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| 5. |
- Ahlgren, Åsa, et al.
(författare)
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Disability pension despite vocational rehabilitation : A study from six social insurance offices of a county
- 2005
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Ingår i: International Journal of Rehabilitation Reserch. - : Ovid Technologies (Wolters Kluwer Health). - 0342-5282 .- 1473-5660. ; 28:1, s. 33-42
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Tidskriftsartikel (refereegranskat)abstract
- Many long-term sick-listed individuals move from vocational rehabilitation to pension, rather than reaching the goal of return to work. There is thus reason to consider whether rehabilitation resources are being used optimally. Individuals receiving disability pensions are consuming financial and personnel resources at the insurance offices and also consume a large amount of health care. The general objective of the study was to evaluate the proportion of individuals granted vocational rehabilitation but then obtaining temporary or permanent disability pensions. All persons receiving any kind of rehabilitation and attending one of six local national insurance offices in a county in Sweden in 1998 and 1999 were studied. A 2-year follow-up was carried out to assess changes in status among those who had received temporary disability pensions. Of all individuals receiving rehabilitation, 46.2% ended up with a disability pension allowance. In addition, a large portion of the temporary disability pensions was transformed to permanent disability pensions within 2 years. For clients with a temporary disability pension, the rate of resuming work was close to nil. Among rehabilitation measures, investigation showed the lowest figures of work resumption while job training showed the best outcome in this respect. The study concluded that a large portion of the financial and personnel resources allocated by the national insurance offices to rehabilitation resulted in disability pensions.
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| 6. |
- Ahlgren, Åsa, et al.
(författare)
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Selection of clients for vocational rehabilitation at six local social insurance offices. : a combined register and questionnaire study on rehabilitation measures and attitudes among social insurance officers.
- 2008
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081 .- 0001-5555. ; 40:3, s. 178-184
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to evaluate possible differences between local social insurance offices with regard to their selection of clients for vocational rehabilitation. A further aim was to determine whether social insurance officers from different local insurance offices have uniform attitudes regarding professional practice in their application of the insurance system. METHODS: A register-based investigation of 815 vocational rehabilitees served by 6 local social insurance offices in a Swedish county. The study was supplemented with a questionnaire to 30 officers about attitudes to social insurance. RESULTS: The office with the lowest rate of sick-listing periods exceeding one year, and a high frequency of employment training, showed the highest degree of work resumption and the lowest pension rate after vocational rehabilitation. There were wide differences in attitude among the local social insurance officers regarding professional practice in their application of the system. CONCLUSION: Intra-county differences occur in handling people on sick-leave who undergo vocational rehabilitation. The local social insurance offices with the highest and lowest outcome rates of work resumption and disability pension, respectively, select clients for vocational rehabilitation from different categories of cases. Social insurance officers from different local offices differ in their attitudes towards the social insurance system and its clients.
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| 7. |
- Ahlgren, Åsa, et al.
(författare)
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Work resumption after vocational rehabilitation : a follow-up two years after completed rehabilitation
- 2007
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Ingår i: Work. - 1051-9815 .- 1875-9270. ; 28:4, s. 343-354
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Tidskriftsartikel (refereegranskat)abstract
- A short-term evaluation of vocational rehabilitation (VR) may give conclusions not automatically applicable over a longer term. The present study follows up alterations in work resumption or in social insurance benefits from the time of completed VR and during the following two years. AIM: The primary objective was to evaluate work resumption among previous sick-leavers granted vocational rehabilitation. The aim of the follow-up was to assess the stability of the outcome of VR over time and to analyse factors of importance for clients that remained at work. METHOD: A register investigation was based on 815 cases where the clients had taken part in vocational rehabilitation and were served by one of six local social insurance offices of a Swedish county. RESULTS: Of the clients studied, 52.4% had attained full working capacity The proportion had decreased to 37.4% two years later. One factor that differed between those who resumed work and those who returned to sick leave was the duration of the previous sick-leave period. Those who returned to work had had shorter sick leave, had jobs to return to and had received job training as a vocational rehabilitation measure. CONCLUSIONS: The clients with the best chances of being in work two years after completed vocational rehabilitation were those with short sickness absence, who had been selected for job training as a vocational rehabilitation, were aged 16-29 years and were employed in industry.
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| 8. |
- Ahlgren, Åsa, et al.
(författare)
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Work resumption or not after rehabilitation? : A descriptive study from six social insurance offices.
- 2004
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Ingår i: International Journal of Rehabilitation Research. - : Ovid Technologies (Wolters Kluwer Health). - 0342-5282 .- 1473-5660. ; 27:3, s. 171-180
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to describe measures and outcomes of vocational rehabilitation at six local national insurance offices in the same county in Sweden. Data were collected from mainframe registers and other records at each office. There were great differences in sickness allowance, incapacity rate, selected rehabilitation measures and resuming work. The percentage of sick-listed people who received any rehabilitation measure differed from 1.2 to 8.7%. The gender distribution for the study population was 36% men and 64% women and the predominant diagnosis was musculoskeletal pain conditions, which was followed by psychiatric disorders. Outcomes varied from office B, which reported 58% fully fit after completed planned rehabilitation, to office C, which reported only 24% fully fit. The clear differences in outcome between the offices indicate that various rehabilitation measures differ in effectiveness. The rehabilitation measure 'investigation of working ability' was not linked to any great proportion of people resuming work, but showed a greater correspondence to full disability pension. There were also large differences in social and demographic factors in the different municipalities. The effect of these on the rehabilitation process requires further investigation.
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| 12. |
- Jakobsson, Björn, et al.
(författare)
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Do systematic multiprofessional rehabilitation group meetings improve efficiency in vocational rehabilitation?
- 2005
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Ingår i: Work. - 1051-9815 .- 1875-9270. ; 24:3, s. 279-290
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of the present study was to investigate differences in the effects on employment between clients whose rehabilitation was coordinated in systematic multiprofessional rehabilitation group meetings and clients whose rehabilitation was coordinated in the "conventional" way. METHOD: The study was based on a sample of 51 individuals who received systematic group meeting coordination. All individuals in the study group were unemployed before the rehabilitation intervention. Two different comparison groups were chosen: one at a local level and another at a national level. The groups were matched on an individual level based on records obtained from The National Labour Market Board (AMS) and The National Social Insurance Board (RFV). The data were analysed by an analysis of variance (ANOVA) for repeated measures for binary responses. RESULTS: 68.6% in the study group and 49% in both the local comparison group and national group had some form of employment 24 months after rehabilitation. The ANOVA analyses (in terms of odds ratio) found that when all measurement points (6, 12 and 24 months after the rehabilitation) were included in the calculations that there was twice as high a chance of becoming employed after having received rehabilitation services through the multiprofessional group than for both comparison groups. The majority of employment in all the groups was associated with some form of subsidy or sheltered employment.
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| 13. |
- Jakobsson, Björn, et al.
(författare)
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Improved co-operation in vocational rehabilitation with systematic rehabilitation group meetings.
- 2002
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 24:14, s. 734-740
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The present aim was to investigate the communicative pattern in two rehabilitation groups. The rehabilitation group consisted of the client, a supervisor, an employer representative, an occupational health physician, a rehabilitation counsellor from the national social insurance office and a support person. METHOD: Participatory observation of 22 rehabilitation meetings. The communication was tape-recorded and transcribed word for word. The transcripts were coded and analysed both qualitatively and quantitatively. RESULTS AND CONCLUSION: The client made the most utterances in the groups, but most often in the form of answers to questions from the other actors. Following the client, the physician made the next most frequent utterances, most often as questions. The subjects most discussed concerned the client's situation regarding work, health and material support. None of the "professionals" dominated the meetings, although one picture that emerged was that the physician and employer representative played more prominent roles as takers of initiative and as coordinators while the client was more passive than the other actors. The discussions were calm and much latitude was allowed for the participants to put forward their own requirements, thoughts and feelings. The rehabilitation group may be viewed as a meeting place for "experts" and clients. The further management of the rehabilitation was by the actor the client most immediately needed. In this, rehabilitation in the rehabilitation group differs from the "case management" common in the rehabilitation field.
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| 14. |
- Jakobsson, Björn, et al.
(författare)
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Improved employment rates after multiprofessional cross-sector cooperation in vocational rehabilitation: A 6-year follow-up with comparison groups
- 2010
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Ingår i: International Journal of Rehabilitation Research. - 0342-5282 .- 1473-5660. ; 33:1, s. 72-80
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to better understand the long-term effects of an improved model for cooperation on employment between rehabilitation professionals in vocational rehabilitation (VR). To compare these effects with those associated with the traditional model of cooperation. The study featured a group of patients who participated in a developmental project. All of the patients had some degree of restricted work capacity, which was evidenced somatically as well as mentally/socially. They had all experienced long periods of unemployment during the 2-year period before the intervention. A 'natural experiment study design' that relied on database records was used. Using matching criteria, we identified 'social twins' from a government register to create comparison groups at the local, county and national levels (n=4×51 patients). Repeated-measures analysis of variance and logistic regression were used to analyse the data. The majority (59%) of the study group was employed 3 years after the intervention compared with 39 and 41% in the two matched control groups, respectively. The corresponding figures after 6 years were 51 versus 39 and 37%. An individual with a somatically restricted work capacity was about twice as likely to secure gainful employment following VR as compared with an individual with a mentally/socially restricted work capacity. In conclusion, the study focused on an improved method of cooperation between rehabilitation actors in the context of VR programmes. A model that included systematic multiprofessional cross-sector group meetings was explored, and we concluded that a substantial percentage of the enrolled patients successfully secured employment over a 6-year period. This percentage exceeded that of matched pairs in a county and national group; we presume that these groups represented 'the usual form of cooperation'.
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| 15. |
- Jakobsson, Björn, et al.
(författare)
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Multi-professional vocational rehabilitation group meetings with female clients - a qualitative study.
- 2008
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Ingår i: Work. - 1051-9815 .- 1875-9270. ; 30:4, s. 413-421
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Tidskriftsartikel (refereegranskat)abstract
- Many women require vocational rehabilitation before they can return to work. The objective with the present study was to describe female clients' situation during the rehabilitation process, as it became apparent during the rehabilitation meetings with the various actors involved. The clients' diagnoses varied, but the majority was affected with musculoskeletal disorders. The meetings were audio-taped and transcribed verbatim, after which they were analysed by qualitative content analysis. The following themes emerged: Adaptation to the rehabilitation group; client's health status; the workplace's significance for rehabilitation; and the client's decision-point. Conflict between health and work was immensely important for rehabilitation. Differences in attitude were apparent during the rehabilitation meetings, as some clients were passive and exercised less influence on the planning, than the other more active clients did.
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| 16. |
- Jakobsson, Björn, et al.
(författare)
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Rehabilitering i Samverkan En process- och registerstudie av Betagruppens arbete i Kungsbacka kommun
- 2004
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med föreliggande rapport är att undersöka den fortsatta utvecklingen av arbetsmetoden; systematiserade flerpartssamtal och att studera effekterna av rehabiliteringsarbetet i Betagruppen. Den föregående utvärderingen av Betaprojektet hade en före- och efterdesign och det var inte så lätt att ställa resultaten av utvärderingen i relation till mera �konventionell� handläggning av rehabiliteringsärenden. För att få en uppfattning om effekterna av Betas arbetssätt jämförs i denna studie Betas arbetssätt med effekter av att arbeta mera �konventionellt�. I studien matchas Betagruppen med individer från andra kommuner i närområdet som har en liknande struktur som Kungsbacka kommun. Dessutom görs också en jämförelse med en riksgrupp. För att få fram effekter av de båda arbetssätten används registerstudier och för att få fram kunskaper om Betagruppens utveckling av samverkan mellan rehabiliteringsaktörerna och eventuella förändringar används gruppintervjuer och enkät.
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| 17. |
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| 18. |
- Klockmo, Carolina, 1976-, et al.
(författare)
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Rehabiliteringsmodeller
- 2023. - 4
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Ingår i: Rehabiliteringsvetenskap. - : Studentlitteratur AB. - 9789144157764 ; , s. 273-290
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 19. |
- Kärrholm, Johan, 1951, et al.
(författare)
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Effects on work resumption of a co-operation project in vocational rehabilitation. Systematic, multi-professional, client-centred and solution-oriented co-operation
- 2006
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Ingår i: Disabil Rehabil. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 28:7, s. 457-67
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The present aim was to evaluate the effect of systematic multi-professional co-ordinated rehabilitation (the Stockholm Co-operation Project) on the number of days' sick leave during the first and second half-years after the rehabilitation co-ordination period, compared to the year before. Another aim was to evaluate the economic effects at national level. METHOD: A matched-pairs design was used. The study group was based on 64 rehabilitees employed by a public employer in Stockholm, who took part in a systematic multi-professional co-operation project. To obtain pairs, the 64 individuals were individually matched with 64 people who received conventionally organised rehabilitation. Thus, there were 128 subjects altogether. RESULTS: The study group had substantially less sick leave days per month than the comparison group during the second half-year after the rehabilitation co-ordination period. The effect was even greater in a subgroup with more previous sick leave. During the first half-year after the intervention the comparison group had relatively more sick leave. No effect was found for a subgroup with less previous sick leave. The economic benefit of the intervention was estimated to 1,278 euros per month and person based on the whole group, and to 2,405 euros per month and person based on those with more sick leave. CONCLUSIONS: People who undergo co-ordinated rehabilitation have more working days after the intervention period than those with conventional rehabilitation. This way for rehabilitation actors to co-operate gives better outcomes for rehabilitation cases with long previous sick leave, but not for cases with less previous sick leave. It also generates economic gains at several levels.
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| 20. |
- Kärrholm, Jenny, et al.
(författare)
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Systematic co-operation between employer, occupational health service and social insurance office : A 6-year follow-up of vocational rehabilitation for people on sick-leave, including economic benefits
- 2008
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 40:8, s. 628-636
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the effects of systematic co-operation among municipal employees on the number of sick-leave days per month and the type of benefit granted by the Social Insurance Office. A further aim was to evaluate the economic consequences for society.Design: A 6-year follow-up study with a matched-pairs design.Methods: Days on sick-leave were calculated for each subject one year before the intervention started and yearly for the following 6-year period. Statistical mixed-model analysis was used. The economic benefit of the intervention was estimated as the increased production stemming from fewer days on sick-leave.Subjects: Sixty-four employees on long-term sick-leave were individually matched with controls from another Social Insurance Office in a county with a socioeconomic structure similar to that of the study group.Results: The study group had 5.7 fewer days on sick-leave per month and person over the 6-year period (p=0.003). The estimated average economic benefit of the intervention was (sic)36,600 per person over the 6-year period. In conclusion, those who received systematic co-operation in vocational rehabilitation had fewer days on sick-leave than their ""treatment-as-usual"" peers. This effect persisted over 6 years, generating substantial net economic gains for society.
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| 21. |
- Kärrholm, Jenny, et al.
(författare)
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The views of sick-listed employees' immediate superiors on co-operation in vocational rehabilitation.
- 2007
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Ingår i: Work. - 1051-9815 .- 1875-9270. ; 29:2, s. 101-111
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this research was to investigate the views of sick-listed employees' immediate superiors on co-operation in vocational rehabilitation before and during a systematic, multi-professional, client-centred, solution-oriented co-operation project in vocational rehabilitation (SMVR intervention). METHOD: A same-subject study with a questionnaire was used, with 95 immediate superiors giving their views on co-operation both before and during the SMVR intervention. RESULTS AND CONCLUSIONS: The immediate superiors felt that the SMVR intervention was successful in promoting co-operation, and reported a significant decrease in referrals of employees from one organisation to another without the problem being resolved. Hence SMVR co-operation was experienced positively by the immediate superiors and in fact led to a joint responsibility in finding solutions. The immediate superiors saw greater possibilities than before for employees to resume regular or other jobs during the SMVR intervention. A more elaborate co-operation model such as the SMVR intervention increased the immediate superiors' experience of successful vocational rehabilitation. Organizations seeking to increase efficiency in vocational rehabilitation might well analyse their work methods and improve their forms of co-operation.
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| 22. |
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| 23. |
- Landstad, Bodil, et al.
(författare)
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Health-related quality of life in women at work despite ill-health. A prospective, comparative study of hospital cleaners/home-help staff before and after staff support
- 2000
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Ingår i: International Journal of Rehabilitation Research. - : Ovid Technologies (Wolters Kluwer Health). - 0342-5282 .- 1473-5660. ; 23:2, s. 91-101
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this prospective, non-randomized, comparative study were to elucidate how 99 female hospital cleaners and home-helps, at work despite ill-health, experienced their quality of life, and to study whether this was affected by a particular programme of staff support. The SF-36 questionnaire was used. This contains questions on physical, mental and social health status. Health status, i.e. experienced health, was assessed by the respondents themselves. Low quality of life relating to the dimensions bodily pain, general health perceptions and vitality proved to apply both to the hospital cleaners and the home-help staff, compared to a normal Swedish female population. No significant differences between the intervention group and the reference group were demonstrated among either the cleaners or the home-helps. Following the intervention/period of customary measures, experienced quality of lift was somewhat changed in the groups compared with the normal Swedish female population. This may indicate a certain unspecific improvement in experienced quality of life in both the intervention groups and the reference groups.
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| 24. |
- Landstad, Bodil J, et al.
(författare)
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Women at work despite ill health : Diagnoses and pain before and after personnel support - A prospective study of hospital cleaners/home-help personnel with comparison groups
- 2001
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Ingår i: Journal of Rehabilitation Medicine. - 1650-1977 .- 1651-2081. ; 33, s. 216-224
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Tidskriftsartikel (refereegranskat)abstract
- The present study sought to elicit the diagnoses behind the pain conditions causing complaints by female hospital cleaners and home-help personnel who were working despite their symptoms. We also wished to describe the prevalence of musculoskeletal diagnoses and the intensity, frequency and location of pain, and changes in the clinical picture and pain after personnel supporting interventions. A prospective study was carried out with intervention groups and non-randomized comparison groups. The hospital cleaners intervention programme comprised occupational organizational measures, competence development, physical and psychosocial working environmental measures and individual and rehabilitation measures on both an individual and a group basis. The home-help programme comprised a 2-week stay at an orthopaedic rehabilitation unit, training of supervisors, comrade massage, purchase of training equipment and stress management. Myalgia/tendinitis occurred in 61% of shoulder girdle elevators, 18% of rotator cuffs, 16% of dorsal neck muscles and 29% of hip muscles. There was musculoskeletal pain in the lower back in 28% of cases. Referred pain from a musculoskeletal focus occurred in about one-sixth to one-third of individuals with the diagnosis in question. Neurogenic pain occurred in 6% of cases. No fibromyalgia syndrome was found. One-third of individuals felt pain all the time or almost all the time. The mean rated perceived “worst pain” was 70 mm on a visual analogue scale of 1-100 mm. Comparisons between intervention and reference groups indicated that some improvement in the clinical picture can be attained using this kind of general support programme for employees.
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| 25. |
- Marnetoft, Sven-Uno, et al.
(författare)
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Factors associated with successful vocational rehabilitation in a Swedish rural area
- 2001
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Ingår i: Journal of Rehabilitation Medicine. - 1650-1977 .- 1651-2081. ; 33, s. 71-78
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to identify factors associated with a positive outcome of vocational rehabilitation, and to identify groups that have been successfully rehabilitated in a Swedish rural area. In this study vocational rehabilitation is defined as medical multidisciplinary, psychological, social and occupational activities aiming to re-establish, among sick or injured people with previous work history, their working capacity and prerequisites for returning to the labour market. The study was based on 732 people on registered long-term sick-leave who, in a rural area in northern Sweden during 1992-94, became objects for vocational rehabilitation. Bivariate and stepwise logistic regression analysis was used to identify factors associated with the outcome. By successful vocational rehabilitation is meant reporting well (no economical benefit) at all three Lime-points 6, 12 and 24 months after termination of rehabilitation, or lowered benefit levels. The results indicate that younger, male, employed persons, with an early start on rehabilitation, in a programme entailing education, and partly sick-listed before the start of this programme, had the greatest chance of successful rehabilitation. In contrast, older, female, unemployed people, with a delayed start on rehabilitation, without education, and fully sick-listed before the start, greatly risked being unsuccessful with vocational rehabilitation. The results indicate how to improve the rehabilitation process: several process-related factors shown to be connected with successful vocational rehabilitation include time before the start of rehabilitation, partial instead of full sickness benefit, and education programmes.
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| 29. |
- Olsson, Inger, 1954-, et al.
(författare)
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Social welfare in Singapore and Sweden : Differences in organisational systems of health care, social security and rehabilitation.
- 2008
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Ingår i: International Journal of Disability Mangement Research. - Brisbane : Australian Academic Press. - 1833-8550 .- 1834-4887. ; 2:3, s. 30-38
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study is to describe and compare the health care, social security and rehabilitation systems in Singapore and Sweden. Two fundamental differences can be identified. First, the system in Singapore are strongly oriented towards a free market system, while Sweden’s demonstrates strong public control. Second, following from how the systems are oriented, Singaporeans are expected to have a higher degree of independence and control over their health care, social security and rehabilitation. It appears that Singapore has had greater success in attaining and maintaining a system of health promotion, which influences the three systems. However, the Swedish welfare system provides greater security to those who are in need of health care, social security and rehabilitation.
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| 30. |
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Rehabiliteringsvetenskap - Rehabilitering till arbetslivet i ett flerdisciplinärt perspektiv, upplaga 3
- 2015
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Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- Boken går igenom olika verksamhetsområden som handhar rehabilitering med inriktning på ansvar och skyldigheter. Även sjukskrivningens komplexitet, principerna bakom rehabilitering, individperspektivet med den försäkrades rättigheter och ansvar i en rehabiliteringssituation, rätten till ersättning med fokus på rekvisiten sjukdom och arbetsoförmåga gås igenom. Funktionstillstånd och funktionshinder analyseras i ett sjukfrånvaroperspektiv. Hindrande och underlättande faktorer vid rehabilitering till arbete behandlas liksom samverkan mellan rehabiliteringsaktörer, olika rehabiliteringsmodeller, ekonomi och rehabilitering inom EU.
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| 31. |
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| 32. |
- Ydreborg, Berit, 1940-
(författare)
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To be in‐between : The road to disability pension with reference to the Swedish social insurance system
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The Social Insurance is part of the Swedish welfare system that is intended to create economic security for citizens in the event of unemployment, sickness, functional disability, and old age. The Swedish sickness‐benefit insurance is based on the standard insurance principle meaning that sickness benefits are related to level of lost income. The increasing number of sick listed people and people with disability pension (DPs) in Sweden may lead to marginalisation of individuals as they are not part of the labour market. The government has decided that the number of sick‐listed people should be halved by 2008, which means a tougher judgment of the applications for sick leave compensation. To be qualified for sickness benefit the disease has to impair the work ability in relation to the specific demands of the work of that person. The evaluation of the work ability in a percentage is an important element with regard to the policy on disability. The social insurance officers (SIOs) who are assessing the work ability are dependent on judgments from the physicians as expertise, and the guidelines in the social insurance act. The eligibility criteria for DP and the process of dealing with applications for DP is scarcely studied.Objectives: The overall aim of the thesis was to explore demographic and health differences between those, who were granted and those, who were not granted disability pension. The second aim was to study how the process from applications to decisions on disability pensions were executed and perceived by the social insurance offices and to elucidate their working conditions during the decision process. Material and methods: The first two studies explored differences between those granted DP and those not granted DP. Study I was a register‐based retrospective case‐control study carried out in the area of a county in Sweden. The cases were all individuals rejected a full disability pension 1999‐2000, in all 99 cases. Controls were every tenth person who was granted a full DP during the same period, 198 controls. Determinants were recorded from the Social Insurance (SI). In study II demographic data and medical diagnoses were obtained from the SI records. Data concerning self‐reported health, HRQoL, social networks and use of health care were collected by a postal questionnaire. The study objects were the same as in study I. In study III and IV indepth interviews were carried through to study the social insurance officers’ perspective on the process from application to decision on disabilitypensions as well as their experiences of prerequisites and hindrances in their work with DP applications. The transcribed data were analysed by an inductive content analysis.Results: Unemployment, living in the main municipality and age below 50 years were determinants for rejection of DP. Medical status as described in the Social Insurance records had less association with the outcome. There are variations in praxis of rejection of applicants between social insurance boards in different geographical areas due to other reasons than medical. The nDP group had more often multiple diagnoses, and lower self‐reported health and HRQoL compared to those granted DP. Those not granted DP also had significantly smaller social networks.The SIOs perceived that they had to make rapid decisions within a limited time frame, based on limited information, mainly on the basis of incomplete medical certificates, and with no firm criteria for the regulations on the individual case level. Communication among the various authorities as employment offices and social services suffered from lack of common goaldirected strategy. In study IV the SIOs described their working conditions when executing the applications for DP. The SIOs perceived recurrent changes in rules and regulations as frustrating as they at the same time had to face the client. The large number of clients prevented them from being able to offer clients activities and support them in the way they were supposed to do. The SIOs powerful position and how their discretion was implemented made them feel responsible for performing their work well. SIOs are to be considered as typical street‐level bureaucrats as they have to perform their work between the policy, rules and clients.Conclusions: The individuals had an increased risk to be rejected DP if they were younger than 50 years, unemployed, and lived in the main city. No evident differences in medical diagnoses were found between the groups. The results indicate that there may be other reasons than medical in praxis. Contrary to expectations, those not granted DP do not seem to have better health, but rather to suffer from more sickness than those, who were granted DP. Unemployment leads to inability to qualify for compensation and benefits that are associated with participation on the labour market. The group not granted disability pension appears to be a disadvantaged group in need for a co‐ordination between different parts of the social welfare system.The different perspectives were perceived as obvious obstacles in the communication between professionals in the welfare system as they had other goals and demands. Clients, that have comprehensive problems and are in need of coordinated measures from many authorities to get entrance to the labour market still suffer from lack of coordination. One question is how the different public officers use their discretion when handling clients and how the cooperation can be improved.
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| 33. |
- Åhrberg, Yvonne, et al.
(författare)
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Desire, longing and vanity : Emotions behind successful return to work for women on long-term sick leave
- 2010
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Ingår i: Work. - 1051-9815 .- 1875-9270. ; 37:2, s. 167-177
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The purpose of this study is to identify situations and phenomena that have simplified returning to work for women on long-term sick leave. Participants: Seven women who were exposed to a relatively large number of risk factors that normally are associated with difficulties in returning to work. Methods: In-depth interviews with qualitative content analysis. Results: The analysis indicated four main categories of factors: The Individual, Interactions, Surrounding Resources, and Situations. In each of the main categories structural factors exist and it appears that these have been of significant importance to the women in their return to work. These are presented as Key Factors and they are: clarification of - and the need for - support in the personal process of change; desire, longing, and vanity; respectful interactions between the individual and people in her surroundings; the structure and content of the rehabilitation clinic; the importance of the perceived reality; and the individual's sense of control during the work related rehabilitation process. Conclusions: The results mostly revealed phenomena that have been indicated and described in earlier research studies. However, emotions such as desire, longing and vanity as motivation and driving forces behind a return to work have not been earlier described.
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