Return to work: A comparison of two cognitive behavioral interventions in cases of work-related psychological complaints among the self-employed

Authors: 
Bogenschutz, M., Rumrill, P. D., Seward, H. E., Inge, K. J., & Hinterlong, P. C.
Year Published: 
2006
Publication: 
Work & Stress
Volume: 
20
Number: 
2
Pages: 
129-144
Publisher: 
Taylor & Francis
Background: 

The effectiveness of two cognitive behavioral interventions in cases of work related psychological complaints (such as anxiety, depression and burnout) among the self employed were investigated. One intervention was conducted by psychotherapists and involved extensive cognitive behavioral therapy (CBT). The other intervention was delivered by "labor experts" and consisted of a brief CBT-derived intervention combined with both individual focused and workplace interventions.

Purpose: 

The purpose of the study was to examine the effects of individual focused and workplace interventions.

Setting: 

The setting for the intervention was either in the persons' homes or workplaces.

Sample: 

The study sample included 122 self employed people who had applied for sickness benefit from an insurance company.

Data Collection: 

Data was collected using scale for psychological complaints, return to work, working conditions and social support.

Intervention: 

The interventions were cognitive behavior therapy, workplace and individual-focused techniques.

Control: 

The comparison condition was cognitive behavioral therapy.

Findings: 

Significant effects on partial and full return to work were found in favor of the combined intervention: partial return occurred 17 and 30 days earlier in this group than in the CBT group and the control group. For full return to work, the difference was approximately 200 days. A decrease in psychological complaints was present in each condition, but no significant interaction effects were found.

Conclusions: 

The results suggest that work resumption should be addressed earlier in individuals receiving CBT.

URL: 
http://psycnet.apa.org/psycinfo/2006-13377-003
Disabilities: 
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Neurocognitive enhancement therapy with vocational services: Work outcomes at two-year follow-up

Authors: 
Berthoud, R.
Year Published: 
2008
Publication: 
Schizophrenia Research
Volume: 
105
Number: 
1
Pages: 
18-29
Publisher: 
Elsevier
Background: 

Neurocognitive enhancement therapy (NET) is a remediation program for the persistent and function-limiting cognitive impairments of schizophrenia. In a previous study in veterans, NET improved work therapy outcomes as well as executive function and working memory.

Purpose: 

The present study aimed to determine whether NET could enhance functional outcomes among schizophrenia and schizoaffective patients in a community mental health center receiving community-based vocational services.

Setting: 

The study setting was a Community Mental Health Center serving individuals with psychiatric disabilities.

Sample: 

Seventy-seven stable outpatients with diagnoses of schizophrenia or schizoaffective disorder were recruited at a large urban community mental health center. Participants met diagnostic criteria based on the Structured Clinical Interview for DSM-IV (First et al., 1996) from the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association & Task Force on DSM-IV, 1994), conducted by research psychologists, and were eligible if they were clinically stable (i.e., GAF > 30, no housing changes, psychiatric medication alterations, or psychiatric hospitalizations in the 30 days prior to intake). Exclusion criteria included history of traumatic brain injury, known neurological diseases, developmental disability, and active substance abuse within the past 30 days

Data Collection: 

The statistical consultant compared hours worked by condition across quarters over the course of the two-year study using mixed models, repeated measures ANOVAs. Analyses were performed separately for total hours of community-based work activity (transitional and competitive payment combined), and hours of community-based work activity paid exclusively by the employer (competitive payment). Because of significant skew introduced by non-working participants in each quarter, analyses were repeated using ranked data as a nonparametric check of the results. Except where corrected for multiple comparisons, alpha was set at .05 and all tests were two-tailed.

Intervention: 

Patients (N = 72) participated in a hybrid transitional and supported employment program (VOC) and were randomized to either NET + VOC or VOC only. NET + VOC included computer-based cognitive training, work feedback and a social information information-processing group. VOC only also included two weekly support groups. Active intervention was 12 months with 12 month follow-up. Follow-up rate was 100%.

Control: 

The control condition was VOC only.

Findings: 

NET + VOC patients worked significantly more hours during the 12 month follow-up period, reached a significantly higher cumulative rate of competitive employment by the sixth quarter, and maintained significantly higher rates of employment.

Conclusions: 

NET training improved vocational outcomes, suggesting the value of combining cognitive remediation with other rehabilitation methods to enhance functional outcomes.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/18715755
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Effect of the early use of the anti-tumor necrosis factor adalimumab on the prevention of job loss in patients with early rheumatoid arthritis

Authors: 
Bell, M., Zito, W., Greig, T., & Wexler, B.
Year Published: 
2008
Publication: 
Arthritis Care & Research
Volume: 
59
Number: 
10
Pages: 
1467-1474
Publisher: 
American College of Rheumatology
Background: 

The impact of rheumatoid arthritis (RA) on work disability and job loss represents a significant economic burden. Recent developments in therapies targeted against tumor necrosis factor (TNF)have changed the approach to RA treatment by rapidly controlling the disease.

Purpose: 

To compare work disability and job loss in early rheumatoid arthritis (RA) patients receiving adalimumab plus methotrexate (adalimumab + MTX) versus MTX alone.

Setting: 

The setting included a variety of medical centers providing treatment for rheumatoid arthritis.

Sample: 

In this multicenter, randomized, controlled trial, patients with RA for <2 years who had never taken MTX and who self-reported work impairment were randomized to adalimumab + MTX or placebo + MTX for 56 weeks.

Data Collection: 

Primary outcome was job loss of any cause and/or imminent job loss at or after week 16. Secondary outcomes included disease activity, function (Health Assessment Questionnaire [HAQ] score), and RA quality of life (RAQoL) questionnaire score. Work was evaluated with work diaries and the RA Work Instability Scale.

Intervention: 

The intervention was adalimumab + MTX.

Control: 

The comparison was treatment using MTX alone.

Findings: 

Although job loss during the 56-week study was significantly lower with adalimumab + MTX (14 of 75 patients) compared with MTX alone (29 of 73 patients; P = 0.005), the primary endpoint was not met (12 of 75 versus 20 of 73 patients; P = 0.092), likely owing to early drop out in the MTX group. There were significant improvements in American College of Rheumatology 20% response criteria, 28-joint Disease Activity Score, HAQ, RAQoL, and working time lost in the adalimumab + MTX group. Twenty-four serious adverse events were reported in 17 participants, with no differences between groups.

Conclusions: 

Adalimumab + MTX reduced job loss and improved productivity in early RA when compared with MTX alone, which supports the early use of anti tumor necrosis factor therapy and suggests its cost efficacy.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/18821658
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Predictors of vocational recovery among young people with first-episode psychosis: Findings from a randomized controlled trial

Authors: 
Baksheev, G. N., Allott, K., Jackson, H. J., McGorry, P. D., & Killackey, E.
Year Published: 
2012
Publication: 
Psychiatric Rehabilitation Journal
Volume: 
35
Number: 
6
Pages: 
421-427
Publisher: 
American Psychological Association
Background: 

A substantial body of knowledge has demonstrated the benefits of the Individual Placement and Support (IPS) model among persons diagnosed with schizophrenia. The IPS model is a form of supported employment that is based on seven key principles, including a focus on securing competitive employment positions, attending to consumers' preferences, and integration with mental health treatment teams (Becker & Drake, 2003). Limited work, however, has examined whether vocational intervention in the early phase of psychosis might also lead to improved vocational outcomes. This is important to consider more fully as the first 5 years following psychosis onset is thought to be a critical period during which the peak levels of disability associated with psychosis emerge (Birchwood & Fiorillo, 2000).

Purpose: 

The purpose of this study was to examine demographic and clinical predictors of vocational recovery among young people with first-episode psychosis who participated in a randomized controlled trial (RCT) investigating the effectiveness of the supported employment model among this population.

Setting: 

The setting was a public mental health clinic in Melbourne Australia.

Sample: 

The study sample included 41 individuals aged 17-25 with mental illness.

Data Collection: 

The study compared Individual Placement and Support and treatment as usual with treatment as usual alone. A series of logistic regression analyses were conducted to assess the predictive power of demographic and clinical factors on vocational recovery.

Intervention: 

The intervention was individual placement and support with regular treatment.

Control: 

The comparison was treatment as usual.

Findings: 

The main finding was that demographic and clinical factors did not significantly predict vocational recovery in the final multivariate analysis. Vocational recovery was solely predicted by participant group. That is, participants who were randomized to receive IPS were over 16 times more likely to secure a competitive employment position or participate in an educational activity during the follow-up period when compared with participants who were randomized to treatment as usual.

Conclusions: 

It is critical that vocational services are introduced as part of an evidence-based, multidisciplinary approach in routine clinical care at early psychosis services. Further replication of these findings is indicated with a larger sample, particularly with the addition of cognitive training interventions to further improve vocational outcomes for young people with first-episode psychosis.

URL: 
http://psycnet.apa.org/journals/prj/35/6/421/
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Multidisciplinary rehabilitation for subacute low back pain: Graded activity or workplace intervention or both?: A randomized controlled trial

Authors: 
Anema, J. R., Steenstra, I. A., Bongers, P. M., de Vet, H. C. W., Knol, D. L., Loisel, P., & van Mechelen, W.
Year Published: 
2007
Publication: 
Spine
Volume: 
32
Number: 
3
Pages: 
291-298
Publisher: 
Lippincott Williams & Wilkins, Inc.
Background: 

Low back pain (LBP) is the most common and expensive musculoskeletal disorder in industrialized countries. LBP is frequently associated with persistent or recurrent disability and absence from work. High costs are mainly due to sick leave and disability. Effective interventions for LBP are needed to prevent long-term disability and promote early and safe return to work.

Purpose: 

To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP).

Setting: 

The setting was Dutch occupational health services and physiotherapy centers.

Sample: 

Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100).

Data Collection: 

Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave.

Intervention: 

The interventions were workplace assessment, work modifications, and case management.

Control: 

The comparison was usual care.

Findings: 

Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2–2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3–0.6; P < 0.001) and functional status. Combined intervention had no effect.

Conclusions: 

Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17268258
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Reduction of job loss in persons with rheumatic diseases receiving vocational rehabilitation

Authors: 
Allaire, S. A., Li, W., & LaValley, M. P.
Year Published: 
2003
Publication: 
Arthritis & Rheumatism
Volume: 
48
Number: 
11
Pages: 
3212-3218
Publisher: 
American College of Rheumatology
Background: 

Health-related job loss is a major consequence of rheumatic diseases. Incidence rates can be expected to increase because the portion of the US workforce that is 55 years of age and older is increasing. Vocational rehabilitation is one approach to addressing health-related job loss. However, there is a shortage of studies evaluating the effectiveness of vocational rehabilitation with this population.

Purpose: 

The purpose of this study was to evaluate the efficacy of vocational rehabilitation provided as primary prevention, using randomized controlled trial of vocational rehabilitation provided to persons with rheumatic diseases who were at risk for job loss, but while they were still working.

Setting: 

The primary setting for the study consisted of multiple workplaces in eastern Massachusetts. Some study components were conducted in participants' homes, state vocational rehabilitation agency offices, and public meeting places (i.e., libraries, restaurants, etc.).

Sample: 

Participants were 242 employed persons with a rheumatic disease who were at risk for job loss and who resided in eastern Massachusetts. Recruitment was carried out through rheumatologists, who sent letters about the study and a screening form to their patients who had a diagnosis of rheumatoid diseases. Participants were randomized into the treatment and control groups. Participants were overwhelmingly white females.

Data Collection: 

Information about job characteristics included the title and three main duties of participants primary job and the physical demands and autonomy of these jobs. Job type was classified according to 12 main categories in the Dictionary of Occupational Titles. Information about demographic, disease, and job characteristics was collected at baseline. The main outcome was time to the first of either permanent job loss, consisting of permanent disability or retirement, or temporary job loss. The demographic and disease characteristics of the experimental and control groups were compared by unpaired t-test or chi-square test. Poisson regression was used to analyze the counts of permanent and temporary job losses.

Intervention: 

The intervention consisted of vocational rehabilitation services designed to promote job retention. The intervention consisted of 3 components: job accommodation, vocational counseling and guidance, and education and self-advocacy. Service duration was from 5 to 9 months.

Control: 

Control group participants were mailed copies of the same pamphlets and flyers about how to manage health-related employment problems and available resources that the experimental group participants received.

Findings: 

At 48 months of follow-up, only 25 permanent and temporary job losses combined occurred in the experimental group, compared with 48 in the control group. Of permanent job losses, 12 occurred in the experimental group and 22 in the control group. Of temporary job losses, 13 occurred in the experimental group versus 26 in the control group. Beginning 12 months post-intervention, a greater percentage of experimental group participants than control group participants remained employed with no job loss. The difference between the groups increased
at 18 months and was sustained over 42 months.

Conclusions: 

Vocational rehabilitation interventions have the capacity to reduce job loss due to rheumatic disease and the high indirect costs associated with rheumatic diseases. Also, because the intervention was relatively brief and the effect persisted over 3.5 years of follow-up, it should be an inexpensive intervention to deliver.

URL: 
http://cicoach.com/pdf/ReductionofJobLossforpersonswithRheaumaticDiseasesthroughVocationalRehab.pdf
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes