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Approaches and Interventions
How does the rehabilitation process make participants feel?

At a glance:
During rehabilitation
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 sessions, encounters with providers can make recipients feel bad. These include interactions where people feel they are not taken seriously, are treated with indifference, or are not taken at their word.
Perspectives:
Employee
Coping with an injury and getting back to work afterwards is difficult. Both are harder if people react negatively to you. Negative reactions can make you withdraw into yourself, which in turn makes rehabilitation harder.

Positive communication can improve the situation – do your best to keep communicating with people who are supportive. This will help you to cope with any negative reactions you get from others.

Talk to your doctor about what you need to do to get back to work. On returning to work try to be productive in whatever capacity you can. Offer your supervisor assistance in sorting this out. Being positive and productive is usually recognised and supported.
Employer
When people think that others judge them negatively, they're likely to communicate less and withdraw into themselves. This makes it more difficult for them to manage the recovery process and their return to work outcome may be worse.

Encourage your employees to be positive, provide them with opportunities to communicate. It's important that you treat them well and avoid letting them think you are unhappy with them unless they've done something wrong. Make arrangements so that communication can occur, for example, brief weekly meetings on the return to work process between the employee and their supervisor.
Treater
Encourage people to return to work as quickly as they can. When a person remains off work, their motivation to return diminishes. Encourage people to make positive suggestions and empower them to be an active participant in managing their return to work.

Doctors can also encourage employers to recognise the positive effects of a helpful employer and the negative effects of an unhelpful workplace. The employer's approach has a great impact on return to work than medical treatment.
Insurer
Being treated with indifference can have a negative impact on people, especially when they are emotionally vulnerable.

Simply encouraging people is not enough, they need to be treated positively and offered a clear path that takes them back to work.
Original Article, Authors & Publication Details:
Tommy Sveon,1 Agneta Karlsson,1 Kristina Alexanderson,1,2 and Cecilia Nordqvist1 (2003)
Shame-inducing encounters. Negative emotional aspects of sickness-absentees' interactions with rehabilitation professionals. Journal of Occupational Rehabilitation; 13(3):183.
1
Division of Social Medicine and Public Health Science, Department of Health and Environment, Faculty of Health Sciences, Linkoping, Sweden.
2Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Background, Study Objectives, How It Was Done:
A person's emotions and attitude affect rehabilitation and return to work. In this study, the authors investigated whether interactions with the rehabilitation system induced negative emotions in rehabilitation recipients.

‘Shame' and ‘pride' are the terms used for the positive and negative feelings discussed. Shame results from being negatively evaluated, and tends to make people withdraw from social interaction. This is detrimental to the rehabilitation and return to work process. Pride has the opposite effect, and makes people happy to be seen and heard. This is helpful for the rehabilitation and return to work process.

The study was part of a broader investigation of sickness absence, health, and living conditions in Sweden. The overall project continued for 12 years, following a group of over 200 people who had been off work for more than a month with spinal or shoulder problems.

This particular study was undertaken through focus group interviews in which 18 people participated.
Study Findings:
Interviewees reported interactions with a broad variety of people during rehabilitation. These included physicians, physiotherapists, psychologists, general health care staff, case and claims managers, and people who helped them find employment.

Two kinds of negative experiences were recorded:

Being distanced:

This includes being treated with indifference, or not having a problem taken seriously, which were sometimes causes of frustration, or hopelessness.

Several participants described encounters with their regular therapist as “habitual' and “routine:' these consultations did not seem to be dealing with their individual situation. This sense of “going through the motions left some participants with the feeling that little more could be done for them.

Being disqualified:

This describes an interaction where the person receiving rehabilitation felt that their account of the problem was not believed. It also describes occasions on which people were treated as incompetent.

An example is a worker who made a suggestion about their rehabilitation and had it rejected as unlikely to succeed. This left the person feeling discouraged and unsupported.

Interviewees said they felt particularly vulnerable during rehabilitation, and that this increased their emotional response. Sometimes respondents wondered whether their therapist thought that some of their symptoms were imagined. This feeling was worse when a diagnosis
diagnosis
The process of identifying a medical condition or disease by its symptoms, the findings from a medical examination, and from the results of various diagnostic procedures.
 or a test result was unclear.
Conclusions:
This study identified several kinds of interactions with the rehabilitation system which made recipients feel bad. These included interaction in which people felt they were treated indifferently or in a routine manner, when they felt their problems were not taken seriously, and when they were not taken at their word.

Rehabilitation programs need to take account of the emotional responses of recipients – these affect return to work outcomes. Providers need to promote self-esteem and self-confidence.
References:
No PubMed Abstract
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