Take Home Messages:

There is evidence that vocational rehabilitation interventions which pay attention to training, work accommodations and feelings of self-confidence in dealing with work-related problems are effective.

Why the research matters:

Helping people stay at work is more effective than helping them return to work. 

What the research involved:

This review summarised information from research that evaluated problem solving and empowerment approaches to job retention for people with long term health problems. The original studies were done in the period 1998 to 2004.

The studies included employees who had one of the following chronic illnesses: diabetes mellitus, rheumatic diseases, hearing disorders, multiple sclerosis, inflammatory bowel disease, epilepsy, chronic kidney failure, chronic obstructive pulmonary disease (COPD) and asthma.

Summary of research findings:

In Europe and America it was found people with a chronic disorder were employed less often than the general population. For example, in the Netherlands 45pc of people with chronic disorders were employed, compared with 60pc of the rest of the population.

It was found patients with chronic diseases needed education about self-management and empowerment, and successful rehabilitation was characterised by the possession of such interpersonal skills as:

• A sense of control, self-efficacy and coping skills
• Decisiveness in maintaining employment - self acceptance and assertiveness
• Critical awareness of the resources needed
• Knowledge and skills for managing resources
• Behavioural components such as participatory behaviour and coping behaviours
• A level of illness severity at work which could be managed or accommodated
• Social support in the workplace - sufficient accommodation
• Knowledge about the disorder and its consequences and legal rights regarding education, counselling and training.

A further consideration was the need for education of doctors and psychiatrists, to encourage them to change their traditional approach to these patients.

It was found:

• Specialists do not always have knowledge of return to work programs and need to pay attention to work-related problems of patients, especially recruitment programs
• Intervention may focus on different aspects of the employee and his/her environment model to understand work-related problems and work disability
• Specialists need to also take into account and understand the importance of self-efficacy and self-confidence as an intermediate factor improved by counselling, role playing and other training, for example, learning through personal experience and observation and through verbal persuasion such as exchanging experiences in group meetings and counselling sessions
• Future research needs to have a strong study design which acquires more evidence of effectiveness, including job retention figures and behavioural and psychosocial measures combined with pre and post tests.

Original Research:

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.

Varekamp I, Verbeek JH, van Dijk FJ.

Int Arch Occup Environ Health. 2006 Nov;80(2):87-97. Epub 2006 Jun 7.

Link to PubMed abstract