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Workers with a chronic disease and work disability

Problems and solutions

Chronisch Kranke im Erwerbsleben

Probleme und Lösungen

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Abstract

The prevalence of chronic diseases in the age group 18–65 years is high. Cardiometabolic conditions and musculoskeletal diseases are the most frequent chronic diseases. Depending on disease and comorbidity, the employment rates are considerably lower than for healthy individuals. Chronically ill workers may have problems in meeting job demands, they may experience physical, cognitive or sensory limitations, have fatigue or pain complaints or other disease symptoms. Psychological distress, depressive feelings, feelings of shame or guilt, lack of coping or communicative skills, and non-supportive colleagues and supervisors may add to work-related problems. The ICF Model (International Classification of Functioning, Disability and Health) of the WHO offers a framework for understanding and considering health-related problems at work and finding solutions. Interventions to prevent problems in functioning, sickness absence and work disability may focus on the worker, the workplace, or health care. Multidisciplinary vocational rehabilitation, exercise therapy, cognitive behavioural interventions, workplace interventions and empowerment are interventions with at least some evidence of effectiveness. Future policy could focus more on promotion of workers’ health and future research should include the interests and motivations of employers concerning disability management, skills of line managers, the feasibility of interventions to prevent work disability and the context sensitivity of study outcomes.

Zusammenfassung

Die Prävalenz chronischer Erkrankungen in der Altersgruppe der 18- bis 65-Jährigen ist hoch. Am häufigsten treten kardiometabolische Störungen und muskuloskeletale Krankheiten auf. In Abhängigkeit von der Erkrankung und Komorbidität liegen die Beschäftigungsraten verglichen mit gesunden Personen wesentlich niedriger. Chronisch kranken Beschäftigten kann es schwer fallen, den beruflichen Anforderungen gerecht zu werden. Sie können physisch, kognitiv und sensorisch eingeschränkt sein sowie an Erschöpfung, Schmerzen oder anderen Krankheitssymptomen leiden. Psychische Belastung, depressive Verstimmungen, Scham- und Schuldgefühle, fehlende Coping- und Kommunikationsfähigkeiten wie auch mangelnde Unterstützung durch Kollegen und Vorgesetzte können die Arbeitsprobleme noch verstärken. Die International Classification of Functioning, Disability and Health (ICF) der Weltgesundheitsorganisation (WHO) bietet einen Rahmen für das Verständnis, die Berücksichtigung und die Lösung gesundheitsbedingter Probleme am Arbeitsplatz. Maßnahmen zur Prävention von Beeinträchtigungen der Funktionsfähigkeit, krankheitsbedingten Fehlzeiten und Arbeitsunfähigkeit können auf den Beschäftigten, den Arbeitsplatz oder die Gesundheitsversorgung zielen. Multidisziplinäre berufliche Rehabilitation, Bewegungstherapie, kognitive Verhaltenstherapie, Interventionen am Arbeitsplatz und Empowerment sind Maßnahmen, für deren Wirksamkeit es zumindest einige Anhaltspunkte gibt. Zukünftige Strategien könnten schwerpunktmäßig die Gesundheit der Beschäftigten fördern. In kommende Untersuchungen sollten die Belange und Motivationen von Arbeitgebern hinsichtlich der betrieblichen Wiedereingliederung („disability management“) einbezogen werden. Auch die Fähigkeiten der Vorgesetzten, die Machbarkeit von Maßnahmen zur Prävention der Arbeitsunfähigkeit und die Kontextsensitivität der Studienergebnisse gilt es zu berücksichtigen.

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Notes

  1. Nowadays, chronic medical conditions are frequently presented under the umbrella term noncommunicable diseases, for instance by the WHO, the UN, and the EU.

  2. These figures slightly underestimate the prevalence of chronic disease and the contribution of chronic disease to unemployment since a number of less prevalent but serious diseases,.e.g. neurological diseases like multiple sclerosis or Parkinson’s disease, are not taken into account in the GEDA studies.

References

  1. Waddell G, Burton AK, Kendall NAS (2008) Vocational rehabilitation. What works, for whom, and when? TSO, London http://www.kendallburton.com/Library/Resources/Vocational_Rehabilitation.pdf. Accessed 10 December 2012

  2. Fuchs J, Busch M, Lange C, Scheidt-Nave C (2009) Prevalence and patterns of morbidity among adults in Germany. Results of the German telephone health interview survey German Health Update (GEDA). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 55:576–586

    Google Scholar 

  3. Kroll LE, Lampert T (2011) Unemployment, social support and health problems: results of the GEDA study in Germany. Dtsch Arztebl Int 108:47–52

    PubMed  Google Scholar 

  4. Koppes L, Vroome E de, Mol M et al (2010) Nationale Enquête Arbeidsomstandigheden 2009. TNO, Hoofddorp

  5. Munir F, Jones D, Leka S, Griffiths A (2005) Work limitations and employer adjustments for employees with chronic illness. Int J Rehabil Res 28:111–117

    Article  PubMed  Google Scholar 

  6. Lerner DJ, Amick BC III, Malspeis S, Rogers WH (2000) A national survey of health-related work limitations among employed persons in the United States. Disabil Rehabil 22:225–232

    Article  PubMed  CAS  Google Scholar 

  7. Munir F, Yarker J, Haslam C et al (2007) Work factors related to psychological and health-related distress among employees with chronic illnesses. J Occup Rehabil 17:259–277

    Article  PubMed  Google Scholar 

  8. Westhoff G, Dörner T, Zink A (2012) Fatigue and depression predict physician visits and work disability in women with primary Sjögren’s syndrome: results from a cohort study. Rheumatology 51:262–269

    Article  PubMed  Google Scholar 

  9. Swain MG (2000) Fatigue in chronic disease. Clin Sci 99:1–8

    Article  PubMed  CAS  Google Scholar 

  10. Donders NC, Roskes K, Gulden JW van der (2007) Fatigue, emotional exhaustion and perceived health complaints associated with work-related characteristics in employees with and without chronic diseases. Int Arch Occup Environ Health 80:577–587

    Article  PubMed  CAS  Google Scholar 

  11. Franssen PM, Bultmann U, Kant I, Amelsvoort LG van (2003) The association between chronic diseases and fatigue in the working population. J Psychosom Res 54:339–344

    Article  PubMed  Google Scholar 

  12. Varekamp I, Verbeek JH, Boer A de, Dijk FJ van (2011) Effect of job maintenance training program for employees with chronic disease—a randomized controlled trial on self-efficacy, job satisfaction, and fatigue. Scand J Work Environ Health 37:288–297

    Article  PubMed  Google Scholar 

  13. Detaille SI, Haafkens JA, Van Dijk FJH (2003) What employees with rheumatoid arthritis, diabetes mellitus and hearing loss need to cope at work. Scand J Work Environ Health 29:134–142

    Article  PubMed  Google Scholar 

  14. Nilsson I, Fitinghoff H, Lilja M (2007) Continuing to work after the onset of rheumatoid arthritis. Work 28:335–342

    PubMed  Google Scholar 

  15. Banks P, Lawrence M (2006) The Disability Discrimination Act, a necessary, but not sufficient safeguard for people with progressive conditions in the workplace? The experiences of younger people with Parkinson’s disease. Disabil Rehabil 28:13–24

    Article  PubMed  Google Scholar 

  16. Lacaille D, White MA, Backman CL, Gignac MA (2007) Problems faced at work due to inflammatory arthritis: new insights gained from understanding patients’ perspective. Arthritis Rheum 57:1269–1279

    Article  PubMed  Google Scholar 

  17. Gustafsson M, Ekholm J, Ohman A (2004) From shame to respect: musculoskeletal pain patients’ experience of a rehabilitation programme, a qualitative study. J Rehabil Med 36:97–103

    Article  PubMed  Google Scholar 

  18. Beatty JA, Joffe R (2006) An overlooked dimension of diversity: the career effects of chronic illness. Organ Dyn 35:182–195

    Article  Google Scholar 

  19. Detaille SI, Heerkens YF, Engels JA et al (2009) Common prognostic factors of work disability among employees with a chronic somatic disease: a systematic review of cohort studies. Scand J Work Environ Health 35:261–281

    Article  PubMed  Google Scholar 

  20. De Croon EM, Sluiter JK, Nijssen TF et al (2005) Work ability of Dutch employees with rheumatoid arthritis. Scand J Rheumatol 34:277–283

    Article  Google Scholar 

  21. Van Amelsvoort LG, Kant IJ, Beurskens AJ et al (2002) Fatigue as a predictor of work disability. Occup Environ Med 59:712–713

    Article  Google Scholar 

  22. WHO (2002) The international classification of functioning, disability and health (ICF) WHO, Geneva

  23. Verbrugge LM, Jette AM (1994) The disablement process. Soc Sci Med 38(1):1–14

    Article  PubMed  CAS  Google Scholar 

  24. Pransky GS, Loisel P, Anema JR (2011) Work disability prevention research: current and future prospects. J Occup Rehabil 21:287–292

    Article  PubMed  CAS  Google Scholar 

  25. Palmer KT, Harris EC, Linaker C et al (2012) Effectiveness of community- and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss: a systematic review. Rheumatology 51:230–242

    Article  PubMed  Google Scholar 

  26. Lambeek LC, Bosmans JE, Van Royen BJ et al (2010) Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomised controlled trial. BMJ 30:341:c6414

    Google Scholar 

  27. De Buck PD, le Cessie S, Hout WB van den et al (2005) Randomized comparison of a multidisciplinary job-retention vocational rehabilitation program with usual outpatient care in patients with chronic arthritis at risk for job loss. Arthritis Rheum 53:682–690

    Article  Google Scholar 

  28. Khan F, Turner-Stokes L, Ng L, Kilpatrick T (2007) Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database Syst Rev (2):CD006036

    Google Scholar 

  29. Hayden JA, Tulder MW van, Malmivaara A, Koes BW (2005) Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev (3):CD000335

    Google Scholar 

  30. Joosen M, Sluiter J, Joling C, Frings-Dresen M (2008) Evaluation of the effects of a training programme for patients with prolonged fatigue on physiological parameters and fatigue complaints. Int J Occup Med Environ Health 21:237–246

    Article  PubMed  Google Scholar 

  31. Moss-Morris R, Weinman J, Petrie KJ et al (2002) The revised illness perception questionnaire (IPQ-R). Psychol Health 17:1–16

    Article  Google Scholar 

  32. Boot CR, Heijmans M, Gulden JW van der, Rijken M (2008) The role of illness perceptions in labor participation of the chronically ill. Int Arch Occup Environ Health 82(1):13–20

    Article  PubMed  Google Scholar 

  33. Boot CR, Exel NJ van, Gulden JW van der (2009) “My lung disease won’t go away, it’s there to stay”: profiles of adaptation to functional limitations in workers with asthma and COPD. J Occup Rehabil 19:284–292

    Article  PubMed  CAS  Google Scholar 

  34. Petrie KJ, Cameron LD, Ellis CJ et al (2002) Changing illness perceptions after myocardial infarction: an early intervention randomized controlled trial. Psychosom Med 64:580–586

    PubMed  Google Scholar 

  35. Jansen DL, Heijmans M, Rijken M, Kaptein AA (2011) The development of and first experiences with a behavioural self-regulation intervention for end-stage renal disease patients and their partners. J Health Psychol 16:274–283

    Article  PubMed  Google Scholar 

  36. Van Oostrom SH, Driessen MT, Vet HC de et al (2009) Workplace interventions for preventing work disability. Cochrane Database Syst Rev (2):CD006955

    Google Scholar 

  37. Anema JR, Steenstra IA, Bongers PM et al (2007) Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial. Spine 32:291–298

    Article  PubMed  Google Scholar 

  38. Feste C, Anderson RM (1995) Empowerment: from philosophy to practice. Patient Educ Couns 26:139–144

    Article  PubMed  CAS  Google Scholar 

  39. Lorig K (1996) Chronic disease self-management; a model for tertiary prevention. Am Behav Sci 39:676–683

    Article  Google Scholar 

  40. Zimmerman MA, Warschausky S (1998) Empowerment theory for rehabilitation research: conceptual and methodological issues. Rehabil Psychol 43:3–16

    Article  Google Scholar 

  41. Varekamp I, Verbeek JH, Dijk FJ van (2006) How can we help employees with chronic diseases to stay at work? A review of interventions aimed at job retention and based on an empowerment perspective. Int Arch Occup Environ Health 80:87–97

    Article  PubMed  Google Scholar 

  42. Schene AH, Koeter MW, Kikkert MJ et al (2007) Adjuvant occupational therapy for work-related major depression works: randomized trial including economic evaluation. Psychol Med 37:351–362

    Article  PubMed  Google Scholar 

  43. Haafkens JA, Kopnina H, Meerman MG, Dijk FJ van (2011) Facilitating job retention for chronically ill employees: perspectives of line managers and human resource managers. BMC Health Serv Res 11:104

    Article  PubMed  Google Scholar 

  44. Lukasczik M, Wolf HD, Gerlich C et al (2011) Current state of vocationally oriented medical rehabilitation—a German perspective. Disabil Rehabil 33:2646–2655

    Article  PubMed  Google Scholar 

  45. Higgins A, O’Halloran P, Porter S (2012) Management of long term sickness absence: a systematic realist review. J Occup Rehabil 22:322–332

    Article  PubMed  Google Scholar 

  46. Young AE, Wasiak R, Roessler RT et al (2005) Return-to-work outcomes following work disability: stakeholder motivations, interests and concerns. J Occup Rehabil 15:543–556

    Article  PubMed  Google Scholar 

  47. Chan F, Strauser D, Gervey R, Lee EJ (2010) Introduction to demand-side factors related to employment of people with disabilities. J Occup Rehabil 20:407–411

    Article  PubMed  Google Scholar 

  48. Lötters FJ, Foets M, Burdorf A (2011) Work and health, a blind spot in curative healthcare? A pilot study. J Occup Rehabil 21:304–312

    Article  PubMed  Google Scholar 

  49. Varekamp I, Haafkens JA, Detaille SI et al (2005) Preventing work disability among employees with rheumatoid arthritis: what medical professionals can learn from the patients’ perspective. Arthritis Rheum 53:965–972

    Article  PubMed  Google Scholar 

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On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Varekamp, I., van Dijk, F. & Kroll, L. Workers with a chronic disease and work disability. Bundesgesundheitsbl. 56, 406–414 (2013). https://doi.org/10.1007/s00103-012-1621-1

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