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  • 1.
    Fahlén, Göran
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Goine, Hans
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Edlund, Curt
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Arrelöv, Britt
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Peter, Richard
    Effort-reward imbalance, "locked in" at work and long term sick leave2009In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 82, no 2, p. 191-197Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objective was to study the relationship between a situation characterized as being in a "locked-in" position (LIP) in occupation and/or place of work, Effort-reward imbalance (ERI), and long-term sick leave. METHODS: The study population derived from one section of a cross-sectional study SKA (sick-leave, culture and attitudes), and comprised all employees at the Swedish Social Insurance Agency responsible for management and compensation of illness in the working population. The analyses were performed for 2,951 women and 534 men who had complete data. Logistic regression was used to calculate odds ratio (OR) for ERI and sick-leave, the latter only for women. RESULTS: The results showed a strong association between LIP within the place of work and ERI (for women OR = 3.28 95% CI 2.65-4.07, and for men 2.74 1.75-4.30). Also LIP within occupation resulted in high ERI (for women OR = 1.96 1.57-2.41, and for men 1.92 1.22-3.03). In women, ERI (OR = 1.40 1.15-1.70) as well as LIP within place of work (1.88 1.50-2.36) and within occupation (1.48 1.12-1.86) were associated with sick leave. ERI showed a significant mediating effect between LIP and sick leave, within place of work and within occupation (Z value 2.20 and 2.88, respectively). CONCLUSIONS: High ERI is associated with a situation characterized by being locked-in within an occupation or/and within a place of work. The results thereby support the theoretical model of Effort-reward imbalance. The results show that high ERI and being locked in are associated with long-term sick leave. ERI is a potential mediator of the association between being locked in and sick leave.

  • 2.
    Sturesson, M.
    et al.
    Department of Community Medicine and Rehabilitation,Division of Occupational Therapy,Umeå University,Umeå,Sweden .
    Edlund, Curt
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Falkdal, A. H.
    Department of Community Medicine and Rehabilitation,Division of Occupational Therapy,Umeå University,Umeå,Sweden .
    Bernspång, B.
    Department of Community Medicine and Rehabilitation,Division of Occupational Therapy,Umeå University,Umeå,Sweden .
    Healthcare encounters and return to work: a qualitative study on sick-listed patients' experiences2014In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 15, no 4, p. 464-475Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sickness absence is a complex phenomenon affected by aspects other than disease. One important factor that can affect sick leave is the individual's experience of healthcare encounters. It is therefore essential to consider the quality of the encounter with health professionals and its impact on the patient's rehabilitation and return to work. AIM: The aim was to explore how sick-listed patients in Sweden perceive their contact with healthcare professionals in primary healthcare and to analyse what they view as crucial components for returning to work. METHODS: A qualitative approach was used. Data were collected by semi-structured telephonic interviews with patients who were or had been on sick leave. The transcribed interview text was analysed according to qualitative content analysis. FINDINGS: The analysis revealed two themes that highlight important areas for persons on sick leave in their healthcare encounters. The theme 'Trust in the relationship' contains categories describing the patients' feelings of participation, and of being believed, confirmed, and listened to, and also dedication on the part of healthcare providers. Healthcare encounters that were characterised by professionalism, knowledge, continuity, and a holistic approach seemed to create trust. The theme 'Structure and balance' contains the participants' views on important factors that could support the return-to-work process. All participants stated the importance of follow-up and a plan for rehabilitation. Sick leave itself can make a person passive, and participants in this study asked for support to balance activity, exercise, and work demands, which could facilitate their return to work. CONCLUSION: Healthcare professionals can facilitate sick-listed persons' rehabilitation back to work by providing a clear structure in the process and support in occupational balance. The healthcare encounters must build on a mutual trust.

  • 3.
    Sturesson, Marine
    et al.
    Umea Univ, Dept Community Med & Rehabil, Div Occupat Therapy, SE-90187 Umea, Sweden..
    Bylund, Sonya Hornqvist
    Cty Council Vasterbotten, Umea, Sweden..
    Edlund, Curt
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Falkdal, Annie Hansen
    Umea Univ, Dept Community Med & Rehabil, Div Occupat Therapy, SE-90187 Umea, Sweden..
    Bernspang, Birgita
    Umea Univ, Dept Community Med & Rehabil, Div Occupat Therapy, SE-90187 Umea, Sweden..
    Quality in sickness certificates in a Swedish social security system perspective2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 8, p. 841-847Article in journal (Refereed)
    Abstract [en]

    Aim: In Sweden, the information in the sickness certificate is crucially important for the sick-listed person as well as for the Swedish Social Insurance Agency and the sick-listed person's employer. The certificate is used as the basis for deciding whether a person is entitled to sickness benefits. Further, it communicates information significant for the return-to-work process. The aim of the study was to evaluate the quality of sickness certificates issued in primary health care and examine if the patients' or physicians' gender influences the information in the sickness certificate. Methods: An insurance specialist at the Swedish Social Insurance Agency assessed the quality of the stated information in a sample of 323 certificates issued by 146 different general practitioners at 29 different primary health care centres in northern Sweden. Results: Thirty-four percent of the certificates did not contain sufficient information requested. The areas of the certificates in need of supplementary information were mainly the descriptions of impairment of body function and activity limitation. More certificates issued for women than certificates issued for men lacked the required information. Full-time sick leave was more often prescribed for male patients than for female. Significant differences between certificates issued for women and certificates issued for men appeared in the group of musculoskeletal diseases. No differences in quality aspects connected to physicians' gender were found. Conclusion: Our study indicates a need for increased knowledge about the descriptions of functioning for sick-listed persons; more cooperation between health professionals in primary health care and a better gender awareness in health care encounters.

  • 4.
    Sturesson, Marine
    et al.
    Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, SE-901 87 Umeå, Sweden .
    Edlund, Curt
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Falkdal, Annie Hansen
    Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, SE-901 87 Umeå, Sweden .
    Fjellman-Wiklund, Anncristine
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Bernspång, Birgitta
    Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, SE-901 87 Umeå, Sweden .
    Work ability as obscure, complex and unique: Views of Swedish occupational therapists and physicians2013In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 45, no 1, p. 117-128Article in journal (Refereed)
    Abstract [en]

    The concept of work ability is not clearly defined although it has a central place in vocational rehabilitation. Several health professions are involved in assessing work ability, physicians and occupational therapists are two of these. OBJECTIVE: The purpose of this study was to explore occupational therapist and physician views about work ability and experiences in assessing work ability. PARTICIPANTS: Fourteen physicians and 23 occupational therapists participated in seven focus group discussions that were audio taped and transcribed verbatim. METHODS: Qualitative content analysis was used. Each author performed an individual preliminary analysis. These analyses were later discussed and refined in the research team and a workshop. The final categorization resulted in one theme, four categories and 13 sub-categories. RESULTS: The overall theme expressed work ability as an obscure, complex and unique concept. The four categories illustrate the affecting factors and confirm the complex structure of work ability: the person, the context of life, the work, and the society. Physicians expressed greater difficulty in assessing work ability than occupational therapists did, because they have fewer instruments to access this concept. CONCLUSIONS: Assessment of work ability requires team cooperation with several different professionals. Cooperation could increase accuracy in issuing sickness certification and strengthens the ability of identifying individual requirements for rehabilitation.

  • 5.
    Sturesson, Marine
    et al.
    Umeå Universitet.
    Hörnqvist Bylund, Sonya
    Umeå Universitet.
    Edlund, Curt
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hansen Falkdal, Annie
    Umeå Universitet.
    Bernspång, Birgitta
    Umeå Universitet.
    Collaboration in work ability assessment for sick-listed persons in primary healthcare2020In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 65, no 2, p. 409-420Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    General practitioners (GPs) have expressed difficulties in issuing sickness certificates and problems may arise if this work is not performed in an adequate manner. There is scant knowledge about how collaboration with other professions could be organized to enhance this work.

    OBJECTIVE:

    Evaluate the feasibility of occupational therapists (OTs) performing supplementary assessments for persons on sick leave.

    METHODS:

    Four healthcare centres (HCs) tested a working approach intervention where sick-listed patients were offered a complementary occupational therapy assessment. The OT assessments were intended to provide useful information for GP issued extended sickness certificates. Data on sick leave, sickness certificates and patient questionnaires were collected at different HCs. Interviews were conducted with GPs and OTs and the Consolidated Framework for Implementation Research was used to analyse the intervention’s implementation.

    RESULTS:

    No major differences in the sickness certificate quality was found. Available data on sick leave increased for all HCs during the project. Not all GPs used the OT assessments, which indicates that the implementation of the intervention was insufficient.

    CONCLUSION:

    Testing a new working approach in primary healthcare requires an implementation strategy. To improve sickness certification quality, this work needs to be prioritized as an important healthcare task.

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