Usability of self-reported assessment of work functioning in municipal occupational rehabilitation teams: A qualitative study.

Aims: This study aimed to explore (1) whether self-reported assessment on work-related functioning, workability, return-to-work (RTW) self-efficacy, and expectation was useful in the professionals' assessment of sick-listed workers and could guide referral to interventions and (2) whether self-reporting in addition to "usual practice" could improve the RTW dialog and involvement in case management. Methods: The qualitative study took place in two municipal job centers in 2021. The assessment was based on the Work Rehabilitation Questionnaire, RTW-Self-efficacy Scale-19, and single items of self-rated health, workability, and RTW expectations. Sick-listed workers (n = 36) were interviewed by telephone. Three focus-group interviews were conducted with professionals who had used the questionnaire. Data were coded and analyzed thematically. Results: Three themes with seven subthemes emerged: (1) accessibility; (2) one tool in the RTW toolbox (subthemes: a supplementary tool, a tool for reflection, facilitating interdisciplinary communication, and enhancing active participation); and (3) the value of "ticking boxes" (subthemes: good days, bad days, the issue of power, and the cultural meaning of words). Conclusion: The professionals would not recommend the present questionnaire for use during their rehabilitation team meeting for assessment, interdisciplinary communication, or choice of interventions. However, using the parts assessing RTW self-efficacy and expectation combined with a dialog may be of value early in the RTW process. The self-reporting assessment tool was perceived to be meaningful to some sick-listed workers, as it provided reflections on important aspects of the RTW process. Some workers believed that it might contribute to the rehabilitation team, and thus, it could improve their involvement.

Population differences in health-related quality of life between cancer survivors and controls: Does low educational attainment widen the gap?

Aims: This study aimed to compare health-related quality of life (HRQOL) among cancer survivors and controls in the Danish population, with special attention given to the impact of low educational attainment. Comparisons were made at population level and for subgroups stratified by education. Furthermore, comparisons were made for all cancer diagnoses combined and for the 14 most prevalent cancer sites and 'other cancer sites'. Finally, the importance of time since initial diagnosis was examined. Methods: HRQOL was measured using the physical component score (PCS) and mental component score (MCS) of the 12-item Short-Form Health Survey version 2 in a population-based survey. By linking data with the Danish Cancer Registry, 11,166 cancer survivors and 151,117 individuals with no history of cancer were identified. Results: HRQOL was reduced in cancer survivors for all cancers combined and most cancer sites. Differences were found at population level and stratified by educational attainment. PCS was reduced to a similar extent in the three educational groups, whereas MCS was reduced slightly more in the low than in the high educational attainment group. HRQOL increased with time since initial diagnosis during the first years. Conclusions: Cancer survivors had lower HRQOL than controls, and HRQOL was lower in the low than in the high educational attainment group. However, low educational attainment did not widen the gap in HRQOL following a cancer diagnosis. Despite this, the combined effect of low educational attainment and a cancer diagnosis markedly reduced HRQOL in some cancer survivors. The study identified groups of cancer survivors with low HRQOL who may have unmet rehabilitation needs.

Cross-cultural translation and adaptation of the Readiness for Return To Work questionnaire for Dutch cancer survivors.

OBJECTIVE: Effective interventions supporting cancer survivors in work participation are lacking, possibly due to the poor fit between interventions and cancer survivors' needs. The 'Readiness for Return To Work' (RRTW) questionnaire could facilitate intervention development tailored to cancer survivors' needs. We performed a cross-cultural translation and adaptation of this questionnaire into Dutch and pre-tested its psychometric properties among cancer survivors. METHODS: Questionnaire translation and adaptation were conducted using a systematic approach of: forward translation, synthesis, backward translation, consolidation of translations with an expert committee, and pre-testing. Pre-testing consisted of interviewing 40 cancer survivors, who completed the questionnaire. RESULTS: The translated and adapted RRTW questionnaire showed reasonable psychometric properties, that is high item-to-stage correlations and internal consistency for all RRTW stages, except for the prepared for action - self-evaluative stage. CONCLUSIONS: The translated and adapted RRTW questionnaire may be useful for tailoring interventions to support cancer survivors in returning to and maintaining at work. However, some items showed poor psychometric properties and several factors, important for work participation, are not captured, for example personal, disease-, treatment- and/or work-related characteristics. We recommend to further test the RRTW questionnaire and to use it in combination with additional measurement instruments when developing tailored work participation interventions.

Validation of the Return To Work Self-Efficacy questionnaire in a population of employees undergoing treatment for cancer.

OBJECTIVE: Several Return To Work Self-Efficacy (RTWSE) questionnaires have been developed and found relevant to understanding the return to work (RTW) process of employees with various health problems, including employees with cancer. The aim of the present study was to examine the reliability and validity of the Danish 19-item RTWSE questionnaire (RTWSE-19DK ) in a sample of employees with cancer. METHODS: Employees undergoing treatment for cancer completed the RTWSE-19DK at baseline (n = 68) and at 1 week (n = 49). Additional questionnaires measured work ability, cancer-related self-efficacy and psychological distress. Internal consistency, test-retest reliability and construct validity were examined. RESULTS: The total and the three subscales of the RTWSE-19DK showed good internal consistencies with Cronbach's alphas between 0.90 and 0.97 and high test-retest reliability with Intraclass Correlation Coefficients between 0.84 and 0.90. Examining construct validity, the RTWSE-19DK showed medium and large correlations with cancer-related self-efficacy (r = 0.54), mental work ability (r = 0.51), and general work ability (r = 0.35), small correlations with physical work ability (r = 0.26) and anxiety (r = -0.10), and no correlations with depression (r = -0.08) and test date (r = 0.03). CONCLUSION: The RTWSE-19DK showed good reliability and adequate validity in employees undergoing cancer treatment. In clinical practice, the RTWSE-19 questionnaire may help practitioners identify areas of concern in the RTW process of cancer patients.

Prediction of 2-year work participation in sickness absentees with neck or shoulder pain: the contribution of demographic, patient-reported, clinical and imaging information.

BACKGROUND: In cases of neck and shoulder pain, the responsibility for assessing work prognosis is held by clinicians with access to different domains of information. One of these domains is magnetic resonance imaging (MRI), and although MRI is increasingly used, it is unknown which domains of information contribute the most to the prediction of work prognosis. This retrospective cohort study explored the contribution of demographic, patient-reported, clinical, and MRI information to the prediction of work participation in sickness absentees with neck or shoulder pain. METHODS: From a secondary care setting, 168 sickness absentees with neck or shoulder pain were included. Based on registry data, a successful work outcome was defined as ≥50% work participation score (WPS) from Weeks 1 to 104 after enrolment. Prognostic variables were categorized into four domains (demographic, patient-reported, clinical, and MRI) resembling the order of information obtained in a clinical setting. Crude logistic regression analyses were used to identify prognostic variables for each domain (p < 0.2). This was followed by multivariable analyses including the identified variables in a domain-wise order. For each added domain, the probability of successful WPS was dichotomized leaving two possible classifications: ≥ 50% chance of successful WPS or not. In cross-tabulations of chance and the actual WPS outcome, positive and negative predictive values (PPV and NPV), sensitivity, specificity and area under the curve (AUC) were calculated. RESULTS: The combination of demographic and patient-reported variables yielded an NPV of 0.72 and a PPV of 0.67, while specificity was 0.82, sensitivity 0.54 and AUC 0.77. None of these values improved notably by adding clinical and MRI variables as predictors of successful WPS. CONCLUSIONS: These results suggest that - among sickness absentees with neck or shoulder pain - clinical and MRI variables provide no additional information for the prediction of work participation compared with only demographic and patient-reported information.

Reading and writing difficulties and self-rated health among Danish adolescents: cross-sectional study from the FOCA cohort.

BACKGROUND: People struggling with reading and writing difficulties may have poor odds of achieving a good and healthy life. Reading and writing difficulties are independent risk factors for not completing education and unemployment, which are essential in order to obtain a good and healthy life. Therefore, the purpose of this study was to investigate the association between reading and writing difficulties and self-rated health among adolescents, and to investigate how mental health mediates the association. METHODS: A cross-sectional study was performed based on the FOCA cohort, a Danish population-based survey among 9th grade pupils, mainly aged 15- and 16-years old, gathered during the first months of 2017. The study population contained 9748 pupils. The dependent variable was a yes-or-no answer to experiencing limitations in every-day life due to reading and writing difficulties. The independent variable was measured with the SF-36 self-rated health question, dichotomised in high (very good, excellent) and low (good, fair, poor). A logistic regression model was applied. RESULTS: Among the study population 953 (9.8%) pupils reported having reading and writing difficulties. The adjusted OR of having a low self-rated health was significantly higher among adolescents with reading and writing difficulties than without (1.37 (95% CI: 1.14-1.66)). Loneliness and perceived stress, explained a minor part of the association, OR attenuated from 1.77 (95% CI: 1.51-2.09) in the crude model to 1.47 (95% CI: 1.23-1.74) in a more adjusted model. CONCLUSION: Adolescents with reading and writing difficulties are not only struggling with reading and writing difficulties but experiencing also low self-rated health. Mental health only explained a minor part of this association. To clarify whether causal relationship between reading and writing difficulties and self-rated health may exist, longitudinal studies are needed. If support for the hypothesised causality is found early identification of reading and writing difficulties is important, to prevent future health inequality in adolescents with reading and writing difficulties.

A systematic review of interventions to retain chronically ill occupationally active employees in work: can findings be transferred to cancer survivors?

Background: Interventions supporting occupationally active cancer survivors to retain work and prevent adverse work outcomes, beyond return to work, are scarce. As lessons may be learned from interventions that have been evaluated in working employees with other chronic diseases than cancer, the objective of this review was to summarize the characteristics of these interventions. Material and methods: Studies were identified through computerized PubMed, EMBASE and PsycINFO searches, without any language or year of publication restrictions. Randomized controlled trials were included if they evaluated the effectiveness of interventions to retain chronically ill occupationally active employees in work. Two authors independently extracted data from each study and assessed the risk of bias. Results: The search identified 536 unique studies, of which 18 met the inclusion criteria. All included studies had a low risk of bias. (Psycho-)educational interventions for chronically ill employees to retain work were evaluated in two studies, physical interventions in three studies, vocational/work-related interventions in five studies, and multidisciplinary interventions in eight studies. Vocational/work-related and multidisciplinary interventions, and the involvement of professional trainers, showed the most promising effects in retaining employees. However, small sample sizes may have caused imprecise effect estimates. Conclusion: Based on studies focusing on occupationally active employees with other chronic diseases than cancer, it is advised that working cancer survivors should be offered tailored interventions, by skilled trainers, to sustain their employability. Shared goal setting, with relevant stakeholders, and vocational components should be included, potentially as part of a multidisciplinary intervention.

Cross-Cultural Adaptation, Reliability and Validity of the Danish Version of the Readiness for Return to Work Instrument.

The objective of the present study was to translate and validate the Canadian Readiness for Return To Work instrument (RRTW-CA) into a Danish version (RRTWDK) by testing its test-retest and internal consistency reliability and its structural and construct validity. Cross-cultural adaptation of the six-staged RRTW-CA instrument was performed in a standardised, systematic five-step-procedure; forward translation, panel synthesis of the translation, back translation, consolidation and revision by researchers, and finally pre-testing. This RRTW-DK beta-version was tested for its psychometric properties by intra-class correlation coefficient and standard error of measurement (n = 114), Cronbach's alpha (n = 471), confirmatory factor analyses (n = 373), and Spearman's rank correlation coefficient (n = 436) in sickness beneficiaries from a municipal employment agency and hospital wards. The original RRTW-CA stage structure could not be confirmed in the RRTWDK. The psychometric properties were thus inconclusive. The RRTW-DK cannot be recommended for use in the current version as the RRTW construct is questionable. The RRTW construct needs further exploration, preferably in a population that is homogeneous with regard to cause of sickness, disability duration and age.

Degenerative findings on MRI of the cervical spine: an inter- and intra-rater reliability study.

Background: Knowledge about the assessment reliability of common cervical spine changes is a prerequisite for precise and consistent communication about Magnetic Resonance Imaging (MRI) findings. The purpose of this study was to determine the inter- and intra-rater reliability of degenerative findings when assessing cervical spine MRI. Methods: Fifty cervical spine MRIs from subjects with neck pain were used. A radiologist, a chiropractor and a second-year resident of rheumatology independently assessed kyphosis, disc height, disc contour, vertebral endplate signal changes, spinal canal stenosis, neural foraminal stenosis, and osteoarthritis of the uncovertebral and zygapophyseal joints. An evaluation manual was composed containing classifications and illustrative examples, and ten of the MRIs were evaluated twice followed by consensus meetings to refine the classifications. Next, the three readers independently assessed the full sample. Reliability measures were reported using prevalence estimates and unweighted kappa (Κ) statistics. Results: The overall inter-rater reliability was substantial (Κ ≥ 0.61) for the majority of variables and moderate only for zygapophyseal osteoarthritis (Κ = 0.56). Intra-rater reliability estimates were higher for all findings. Conclusions: The present classifications for some of the most common cervical degenerative findings yielded mainly substantial inter-rater reliability estimates and substantial to almost perfect intra-rater reliability estimates. . Trial registration: Regional Data Protection Agency (J.no. 1-16-02-86-16). The letter of exemption from the Regional Ethical Committee is available from the author on request (case no. 86 / 2017).

Effect of the patient education - Learning and Coping strategies - in cardiac rehabilitation on return to work at one year: a randomised controlled trial show (LC-REHAB).

BACKGROUND: Personal resources are identified as important for the ability to return to work (RTW) for patients with ischaemic heart disease (IHD) or heart failure (HF) undergoing cardiac rehabilitation (CR). The patient education 'Learning and Coping' (LC) addresses personal resources through a pedagogical approach. This trial aimed to assess effect of adding LC strategies in CR compared to standard CR measured on RTW status at one-year follow-up after CR. METHODS: In an open parallel randomised controlled trial, patients with IHD or HF were block-randomised in a 1:1 ratio to the LC arm (LC plus CR) or the control arm (CR alone) across three Danish hospital units. Eligible patients were aged 18 to ≤60 and had not left the labour market. The intervention was developed from an inductive pedagogical approach consisting of individual interviews and group based teaching by health professionals with experienced patients as co-educators. The control arm consisted of deductive teaching (standard CR). RTW status was derived from the Danish Register for Evaluation of Marginalisation (DREAM). Blinding was not possible. The effect was evaluated by logistic regression analysis and reported as crude and adjusted odds ratios (OR) with 95% confidence interval (CI). RESULTS: The population for the present analysis was N = 244 (LC arm: n = 119 versus control arm: n = 125). No difference in RTW status was found at one year across arms (LC arm: 64.7% versus control arm: 68.8%, adjusted odds ratio OR: 0.76, 95% CI: 0.43-1.31). CONCLUSION: Addition of LC strategies in CR showed no improvement in RTW at one year follow-up. TRIAL REGISTRATION: www.clinicaltrials.gov identifier NCT01668394. First Posted: August 20, 2012.

Return to Work in Employees on Sick Leave due to Neck or Shoulder Pain: A Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention with One-Year Register-Based Follow-Up.

Purpose The aim of this study was to evaluate the effect of a multidisciplinary intervention (MDI) compared to a brief intervention (BI) with respect to return to work (RTW), pain and disability in workers on sick leave because of neck or shoulder pain. Methods 168 study participants with sickness absence for 4-16 weeks due to neck or shoulder pain were enrolled in a hospital-based clinical study and randomized to either MDI or BI. The primary outcome was RTW obtained by a national registry on public transfer payments. Secondary outcomes were self-reported pain and disability levels. One-year follow-up RTW rates were estimated by Cox proportional hazard regression adjusted for gender, age, sick leave prior to inclusion, part-time sick leave and clinical diagnosis. Secondary outcomes were analysed using logistic and linear regression analysis for pain and disability, respectively. Results In the MDI group, 50 participants (59%) experienced four or more continuous weeks of RTW while 48 (58%) returned to work in the BI group during the 1 year of follow-up. Results showed a statistically non significant tendency towards a lower rate of RTW in the MDI group than in the BI group (adjusted HR = 0.84, 95% CI 0.54, 1.31). There were no statistically significant differences in secondary outcomes between the MDI and BI groups. Conclusion The brief and the multidisciplinary interventions performed equally with respect to both primary and secondary outcomes. The added focus on RTW in the multidisciplinary group did not improve RTW rates in this group.

Labour market participation and sick leave among patients diagnosed with myasthenia gravis in Denmark 1997-2011: a Danish nationwide cohort study.

BACKGROUND: To examine labour market participation and long-term sick leave following a diagnosis with myasthenia gravis (MG) compared with the general Danish population and for specific subgroups of MG patients. METHODS: A nationwide matched cohort study from 1997 to 2011 using data from population-based medical and social registries. The study includes 330 MG patients aged 18 to 65 years old identified from hospital diagnoses and dispensed prescriptions, and twenty references from the Danish population matching each MG patient on age, gender, and profession. Main outcome measures are labour market participation (yes/no) and long-term sick leave ≥9 weeks (yes/no) with follow-up at 1- and 2 years after the time of MG diagnosis or match. Based on complete person-level information on all public transfer payments in Denmark, persons having no labour market participation are defined as individuals receiving social benefits for severely reduced workability, flexijob, and disability pension. RESULTS: MG is consistently associated with higher odds of having no labour market participation and long-term sick leave compared with the general Danish population (no labour market participation & ≥9 weeks sick leave at 2-year follow-up, adjusted OR (95% CI): 5.76 (4.13 to 8.04) & 8.60 (6.60 to 11.23)). Among MG patients, females and patients treated with both acetylcholinesterase inhibitors and immunosuppression have higher odds of lost labour market participation and long-term sick leave. CONCLUSIONS: This study suggests that MG patients have almost 6 times higher odds of no labour market participation and almost 9 times higher odds of long-term sick leave 2 years after diagnosis compared with the general Danish population. In particular female MG patients and patients treated with both acetylcholinesterase and immunosuppression have high odds of a negative labour market outcome. Future research should focus on predictors in workplace and labour market policy of labour market participation among MG patients.

Effects of a randomized controlled intervention trial on return to work and health care utilization after long-term sickness absence.

BACKGROUND: The aim of the RCT study was to investigate if the effect of a multidisciplinary intervention on return to work (RTW) and health care utilization differed by participants' self-reported health status at baseline, defined by a) level of somatic symptoms, b) health anxiety and c) self-reported general health. METHODS: A total of 443 individuals were randomized to the intervention (n = 301) or the control group (n = 142) and responded to a questionnaire measuring health status at baseline. Participants were followed in registries measuring RTW and health care utilization. Relative risk (RR) and odds ratio (OR) were used as measures of associations. Results were adjusted for gender, age, educational level, work ability and previous sick leave. RESULTS: Among all responders we found no effect of the intervention on RTW. Among participants with low health anxiety, the one-year probability of RTW was lower in the intervention than in the control group (RR = 0.79 95 % CI 0.68-0.93), but for those with high health anxiety there was no difference between the groups (RR = 1.15 95 % CI 0.84-1.57). Neither general health nor somatic symptoms modified the effect of the intervention on RTW. The intervention had no effect on health care utilization. CONCLUSIONS: The multidisciplinary intervention did not facilitate RTW or decrease health care utilization compared to ordinary case management in subgroups with multiple somatic symptoms, health anxiety or low self-rated health. However, the intervention resulted in a reduced chance of RTW among participants with low health anxiety levels. TRIAL REGISTRATION: ISRCTN43004323 , and ISRCTN51445682.

Cross-cultural adaptation and validation of the Danish version of the 19-item return-to-work self-efficacy (RTWSE-19) questionnaire.

OBJECTIVES: The aim of this study was to perform a cross-cultural adaptation of the return-to-work self-efficacy (RTWSE-19) scale into Danish and test the reliability, validity and responsiveness of the final version. METHODS: The adaptation process followed standard guidelines and the pretest was performed on 40 sickness absence beneficiaries. Tests of reliability, validity and responsiveness of the final version was performed on 782 participants of whom 440 (56%) responded. For the sub- and global scales, internal consistency was evaluated by Cronbach's alpha and reproducibility using paired t-test and intraclass correlation coefficient (ICC), respectively Responsiveness was evaluated by paired t-test and the association between RTWSE-19 and job status at ten weeks was tested in a logistic regression model, adjusted for gender, age and baseline job status. RESULTS: The face validity and reliability of the Danish version of the RTWSE-19 questionnaire were satisfactory. The internal consistency (alpha) for the three subscales ranged from 0.93 to 0.97. A test-retest showed no difference as well as high ICC between scale scores at baseline and one week later. The content validity of the final version was confirmed. High baseline RTWSE-19 level was associated with being at work after ten weeks odds ratio (OR) 3.24, 95% confidence interval (95% CI) 1.48-7.07. CONCLUSIONS: The RTWSE-19 cross-cultural translation to Danish was performed satisfactorily. A modified final version was produced, and the test of the instrument's reliability and validity showed that the psychometric properties of the questionnaire were partly confirmed. The instrument may be useful in rehabilitation practice to guide further assessment, goal setting and RTW decision-making.

Attitudes towards sickness absence and sickness presenteeism in health and care sectors in Norway and Denmark: a qualitative study.

BACKGROUND: In the health and care sector, sickness absence and sickness presenteeism are frequent phenomena and constitute a field in need of exploration. Attitudes towards sickness absence involve also attitudes towards sickness presenteeism, i.e. going to work while sick, confirmed by previous studies. Sickness behavior, reflecting attitudes on work absence, could differ between countries and influence absence rates. But little is known about attitudes towards sickness absence and sickness presenteeism in the health and care sectors in Norway and Denmark. The aim of the present paper is therefore to explore attitudes towards sickness absence and sickness presenteeism among nursing home employees in both countries. METHODS: Eight focus group discussions (FGDs) were conducted using a semi-structured interview guide, the main attention of which was attitudes towards sickness absence and sickness presenteeism. FGDs were conducted in two nursing homes in Norway and two in Denmark, with different geographic locations: one in a rural area and one in an urban area in each country. FGDs were recorded, transcribed and analyzed using framework analysis to identify major themes and explanatory patterns. RESULTS: Four major significant themes were identified from the FGDs: a) sickness absence and sickness presenteeism, b) acceptable causes of sickness absence, c) job identity, and d) organization of work and physical aspects of the workplace. Our analyses showed that social commitment and loyalty to residents and colleagues was important for sickness absence and sickness presenteeism, as were perceived acceptable and non-acceptable reasons for sickness absence. Organization of work and physical aspects of the workplace were also found to have an influence on attitudes towards sickness absence. CONCLUSIONS: The general interpretation of the findings was that attitudes towards sickness absence and sickness presenteeism among nursing home employees were embedded in situational patterns of moral relationships and were connected to a specific job identity. These patterns were constituted by the perception of colleagues, the social commitment to residents, and they influence on what was deemed as acceptable and non-acceptable reasons for sickness absence. In other words, attitudes towards sickness absence and sickness presenteeism were socially and morally determined at personal levels by an overall concept of work, independent of country.

Sick leave patterns as predictors of disability pension or long-term sick leave: a 6.75-year follow-up study in municipal eldercare workers.

OBJECTIVES: The aim was to study whether a workplace-registered frequent short-term sick leave spell pattern was an early indicator of future disability pension or future long-term sick leave among municipal eldercare workers. SETTING: The municipal healthcare sector in the city of Aarhus, which is the second largest city in Denmark. PARTICIPANTS: All elder care employees who worked the entire year of 2004 in the municipality of Aarhus, Denmark (N=2774). The employees' sick leave days during 2004 were categorised into: 0-2 and 3-17 short (1-7 days) spells, 2-13 mixed short and long (8+ days) spells and long spells only. Student workers (n=180), employees who were absent due to maternal/paternal leave (n=536) and employees who did not work the entire year of 2004 (n=1218) were not included. PRIMARY OUTCOME: Disability pension and long-term sick leave (≥8 weeks) were subsequently identified in a National register. The cumulative incidence proportion as a function of follow-up weeks was estimated using the Kaplan-Meier curve. The relative cumulative incidence (RR) of experiencing events within 352 weeks was analysed in a generalised linear regression model using the pseudo values method adjusted for age, occupation, unfavourable work factors and sick leave length. RESULTS: A frequent short-term and a mixed sick leave pattern showed RRs of being granted a disability pension of 2.08 (95% CI 1.00 to 4.35) and 2.61 (95% CI 1.33 to 5.12) compared with 0-2 short spells. The risk of long-term sick leave was significantly increased for all sick leave patterns compared with 0-2 short spells. Adding sick leave length to the models attenuated all RRs and they became non-significant. CONCLUSIONS: Sick leave length was a better indicator of future workability than spell frequency. Preventive actions should target employees engaged in homecare. The more sick leave days the greater the preventive potential seems, irrespective of spell frequency.

Are environmental characteristics in the municipal eldercare, more closely associated with frequent short sick leave spells among employees than with total sick leave: a cross-sectional study.

BACKGROUND: It has been suggested that frequent-, short-term sick leave is associated with work environment factors, whereas long-term sick leave is associated mainly with health factors. However, studies of the hypothesis of an association between a poor working environment and frequent short spells of sick leave are few and results are inconsistent. Therefore, we aimed to explore associations between self-reported psychosocial work factors and workplace-registered frequency and length of sick leave in the eldercare sector. METHODS: Employees from the municipal eldercare in Aarhus (N = 2,534) were included. In 2005, they responded to a work environment questionnaire. Sick leave records from 2005 were dichotomised into total sick leave days (0-14 and above 14 days) and into spell patterns (0-2 short, 3-9 short, and mixed spells and 1-3 long spells). Logistic regression models were used to analyse associations; adjusted for age, gender, occupation, and number of spells or sick leave length. RESULTS: The response rate was 76%; 96% of the respondents were women. Unfavourable mean scores in work pace, demands for hiding emotions, poor quality of leadership and bullying were best indicated by more than 14 sick leave days compared with 0-14 sick leave days. For work pace, the best indicator was a long-term sick leave pattern compared with a non-frequent short-term pattern. A frequent short-term sick leave pattern was a better indicator of emotional demands (1.62; 95% CI: 1.1-2.5) and role conflict (1.50; 95% CI: 1.2-1.9) than a short-term non-frequent pattern.Age (= < 40 / >40 years) statistically significantly modified the association between the 1-3 long-term sick leave spell pattern and commitment to the workplace compared with the 3-9 frequent short-term pattern. CONCLUSIONS: Total sick leave length and a long-term sick leave spell pattern were just as good or even better indicators of unfavourable work factor scores than a frequent short-term sick leave pattern. Scores in commitment to the workplace and quality of leadership varied with sick leave pattern and age. Thus, different sick leave measures seem to be associated with different work environment factors. Further studies on these associations may inform interventions to improve occupational health care.

Validation of sick leave measures: self-reported sick leave and sickness benefit data from a Danish national register compared to multiple workplace-registered sick leave spells in a Danish municipality.

BACKGROUND: Previous validation studies of sick leave measures have focused on self-reports. Register-based sick leave data are considered to be valid; however methodological problems may be associated with such data. A Danish national register on sickness benefit (DREAM) has been widely used in sick leave research. On the basis of sick leave records from 3,554 and 2,311 eldercare workers in 14 different workplaces, the aim of this study was to: 1) validate registered sickness benefit data from DREAM against workplace-registered sick leave spells of at least 15 days; 2) validate self-reported sick leave days during one year against workplace-registered sick leave. METHODS: Agreement between workplace-registered sick leave and DREAM-registered sickness benefit was reported as sensitivities, specificities and positive predictive values. A receiver-operating characteristic curve and a Bland-Altman plot were used to study the concordance with sick leave duration of the first spell. By means of an analysis of agreement between self-reported and workplace-registered sick leave sensitivity and specificity was calculated. Ninety-five percent confidence intervals (95% CI) were used. RESULTS: The probability that registered DREAM data on sickness benefit agrees with workplace-registered sick leave of at least 15 days was 96.7% (95% CI: 95.6-97.6). Specificity was close to 100% (95% CI: 98.3-100). The registered DREAM data on sickness benefit overestimated the duration of sick leave spells by an average of 1.4 (SD: 3.9) weeks. Separate analysis on pregnancy-related sick leave revealed a maximum sensitivity of 20% (95% CI: 4.3-48.1).The sensitivity of self-reporting at least one or at least 56 sick leave day/s was 94.5 (95% CI: 93.4 - 95.5) % and 58.5 (95% CI: 51.1 - 65.6) % respectively. The corresponding specificities were 85.3 (95% CI: 81.4 - 88.6) % and 98.9 (95% CI: 98.3 - 99.3) %. CONCLUSIONS: The DREAM register offered valid measures of sick leave spells of at least 15 days among eldercare employees. Pregnancy-related sick leave should be excluded in studies planning to use DREAM data on sickness benefit. Self-reported sick leave became more imprecise when number of absence days increased, but the sensitivity and specificity were acceptable for lengths not exceeding one week.