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People Factors
Different influences combine to affect whether a person will return to work after sick leave

At a glance:
Many factors combine to influence people on an extended leave of absence from work. If an individual expected to return to work, they were much more likely to do so. Participants were also more likely to return to work if they:

Hadn't had many days on sick leave in the past (before their injury or illness)
Were in white-collar jobs in the private sector
Had a higher level of education
Were satisfied with life
Had a sense of understanding and meaning from life
Perspectives:
Employee
Your beliefs about returning to work are the best predictor of whether you will or not.

If you believe you are going to return to the job, then that is the likely outcome. If you don't think that is going to occur, then there is a reasonable chance it won't happen. While this might sound obvious, it is actually not a question that is often asked, or openly discussed in many return to work situations.

What do you think about returning to work? Do you think it's realistic? If not, talk to the people involved. Your doctor can help you understand if your health problem is a concern, or if a different approach is needed. Your employer can discuss what can be done to accommodate your needs so you can get back to making a useful contribution.
Employer
Talk to your employee. If the employee does not believe they are going to be able to return to the job, then the reasons for this view need to be addressed. It may be that a better understanding of the medical condition is needed, or the job needs to be modified. What are their concerns, what do they see as the problems interfering with their ability to return to the job?

Are there obstacles in the workplace getting in the way that can be managed?
Do they need further medical care, particularly medical advice about the nature of their condition?
Are they worried that activities will do them harm?

Get into the world of the employee and understand the situation. Outcomes will be improved when you work in partnership and resolve with all of the relevant issues.
Treater
Various factors influence return to work. The person's beliefs about return to work is the best predictor of outcomes.

Does the individual consider that they will be able to return to the job?
Do they have a good understanding of the medical condition, or are they unnecessarily worried?
Do you think they will be able to return to the job, do you have sufficient information on which to base that decision?
Does this issue need to be more openly discussed, and longer term strategies put in place?
Does the person have a realistic understanding of the issues, are there some ways the job can be modified?
It is return to the normal job unrealistic, are other options needed in the long term?

Most people can return to their normal job. We know that people with a range of health and medical conditions return quickly to physically demanding activities and roles. These include high-level sports people, or people who do physically demanding jobs. Their return to work often relates to the persons' belief about their abilities, rather than the physical condition, or the task in hand. When people have a full understanding of the medical problems they are often more confident to return to everyday tasks.
Insurer
If return to work is not going smoothly there may be particular barriers that need to be overcome to achieve a successful outcome. This study indicates that a range of factors will influence return to work outcomes. One of the most important is the person's beliefs about whether they are going to be able to return to their normal job.

Addressing these issues is important. If the person doesn't believe they will be able to return to the job, it is less likely they will do so. However, there may be specific issues that can be overcome, and talking to the worker about their concerns and beliefs is a necessary first step.
Original Article, Authors & Publication Details:
A. Hansen1, C. Edlund2 and M. Henningsson3 (2006).

Factors relevant to a return to work: A multivariate approach. Work; 26(2):179-190

1Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
2Department of Public Health and Medicine, Umeå University, Umeå, Sweden.
3Department of Psychology, Umeå University, Umeå, Sweden.
Background, Study Objectives, How It Was Done:
Many factors seem to influence whether a person will remain on long term sick leave. People who have a similar condition and social situation can respond very differently to treatment. The longer a person is on sick leave, the more difficult it becomes for them to return to work, so identifying a person's possibilities for and obstacles to return to work early can help their 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.
 

Risk factors have been identified (e.g. beliefs about the future, coping strategies and length of time off work) that can be used to predict whether a person will be able to return to work after injury or illness. However, further investigation is needed to determine if these factors affect people of different genders, ages and family situations differently.

This study aims to identify sub-groups of people who are on sick leave from work, and investigate the differences between them and the factors that influence return to work for each group. The authors used special statistical techniques for analysing the data, which allowed them to look at a large number of influences at the same time.

In 1999, 180 participants were recruited from 8 regional social insurance offices in Sweden. All participants had been absent from work for a period of 28 days or more. Participants were given a questionnaire and information about the aim of the study. 135 (75%) completed and returned the survey. Two thirds of the participants were women, 80% were “blue-collar' workers and 23% were unemployed. Most patients (75%) were on full-time sick leave.

The questionnaire asked about the patients':

Diagnosis.
Physical and psychological
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 symptoms.
Days on sick leave.
Job type.
Area of residence.
Education.
Gender, age, marital status etc.
Job and life satisfaction.
Sense of understanding and meaning in life.
Coping strategies.
Expectations about returning to work.
Limitation due to disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 (how their life was affected).

Information about the participants' sickness absences in the two years prior to and the two years after the questionnaire was completed was obtained from the National Social Insurance Board register.
Study Findings:
Work:

Workers had fewer days off work in the two years after the survey if they:

Were white collar workers
Had a higher level of education
Were satisfied with their jobs, including their physical work environment

Diagnosis and symptoms:

The study participants' diagnoses, from doctors' certificates, were in three categories:

69% had musculoskeletal
musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 conditions (problems with the skeleton, joints or muscles)
21% had internal ailments (e.g. heart problems)
10% had a mental illness

A person's own report of their symptoms was better able to predict whether they would return to work than was their doctor's diagnosis.

Many patients (19%) reported an array of symptoms outside of their 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.
 These patients were said to have “multifaceted' symptoms, and were mostly women with musculoskeletal conditions.

Age, gender, family life:

Two years after the questionnaire:

73% of men were back at work (full-time or part-time)
57% or women were back at work (full-time or part-time)

Most factors influencing return to work were common to both genders. However:

Men were more likely to return to work if they:

o Had good resources for coping
o Were satisfied with life
o Had a sense of understanding and meaning from life

Women were more likely to remain on sick leave if they:

o Were blue-collar workers in the public sector
o Had “multifaceted' symptoms
o Tried to describe themselves in a socially favourable way

Psychological state:

Participants who expected that they would return to work were much more likely to.
Men who had good coping strategies were more likely to return to work, while women's coping strategies did not affect their return to work.
Both men and women with a sense of understanding and meaning in life were more likely to return to work, but the effect was greater in men than women.
All participants in this study wanted to describe themselves in a socially desirable way, with women who had taken many days of sick leave having particularly high levels.
Conclusions:
Many factors combine to influence people on an extended leave of absence from work. If an individual expected to return to work they were much more likely to do so. Participants were also more likely to return to work if they:

Hadn't had many days on sick leave in the past (before their injury or illness)
Were in white-collar jobs in the private sector
Had a higher level of education
Were satisfied with life
Had a sense of understanding and meaning from life

Participants were less likely to return to work if they:

Had “multifaceted' symptoms (i.e. an array of symptoms not related to their diagnosis)
Wanted to describe themselves in a socially desirable way
Were blue-collar workers in the public sector
References:
PubMed Abstract
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