How can we help employees with chronic diseases to stay at work? A review of interventions aimed at job retention and based on an empowerment perspective

Abstract

Objectives: A growing number of persons aged 16–65 is hampered by a chronic condition in performing job activities. Some of them quit the labour market prematurely. Vocational rehabilitation used to focus on (re)entering the labour market. Recently more attention is paid to interventions aimed at job retention. Some of these use an empowerment perspective. The objective of this study is to describe the characteristics, feasibility and effectiveness of such vocational rehabilitation interventions in order to decide which approaches are fruitful. Method: The Medline, Embase, Cinahl and Psycinfo databases were systematically researched for studies published between 1988 and March 2004. Studies were included if they were experimental, included an intervention that aimed at job retention by means of solving work-related problems, used an empowerment perspective and concerned employees with one of the following chronic illnesses: diabetes mellitus, rheumatic diseases, hearing disorders, multiple sclerosis, inflammatory bowel disease, epilepsy, chronic kidney failure, COPD and asthma. Results: Nine studies were detected. The aims of the intervention programs were to improve psychosocial skills or implement work accommodations. They were structured as individual (6×) or group programmes (3×). They used methods like education (9×), assessment (7×), counselling (5×), training or role playing (5×). The most important outcome measures were employment status (5×), actions to arrange work accommodations (3×), and psychosocial measures like self-efficacy and social competence (3×). Employment status was claimed to be positively influenced in four out of five studies, obtaining work accommodations was successful in all three studies and psychological outcome measures improved in two out of three studies. Conclusions: There is some evidence that vocational rehabilitation interventions that pay attention to training in requesting work accommodations and feelings of self-confidence or self-efficacy in dealing with work-related problems are effective. There is no evidence for greater effectiveness of group programs compared to individual programs. Attention has to be paid to feasibility aspects such as recruitment of participants and cooperation between medical professionals, occupational physicians, and vocational rehabilitation experts. Medical specialists and nursing specialists should pay more attention to work. Although many studies claim effectiveness, evidence for this was often weak due to short follow-up and the lack of control groups. More rigorous evaluation is needed.

Appendix: Search terms

Medline

Search strategy for work-related terms (explode function), Mesh terms or free text words (all fields): “return to work”[All Fields] OR “workplace”[MeSH Terms] OR “employment”[MeSH Terms] OR “employment status”[All Fields] OR “work disability”[All Fields] OR “sick leave”[MeSH Terms] OR “job satisfaction”[MeSH Terms] OR “work ability”[All Fields] OR employability[All Fields] OR “occupational medicine”[MeSH Terms] OR “rehabilitation, vocational”[MeSH Terms] OR “occupational health”[MeSH Terms] OR “disability management”[All Fields].

Search terms for chronic diseases, all Mesh major topic, except where otherwise specified: diabetes mellitus/rheumatic diseases/hearing loss [Majr] NOT deafness [Mesh] OR hearing impaired persons [Majr]/inflammatory bowel diseases/multiple sclerosis/kidney failure, chronic/epilepsy/asthma OR pulmonary disease, chronic obstructive.

Embase

Search strategy for work-related terms [subject headings, not exploded except where otherwise specified (exp), not focused, or text words (mp)]: work resumption OR workplace OR employment OR employment status(mp) OR work disability OR absenteeism OR job satisfaction OR work ability (mp) OR work capacity OR job performance OR employability OR occupational medicine OR vocational rehabilitation OR occupational health OR occupational health service OR disability management (mp)

Search terms for chronic diseases, [all terms exploded and focused, unless otherwise specified): diabetes mellitus/rheumatic diseases/hearing loss (not exp)/Crohn disease (not exp) or ulcerative colitis (not exp)/multiple sclerosis/chronic kidney failure/seizure, epilepsy and convulsion/chronic obstructive lung disease or asthma.

Cinahl

Search strategy for work-related terms [subject headings, not exploded except where otherwise specified, and not focused, or text words (mp)]: job re-entry OR employment (exp) OR work disability (mp) OR work capacity evaluation OR sick leave OR disabled OR job satisfaction OR work ability (mp) OR employability (mp) OR occupational health services (exp) OR rehabilitation, vocational OR disability management (mp) OR job performance.

Search terms for chronic diseases, (all terms exploded and focused): diabetes mellitus/rheumatic diseases/hearing loss, partial/inflammatory bowel diseases/multiple sclerosis/kidney failure, chronic/seizures or epilepsy/lung diseases, obstructive.

Psycinfo

Search strategy for work-related terms: [free text words or subject headings (DE)]: [(job-satisfaction) in DE] or [(employee-absenteeism) in DE] or [(job-performance) in DE] or (work-disability) or [(employment-status) in DE] or [(disabled-personnel) in DE] or [(reemployment) in DE] or (return-to-work) or (job-retention) or (job-maintenance) or [(disability-management) in DE] or (occupational-health) or [(vocational-rehabilitation) in DE] or (occupational-medicine) or [(employability) in DE] or [(occupational-adjustment) in DE] or (work-ability)

Search terms for chronic diseases (all subject heading, unless otherwise specified): diabetes-mellitus/rheumatoid-arthritis/(hearing-disorders not deaf) or partially-hearing-impaired/ulcerative-colitis or colon-disorders/multiple-sclerosis/kidney-diseases/epilepsy or epileptic-seizures or convulsions/asthma or lung disorders or copd (free textsword).