic condition in the Netherlands.