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Sustained Attention and Working Memory Predict the Number of Days on Health-Related Benefits in the Year Following Occupational Rehabilitation

Authors:
  • Norwegian National Advisory Unit on Occupational Rehabilitation
  • NORCE Norwegian Research Centre
  • Catosenteret Rehabilitation Center

Abstract and Figures

Purpose The objective of this study was to investigate the association between cognitive and emotional functioning and the number of days on health-related benefits such as sick leave, work assessment allowance and disability pension. We investigated whether cognitive and emotional functioning at the start of rehabilitation and the change from the start to the end of rehabilitation predicted the number of days on health-related benefits in the year after occupational rehabilitation. Methods A sample of 317 individuals (age 19–67 years), mainly diagnosed with a musculoskeletal or mental and behavioural ICD-10 disorder, participated. The sample was stratified depending on the benefit status in the year before rehabilitation. Those receiving health-related benefits for the full year comprised the work assessment allowance and disability pension (WAA) group and those receiving benefits for less than a year comprised the sick leave (SL) group. The participants were administered cognitive and emotional computerised tests and work and health questionnaires at the beginning and end of rehabilitation. The cumulative number of days on health-related benefits during 12 months after rehabilitation was the primary outcome variable and age, gender, educational level, subjective health complaints, anxiety, and depression were controlled for in multiple regression analyses. Results The WAA group (n = 179) was significantly impaired at baseline compared to the SL group (n = 135) in focused attention and executive function, and they also scored worse on work and health related variables. Higher baseline scores and change scores from the start to the end of rehabilitation, for sustained attention, were associated with fewer number of health-related benefit days in the WAA group, while higher baseline scores for working memory were associated with fewer number of health-related benefit days in the SL group. Conclusions New knowledge about attention and memory and return to work in individuals with different benefit status may pave the way for more targeted programme interventions. Rehabilitation programmes could benefit from designing interventions that respectively improve sustain attention and working memory related to working life in individuals on sick leave or work assessment allowance and disability pension.
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Vol:.(1234567890)
Journal of Occupational Rehabilitation (2021) 31:592–603
https://doi.org/10.1007/s10926-020-09944-5
1 3
Sustained Attention andWorking Memory Predict theNumber
ofDays onHealth‑Related Benefits intheYear Following Occupational
Rehabilitation
ThomasJohansen1· IreneØyeaten1,2· HegeR.Eriksen3· PeterS.Lyby4· WinandH.Dittrich5· IngeHolsen6·
HanneJakobsen7· RubyDelRiscoKollerud1· ChrisJensen1
Accepted: 3 November 2020 / Published online: 20 January 2021
© The Author(s) 2021
Abstract
Purpose The objective of this study was to investigate the association between cognitive and emotional functioning and
the number of days on health-related benefits such as sick leave, work assessment allowance and disability pension. We
investigated whether cognitive and emotional functioning at the start of rehabilitation and the change from the start to the
end of rehabilitation predicted the number of days on health-related benefits in the year after occupational rehabilitation.
Methods A sample of 317 individuals (age 19–67years), mainly diagnosed with a musculoskeletal or mental and behavioural
ICD-10 disorder, participated. The sample was stratified depending on the benefit status in the year before rehabilitation.
Those receiving health-related benefits for the full year comprised the work assessment allowance and disability pension
(WAA) group and those receiving benefits for less than a year comprised the sick leave (SL) group. The participants were
administered cognitive and emotional computerised tests and work and health questionnaires at the beginning and end of
rehabilitation. The cumulative number of days on health-related benefits during 12months after rehabilitation was the primary
outcome variable and age, gender, educational level, subjective health complaints, anxiety, and depression were controlled
for in multiple regression analyses. Results The WAA group (n = 179) was significantly impaired at baseline compared to
the SL group (n = 135) in focused attention and executive function, and they also scored worse on work and healthrelated
variables. Higher baseline scores and change scores from the start to the end of rehabilitation, for sustained attention, were
associated with fewer number of health-related benefit days in the WAA group, while higher baseline scores for working
memory were associated with fewer number of health-related benefit days in the SL group. Conclusions New knowledge
about attention and memory and return to work in individuals with different benefit status may pave the way for more targeted
programme interventions. Rehabilitation programmes could benefit from designing interventions that respectively improve
sustain attention and working memory related to working life in individuals on sick leave or work assessment allowance
and disability pension.
Keywords Occupational rehabilitation· Return to work· Sick leave· Cognition· Attention· Memory
* Thomas Johansen
thomas.johansen@arbeidoghelse.no
1 Norwegian National Advisory Unit onOccupational
Rehabilitation, Haddlandsvegen 20, 3864Rauland, Norway
2 NORCE, Norwegian Research Centre, Bergen, Norway
3 Department ofSport, Food andNatural Sciences, Western
Norway University ofApplied Sciences, Bergen, Norway
4 Catosenteret Rehabilitation Center, Son, Norway
5 FOM Hochschule, KCI Competence Center forBehavioral
Economics, Frankfurt, Germany
6 Red Cross Haugland Rehabilitation Center, Flekke, Norway
7 Valnesord Health Sports Centre, Fauske, Norway
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593Journal of Occupational Rehabilitation (2021) 31:592–603
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Introduction
Participation in working life involves mental and cognitive
demands, coping with different social interactions, adjust-
ing to multiple roles, and adapting to various occupational
contexts. Therefore, it can be assumed that cognitive and
emotional abilities such as attention, memory, executive
function and emotion regulation are essential for perform-
ing well in working life [13]. Cognitive impairments are
prevalent in individuals on long-term sick leave [47]
and improving cognitive and emotional functioning will
enhance the ability to stay focused, process and remember
information, and shift focus when required because indi-
viduals have increased mental resources and capacity [7].
Emotional functioning refers to our ability to regulate and
label our emotions enabling us to influence and direct our
attention away from negative emotions and biases result-
ing in better coping [10]. The benefits of improved cogni-
tive and emotional functioning are better flexibility, better
regulation of our emotions and experiences, and increased
quality of life [810]. Efforts have been made to better
understand cognitive as well as emotional functioning in
long-term sick-listed individuals participating in occupa-
tional rehabilitation [4, 7, 1113]. In Norway, the occupa-
tional rehabilitation programmes are designed to facilitate
return to work (RTW) through physical and psychological
empowerment and communication with the employer.
We have recently reported that focused and sustained
attention improved more than memory, executive function
and emotion recognition during occupational rehabilita-
tion [7]. The next step is to investigate whether baseline
scores and change scoresduring rehabilitation in cognitive
and emotional functioning, such as sustained attention and
emotion recognition, are associated with a higher probabil-
ity of RTW when the duration of sick leave before enrol-
ment in the programme is taken into account. If such asso-
ciations are present, the treatment success of occupational
rehabilitation may depend, at least partly, on improving
cognitive functioning [7] and cognitive beliefs related to
work through cognitive therapy [14].
The treatment components in occupational rehabilita-
tion programmes have a cognitive behavioural approach
and consist of an assessment of the work and health situ-
ation, physical activity, individual consultations, and
collaboration with the workplace [15, 16]. The cognitive
approach draws on principles and interventions from evi-
dence-based psychological treatments such as cognitive
therapy, acceptance and commitment therapy and motiva-
tional interviewing [1719]. Psychological interventions
are the most common form of treatment for mental health
problems such as anxiety, depression, pain and stress [20],
which are prevalent in the patient groups being referred to
occupational rehabilitation [15, 21]. Psychological inter-
ventions have also shown to improve functional outcomes
such as physical functioning, coping with pain and fatigue
[20, 22] and RTW [18]. However, functional changes seem
to occur to a lesser extent compared to changes in cog-
nition and behaviour [20]. The effect of using a cogni-
tive approach, together with other treatment components,
has shown that work participation increased for patients
attending a long inpatient programme compared to asix
week outpatient programme with two weekly hours of
treatment [16], while a short inpatient programme, with
the same treatment components as the long, was also com-
pared to the outpatient programme but showed no superior
effects on work participation [17].
Given the documentation of cognitive impairments
in individuals on sick leave [5, 6, 2326], the association
between cognitive functioning and RTW has not received
sufficient attention. Besides, other studies have also reported
that impaired cognitive and executive functioning have
been found to negatively affect occupational status [2729].
The present study sought to overcome some of the meth-
odological limitations in previous studies investigating the
relationship between cognition and RTW. These studies did
not obtain register-based sick leave [30, 31], generally had
small sample sizes when investigating RTW [31], failed to
include emotional tests [25] and interventions were not pro-
vided in a systematic manner [5, 6]. In the current study,
objective cognitive and emotional tests were administered,
health-related benefits status up to one year after rehabilita-
tion, based on register data, were obtained, and all patients
participated in occupational rehabilitation. It was expected
that attention would be associated with the number of days
on health-related benefits in the year following rehabilita-
tion as specific improvements in functioning related to atten-
tion is likely to occur during the rehabilitation programmes.
Thus, the aim of the study was to investigate the association
between cognitive and emotional functioning and RTW,
within two groups of patients characterised by different
durations of sick leave before participation in occupational
rehabilitation.
Methods
Participants
In total, 317 individuals completing either inpatient or
outpatient occupational rehabilitation were recruited from
four clinics. Those that had received health-related benefits
for the full year before rehabilitation comprised the work
assessment allowance and disability pension (WAA) group
and thosereceiving health-related benefits for less than a
year comprised the sick leave (SL) group. This split was
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594 Journal of Occupational Rehabilitation (2021) 31:592–603
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decided upon because, in the Norwegian health-related ben-
efit system, there is a natural step from sick leave benefits
after one year, where 100% of wages are compensated, to
work assessment allowance benefits, where 66% of wages
are compensated. Eight participants did not receive health-
related benefits at the time of inclusion in the study but were
on full time (inpatient) or part time (outpatient) sick leave
during rehabilitation. The majority of patients had diagnoses
in the categoriesM, diseases of the musculoskeletal sys-
tem and connective tissue (53%), F, mental and behavioural
disorders (27%), or, G, disease of the nervous system (8%)
within ICD-10 [32]. Individuals with a history of head injury
or in the process of applying for full disability pension were
excluded from the study.
Study Design
This study was a multicentre prospective cohort study
involving four rehabilitation clinics. All participants were
followed for 12months with register data on the health-
related benefit status provided by the the Norwegian Labour
and Welfare Administration. The participants completed
cognitive and emotional tests and questionnaires on the top-
ics of work and health pre and post rehabilitation. That is, on
the first, second or third day after arrival at the rehabilitation
clinic (baseline), and to enable the calculation of change
scores the participants completed a second assessment one
to three days before the end of rehabilitation (change score).
All assessments took place in a quiet room at each clinic
and completion of the tests and questionnaires took approxi-
mately 1h and 30min at each assessment. Three research
assistants, who all took online training provided by Cam-
bridge Cognition in administering the Cambridge Neuropsy-
chological Test Automated Battery (CANTAB), and the first
author (TJ), having extensive training in neuropsychological
administration, were responsible for all data collection.
Intervention
The duration of the rehabilitation programmes varied
between the four clinics from three to 12weeks. The clinics
had similar treatment components which included physical
activity adjusted according to patients’ capacity applying
endurance and resistance exercises, cognitive behaviour
treatment components based on principles from cognitive
behaviour therapy focusing on work and health issues, and
when deemed appropriate, collaboration with the workplace,
the patients’ general practitioners, and the social security
office. The majority of patients made a written plan during
rehabilitation specifying the steps needed to RTW. Patients
were followed up individually and in groups by an interdis-
ciplinary team consisting of, but not limited to, a physician,
physiotherapist, sports pedagogue, psychologist, work con-
sultant/coach and nurse/psychiatric nurse.
Health‑Related Benefits System
In Norway, medically certified sick leave is granted for a
maximum of 52weeks with 100% compensation of which
the employer is responsible for economic compensation
during the first 16days, and after that, the Norwegian
Labourand Welfare Administration. If long term benefits
are required after 52weeks it is possible to apply for work
assessment allowance of which 66% of the wage is com-
pensated. This can be granted for a maximum of 3years
and during this period or after, disability pension may be
granted. All benefits can be granted in combination with
partial work participation and are commonly named sick
leave benefits, work assessment allowance benefits and dis-
ability benefits.
Materials
More details about the cognitive and emotional tests and the
work and healthrelated questionnaires are available from
Johansen etal. [7].
Tests onCognitive andEmotional Functions
A battery of eight cognitive and emotional tests from the
CANTAB was administered to cover a broad range of func-
tions. The following tests were administered: Simple Reac-
tion Time, Choice Reaction Time, Rapid Visual Information
Processing, Spatial Working Memory, Spatial Recognition
Memory, Stockings of Cambridge (a version of the Tower
of London task measuring executive planning), Intra-Extra
Dimensional Set Shift, Emotion Recognition Task. All tests
were administered on a touch-sensitive computer screen. The
administration of the tests was counterbalanced in two orders
so that each participant experienced each order once. This
was carried out to avoid the effects of order which could
potentially influence the performance.
Work andHealth Questionnaires
The following questionnaires and single-item questions were
administered: Work ability measured by one item compar-
ing current work ability with lifetime best [33]; Expectation
to RTW based on one item asking about when the partici-
pant expected to RTW [34]; Return to Work Self-Efficacy
(RTWSE–19) [35, 36]; Subjective Health Complaints (SHC)
inventory [37]; Theoretically Originated Measure of the
Cognitive Activation Theory of Stress (TOMCATS) [38];
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595Journal of Occupational Rehabilitation (2021) 31:592–603
1 3
Fear Avoidance Beliefs Questionnaire (FABQ) [39]; Hospi-
tal Anxiety and Depression Scale (HADS) [40].
Statistical Analysis
SPSS version 25 was used to analyse the data (SPSS Inc.,
2019). As described under participants, the sample was split
into two groups based on the individuals’ health-related ben-
efit status in the year before rehabilitation. The cognitive
and emotional distribution of baseline and change scores
were both graphically and descriptively examined in terms
of skewness and outliers. It was decided to remove extreme
latencies and error rates, which were considered subtle and
clearly distinguishable from the rest [41]. In total, six outli-
ers were removed. Between-group differences at baseline
were examined for demographic, work and health character-
istics and baseline performance in cognitive and emotional
functioning using independent samples t-tests. Gender,
education and expectation to RTW were subjected to chi-
square analysis. The two groups were separately subjected to
multiple linear regression analysis. The predictor variables
were the tests within thecognitive domains attention, mem-
ory, executive function, and emotion. The outcome variable
was measured using register data on health-related benefits
one year from the second assessment and was the accumu-
lated number of days on either sick leave, work assessment
allowance or disability pension. The number of days was
counted from the second assessment to take into account
the difference in duration of the rehabilitation programmes
between the four clinics. Graded benefits were converted to
full days. This ensured that all health-related benefit days
were counted from the same time point for all participants.
The analyses were split in two, first using baseline cogni-
tive and emotional scores as predictors and secondly using
the change scores in cognitive and emotional performance
as predictors. Prior to the multiple regression analysis, the
association between each of the cognitive and emotional pre-
dictors (baseline scores and change scores) and the depend-
ent variable was separately examined in the two groups by
bivariate linear regression analyses. Three multiple regres-
sion models were subsequently created.
Model 1: Predictors associated with the dependent
variable at a statistically significant level of p < 0.20 in
thebivariate analyses were further analysed in multiple
regression analyses controlling for age, gender and educa-
tion, separately for each cognitive and emotional domain
(see Tables36). Model 2: Same as model 1 but adding
the variables SHC pseudoneurology and SHC musculoskel-
etal pain. Model 3: Same as model 1 but adding the vari-
ables HADS anxiety and HADS depression. The independ-
ent variables included in the three models were separately
checked for multicollinearity in the WAA and SL group by
the variance inflation factor (VIF), where values > 5 indicate
multicollinearity [42]. Statistical significance was accepted
with a two-tailed p-value of ≤ 0.05.
Results
There were no group differences at baseline in age and edu-
cation, while the number of female participants was higher
in the WAA compared to the SL group (Table1). Partici-
pants in the SL group had expectations about faster RTW
compared to the WAA group. For the work variables, the SL
group compared to the WAA group reported higher work
ability and higher RTW self-efficacy for the factors “meeting
job demands” and “modifying job tasks”. For the health var-
iables, the SL group showed better coping and lower scores
on the SHC pseudoneurology, TOMCATS hopelessness,
FABQ for work and physical activity, and HADS depression.
Overall, the SL participants performed better on most
of the cognitive and emotional tests compared to the WAA
group, where significant group differences were found in
focused attention on the simple and choice reaction time
tests and in executive function on the stockings of Cam-
bridge task (Table2).
Sustained attention and executive function were associ-
ated with the number of days on health-related benefits in
the year after rehabilitation for the WAA group (Table3) and
working memory and executive function for the SL group
(Table4). Thus, these variables were separately included for
each group, as baseline predictors and change score predic-
tors, in the multiple regression analysis.
Cognitive Baseline andChange Score Predictors
andNumber ofDays onHealth‑Related Benefits
intheWork Assessment Allowance andDisability
Pension Group
Regression model 1 indicated that latency on the rapid
visual information processing test was significant both at
baseline (t (163) = 2.574, p = 0.011) and as change score
(t (150) = − 2.527, p = 0.013) (Table5). Latency on therapid
visual information processing testremained significant in
models 2 and 3 after controlling for SHC pseudoneuroloy
and musculoskeletal pain and HADS anxiety and depression
respectively. In model 3, the change score for HADS depres-
sion was also significant (p = 0.019). For the domain execu-
tive function, the change score for HADS depression was
significant in model 3 (p = 0.044) (Table5). These results
did not change when the same analyses were run including
the outliers.
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596 Journal of Occupational Rehabilitation (2021) 31:592–603
1 3
Cognitive Baseline andChange Score Predictors
andtheNumber ofDays onHealth‑Related Benefits
intheSick Leave Group
Errors on the spatial working memory test was signifi-
cant at baseline in regression model 1 (t (131) = 2.067,
p = 0.041) and 2 (t (122) = 2.533, p = 0.013) (Table6).
For the domain executive function, choice duration on the
stockings of Cambridge test at baseline was significant in
model 3 (t (121) = -2.051, p = 0.043). The results did not
change when the same analyses were run including the
outliers.
The VIF of the independent variables in the three mod-
els for the WAA and SL group were all below 2.0, indicat-
ing no multicollinearity.
Table 1 Demographic, work and health characteristics at baseline
SD standard deviation, Χ2 chi-square statistic, RTWSE-19 return-to-work self-efficacy, SHC subjective health complaints inventory, TOMCATS
theoretically originated measure of the cognitive activation theory of stress, FABQ fear avoidance beliefs questionnaire, HADS hospital anxiety
and depression scale
# Not all participants responded
Work assessment
allowance and disability
pension (n = 181)
Sick leave (n = 136) Statistics
Variable Mean SD Mean SD t (df)#p-value
Age 45.3 9.8 44.3 9.7 0.936 (315) 0.350
Number of days on health-related benefits one year after
rehabilitation 263.2 90.1 15.5 14.5 Not applicable
Work ability (0–10; 10 = best work ability) 3.0 2.1 4.8 2.2 − 6.997 (291) 0.000
RTWSE-19
Meeting job demands (1–70; 70 = highest SE) 28.4 17.3 40.7 17.8 − 5.670 (266) 0.000
Modifying job tasks (1–60; 60 = highest SE) 26.4 12.9 31.3 13.7 − 2.975 (263) 0.003
Communicating needs (1–60; 60 = highest SE) 34.9 14.8 38.2 14.2 − 1.826 (269) 0.069
SHC
Pseudoneurology (0–21; 21 = most complaints) 7.6 4.1 6.7 4.2 1.977 (289) 0.049
Musculoskeletal pain (0–24; 24 = most complaints) 10.3 4.9 9.6 5.2 1.103 (286) 0.271
TOMCATS
Coping (1–4; 1 = best coping)) 2.1 0.6 1.9 0.6 2.443 (285) 0.015
Hopelessness (1–12; 1 = most hopelessness) 8.8 1.9 9.4 1.9 − 2.737 (286) 0.007
Helplessness (1–12; 1 = most helplessness) 9.5 2.1 9.7 1.9 − 1.148 (284) 0.252
FABQ
Work (0–42; 0 = no fear avoidance) 21.9 11.4 18.8 11.2 2.258 (266) 0.025
Physical activity (0–24; 0 = no fear avoidance) 9.7 6.1 8.2 5.9 2.078 (270) 0.039
HADS
Anxiety (0–21; 0 = no anxiety) 8.6 4.1 7.9 4.6 1.265 (280) 0.207
Depression (0–21; 0 = no depression) 6.8 3.9 5.7 3.8 2.232 (280) 0.026
Variable n % n % Χ2 (df)#
Gender
Female 131 72 78 57 7.802 (1) 0.005
Male 50 28 58 43
Education
Elementary 23 13 16 12 0.426 (2) 0.808
Secondary 73 43 62 46
Higher 75 44 56 42
Expectation to return to work
Within 3 months 58 37 99 79 49.039 (1) 0.000
More than 3 months 97 63 26 21
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597Journal of Occupational Rehabilitation (2021) 31:592–603
1 3
Discussion
The association between cognitive and emotional func-
tioning and RTW in employees on health-related ben-
efits is under-studied. We investigated this relationship in
work assessment allowance, disability pension and sick
leave groups participating in occupational rehabilitation.
Individuals in the WAA group had been on health-related
benefits for the whole year before entering the rehabilita-
tion programme, while the SL group had been on benefits
for less than a year. Our results indicated that baseline and
change scores from the start to the end of rehabilitation for
sustained attention in the WAA group and baseline scores
for working memory in the SL group were associated with
fewer number of health-related benefit days in the year after
rehabilitation. That is, better functional status in sustained
attention and working memory at baseline, and the greater
the improvement in sustained attention during rehabilitation,
the fewer days on health-related benefits are expected. The
association seemed strongest in the WAA group, as the effect
of sustained attention remained even after controlling sepa-
rately for SHC pseudoneuroloy and musculoskeletal pain
and HADS anxiety and depression. In the SL group, the
working memory baseline association remained when con-
trolling for SHC pseudoneuroloy and musculoskeletal pain.
In the WAA group, change scores for depression showed an
association with days on health-related benefits, and in the
SL group, baseline scores for executive function also showed
an association, albeit difficult to interpret. Therefore, in the
following, we focus on the most robust results and discuss
the cognitive aspects related to work for sustained attention
and working memory. The WAA and SL group differed in
cognitive performance at baseline, with the former scoring
worse in focused attention and executive function. On the
work variables, the WAA group reported lower work abil-
ity and RTW self-efficacy compared to the SL group. They
also had lower expectations about RTW, where the majority
reported that it would take more than three months to RTW.
The WAA group reported lower health status compared to
the SL group as they scored higher in SHC pseudoneurology
symptoms, hopelessness, fear avoidance for work and physi-
cal activity, depression and worse on coping.
In line with the present findings, a recent study reported
an association between subjective cognitive complaints
Table 2 Cognitive and
emotional performance at
baseline
Variables Work assessment
allowance and
disability pension
(n = 179)
Sick leave
(n = 135) Statistics
Mean SD Mean SD t (df) p-value
Attention
Simple reaction time
Reaction time (milliseconds) 264.8 73.1 248.5 39.8 2.334 (312) 0.020
Choice reaction time
Reaction time (milliseconds) 329.6 74.0 313.2 49.8 2.214 (310) 0.028
Rapid visual information processing
Latency (milliseconds) 411.9 89.2 406.1 84.7 0.574 (305) 0.567
Probability of hit 0.60 0.20 0.62 0.15 − 0.990 (306) 0.323
Memory
Spatial working memory
Total between errors 13.7 10.0 11.9 9.8 1.573 (313) 0.117
Spatial recognition memory
Response time (milliseconds) 2729.4 1032.7 2716.5 767.3 0.121 (311) 0.904
Total correct (%) 79.5 10.2 81.4 9.9 − 1.669 (313) 0.096
Executive function
Stockings of Cambridge
Choice duration (milliseconds) 4007.4 1752.5 4279.0 2210.7 − 1.208 (309) 0.228
Total correct 8.6 2.1 9.1 2.0 − 2.128 (313) 0.034
Intra-extra dimensional set shift
Trials extradimensional shift stage 10.1 9.3 8.5 8.8 1.502 (312) 0.134
Emotion recognition
Emotion recognition task
Total correct (%) 59.0 10.1 58.2 10.5 0.646 (312) 0.519
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598 Journal of Occupational Rehabilitation (2021) 31:592–603
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Table 3 Bivariate linear regression analysis for the work assessment allowance and disability pension group using baseline and change scores
from cognitive and emotional tests to examine the association with number of days on health-related benefits up to oneyear after rehabilitation
Bold values denote statistical significance at the p<0.20 level
SRT simple reaction time, CRT choice reaction time, RVP rapid visual information processing, SWM spatial working memory, SRM spatial rec-
ognition memory, SOC stockings of Cambridge, EDS intra-extra dimensional set shift, ERT emotion recognition task
Work assessment allowance and disability pension (n = 165)
Baseline predictors Change score predictors
β, Beta 95% CI p β, Beta 95% CI p
Attention
SRT reaction time (s) 69.737 − 112.896/252.370 0.452 − 100.287 − 419.546/218.973 0.536
CRT reaction time (s − 15.602 − 197.519/166.615 0.866 99.511 − 123.504/322.526 0.379
RVP latency (s) − 170.972 − 321.472/− 20.471 0.026 − 195.375 − 357.519/− 33.231 0.019
RVP probability of hits − 13.038 − 82.052/55.976 0.710 − 8.523 − 112.246/95.201 0.871
Memory
SWM total errors − 0.804 − 2.127/.518 0.232 − 0.450 − 2.211/1.311 0.614
SRM latency (s) − 8.311 − 21.119/.4.496 0.202 6.629 − 9.582/22.839 0.421
SRM total correct (%) 0.357 − .943/1.658 0.589 0.149 − 1.067/1.366 0.809
Executive function
SOC choice duration (s) 3.969 − 3.644/11.581 0.305 7.970 − 0.664/16.605 0.070
SOC total correct 1.080 − 5.259/7.419 0.737 − 2.976 − 10.360/4.408 0.427
EDS trials − 0.454 − 1.881/.973 0.531 − 0.082 − 1.835/1.672 0.927
Emotion recognition
ERT total correct (%) − 0.483 − 1.792/0.827 0.468 − 0.545 − 2.593/1.503 0.600
Table 4 Bivariate linear
regression analysis for the sick
leave group using baseline and
change scores from cognitive
and emotional tests to examine
the association with number
of days on health-related
benefits up to oneyear after
rehabilitation
Bold values denote statistical significance at the p<0.20 level
SRT simple reaction time, CRT choice reaction time, RVP rapid visual information processing, SWM spatial
working memory, SRM spatial recognition memory, SOC stockings of Cambridge, EDS intra-extra dimen-
sional set shift, ERT emotion recognition task
Sick leave (n = 132)
Baseline predictors Change score predictors
β, Beta 95% CI p β, Beta 95% CI p
Attention
SRT reaction time (s) − 24.431 − 86.837/37.975 0.440 − 26.692 − 96.540/43.155 0.451
CRT reaction time (s) − 1.482 − 51.372/48.408 0.953 − 20.815 − 89.295/47.665 0.548
RVP latency (s) − 6.972 − 36.792/22.848 0.644 − 14.310 − 45.089/16.470 0.359
RVP probability of hits − 5.042 − 21.879/11.075 0.518 6.479 − 12.030/25.527 0.478
Memory
SWM total errors 0.290 0.040/0.540 0.023 0.234 − 0.125/0.593 0.200
SRM latency (s) − 0.560 − 3.849/2.729 0.737 0.777 − 2.962/4.517 0.681
SRM total correct (%) − 0.133 − 0.385/0.118 0.296 0.014 − 0.217/0.245 0.903
Executive function
SOC choice duration (s) − 0.903 − 2.028/.222 0.115 − 1.069 − 2.461/.323 0.131
SOC total correct − 0.754 − .2.004/0.497 0.235 0.194 − 1.271/1.660 0.793
EDS trials 0.030 − 0.255/0.314 0.837 0.094 − 0.208/0.396 0.538
Emotion recognition
ERT total correct (%) − 0.087 − 0.326/0.152 0.474 0.035 − 0.398/0.469 0.874
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
599Journal of Occupational Rehabilitation (2021) 31:592–603
1 3
and sickness absence in a specific occupational group [43].
While the current study used objective measures of cog-
nition through computerised testing, it may be plausible
that both objective and subjective assessments of cognitive
impairments could be associated with sickness absence and
RTW. Studies using sick leave status based on self-report
have either not investigated the association between objec-
tive assessments of cognition and RTW [25, 44] or failed
to find an association despite substantial improvement in
memory and attention and an increase in RTW two years
after a workplace intervention [30, 31]. Official data from
registries, as collected in the present study, is often preferred
due to the longitudinal and validated nature of data, which is
often hard to obtain through self-report [45].
Several potential mechanisms may explain an associa-
tion between sustained attention, working memory and fewer
days on health-related benefits. While supposed to be capac-
ity limited, sustained attention is needed to keep us continu-
ously focused for more than a few seconds while ignoring
competing or distracting information. Working memory rep-
resents a cognitive function that retains information over the
short term and enables us to act on that information. As both
functions seem to have capacity limitations and depend on
each other in selecting and storing information, our atten-
tional system must select the most relevant information to
be stored in working memory [46, for a detailed review].
Working memory and attention are also dependent on the
control of the executive functions inhibition, updating, and
shifting of attention [47]. These are key factors in attention
and executive control [48, 49]. We know that engaging in
specific goal-related and repetitive tasks are important in any
work situation [50], and these tasks require working memory
to be constantly updated throughout the day with the support
of sustained attention. This is based on the argument that
being in work helps maintain both attention and working
memory to operate efficiently, because work can be seen as a
training arena for cognitive functions [2]. This gives support
to the hypothesis of «use it or lose it» [2, 51]. Our ability
to stay focused is more likely to increase if the demands at
work on sustained attention and working memory are high
[3, 50] and when we perform complex tasks either at home
or in work [2]. Therefore, occupational rehabilitation [7, 13],
physical activity [52], better emotion regulation [9, 10] or
attention bias modification training [53] also improve cogni-
tive and emotional functions and seem likely to pave the way
for better performances at work.
Table 5 Multiple linear regression analysis for the work assessment
allowance and disability pension group using significant baseline and
change score predictors together with age, gender and education to
examine the association with number of days on health-related ben-
efits up to one year after rehabilitation
Bold values denote statistical significance at the p<0.05 level
Work assessment allowance and disability pension (n = 165)
Baseline predictors Change score predictors
β, Beta 95% CI p β, Beta 95% CI p
Attention model 1 Attention
RVP latency (s) − 202.936 − 358.653/− 47.219 0.011 − 205.591 − 366.377/− 44.806 0.013
Attention and SHC model 2
RVP latency (s) − 184.489 − 350.012/− 18.966 0.029 − 207.482 − 388.808/− 26.157 0.025
SHC pseudoneurology − 0.727 − 4.550/3.097 0.708 − 0.892 − 6.603/4.819 0.758
SHC musculoskeletal pain − 2.067 − 5.379/1.245 0.219 − 2.374 − 7.257/2.508 0.337
Attention and HADS model 3
RVP latency (s) − 206.905 − 371.773/− 42.036 0.014 − 240.993 − 413.977/− 68.009 0.007
HADS anxiety − 1.236 − 5.818/3.347 0.595 0.342 − 5.841/6.525 0.913
HADS depression 0.277 − 4.435/4.990 0.116 − 6.906 − 12.658/− 1.154 0.019
Executive function model 1
SOC choice duration (s) 7.419 − 1.195/16.032 0.091
Executive function and SHC model 2
SOC choice duration (s) 6.680 − 2.436/15.795 0.149
SHC pseudoneurology − 0.156 − 5.843/5.531 0.957
SHC musculoskeletal pain − 4.015 − 8.730/0.700 0.094
Executive function and HADS model 3
SOC choice duration (s) 6.325 − 2.835/15.485 0.174
HADS anxiety 2.069 − 4.151/8.288 0.512
HADS depression − 5.814 − 11.481/− 0.148 0.044
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
600 Journal of Occupational Rehabilitation (2021) 31:592–603
1 3
Clinical Implications
The current study adds further knowledge about occupa-
tional rehabilitation and presents an association between
cognition and RTW in the WAA and SL group. Previous
findings from our group have demonstrated that focused and
sustained attention and working memory improve more than
executive function and emotion recognition during rehabili-
tation [7, 13]. Although it cannot be elucidated at this stage
which interventions in the rehabilitation programme improve
attention and working memory, it can be claimed that the
combined effects of all treatment components [54], such as
physical activity, cognitive approach, collaboration with the
workplace and following an RTW plan, improve certain cog-
nitive functions more than others.
The present findings emphasise the importance of assess-
ing cognitive functioning in different patient groups based
on the length of sick leave. If such assessments are not con-
ducted, clinicians are left with only self-reported assess-
ments of work and health and may fail to meet the goal of a
holistic [55] and comprehensive assessment [4]. The impli-
cations for clinical practice revolve around the issue of iden-
tifying those individuals displaying cognitive impairments
at baseline while at the same time investigating both their
benefit and work status. This adds to the debate about when
different work-related interventions could be applied and for
whom [56]. It could be argued that WAA individuals may
require more specific interventions related to the cognitive
function sustained attention, while SL individuals may ben-
efit from working memory interventions. This postulation is
worth following up as sick leave is associated with a dete-
rioration in health and quality of life [57, 58], but also the
fact that improvements in attention are associated with better
work ability and a reduction in subjective health complaints
[7]. The treatment success of occupational rehabilitation
may depend, at least partly, on improving cognitive function-
ing, specifically sustained attention, to increase the chances
of RTW for individuals having been away from work for
more than a year [7, 14].
Specific cognitive training may improve certain cogni-
tive functions, and this has been carried out for chronic
pain [59], depression, [53] and occupational rehabilitation
patients [12]. However, these training methods have to be
carefully selected bearing in mind that working memory
training does not seem transferable to cognitive abilities
required at work or in everyday life [60]. Currently, it seems
more fruitful to develop training programmes that show an
Table 6 Multiple linear regression analysis for the sick leave group using significant baseline and change score predictors together with age, gen-
der and education to examine the association with number of days on health-related benefits up to one year after rehabilitation
Bold values denote statistical significance at the p<0.05 level
Sick leave (n = 132)
Baseline predictors Change score predictors
β, Beta 95% CI p β, Beta 95% CI p
Memory
SWM total errors 0.288 0.012/0.564 0.041 0.238 − 0.125/0.601 0.197
Memory and SHC Model 2
SWM total errors 0.384 0.084/0.684 0.013 0.293 − 0.147/0.734 0.189
SHC pseudoneurology 0.418 − 0.275/1.111 0.235 − 0.126 − 1.289/1.037 0.830
SHC musculoskeletal pain 0.087 − 0.488/0.661 0.766 0.011 − 0.896/0.918 0.981
Memory and HADS Model 3
SWM total errors 0.286 − 0.005/0.576 0.054 0.252 − 0.158/0.663 0.226
HADS anxiety 0.612 − 0.200/1.424 0.138 − 0.485 − 1.695/0.724 0.428
HADS depression 0.073 − 0.903/1.048 0.883 0.036 − 1.084/1.157 0.949
Executive function model 1
SOC choice duration (s) − 1.105 − 2.277/0.068 0.065 − 1.191 − 2.608/0.226 0.099
Executive function and SHC Model 2
SOC choice duration (s) − 1.215 − 2.436/0.006 0.051 − 1.417 − 3.089/0.255 0.096
SHC pseudoneurology 0.339 − 0.360/1.037 0.339 − 0.247 − 1.414/0.919 0.675
SHC musculoskeletal pain 0.210 − 0.380/0.800 0.483 − 0.069 − 0.970/0.832 0.879
Executive function and HADS Model 3
SOC choice duration (s) − 1.261 − 2.479/− 0.043 0.043 − 1.357 − 2.956/0.242 0.095
HADS anxiety 0.543 − 0.273/1.359 0.190 − 0.580 − 1.781/0.621 0.340
HADS depression 0.098 − 0.881/1.077 0.843 0.131 − .994/1.256 0.817
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601Journal of Occupational Rehabilitation (2021) 31:592–603
1 3
effect on work-related factors [61] to improve work-related
working memory and sustained attention. The promising
attention bias modification task [53] could be adapted to
work settings and is a fruitful avenue to pursue. Such train-
ing, in combination with the cognitive approach, physical
activity and collaboration with the workplace, may be worth
piloting in collaboration between researchers and clinicians.
These suggestions may result in occupational rehabilitation
programmes becoming more individually tailored accord-
ing to benefit status, while still maintaining the group-based
approach in most interventions.
Study Limitations
Recruiting patients from four different clinics could be a
potential confounder in the study. Despite that all patients
received the same treatment components in occupational
rehabilitation, differences in procedures, intervention dosage
and alliances with the patients at the four clinics could not be
accounted for. Only the first item in the work ability index
(current work ability compared with the lifetime best) was
used as opposed to the entire measure of seven items [62],
and we cannot claim that we measured the whole concept of
work ability. The rationale for using one item, as opposed to
the entire measure, was due to its predictive value on RTW
[33] and the fact thatnot all items were applicable to this
patient group. Another limitation of our study is that the
findings cannot explain which treatment components in the
rehabilitation programme positively affected sustained atten-
tion and working memory which were associated with fewer
health-related benefit days in the year after rehabilitation. It
can only be assumed that the combination of all interven-
tions contributed to the association between cognition and
RT W.
Conclusion
This study has demonstrated that better sustained attention
and working memory are associated with fewer health-
related benefit days in the year following rehabilitation.
These results showed that baseline and change scores in cog-
nitive performance during occupational rehabilitation could
be an indicator of future days on health-related benefits after
rehabilitation. Sustained attention and working memory are
interlinked and important functions to keep intact to enable
performances in most occupations. The quality of occupa-
tional rehabilitation programmes could be enhanced if work-
related sustained attention and working memory interven-
tions are respectively targeted in individuals on sick leave or
work assessment allowance and disability pension.
Acknowledgements We thank all participants who volunteered to
participate in this study. We are particularly grateful to Erik Storli at
Catosenteret Rehabilitation Center and Ann Marit Flokenes at Val-
nesord Health Sports Centre for the data collection as well as Heidi
Bjorå Arset and Lena Klasson, Idrettens Helsesenter, Oslo, Norway for
the continuous support. Thank you also to psychologist Magnus Lia,
Skogli Health and Rehabilitation Center, Lillehammer, Norway, for
fruitful discussions about cognition, mental health and return to work.
Funding The funding was provided by the Norwegian Labour and
Welfare Administration and the Northern Norway Regional Health
Authority (grant number SFP1173-14).
Compliance with Ethical Standards
Conflict of interest The authors declare that they have no conflict of
interest.
Ethical Approval The study was approved by the South-East Regional
Committee for Medical and Health Research Ethics, Norway
(2013/1559). All procedures followed were in accordance with the ethi-
cal standards of the responsible committee on human experimentation
(institutional and national) and with the Helsinki Declaration of 1975,
as revised in 2000. Informed consent was obtained from all patients
before being included in the study.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article’s Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article’s Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/.
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... The significant results regarding cognitive predictors of rehabilitation success suggest that even with individual vocational and psychosocial services, higher baseline cognitive functioning predicts better work-related outcomes. This is in line with studies showing that improvement in cognitive functioning can contribute to more positive outcomes of rehabilitation interventions (70,71). Furthermore, cognitive remediation has the potential to improve work outcomes of rehabilitation interventions (38). ...
Article
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_____Background_____ Major depression is one of the leading causes of disability and limited capacity to work. Neuropsychological impairment is a common symptom in acute and remitted major depression and is associated with poor psychosocial functioning. This scoping review aimed to identify research on the role of neuropsychological functioning in outcomes of vocational rehabilitation programs in individuals with depression. _____Methods______ We report on the conduct of this pre-registered (https://osf.io/5yrnf) scoping review in accordance with PRISMA-ScR guidelines. PubMed and PsychInfo were systematically searched for English or German research articles published between 1990 and September 2021 that studied objective neuropsychological tests as predictors of vocational rehabilitation interventions and included participants with depression. _____Results_____ The systematic literature search yielded no studies that specifically targeted subjects with major depression. However, eight articles published since 2016 were included in the review, analyzing data from five trials that evaluated the effectiveness of supported employment in North America and Europe in severe mental illnesses. An estimated 31% of the total number of participants included (n = 3533) had major depression. Using a variety of cognitive tests and covariates, seven articles found that neuropsychological functioning - especially global cognition scores, verbal and visual learning and memory - significantly predicted vocational outcomes of rehabilitation programs. _____Conclusion______ Despite a lack of studies specifically targeting major depressive disorder, the identified literature suggests that higher baseline neuropsychological functioning predicts better vocational outcomes of supported employment programs in individuals with depression. In clinical practice, additional neuropsychological modules during return-to-work interventions might be helpful for vocational outcomes of such programs.
Chapter
The concept of work ability encompasses issues of individual workers’ abilities in light of their present job tasks taking into account the demands and resources that might be important in the future. Due to a rise in life expectancy in the EU, there has been an increase in the proportion of elderly workers. Aging workers put forth new challenges as aging is usually accompanied by chronic health issues and early exits from the labor market, which puts pressure on the social security systems. One of the ways to support social security systems is through reintegration of workers into the labor force (concept of “return to work”). Austria has been one of the EU member states recognised as having an inclusive return to work system with a strong emphasis on prevention. However, issues remain in lack of cross-policy communication and legislative framework. The following chapter provides an insight into the most common ways work ability is conceptualized, followed by a short analysis of the Austrian social insurance system with emphasis on issues of rehabilitation and return to work.
Chapter
Occupational rehabilitation, part of the specialist health care services, has existed in Norway for more than 25 years. Individuals who are on long-term sick leave can be offered occupational rehabilitation, based on cognitive interventions and physical activity, aiming to improve functioning and work ability, self-efficacy related to home and work tasks and sustainable return to work. However, a surprisingly small number of empirical studies have been conducted to evaluate and document the quality and effect of the cognitive interventions. Thus, it is essential to investigate the relationship between cognitive and emotional factors and return to work; in particular memory, attention, executive function and appraisal of emotional stimuli from faces, pictures and words. Therefore, the application of the cognitive psychological approach in this field is original. The elucidation of which cognitive changes take place during occupational and work-related rehabilitation in individuals reporting anxiety, depression and musculoskeletal pain should improve the quality of rehabilitation programmes. Relevant empirical literature and its clinical implications along with recommendations for future studies are highlighted.
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Knowledge-intensive work requires capabilities like monitoring multiple sources of information, prioritizing between competing tasks, switching between tasks, and resisting distraction from the primary task(s). We assessed whether subjective cognitive complaints (SCC), presenting as self-rated problems with difficulties of concentration, memory, clear thinking and decision making predict sickness absence (SA) in knowledge-intensive occupations. We combined SCC questionnaire results with reliable registry data on SA of 7743 professional/managerial employees (47% female). We excluded employees who were not active in working life, on long-term SA, and those on a work disability benefit at baseline. The exposure variable was the presence of SCC. Age and SA before the questionnaire as a proxy measure of general health were treated as confounders and the analyses were conducted by gender. The outcome measure was the accumulated SA days during a 12-month follow-up. We used a hurdle model to analyse the SA data. SCC predicted the number of SA days during the 12-month follow-up. The ratio of the means of SA days was higher than 2.8 as compared to the reference group, irrespective of gender, with the lowest limit of 95% confidence interval 2.2. In the Hurdle model, SCC, SA days prior to the questionnaire, and age were additive predictors of the likelihood of SA and accumulated SA days, if any. Subjective cognitive complaints predict sickness absence in knowledge-intensive occupations, irrespective of gender, age, or general health. This finding has implications for supporting work ability (productivity) among employees with cognitively demanding tasks.
Article
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Background There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of what someone buying, providing, or receiving rehabilitation can actually expect. Method This editorial extracts information from systematic reviews that find rehabilitation to be effective, to discover the key features and to develop an empirical definition. Findings The evidence shows that rehabilitation may benefit any person with a long-lasting disability, arising from any cause, may do so at any stage of the illness, at any age, and may be delivered in any setting. Effective rehabilitation depends on an expert multidisciplinary team, working within the biopsychosocial model of illness and working collaboratively towards agreed goals. The effective general interventions include exercise, practice of tasks, education of and self-management by the patient, and psychosocial support. In addition, a huge range of other interventions may be needed, making rehabilitation an extremely complex process; specific actions must be tailored to the needs, goals, and wishes of the individual patient, but the consequences of any action are unpredictable and may not even be those anticipated. Conclusion Effective rehabilitation is a person-centred process, with treatment tailored to the individual patient’s needs and, importantly, personalized monitoring of changes associated with intervention, with further changes in goals and actions if needed.
Article
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Background: Bipolar disorder is associated with significant functional deficits including occupational functioning. Despite the high rates of unemployment and sick leave in the patient population, only a limited number of studies have examined factors associated with occupational functioning in bipolar disorder. The aim of the study was to investigate the relative importance of demographic, clinical, and neuropsychological factors on occupational dysfunction in bipolar disorder. Methods: A sample of 120 partially or fully remitted bipolar disorder I and II patients were included in the study. Patients were stratified into an active and an inactive group based on the number of hours per week working or studying. Active (n = 86) and inactive (n = 34) patients were compared with respect to demographic factors, clinical characteristics, medication, measures of psychosocial functioning, and cognitive functioning (i.e., IQ and executive functions). No other cognitive domains were examined. Results: Univariate analyses revealed better overall cognitive function in active patients in terms of IQ and executive functioning. However, only executive functioning accounted for a significant amount of the variance in occupational status when other significant predictors were taken into account. Conclusions: Executive functioning was a more powerful predictor of occupational status in bipolar disorder patients than IQ and other clinical factors, including illness severity.
Article
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Objectives This study aimed to investigate whether inpatient multimodal occupational rehabilitation (I-MORE) reduces sickness absence (SA) more than outpatient acceptance and commitment therapy (O-ACT) among individuals with musculoskeletal and mental health disorders. Methods Individuals on sick leave (2-12 months) due to musculoskeletal or common mental health disorders were randomized to I-MORE (N=86) or O-ACT (N=80). I-MORE lasted 3.5 weeks in which participants stayed at the rehabilitation center. I-MORE included ACT, physical exercise, work-related problem solving and creating a return to work plan. O-ACT consisted mainly of 6 weekly 2.5 hour group-ACT sessions. We assessed the primary outcome cumulative SA within 6 and 12 months with national registry-data. Secondary outcomes were time to sustainable return to work and self-reported health outcomes assessed by questionnaires. Results SA did not differ between the interventions at 6 months, but after one year individuals in I-MORE had 32 fewer SA days compared to O-ACT (median 85 [interquartile range 33-149] versus 117 [interquartile range 59-189)], P=0.034). The hazard ratio for sustainable return to work was 1.9 (95% confidence interval 1.2-3.0) in favor of I-MORE. There were no clinically meaningful between-group differences in self-reported health outcomes. Conclusions Among individuals on long-term SA due to musculoskeletal and common mental health disorders, a 3.5-week I-MORE program reduced SA compared with 6 weekly sessions of O-ACT in the year after inclusion. Studies with longer follow-up and economic evaluations should be performed.
Article
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Introduction: Occupational rehabilitation may be offered to workers on long-term sick leave who often report problems with cognitive functioning, anxiety, depression, pain, and reduced work ability. The empirical knowledge is sparce on how occupational rehabilitation may influence cognitive and emotional functioning and patients have not previously been subjected to comprehensive objective testing. The main aim of this study was to assess possible changes in cognitive and emotional functioning such as memory, attention, executive function, and emotion recognition among patients in occupational rehabilitation. Methods: A large sample of 280 sick-listed workers referred to inpatient and outpatient occupational rehabilitation was recruited. The rehabilitation programs had a mean duration of 28 days and comprised physical activity, cognitive behavior treatment components and collaboration with the workplace. A pre-post design was applied to investigate possible changes in cognitive and emotional functioning (primary outcomes) and work and health measures (secondary outcomes), comparing the rehabilitation group with a control group of 70 healthy workers. Individuals in the control group were tested at random time points with an approximately 28 day interval between pre- and post-test, thus coinciding with the duration of rehabilitation. Repeated measures analysis of variance was used for the main analyses. Results: Compared to the control group, the rehabilitation group had greater gains from pre- to post-test in focused and sustained attention, as well as greater improvements in work ability and reduction in subjective health complaints (SHC), helplessness, pain, pain related to work, anxiety, and depression. In the rehabilitation group, exploratory correlational analysis indicated that improvements in focused and sustained attention were associated with improvements in return-to-work self-efficacy, work ability as well as a reduction in SHC. Conclusion: The sick-listed workers improved in focused and sustained attention and work and health measures after participating in occupational rehabilitation. This study is one of the first to systematically investigate changes in cognitive and emotional functioning during occupational rehabilitation. Clinical practice should benefit from increased knowledge about all cognitive functions and should be specifically aware of the improvements in focused and sustained attention, while memory, executive function and emotion recognition remained unchanged. The results can be used as a motivation to tailor specific interventions to gain further improvements in all cognitive and emotional functions.
Article
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Background: The Return-To-Work Self-Efficacy Scale questionnaire maps self-efficacy upon return to work following acute lower back pain. We wished to translate and validate the questionnaire, as well as to assess the concordance between the translated form and two other forms. Material and method: The questionnaire was translated into Norwegian according to recommended guidelines. Employees in the health and care service with musculoskeletal symptoms were recruited for the study. Cross-cultural validity was assessed by principal component analysis and internal consistency by Cronbach's alpha. Conceptual validity was assessed by correlation between the translated form and simultaneous measurements from two questionnaires that focus on closely related characteristics: the Tampa scale for kinesiophobia and the Demand-ControlSupport model. Results: The Norwegian questionnaire is called 'Job-related self-efficacy'. Of a sample of 229 persons, 206 (89.9 %) were included in the analyses. Principal component analysis supported cross-cultural validity through findings of a three-factor structure in accordance with the original questionnaire. Internal consistency was high for all questions in the questionnaire (0.95), as well as for each of the three factors: meet job requirements (0.99), communicate needs to others (0.97) and adapt work duties (0.96), after adjusting for the number of questions. There were low correlations (< 0.40) between Job-Related Self-Efficacy and the Tampa scale for kinesiophobia, and the various factors in the Demand-Control-Support questionnaire, respectively. Interpretation: The 'Job-Related Self-Efficacy' questionnaire has satisfactory cross-cultural validity after it was translated, and satisfactory internal consistency.
Article
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Multicollinearity represents a high degree of linear intercorrelation between explanatory variables (EVs) in a multiple regression model. Because of its presence, the results of regression analysis go wrong. The diagnostic tools of multicollinearity include variance inflation factor (VIF), condition index (CI) and condition number (CN), and variance decomposition proportion (VDP). Multicollinearity can be presented by the coefficient of determination (Rh2) for a multiple regression model with one EV (Xh) as the model's response variable and the others (Xi[i≠h]) as its EVs. The variances (σh2) of the regression coefficients constituting the final regression model are proportional to VIF (1-Rh2/1). Hence, an increase in Rh2 (strong multicollinearity) inflates σh2. The inflated σh2 produce unreliable probability values and confidence intervals of the regression coefficients. The square root of the ratio of the maximum eigenvalue to each eigenvalue from the correlation matrix of standardized EVs is termed as CI. CN is the maximum of CI. Multicollinearity is present when VIF is higher than 5 to 10 or condition indices are higher than 10 to 30. However, they cannot indicate EVs with multicollinearity. VDPs obtained from the eigenvectors can identify the variables with multicollinearity by showing the extent of the inflation of σh2 according to each CI. When two or more VDPs, which correspond to a common CI higher than 10 to 30, are higher than 0.8 to 0.9, the EVs associated with the VDPs are multicollinear. Excluding multicollinear EVs makes statistically stable multiple regression models.
Article
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Background Following treatment, many depressed patients have significant residual symptoms. However, large randomised controlled trials (RCT) in this population are lacking. When Attention bias modification training (ABM) leads to more positive emotional biases, associated changes in clinical symptoms have been reported. A broader and more transparent picture of the true advantage of ABM based on larger and more stringent clinical trials have been requested. The current study evaluates the early effect of two weeks ABM training on blinded clinician-rated and self-reported residual symptoms, and whether changes towards more positive attentional biases (AB) would be associated with symptom reduction. Method A total of 321 patients with a history of depression were included in a preregistered randomized controlled double-blinded trial. Patients were randomised to an emotional ABM paradigm over fourteen days or a closely matched control condition. Symptoms based on the Hamilton Rating Scale for Depression (HRSD) and Beck Depression Inventory II (BDI-II) were obtained at baseline and after ABM training. Results ABM training led to significantly greater decrease in clinician-rated symptoms of depression as compared to the control condition. No differences between ABM and placebo were found for self-reported symptoms. ABM induced a change of AB towards relatively more positive stimuli for participants that also showed greater symptom reduction. Conclusion The current study demonstrates that ABM produces early changes in blinded clinician-rated depressive symptoms and that changes in AB is linked to changes in symptoms. ABM may have practical potential in the treatment of residual depression. Trial registration ClinicalTrials.gov ID: NCT02658682 (retrospectively registered in January 2016). Electronic supplementary material The online version of this article (10.1186/s12888-019-2105-8) contains supplementary material, which is available to authorized users.
Article
Objectives: Previous work has shown that high mental demands are associated with better cognitive functioning in old age. As there is a lack of a general conceptual framework for this association, the aim of the study was to investigate how mental demands and other work-related factors relate to cognitive functioning as a foundation for developing such a framework. Methods: An expert panel discussion was conducted with the aim of determining relevant work-related factors, which were then tested in a survey with 346 employees aged 50+ years, who were actively working. Assessment of cognitive functioning comprised complex attention, executive function, learning/memory, language, perceptual-motor, and social cognition. Confirmatory factor analysis was conducted to confirm factor belonging. Associations with cognitive functioning were analyzed using structure equation modelling to confirm associations and to identify additional direct and indirect paths. Results: Only 42.3% (22/52) of the work-related factors and 19.0% (4/21) of the mediating paths suggested by the experts were significant with respect to cognitive functioning. Factor analysis and structural equation modeling indicated that high mental demands are only associated with better cognitive functioning in old age to the extent that they are intellectually stimulating and this effect is embedded in individual capacities and the social context. Conclusion: Based on the panel discussion and the empirical testing, we propose the Conceptual Framework of Social Dependency of Intellectual Stimulation on Cognitive Health. We recommend researchers and workplace health experts to pay attention to the component of this theory when assessing workplace risk.
Chapter
The field of psychotherapy has witnessed remarkable developments since it first emerged in the latter part of the 1800s. Perhaps the most significant advance in recent years began in the 1970s, with the evolution of what is now termed generally as the field of cognitive behavioural therapy (CBT). While any effort to capture the breadth and depth of CBT is bound to fail in some respects, the current chapter provides a review of six of the key articles that helped to propel CBT to a dominant position among contemporary psychotherapy models. These articles are related to disorders as varied as major depression, panic disorder, bulimia nervosa, anxiety in youth, and borderline personality disorder. The articles were also selected to demonstrate the development of the field from a focus on approaches that emphasized cognitive change as a critical aspect of treatment, to more contemporary models that also draw on concepts such as mindfulness and acceptance to effect therapeutic change. The chapter concludes with some general statements about the field of CBT and potential direction for the future.