Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments

Abstract

ObjectiveComprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers.DesignCommunity-level, cross-sectional analysis with multidimensional clinical work ability assessments.SettingPaltamo, Finland.ParticipantsUnemployed citizens either participating in the Full-Employment Project or long-term unemployed (n = 230, 81%).Main outcome measuresBased on data from theme interviews, patient records, supervisors’ observations of work performance and clinical examinations, a physician concluded the individual’s work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated.ResultsOnly about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability.ConclusionsWork disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed. KEY POINTSAlthough the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce.Work disabilities are common among the unemployed.Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to work.Context sensitivity may add to the accuracy of the doctor’s conclusions on work ability.

Development and content validity of the Abilitator: a self-report questionnaire on work ability and functioning aimed at the population in a weak labour market position

“…It has been suggested that the resources of, for example, health services should focus more on those whose perceived health and work ability has started to decline [22,33]. It has also been recognised that many work ability limitations go unnoticed by these services, resulting in unused opportunities for rehabilitation [2,34,35]. In terms of work ability, the unemployed can be split into three groups: 1) those with good work ability, 2) those unable to work, and 3) those whose work ability can be restored with adequate rehabilitation [27].…”

“…In terms of work ability, the unemployed can be split into three groups: 1) those with good work ability, 2) those unable to work, and 3) those whose work ability can be restored with adequate rehabilitation [27]. These groups vary greatly in their needs for support [34]. To direct resources appropriately, new approaches are needed to assess work ability and functioning more individually.…”

Development and content validity of the Abilitator – a self-report questionnaire on work ability and functioning aimed at the population in a weak labour market position

“…It has been suggested that the resources of, for example, health services should focus more on those whose perceived health and work ability has started to decline [22,33]. It has also been recognised that many work ability limitations go unnoticed by these services, resulting in unused opportunities for rehabilitation [34,2,35]. In terms of work ability, the unemployed can be split into three groups: 1) those with good work ability, 2) those unable to work, and 3) those whose work ability can be restored with adequate rehabilitation [27].…”

Development and content validity of the Abilitator – a self-report questionnaire on work ability and functioning aimed at the population in a weak labour market position

“…It has been suggested that the resources of, for example, health services should focus more on those whose perceived health and work ability has started to decline [14,26]. It has also been recognised that many work ability limitations go unnoticed by services, leading to opportunities for rehabilitation being unused [27,2,28]. In terms of work ability, the unemployed can be split into three groups: 1) those who have good work ability, 2) those who are unable to work, and 3) those whose work ability can be restored with adequate rehabilitation [20].…”

“…These groups vary greatly in their needs for support [27]. To direct resources appropriately, new approaches are needed to more individually assess work ability and functioning.…”