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The Worker Role Interview - understanding the person

At a glance:
The Worker Role Interview takes into account the effect of motivation, lifestyle and environment on a person's ability to return to work. The factors supporting return to work found to most influence a persons future work status were:

Ability to assess own abilities and limitations
Expectation of a successful return to work
Ability to take responsibility
Understanding what's expected at work
Work setting – perception of whether the physical work environment would support their return to work
Perspectives:
Employee
A person's physical condition has an effect on their daily life and ability to function. It will impact the activities they can do, and how long they are able to perform certain tasks.

This study shows that return to work in the long term it impacted by a number of factors. One is “Personal causation' which means an individual's ability of focus on achieving outcomes, and their ability to take responsibility for the situation. There are many barriers for people to overcome in return to work. However, when an individual has the confidence to take on overcoming barriers they do better. These barriers may be in internal, i.e. getting themselves focused and motivated, or they may be workplace issues. The way that people take responsibility for themselves include:

Making sure they understand their health or medical condition
Making sure they understand what they are able to do to help their own condition
Working to influence the workplace to overcome barriers
Developing positive relationships with those involved in the case
Making positive suggestions about what can be done to improve their situation
Still getting disheartened by setbacks, but finding ways to overcome them
Employer
A person's physical condition can make it difficult to do certain tasks.

Most people return to work without difficulty, however some people get stuck and return to work becomes difficult.

Employers can help by providing appropriate duties, supporting the person returning to work, and helping the individual to be confident in their abilities.

Working in partnership with the person returning to work increases their confidence in overcoming barriers.
Treater
This study supports the notion that a range of factors influence return to work. The factor that makes the major difference is the individual's focus and ability to take charge of their situation.

Encouraging people to understand their health problem, to work out ways to help themselves and have confidence in their abilities to influence others can improve return to work outcomes.

Most people return to work without difficulty. However, supporting long term cases to understand that they have an important role in determining a positive outcome is important.

Exploring the range of factors that can influence return to work outcomes is important. When this can be done with the patient in an open manner, they will often begin to understand the important factors influencing the outcome that are under their control.

The result is a patient empowered to have greater choice in their longer term options.
Insurer
When an individual has confidence in their ability to return to work and understands how to overcome barriers they do better. These barriers may be internal, i.e. getting themselves focused and motivated, they may be workplace issues, or health-related problems. Ways that people can help themselves include:

Making sure they understand their health or medical condition
Making sure they understand what they are able to do to help their own condition
Working to influence the workplace to overcome barriers
Developing positive relationships with those involved in the case
Making positive suggestions about what can be done to improve their situation
Still getting disheartened by setbacks, but finding ways to overcome them
Original Article, Authors & Publication Details:
E. Ekbladh1, L. Haglund1, L. Thorell2 (2004).

The worker role interview – Preliminary data on the predictive validity of return to work of clients after the insurance medicine investigation. Journal of Occupational Rehabilitation; 14(2):131-141

1Department of Neuroscience and Locomotion, Section of Occupational Therapy, Faculty of Health Sciences, Linköpings universitet, Linköping,Sweden.
2Department of Neuroscience and Locomotion, Section of Psychiatry, Faculty of Health Sciences, Linköpings universitet, Linköping, Sweden.
Background, Study Objectives, How It Was Done:
It is difficult to accurately assess a person's ability to work after a period of sick leave. It is not only physical disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 that affects a person's ability to work, but a range of social, psychological
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 and environmental factors.

The Worker Role Interview is a questionnaire that can be used to identify psychosocial
psychosocial
Refers to psychological and social factors. Examples of psychosocial factors that affect return to work area include: a person's beliefs about how they will cope with their condition, the attitude of the inured worker's family to their condition and return to work, the employer's return to work policy and the influence of the WorkCover system on a person.
 and environmental factors that affect a person's ability to return to work after sickness or injury. It is a semi-structured interview that rates 17 areas that may impact a return to work. A person's motivation is assessed by questions about their:

Personal causation

o Ability to assess own limitations
o Expectation that they will successfully return to work
o Ability to take responsibility

Values

o Commitment to work
o Ability to set work goals

Interests

o Enjoyment of work
o Pursuit of other interests

How a persons lifestyle affects their work is assessed by questions about their:

Roles

o Identifies their role as a worker
o An understanding of what's expected at work

Habits

o Work routines
o Daily routines
o Ability to adapt tasks to accommodate injury

How a persons physical and social environment affects their work is assessed by questions about their:

Environment

o Work setting
o Family and friends
o Boss
o Workmates

The aim of this study was to see if the Worker Role Interview could reliably predict whether a person would return to work within two years after a workers compensation claim.

202 patients who attended National Social Insurance Board hospitals in Sweden were selected during a 10 month period in the late 1990s. The patient's ability to work was investigated and this included the patient completing the WRI. Other information recorded was the person's 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.
 occupation, country or origin, social status, time since working and employment status.

Two years after this the patients were contacted and asked about their work situation. 189 patients were available for follow-up, and of these 61 replied with 59 agreed to participate. The participants were classified as “working' if they were working at least 25% of full-time hours.

There were 48 patients who both had WRI scores and participated in the two year follow-up, and these were the primary participant group (25% of the initial study participants).

Six months later a second letter was sent to those who did not reply to the first follow-up request (128 patients) and 63 replied. These 63 patients were grouped with the 11 patients with no WRI scores available into the secondary participant group (39% of the initial study participants). This group was included in the study to see whether there were any differences between those included in the analysis (the primary participant group) and those that weren't (the secondary participant group) that could affect the study findings.
Study Findings:
For the primary participant group, at the two year follow-up:

6 people (13%) were working
42 people (87%) were not working

If participants were supported in returning to work in five of the Worker Role Interview areas they were more likely to be working at the two year follow-up. These areas were:

o Ability to assess own limitations
o Expectation of job success
o Ability to take responsibility
o Understanding what's expected at work
o Work setting

There were no differences between the primary and the secondary participant groups in age, gender or work status at the two year follow-up, suggesting that choosing the 48 study participants did not bias the results.
Conclusions:
The Worker Role Interview can predict whether a person will have returned to work two years after a period of sick leave. The factors supporting return to work that most influenced a persons future work status were:

Ability to assess own abilities and limitations
Expectation of a successful return to work
Ability to take responsibility
Understanding what's expected at work
Work setting – perception of whether the physical work environment would support their return to work

Thus, a persons likelihood of returning to work was most affected by their “personal causation', meaning their ability to take control of and responsibility for their own work situation.

The finding of this study show it is important to consider the effect an individual's beliefs, expectations and perceptions of their environment has on their ability to return to work when planning their rehabilitation.
References:
PubMed Abstract
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