1. Work participation of people with a chronic disease Marloes Vooijs Monique Leensen Jan Hoving Haije Wind Monique Frings-Dresen

2. Background Increase in people with a chronic disease People with chronic disease experience limitations in work Limitations negatively affect work participation Limitations are common in different diagnosis - World Health Organization. Global Status Report on noncommunicable diseases 2010. WHO 2011. http://www.who.int/nmh/publications/ncd_report_full_en.pdf. - European Commission Eurostat. Health status statistics—statistics explained (2014/2/3). European Commission Eurostat 2014. http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/ Health_status_statistics.

3. Project: Guideline Research is part of guideline focusing on: Factors associated with work participation Effective interventions enhancing participation Role of people with a chronic disease Role of the professionals involved in the work participation of people with a chronic disease Aiming to enhance guidance of occupational health professionals of people with a chronic disease

4. Project 1: Disease-generic factors associated with work participation

5. Research question Which disease-generic factors are associated with work retention or return to work of people of working age with a chronic disease?

6. Method: Search Search conducted in: Dutch guidelines focusing on specific disease Including evidence on ‘work’ Results based on international literature Guidelines published between 2004 - 2015

7. Method: Inclusion criteria 1.Guideline needs to include evidence on work participation 2.Factors are associated with work retention/return to work 3.People included have a chronic disease 4.People included are of working age (18-65y) 5.Factor is found in > 1 guideline to be rated ‘generic’

8. Results 74 guidelines including work participation & chronic disease Vijf ziekte-generieke reviews gevonden van voldoende kwaliteit 55 guidelines focused on factors 31 guidelines included 23 factors regarding work participaton

9. Results: Factors (+) SociodemograficDiseaseEnvironmentPsychosocially Young ageFew limitationsSupport colleagues/ employer High recovery expectancy High education Little painDeskworkHigh motivation Short duration of absence Opportunities for job changes Good physical functioning Perceived social support

10. Results: Factors (-) SociodemograficDiseaseEnvironmentPsychosocially High ageCo-morbidityHeavy workAnxiety Low educationPhysical limitations High work pressure Emotional imbalance Female genderFatigueLittle autonomyInactive coping Psychical/ cognitive limitations Insufficient support work environment Low recovery expectation Long disease duration Low-skilled work Stigmatization

11. Conclusion Factors retrieved could be considered common for different diagnosis (‘generic’) Disease-generic factors provide insight in who is at risk for reduced participation

12. Implications Some factors: serve as indicator Some factors: amenable to change

13. Project 2: Effective interventions to enhance work particiption

14. Research question Which interventions are effective in enhancing work participation of people with a chronic disease and of working age?

15. Method: Search Systematic review of reviews Search conducted in: PubMed EMBASE PsycINFO CINAHL Cochrane Library Publications between 2004 – 2015

16. Method: Inclusion criteria 1.Systematic review 2.People included having a chronic disease 3.People included are of working age (18-65y) 4.People of various diagnosis included in the review 5.Interventions described aimed at participation in work

17. AMSTAR Assessment of reviews on 11 points Medium quality review: 5-8 points High quality reviews: 9-11 points Decision: Only reviews of medium or high quality included Method: Quality assessment

18. Results: Flowchart Hits found (Pubmed, EMBASE, PsycINFO, CINAHL, Cochrane): 4866 Hits after deduplication: 3118 Full-text articles: 102 Full-text included: 9

19. Results 5 disease-generic reviews of medium/high quality Vijf ziekte-generieke reviews gevonden van voldoende kwaliteit 4 reviews included interventions aimed at work 3 reviews included effective interventions aimed at work

20. Results: Intervention 1 Components: Changes to workplace, equipment, work design, work organisation, work conditions Case management with worker and employer Outcome: Time until first return to work (RTW) Effect: Workplace interventions more effective than CAU at 12-month follow-up (HR: 1.6, 95%CI: 1.3-2.2) Vijf ziekte-generieke reviews gevonden van voldoende kwaliteit

21. Results: Intervention 2 Components: Early contact with worker by workplace Healthcare provider contact with workplace Worksite ergonomic visit, work accommodation offer Physiotherapist Outcome: Work disability duration and RTW rate Effect: Higher RTW rate (OR: 2.2, 95%CI: 1.0-4.8) Faster RTW (OR: 1.9, 95%CI: 1.2-3.1) Vijf ziekte-generieke reviews gevonden van voldoende kwaliteit

22. Results: Intervention 3 Components: Work accommodations, consisting of: redesign of work schedules, work organisation, work environment, assistive technology, assistance of others, special transportation Outcome: Employment, defined as work retention and RTW Effect: Work retention (OR: 0.6, 95%CI: 0.3-0.9) Employment rate (OR: 5.6, 95%CI: 2.2-14.1) Vijf ziekte-generieke reviews gevonden van voldoende kwaliteit

23. Conclusion Effective interventions directed at work can be used as a generic approach to enhance work participation of people with a chronic disease.

24. Implications Work-directed interventions can be used generic. Therefore, it can be used as part of a work participation plan next to specific interventions. These interventions can also be used for diagnosis which no evidence is present.

25. Summary Increase in people with a chronic disease Work participation can be difficult for people with a chronic disease Various factors are associated with work participation (negatively/positively) Some factors serve as indicator, some are amenable to change Work-directed interventions can be used to enhance work participation

26. Thanks for your attention! Any questions? Marloes Vooijs: i.m.vooijs@amc.nl