Background To provide both preventive and rehabilitative conditions in a workplace, one must understand how employees experience work demands. Such an understanding can be obtained from each individual with valid and quality-assured questionnaires. The Work Environment Impact Questionnaire (WEIQ) is a new questionnaire for measuring employees' self-perceived work ability in relation to their specific workplace environment. The purpose of this study was to assess the measurement properties in terms of construct validity of the WEIQ.Methods A cross-sectional survey study was conducted with 288 respondents from three different workplaces involving assisted living personnel, vocational rehabilitation personnel and personnel at a research institute. The measurement properties of the WEIQ were assessed according to Rasch Measurement Theory (RMT), including assessment of item-to-sample targeting, threshold ordering, item fit statistics, unidimensionality and reliability.Results Item fit, i.e., fit residuals, item characteristic curves (ICC) and chi square values, were all satisfactory, and no disordered thresholds were present after collapsing the lowest response categories. However, issues with local dependent (LD) item correlations was present in 7.6% cases, four items showed statistically significant differential item functioning (DIF), where 11% of the respondents had person fit residuals outside the recommended range of +/- 2.5 and the t-test for unidimensionality did not meet the criterion of 5%. Scale-to-sample targeting and reliability (0.92) were good. LD could be resolved with testlets and at the same time maintaining fit and improving dimensionality, but then the reliability decreased to 0.82.Conclusions This study provides an initial validation of the WEIQ to be used for assessing employees' self-perceived work ability. Most measurement properties were acceptable, but further exploration of LD, DIF and unidimensionality in additional work settings and with larger sample sizes is warranted.Trial registration Not applicable.

BACKGROUND:

Establishment in productive occupations i.e. work and further studies, is challenging for students who experience special educational needs (SEN).

OBJECTIVE:

The study aim was to investigate productive occupations and perceived work ability one year after upper secondary education among former students with SEN who had received a student-centred information and communication technology (ICT) intervention.

METHODS:

Questionnaire data on productive occupations (n = 81) were complemented with the semi-structured Worker Role Interview (WRI) concerning perceived work ability (n = 20), in an embedded mixed methods design. Group comparisons between participants who were and were not established in productive occupations were performed. Written notes from the WRI were analysed with a deductive content analysis.

RESULTS:

Findings demonstrated that almost two-thirds (63% n = 51) of the former students with SEN were established in productive occupations. The established group had to a higher extent obtained pass grades and had to a lesser extent received time-assisting ICT. Managing daily routines in combination with a productive role in a satisfactory manner was perceived as most challenging for the participants in relation to their work ability.

CONCLUSION:

The results indicate that students with SEN need person-centred support to handle difficulties both in and outside upper secondary school to promote the transition from school to establishment in productive occupations.

BACKGROUND: There is a need for simple and suitable tools for assessing sleep in a natural home environment. OBJECTIVE: This study explores the feasibility in terms of implementation and acceptability of a new homebased ballistocardiographic (BCG) tool for objective sleep-assessment in a real-life context. METHODS: The participants included thirty-nine workers, taking part in two seven nights sleep-assessment periods. Objective data regarding sleep was collected with BCG. Subjective data regarding sleep was collected with a sleep diary. Implementation was analysed by determining the number of nights with usable signal quality and comparing with the total number of potential nights and by exploring associations between objective and subjective sleep data. Acceptability was analysed by categorizing the participants experiences of how the BCG tool impacted the sleep. RESULTS: In terms of implementation, usableBCGdata increased from 40% at assessment phase 1 to 70% during assessment phase 2. Moreover, in assessment phase 2, there was a significant moderate correlation between the `time in bed assessed by the BCG and in sleep diary by participants in the first five nights. In terms of acceptability, almost one third of the participants did not experience any impact of the BCG on the sleep. Two participants experienced a major negative impact on the sleep. CONCLUSION: This study indicates that the novel BCG tool could be feasible for objective assessing of sleep in workers natural home-environment in the future, but there is still a need for development of the BCG both regarding technology and implementation process.

Background Evidence-based information and communication technology (ICT) interventions to enhance school participation among students with special educational needs (SEN) are required. Aim To evaluate the impact of an ICT intervention on school participation among upper secondary school students with special educational needs. Materials and methods Data on 300 students assessments with the School Setting Interview (SSI), grades and school attendance were used in this quasi-experimental study, with a one-group pretest-posttest design. Descriptive and inferential statistics and effect size were used, as well as Rasch analysis to generate interval data on the students ordinal SSI ratings. Results In the ICT intervention (median time eight hours), 54% of the students received a tablet, and software concerned with planning and structure was received by 85%. After the ICT intervention, a significant decrease in perceived need for adjustments in school activities was found on a group level and 30% of the students improved their school attendance. Students who benefitted the most from the ICT intervention had few adjustment needs in school activities and no special educational support at baseline. Conclusion An ICT intervention is promising for improving school participation among upper secondary school students with SEN.

BackgroundThe assessment of work ability with reliable, thoroughly tested instruments, is central to evidence-based occupational therapy practice.Aims/ObjectivesThe aim of this study was to investigate the psychometric properties of the Finnish version of the WRI with a focus on construct validity and measurement precision.Material and MethodsNinety-six WRI-FI assessments were performed by 19 occupational therapists in Finland. A Rasch analysis was conducted to evaluate the psychometric properties.ResultsThe WRI-FI presented an overall fit to the Rasch model, with good targeting and separation among persons. The four-point rating scale structure was supported by the Rasch analysis, except for one item with disordered thresholds. The WRI-FI indicated stable measurement properties across gender. Seven of the 96 persons showed misfit, which slightly exceeds the criteria of 5%.ConclusionsThe findings from this first psychometric evaluation of the WRI-FI provided evidence of construct validity and support for measurement precision. The hierarchy among items corresponded with previous studies. The WRI-FI can offer occupational therapy practitioners a valid tool to evaluate psychosocial and environmental perspectives of persons work ability.

Students in vocational programs have lower qualifications and more difficulties with successful entry into the labor market if they graduate without a diploma. The aim of this study was to describe the student - environment fit for high school students who are struggling with their studies in vocational programs, in terms of their perceived adjustment needs, and to describe planned interventions based on the students needs. The aim was also to investigate whether there was a relationship between students perceived adjustment needs and students self-reported mental health. The study included 25 students in six vocational programs at three different high schools in Sweden. The School Setting Interview was used to identify adjustment needs, and mental health problems were identified using the Strengths and Difficulties Questionnaire. Results showed that students identified adjustment needs to increase their participation in several school activities, and that academic school activities had the most identified needs. Interventions related to planning and organizing were most common. Results also showed a correlation between self-perceived adjustment needs and mental health. By identifying students adjustment needs, the chances of succeeding with student-centered interventions are increased, which in turn can support educational achievement.

Introduction: Life after stroke is a comprehensive area that involves engagement in meaningful everyday activities, including work, and can be adversely affected by post-stroke fatigue. This study investigates post-stroke fatigue, its development over time, and its impact on return to work and other everyday life activities. In addition, we investigated whether post-stroke fatigue could predict functioning in everyday life activities one year after stroke.Material and methods: This prospective registry-based study includes 2850 working age (18 - 63 years) patients registered in the Swedish Stroke Register (Riksstroke) during year 2017 and 2018. Post-stroke fatigue and everyday activities were analyzed 3- and 12-months post-stroke.Results: The mean age of the included participants was 54 years and the majority, 65%, were men. Three months post-stroke, 43% self-reported fatigue, at 12-months the proportion increased to 48%. About 90% of the patients were independent in basic ADL at 3-month. Dependence in complex activities one year post-stroke was significantly associated with fatigue. Not experiencing fatigue one year after stroke could predict positive functioning in everyday activities, increasing the chance of returning to work (OR = 3.7) and pre-stroke life and everyday activities (OR = 5.7).Conclusion: Post-stroke fatigue is a common persistent disability that negatively impacts complex activities; therefore, fatigue needs to be acknowledged and addressed long term after discharge.

The aim of this study was to investigate student-environment fit and perceived need of adjustments for students in the regular upper secondary school, with and without a diagnosis. The students (n = 419) were interviewed with the assessment School Setting Interview. The results showed that for seven of the 16 items, 60% or more of the students experienced that the demands of the school environment were not consistent with their abilities. Girls had a greater need of adjustments in eight of nine SSI school activities. The findings put an emphasis on the importance of recognizing the students individuals need of adjustments, and on offering flexible support in order to enhance the student-environment-fit and well-being of students in need of special educational support.

Background: This case study explores changes in work potential and work performance for ten people who worked before their stroke while participating in the ReWork-Stroke programme. It describes measures performed by the occupational therapists to enhance work potential and work performance and the participants level of work re-entry nine months after the start of their work trial. Methods: Ten people who had experienced a mild or moderate stroke participated. Changes were assessed using the Worker Role Interview and the Assessment of Work Performance. Logbooks relating to work potential and work performance were analysed using content analysis. Results: The participants work potential was in general supportive to returning to work at baseline and remained so at the three-month follow-up. Most changes occurred in the environmental factors regarding the participants belief that adaptations at the workplace would make re-entry possible. Changes concerning work performance were predominately in a positive direction. Seven of the participants returned to paid work. Conclusion: The ReWork-Stroke programme seems promising for promoting changes in work potential, work performance, and return to paid work. However, further studies are needed to evaluate changes in work potential and work performance and the programmes effectiveness for increasing work re-entry for people who have had stroke.

The aim of this study was twofold: (1) to identify factors associated with a high level of accommodation needs in school activities among students with special educational needs (SEN) in regular upper secondary education; and (2) to investigate the extent to which schools have met students’ perceived accommodation needs. Accommodation needs and their provision in school activities were assessed with the School Setting Interview for 484 students with SEN. Students’ mean age was 17.3 years and 50% did not have a diagnosis. A logistic regression analysis revealed that a high level of school absence, studying a vocational programme, and a neuropsychiatric disorder were associated with a high level of accommodation needs. In the majority of school activities, about 50% of students had not received any accommodation despite an experienced need for support. About 30% of students perceived a need for support even though they had been provided with accommodations, and around 25% stated they were satisfied with received accommodations. Regular upper secondary school students with SEN are insufficiently provided with accommodations to satisfactorily participate in education. Specific student characteristics, e.g. high level of school absence, should receive special attention when investigating and accommodating students’ needs for support in school activities.

Background: Participation in education is a vital component of adolescents everyday life and a determinant of health and future opportunities in adult life. The School Setting Interview (SSI) is an instrument which assesses student-environment fit and reflects the potential needs for adjustments to enhance students participation in school activities. The aim of the study was to investigate the psychometric properties of the SSI for students with special educational needs in regular high school. Methods: A sample of 509 students with special educational needs was assessed with the SSI. The polytomous unrestricted Rasch model was used to analyze the psychometric properties of the SSI regarding targeting, model fit, differential item functioning (DIF), response category functioning and unidimensionality. Results: The SSI generally confirmed fit to assumptions of the Rasch model. Reliability was acceptable (0.73) and the SSI scale was able to separate students into three different levels of student-environment fit. DIF among gender was detected in item "Remember things" and in item "Homework" DIF was detected among students with or without diagnosis. All items had disordered thresholds. The SSI demonstrated unidimensionality and no response dependence was present among items. Conclusion: The results suggest that the SSI is valid for use among students with special educational needs in order to provide and evaluate environmental adjustments. However, the items with the detected DIF and the SSI rating scale with its disordered thresholds needs to be further scrutinized.

Background: Work ability assessments are used to guide interventions designed to reduce or eliminate work disability and facilitate work participation. The clinical utility of assessments concerns the extent to which the assessment results support clinical decision-making. Aim: The aim was to investigate how users perceive the clinical utility of the Swedish version of the Worker Role Interview (WRI-S). An additional aim was to investigate differences in clinical utility related to the users’ level of WRI-S experience, attendance at courses on WRI-S application, and knowledge of the Model of Human Occupation. Material and methods: Data are based on 187 respondents’ answers to a web-based questionnaire and analysed through descriptive and inferential statistics. Results: In total, the respondents performed 12 000 WRI-S assessments. The respondents were mainly satisfied with the clinical utility of the WRI-S and experienced the assessment as supporting clinical practice. The main hindrance affecting clinical utility was the amount of time needed for conducting a WRI-S assessment. Experienced users and users with very good knowledge of MOHO conduct WRI-S assessments in a more time-effective manner. Conclusion: This study contributes to further development of the clinical utility of the Swedish version of the WRI-S, mainly focusing on time consumption.

A description of how people with the experience of long-term sick leave resulting from common mental disorders perceive that psychosocial factors influence their work ability. The Worker Role Interview was conducted with 14 informants and analyzed using qualitative content analysis. The informants believed in their future work ability. Most had had to adjust their habits and routines to manage their working and private lives in relation to their mental health problems. Occupational therapists need more knowledge about how to strengthen clients' beliefs in their occupational abilities and how to organize their daily activities in a balanced fashion.

The Work Environment Impact Scale (WEIS) is an assessment that focuses on the fit between a person and his or her work environment. It is based on Kielhofner’s Model of Human Occupation and designed to gather information on how clients experience their work environment.

The aim of this study was to examine the psychometric properties of the Swedish version of the WEIS assessment instrument.

In total, 95 ratings on the 17-item WEIS were obtained from a sample of clients with experience of sick leave due to different medical conditions. Rasch analysis was used to analyze the data. 

Overall, the WEIS items together cohered to form a single construct of increasingly challenging work environmental factors. The hierarchical ordering of the items along the continuum followed a logical and expected pattern, and the participants were validly measured by the scale. The three occupational therapists serving as raters validly used the scale, but demonstrated a relatively high rater separation index, indicating differences in rater severity.  

The findings provide evidence that the Swedish version of the WEIS is a psychometrically sound assessment across diagnoses and occupations, which can provide valuable information about experiences of work environment challenges.

This study examined the validity and reliability of the Assessment of Work Performance (AWP) using Rasch analysis. The AWP was administered to 365 clients with a variety of work-related problems. Rasch analysis and principal component analysis were used to examine the appropriateness of the rating scales and unidimensionality of AWP items. The person-response validity, internal consistency, targeting appropriateness, and differential item function were also analyzed. The Rasch analysis confirmed the 4-point rating scale, and the item set met the criteria of unidimensionality. The AWP exhibited satisfactory person-response validity and internal consistency. Among the three subdomains, the targeting of item-difficulty was sufficient in the motor skills and process skills subdomains. Differential item functioning was found across gender and diagnoses. This study presented evidence to support that the AWP functioned as a reliable and valid assessment in assessing work performance.

Objective: To analyze if the combination of organizational climate and work commitment can predict return to work (RTW). Methods: This prospective Swedish study was based on 2285 participants, 19 to 64 years old, consecutively selected from the employed population, newly sick-listed for more than 14 days. Data were collected in 2008 through postal questionnaire and from register data. Results: Among women, the combination of good organizational climate and fair work commitment predicted an early RTW with an adjusted relative risk of 2.05 (1.32 to 3.18). Among men, none of the adjusted variables or combinations of variables was found significantly to predict RTW. Conclusions: This study demonstrated the importance of integrative effects of organizational climate and individual work commitment on RTW among women. These factors did not predict RTW in men. More research is needed to understand the RTW process among men.

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.

"Return to Work - the Predictive Validity of the Assessment Instrument Worker Role Interview"

Introduction: Long-term sick-listing entails great costs for the society and suffering for the individual. As rehabilitation could decrease these costs, valid and reliable methods are then required for assessing work ability and identifying individual rehabilitation needs. There is a need to develop and investigate the validity of work-related assessments tools and in particular assessments concerned with psychosocial aspects in relation to return to work.

Objectives: The aims of this study were to investigate if and how the Worker Role Interview (WRI) can predict return to work and how the predictive validity of the WRI for return to work changes over a period of two years.

Methods: WRI is an assessment tool designed to identify psychosocial and environmental factors which influence a person’s ability to return to work. Fifty three long-term sick-listed people constituted the study group. Differences in WRI 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

Results: The item ‘Expectation of job success’ which concerns the person’s belief in their abilities in relation to return to work emerged as an important predictive factor for return to work in all statistical analyses. Eight of 16 items in WRI were rated differently between the working or non-working groups at one or more of the three follow-ups. The regression models based on the WRI ratings had an overall correct prediction rate ranging from 81% to 96% between the follow-ups.

Conclusion and contribution to practice and evidence base of occupational therapy: The WRI assessment contains items which predict return to work. This implies that the WRI is a useful tool for occupational therapist working with vocational rehabilitation for identifying individual rehabilitation needs for people who are sick-listed.

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.

Manual för Work Environment Impact Scale (WEIS)

Den här manualen är tänkt att vara ett stöd för användare av WEIS. Bedömningsinstrumentet WEIS består av en semistrukturerad intervju och en fyrgradig skattningsskala. Intervjun är utformad för att erhålla information om hur personer upplever sin arbetsmiljö. Genom WEIS intervjun erhålls information om hur personen uppfattar att psykosociala och fysiska faktorer i personens unika arbetsmiljö påverkar personens känsla av tillfredställelse och välbefinnande vid utförande av arbete. Vid WEIS intervjun efterfrågas information om hur en given arbetsmiljö påverkar den enskilde personen. Model of Human Occupation (MOHO) utgör den teoretiska grunden till WEIS.

WEIS kan användas för att identifiera arbetslivsinriktade rehabiliteringsbehov och som en del i bedömning av en persons arbetsförmåga.  För att få en så rik och mångsidig bild som möjligt av personen bör WEIS bedömningar kompletteras med andra bedömningar och bedömningsmetoder. Denna tredje svenska upplaga av WEIS kan användas för personer som är sjukskrivna och som har en anställning samt för personer som är i arbete eller utför arbetsliknande uppgifter i någon form av arbetsmiljö.

Theory based assessment of work ability

In the return to work process, assessments of peoples’ work ability play an important role. Credible and theoretically sound assessment methods for assessing clients’ work ability strengthen the possibilities for making valid interpretations which can guide suitable interventions in the process of returning to work. In this area occupational therapists can offer valuable contribution.

A single assessment instrument generally does not address all the multiple factors involved in a client’s work ability. Therefore, assessors should use several instruments in combination. Four instruments frequently used in vocational rehabilitation are:

• The Assessment of Work Characteristics (AWC) is an observation instrument that describes the extent to which a client has to use different working skills to perform a work task in an efficient and appropriate way.
• The Assessment of Work Performance (AWP) assesses a client’s observable (working) skills during work performance, i.e. it assesses how efficient and appropriate the client performs a work activity.
• The Worker Role Interview (WRI) is an interview instrument that focuses on how psychosocial and environmental factors influence a client’s ability to return to work.
• The Work Environment Impact Scale (WEIS) is an interview instrument that describes how clients experience their work environment.

The instruments AWC, AWP, WEIS and WRI  are all based on The Model of Human Occupation (MOHO). MOHO is a theoretical framework that explains the meaning and importance of activities for human beings and offers a conceptual framework for the description of human occupation. Assessment instruments based on theoretical models have the advantage that they create conditions that are conducive to valid interpretations of assessment results and yield intervention strategies.

Ongoing and future research will focus on further psychometric evaluation and studies of how and with what results the above instruments could be combined with each other.

Återgång till arbete-

bedömning av subjektiva psykosociala och miljömässiga faktorer

Bakgrund: Bristen på valida, reliabla och teoretiskt förankrade bedömningsinstrument för bedömning av arbetsförmåga är ett bekymmer eftersom tillförlitliga bedömningar är en förutsättning för utformning och genomförande av adekvata interventioner i syfte att stödja 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.

Syfte: Det övergripande syftet med avhandlingsarbetet har varit att undersöka WRI och WEIS användbarhet för identifiering av psykosociala och miljömässiga rehabiliteringsbehov av betydelse för återgång i arbete.

Metod: Avhandlingen består av fem empiriska studier. Samtliga studier har bearbetats kvantitativt och i en av studierna har även kvalitativ bearbetning genomförts. Tre studier är tvärsnittsstudier och två studier är två års longitudinella studier.

Resultat: WRI är användbart för bedömning av psykosociala faktorers påverkan på arbetsförmågan. I WRI ingår flera variabler som kan predicera återgång till arbete upp till två år efter genomförd bedömning. WEIS är användbart för att identifiera arbetsmiljöfaktorer som stödjer respektive hindrar personers välbefinnande och utförande av arbete.

Konklusion: Den information som WRI- och WEIS-intervjuer genererar är värdefull, då den kan utgöra en viktig grund för planering av individspecifika rehabiliteringsinsatser. Bedömningsinstrumenten WRI och WEIS med teoretisk förankring i Model of Human Occupation är användbara för att identifiera psykosociala och miljömässiga rehabiliteringsbehov i syfte att stödja personer i processen åter till arbete efter sjukskrivning.

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.

  Model of Human Occupation, Fourth Edition offers a complete and current presentation of the most widely used model in occupational therapy, and delivers the latest in MOHO theory, research, and application to practice. This authoritative text explores what motivates individuals, how they select occupations and establish everyday routines, how environment influences occupational behavior, and more. NEW TO THIS EDITION: Case Vignettes that illustrate key concepts that students need to know Case Studies that help students apply the model to practice Chapter on evidence based practice (ch. 25) Chapter on World Health Organization and AOTA practice framework and language links the MOHO model to two widely used frameworks (ch. 27) Photographs of real patients help bring the concepts and cases to life

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.

Interventions used to impact sick leave

-          An analysis of approaches

This review concerns intervention research published during the 21st century where the purpose of the interventions was to impact sick leave in work life. The aim of this review was to create a systematic chart of interventions published in scientific journals during the period mentioned above. A second aim was to analyze the procedures in the papers and their overall goal concerning their interventions for papers published in year 2003. The papers were analyzed through Blake and Moutons’ model of intervention approaches. The review resulted in 60 scientific papers with intervention research concerning sick leave. During year 2003, 17 papers were published concerning this topic, which was the most during any year in the 21st century.  The intervention approach that was most common was the “ prescriptive interventions” (n=11). One explanation for this could be that many of the interventions (n=7) were carried out in a health care arena that has a long tradition of an expert authority relation towards the client. Twelve of the papers described disease prevention interventions and five described health promotion interventions. None of the 17 papers had a qualitative approach, which is noteworthy since it has been recommended that a combination of quantitative and qualitative approaches is the best method in intervention evaluation.

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.

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.