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Return to Work: Assessment of Subjective Psychosocial and Environmental Factors
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Introduktion: Sjukfrånvaron i Sverige är hög och kunskap om vad som påverkar återgång i arbete efter sjukskrivning behöver utvecklas. I processen kring återgång i arbete är bedömning av arbetsförmåga en viktig del. Bristen på valida, reliabla och teoretiskt förankrade bedömningsinstrument inom området är dock ett bekymmer eftersom tillförlitliga bedömningar av arbetsförmåga är en förutsättning för utformning och genomförande av interventioner för att stödja återgång i arbete. Denna typ av interventioner kräver multidisciplinär kompetens där arbetsterapeuter utgör en viktig funktion. Vid bedömning av arbetsförmåga bör personens subjektiva uppfattning om sin situation beaktas, då den har betydelse för utfallet av återgång i arbete. Worker Role Interview (WRI) och Work Environment Impact Scale (WEIS) är två arbetsrelaterade intervjuinstrument, som har utvecklats i syfte att bedöma subjektiva psykosociala och miljömässiga faktorers påverkan på arbetsförmåga. Den teoretiska grunden till WRI och WEIS är Model of Human Occupation, som är en modell med fokus på aktivitetsutförande i relation till psykosociala faktorer. Inledande prövningar av WRI och WEIS reliabilitet och validitet har genomförts. Bedömningsinstrumenten har bearbetats och översatts till svenska och används främst av arbetsterapeuter, som arbetar med personer med arbetsrelaterad problematik.

Syfte: Det övergripande syftet med avhandlingen är att undersöka användbarheten av bedömningsinstrumenten Worker Role Interview och Work Environment Impact Scale för identifiering av psykosociala och miljömässiga rehabiliteringsbehov av betydelse för återgång i arbete.

Metod: Avhandlingen består av fem empiriska studier. I samtliga studier har erhållen information bearbetats kvantitativt. I studie IV har även kvalitativ bearbetning genomförts. Studie I, II och IV är tvärsnittsstudier och studie II och V är två års longitudinella studier. I studie I samlades information in via enkät. I studie II, III och V bestod den huvudsakliga informationen av skattningar utifrån WRI variabler och i studie IV var bedömningar utifrån WEIS i form av skattningar och nedskrivna kommentarer till skattningarna den huvudsakliga informationen.

Resultat: I studie I undersöktes vilka teoretiska utgångspunkter och professionsspecifika modeller arbetsterapeuter i Sverige ansåg påverka den psykiatriska vården och den psykiatriska arbetsterapin. Det psykosociala perspektivet var den teoretiska utgångspunkt som hade störst påverkan både på psykiatrisk vård och på psykiatrisk arbetsterapi. Den arbetsterapeutiska modell som flest identifierade var Model of Human Occupation. Detta resultat indikerar att Model of Human Occupation verkar vara användbar inom arbetsterapi och motiverade vidare användning av modellen i denna avhandling. Det som dock också framkom i studie I var att arbetsterapeuter inom psykiatrisk vård använde professionsspecifika modeller i en relativt liten utsträckning. Ett sätt att öka tillämpningen av teori i praktik är att använda teoretiskt grundade bedömningsinstrument. I studie II, III, IV och V har endera av de Model of Human Occupation- baserade bedömningsinstrumenten WRI och WEIS använts och värderats.

I studie II och V prövades WRI:s förmåga att predicera återgång i arbete efter långvarig sjukskrivning. Det område i WRI som uppvisade bäst prediktivitet var området ”Självuppfattning” vars variabler beaktar personens motivation för återgång i arbete i form av personens upplevelse av kompetens och effektivitet för att utföra arbetsuppgifter och hantera utmaningar i arbetet. De två WRI variabler som bäst kunde predicera vilka som skulle återgå respektive inte återgå i arbete vid uppföljning efter två år var: ”Tro på sin arbetsförmåga”, och ”Dagliga vanor och rutiner”. Resultaten tyder på att kunskap om hur tro på den egna förmågan stärks och kunskap om dagliga vanor och rutiners påverkan på utförande av arbete är central vid genomförande av interventioner i syfte att stödja personer att återgå till arbete efter sjukskrivning.

I studie III prövades WRI:s konstrukturella validitet i en internationell studie. Samtliga variabler i WRI, förutom de som tillhör miljöområdet, uppvisade en god konstrukturell validitet dvs mätte psykosociala faktorers påverkan på arbetsförmågan. WRI:s skattningsskala verkar stabil och valid mellan olika länder och för personer med olika diagnoser. I analysen framkom att WRI kunde särskilja mellan personers psykosociala arbetsförmåga på tre olika nivåer.

I studie IV undersöktes hur personer med erfarenhet av långtidssjukskrivning uppfattar att faktorer i arbetsmiljön stödjer respektive hindrar personens utförande av arbete och välbefinnande genom bedömningar utifrån WEIS. De faktorer som uppfattades som mest

stödjande var olika former av sociala interaktioner på arbetet samt uppfattningen om arbetets värde och mening. De faktorer som uppfattades som mest hindrande var olika krav i relation till arbetsgenomförandet samt den belöning som erhålls för arbetet.

Konklusion: Sammanfattningsvis så kan WRI användas för bedömning av psykosociala faktorers påverkan på arbetsförmågan. I WRI ingår variabler som kan predicera återgång till arbete upp till två år efter genomförd bedömning. WEIS verkar användbart för att identifiera arbetsmiljöfaktorer som stödjer respektive hindrar personers välbefinnande och utförande av arbete. Att komplettera olika datainsamlingsmetoder är en förutsättning för att uppnå en så god bedömning av arbetsförmåga som möjligt. Den information som WRI- och WEISintervjuer genererar är värdefull, då den kan utgöra en viktig grund för planering av individspecifika rehabiliteringsinsatser. Bedömningsinstrumenten WRI och WEIS med sin teoretiska förankring i Model of Human Occupation kan anses vara användbara för att identifiera psykosociala och miljömässiga rehabiliteringsbehov i syfte att stödja personer i processen åter till arbete efter sjukskrivning.

Abstract [en]

Introduction: In Swedish society the sick-leave rate is high and a better understanding is required of the factors that facilitate return to work. In the return to work process, assessments of peoples’ work ability play an important role. However, the lack of usable, valid, reliable, and theoretically sound assessment instruments for assessing work ability is a concern. Credible and theoretically sound assessment methods for assessing clients’ work ability strengthen the possibilities for making valid interpretations and obtaining important information for composing further intervention strategies which can guide suitable interventions in the process of returning to work. Such interventions need multi-professional expertise. In this area occupational therapists can offer valuable contribution. In the overall assessment of work ability the unique individual’s subjective perception of the situation needs to be considered since this has been found greatly relevant for return to work. The Worker Role Interview (WRI) and the Work Environment Impact Scale (WEIS) are two work-related interview assessment instruments that have been developed to assess subjective psychosocial and environmental factors of work ability. The WRI and the WEIS have been primarily tested for reliability and validity and are theoretically founded in the Model of Human Occupation (MOHO), which is an occupation-focused model addressing psychosocial factors. They have been adapted and translated to Swedish and are used among Swedish occupational therapists working with clients experiencing work-related problems.

Aim: The overall aim of this thesis was to evaluate the usefulness of the assessment instruments the Worker Role Interview and the Work Environment Impact Scale for identifying psychosocial and environmental rehabilitation needs essential for returning to work.

Methods: Five empirical studies were performed, all of which were analysed quantitatively, with the exception of study IV in which both qualitative and quantitative analysing methods were used. Studies I, III and IV were cross-sectional while studies II and V were two-year longitudinal studies. In study I, data were collected by a questionnaire, in studies II, III and V the primary data constituted of ratings on the WRI items. In study IV the primary data were ratings of the WEIS items and the written notes beside the rating on each item.

Results: In study I, theoretical approaches and professional models that influenced psychiatric care and psychiatric occupational therapy practice among occupational therapists in Sweden was investigated. The most common approach in psychiatric care was the psychosocial approach, and the practice model which was most often used was the Model of Human Occupation. The results indicated that the psychosocial approach and the Model of Human Occupation seemed applicable in occupational therapy, motivating further use of that model. However, it was also found that occupational therapists in psychiatric care used professional practice models to a rather low extent. One way to enhance the application of theory into practice is the use of theory- based assessment instruments. Consequently, the Model of Human Occupation- based assessment instruments, the WRI and the WEIS, have been evaluated and used in the other studies in the present thesis The value of the WRI for predicting return to work after long term sick-leave was investigated in studies II and V. The content area in the WRI with best overall predictive validity for return to work was ‘Personal causation’. Its items focus on the individual’s motivation for return to work in relation to the individual’s feeling of competence and effectiveness in doing work tasks and facing challenges at work. The two WRI items which best predicted whether the participants would be in the working or the non-working groups at the two-year follow up were ‘Expectations of job success’, which concerns beliefs in personal abilities in relation to returning to work, and the item ‘Daily routines’ which concerns the individual’s routines and organisation of time outside work. These results suggest that knowledge about how to strengthen the person’s belief in his or her abilities, how routines impact occupational performance, and how to support the individual in structuring his or her daily doings are needed in interventions aiming at supporting the individual to return to work.

In study III the construct validity of the WRI was investigated in an international study. All the WRI items except those related to the environment area seemed to capture the intended construct of the WRI, namely psychosocial ability for return to work. The construct of the WRI seems to be stable and valid across different countries and populations, and the WRI showed an ability to separate clients into three distinct levels of psychosocial ability for return to work.

In study IV the impact of the work environment was investigated by using the WEIS among people with experiences of sick-leave. Social interactions at work and the meaning of the work had the most supportive impact and different work demands and the rewards received for the work were perceived as most interfering with work performance, well-being, and satisfaction.

Conclusion: The WRI seems to be suitable for estimating psychosocial work ability. In addition it contains items which can predict return to work up to two years after the assessment is conducted. The use of the WEIS revealed supportive and interfering factors for work performance, well-being, and satisfaction among people with experiences of long term sick-leave. The interview format of the WRI and the WEIS seems valuable since it provides comprehensive information which can contribute to the planning of rehabilitation interventions for the unique client. Thus, the WRI and the WEIS, which are theoretically founded in the Model of Human Ocupation are juged to be useful for identifying psychosocial and environmental rehabilitation needs in order to support the individual in returning to work after sick-leave.

Place, publisher, year, edition, pages
Institutionen för samhälls- och välfärdsstudier , 2008. , 58 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1066
Keyword [sv]
Bedömningsinstrument, arbetsterapi, arbetsförmåga, arbetslivsinriktad rehabilitering, sjukfrånvaro, Model of Human Occupation (MOHO), WRI, WEIS
National Category
Occupational Therapy
Identifiers
URN: urn:nbn:se:liu:diva-11744ISBN: 978-91-7393-876-1 (print)OAI: oai:DiVA.org:liu-11744DiVA: diva2:18168
Public defence
2008-05-30, K1, Kåkenhus, Campus Norrköping, Linköpings universitet, Norrköping, 09:15 (English)
Opponent
Supervisors
Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2010-12-01Bibliographically approved
List of papers
1. Practice models in Swedish psychiatric occupational therapy
Open this publication in new window or tab >>Practice models in Swedish psychiatric occupational therapy
2000 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, Vol. 7, no 3, 107-113 p.Article in journal (Refereed) Published
Abstract [en]

In clinical settings, occupational therapists need models both from their own field, occupational therapy, and from other fields in order to offer the clients adequate treatment. It is unknown which theoretical approaches and practice models influence Swedish occupational therapists' daily work. In this study a questionnaire (n=334) was used to investigate approaches and models used in Swedish psychiatric care service and in psychiatric occupational therapy service. The results showed that the psychosocial approach influenced both psychiatric care and psychiatric occupational therapy most. The most frequently used practice model was the Model of Human Occupation. However, 75% of the respondents did not identify theoretical thinking based on models from their own field behind their actions. Many practitioners seemed to use knowledge developed by other disciplines more often. Years of clinical experience in the profession or education did not seem to have any impact on the ability to identify the practice models that were used. The results indicate that education in occupational therapy must emphasize knowledge in its own field more than has been done up to now.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13268 (URN)10.1080/110381200300006050 (DOI)
Available from: 2008-05-07 Created: 2008-05-07
2. The Worker Role Interview: Preliminary data on the predictive validity of return to work of clients after an insurance medicine investigation
Open this publication in new window or tab >>The Worker Role Interview: Preliminary data on the predictive validity of return to work of clients after an insurance medicine investigation
2004 (English)In: Journal of Occupational Rehabilitation, ISSN 1053-0487, Vol. 14, no 2, 131-141 p.Article in journal (Refereed) Published
Abstract [en]

The aim was to investigate the predictive validity of the Worker Role Interview (WRI) for return to work at a 2-year follow-up of clients who attended an insurance medicine investigation center. The WRI identifies psychosocial and environmental factors that influence a person's abilities to return to work. Forty-eight of 202 consecutively selected clients constituted the study group. The Mann–Whitney U test was used to test the statistically significant differences in WRI ratings between those who were working (n=6) and those who were not (n=42) 2 years after their investigations. Five of the 17 items in WRI had a tentative predictive validity of return to work. The content area personal causation in WRI, had the best predictive validity. The results emphasize the importance of considering the unique individual's beliefs and expectations of his/her effectiveness at work when assessing clients' work ability and planning for further rehabilitation.

Keyword
prediction, return to work, assessment, psychosocial, sick leave, insurance medicine
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13269 (URN)10.1023/B:JOOR.0000018329.79751.09 (DOI)
Note
Original Publication: Elin Ekbladh, Lena Haglund and Lars-Håkan Thorell, The Worker Role Interview: Preliminary data on the predictive validity of return to work of clients after an insurance medicine investigation, 2004, Journal of Occupational Rehabilitation, (14), 2, 131-141. http://dx.doi.org/10.1023/B:JOOR.0000018329.79751.09 Copyright: Springer http://www.springerlink.com/ Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2010-12-06
3. Psychometric properties of the Worker Role Interview
Open this publication in new window or tab >>Psychometric properties of the Worker Role Interview
Show others...
2006 (English)In: Work, ISSN 1051-9815, Vol. 27, no 3, 313-318 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. This study examined the psychometric properties of the rating scale of the Worker Role Interview (WRI). The study also asked whether the scale's items formed a valid measure of the construct, psychosocial capacity for work, and whether they were targeted to and could effectively discriminate between persons at different levels of psychosocial ability for work.

Method of study. Data were collected from 21 raters on 440 participants from the United States, Sweden and Iceland. A many-faceted Rasch model was used to analyze the data.

Results. Most items of the scale worked effectively to measure the underlying construct for which the WRI was designed. In addition, the items were ordered from least to more of the underlying construct as expected. The scale validly measured 90.23% of the participants, who varied by nationality, culture, age and diagnostic status. The scale's items distinguished participants into approximately three different strata and were appropriately targeted to the participants. Seventeen of the 21 raters used scale in a valid manner.

Conclusions. The WRI scale and items are valid across ages, diagnoses, and culture and effectively measure a wide range of persons.

Keyword
Assessment, worker role, model of human occupation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13270 (URN)
Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2009-05-14
4. Perceptions of the work environment among people with experience of long term sick leave
Open this publication in new window or tab >>Perceptions of the work environment among people with experience of long term sick leave
2010 (English)In: WORK-A JOURNAL OF PREVENTION ASSESSMENT and REHABILITATION, ISSN 1051-9815, Vol. 35, no 2, 125-136 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aims were to describe and analyze how people with experience of long term sick leave perceive that factors in their work environment support or interfere with work performance, satisfaction, and well-being. Method: The 53 participants were interviewed with the Work Environment Impact Scale (WEIS). The WEIS ratings and belonging notes were analyzed by descriptive statistics and qualitative analysis respectively. Differences in WEIS ratings between; women and men; participants with somatic and mental diseases; and participants working and on full-time sick leave were tested. Results: The most supportive factors concerned social interactions at work, and the value and meaning of work. The factors perceived as most interfering concerned work demands and rewards. The social relations at work were perceived as more supportive by the working group than by those on full-time sick leave. The participants with somatic diseases perceived physical work factors as more interfering than did participants with mental diseases, who in turn perceived the value and meaning of work as more interfering. Conclusion: Knowledge about the interaction between the worker and the work environment could reveal useful information about the complex phenomenon of reducing sick leave. The WEIS seems useful in providing information about how alterations and accommodations in the work environment could support individual workers.

Keyword
Psychosocial, assessment, WEIS, well-being, RTW, occupational therapy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54491 (URN)10.3233/WOR-2010-0964 (DOI)000275284100003 ()
Note
Original Publication: Elin Ekbladh, Lars-Håkan Thorell and Lena Haglund, Perceptions of the work environment among people with experience of long term sick leave, 2010, WORK-A JOURNAL OF PREVENTION ASSESSMENT and REHABILITATION, (35), 2, 125-136. http://dx.doi.org/10.3233/WOR-2010-0964 Copyright: IOS Press http://www.iospress.nl/ Available from: 2010-03-19 Created: 2010-03-19 Last updated: 2010-12-06
5. Return to work: the predictive value of the Worker Role Interview (WRI) over two years
Open this publication in new window or tab >>Return to work: the predictive value of the Worker Role Interview (WRI) over two years
2010 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 35, no 2, 163-172 p.Article in journal (Refereed) Published
Abstract [en]

Worker Role Interview (WRI) is an assessment tool designed to identify psychosocial and environmental factors which influence a persons ability to return to work. The purpose of this study was to investigate if the Worker Role Interview (WRI) can predict return to work over a period of two years. Fifty three long-term sick-listed people were interviewed and rated with the WRI. Differences in ratings and the ability of WRI to correctly predict whether these people would fall into the working or non-working groups at 6, 12 and 24 month follow-ups were tested by Mann-Whitney test and logistic regression respectively. Eight of 17 items in WRI were rated differently between the groups at one or more of the follow-ups. The regression models based on the WRI ratings had an overall correct prediction rate ranging from 81% to 96%. Expectation of job success which concerns the persons belief in abilities in relation to return to work emerged as an important predictive factor for return to work in all statistical analyses. The WRI assessment contains items that could predict return to work. This implies that the WRI could be a useful tool in vocational rehabilitation for identifying individual rehabilitation needs.

Keyword
assessment, motivation, psychosocial, RTW, sick-leave, work ability, vocational rehabilitation, occupational therapy, Model of Human Occupation, Bedömningsinstrument, arbetsförmåga, arbetsterapi, sjukfrånvaro, Model of Human Occupation
National Category
Medical and Health Sciences Occupational Therapy
Identifiers
urn:nbn:se:liu:diva-13272 (URN)10.3233/WOR-2010-0968 (DOI)000275284100007 ()
Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2017-12-13

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