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.
OBJECTIVE
A growing number of persons aged 16-65 is hampered by a chronic condition in performing job activities. Some of them quit the labour market prematurely. Vocational rehabilitation used to focus on (re)entering the labour market. Recently more attention is paid to interventions aimed at job retention. Some of these use an empowerment perspective. The objective of this study is to describe the characteristics, feasibility and effectiveness of such vocational rehabilitation interventions in order to decide which approaches are fruitful.


METHODS
The Medline, Embase, Cinahl and Psycinfo databases were systematically researched for studies published between 1988 and March 2004. Studies were included if they were experimental, included an intervention that aimed at job retention by means of solving work-related problems, used an empowerment perspective and concerned employees with one of the following chronic illnesses: diabetes mellitus, rheumatic diseases, hearing disorders, multiple sclerosis, inflammatory bowel disease, epilepsy, chronic kidney failure, COPD and asthma.


RESULTS
Nine studies were detected. The aims of the intervention programs were to improve psychosocial skills or implement work accommodations. They were structured as individual (6x) or group programmes (3x). They used methods like education (9x), assessment (7x), counselling (5x), training or role playing (5x). The most important outcome measures were employment status (5x), actions to arrange work accommodations (3x), and psychosocial measures like self-efficacy and social competence (3x). Employment status was claimed to be positively influenced in four out of five studies, obtaining work accommodations was successful in all three studies and psychological outcome measures improved in two out of three studies.


CONCLUSIONS
There is some evidence that vocational rehabilitation interventions that pay attention to training in requesting work accommodations and feelings of self-confidence or self-efficacy in dealing with work-related problems are effective. There is no evidence for greater effectiveness of group programs compared to individual programs. Attention has to be paid to feasibility aspects such as recruitment of participants and cooperation between medical professionals, occupational physicians, and vocational rehabilitation experts. Medical specialists and nursing specialists should pay more attention to work. Although many studies claim effectiveness, evidence for this was often weak due to short follow-up and the lack of control groups. More rigorous evaluation is needed.
Varekamp
Inge
I
Coronel Institute of Occupational Health, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands. i.varekamp@amc.uva.nl
Verbeek
Jos H A M
JH
van Dijk
Frank J H
FJ
D002908:Chronic Disease / Q000453:epidemiology*; D016832:Employment, Supported / Q000639:trends*; D006801:Humans; D016272:Occupational Health; D011209:Power, Psychological; D012050:Rehabilitation, Vocational / Q000379:methods*