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Objectives: To estimate the working life expectancies (WLE) of men and women with depression, examining depression by symptom trajectories from the late 20s to early 50s, and to estimate WLE by race/ethnicity and educational attainment. Methods: Data from 9206 participants collected from 1979 to 2018 in the US National Longitudinal Survey of Youth 1979 cohort were used. Depression was measured using the Center for Epidemiologic Studies Depression Scale Short Form at four time points (age 28–35, age 30–37, age 40, and age 50). Labor force status was measured monthly starting at age 30 until age 58–62. Depressive symptom trajectories were estimated using growth mixture modeling and multistate modeling estimated WLE from age 30–60 for each gender and depressive symptom trajectory. Results: Five latent symptom trajectories were established: a persistent low symptom trajectory (n = 6838), an episodic trajectory with high symptoms occurring before age 40 (n = 995), an episodic trajectory with high symptoms occurring around age 40 (n = 526), a trajectory with high symptoms occurring around age 50 (n = 570), and a persistent high symptom trajectory (n = 277). The WLE for men at age 30 was 30.3 years for the persistent low symptom trajectory, 22.8 years for the episodic before 40 trajectory, 19.6 years for the episodic around age 40 trajectory, 18.6 years for the episodic around age 50 trajectory, and 13.2 years for the persistent high symptom trajectory. Results were similar for women. WLE disparities between depression trajectories grew when stratified by race/ethnicity and education level. Conclusions: Roughly a quarter of individuals experienced episodic depressive symptoms. However, despite periods of low depressive symptoms, individuals were expected to be employed ~5–17 years less at age 30 compared to those with low symptoms. Accessible employment and mental health disability support policies and programs across the working life course may be effective in maintaining work attachment and improving WLE among those who experience depression. [ABSTRACT FROM AUTHOR]

Health and social care services can enhance the community experiences of people with Alzheimer's disease and their caregivers but making decisions about service use is complex. Using a grounded theory methodology, we explored service use decision‐making in 40 spousal and adult children caregivers for people with Alzheimer's disease across the caregiving and disease trajectory. Participants' perception of their initial service interactions influenced their decision‐making process and use of services. Difficulties navigating the healthcare system and finding available services also influenced decision‐making. Caregivers make decisions to sustain care in the community that change throughout the caregiving and disease trajectory. Two key factors influence service use (a) the goals of caregiving and (b) the practicalities of accessing services. Both factors change across caregiving phases. By expanding our understanding of how caregivers make service use decisions, we can augment future practice to help caregivers access services that can better support them across the disease trajectory. [ABSTRACT FROM AUTHOR]

Caregivers of individuals with Alzheimer's disease require support across the full disease trajectory. The aim of this study was to develop a conceptual framework of caregiving phases across the Alzheimer's disease and caregiving trajectories and the corresponding caregiver support needs. Constructivist grounded theory informed data collection and analysis. 40 spousal (n = 20) and adult children (n = 20) caregivers were interviewed. Recruitment was completed when theoretical saturation was achieved. Member-checking interviews occurred with 10 participants. Participants described five phases of caregiving related to their responsibilities to support people with Alzheimer's disease including monitoring initial symptoms, navigating their diagnosis, assisting with instrumental activities of daily living, assisting with basic activities of daily living, and preparing for the future. Support (i.e., informational, emotional, instrumental, and appraisal) needs were often specific to the phase of care. For example, during the initial symptoms phase, caregivers reported needing information to assist them to distinguish normal aging from cognitive impairment. In contrast, during the preparing for the future phase, caregivers emphasized support for accessing institutional long term-care placement. Findings highlight caregiver-identified phases of caregiving and corresponding support needs across the Alzheimer's disease trajectory. Findings can inform the development, evaluation and implementation of programs and services to meet caregivers' changing needs across the disease trajectory. Caregivers for individuals with Alzheimer's disease can experience distinct caregiving phases across the disease trajectory with corresponding support needs. Rehabilitation clinicians can use these findings to help caregivers navigate available supports at appropriate times to ensure that their needs are addressed across the disease trajectory. Occupational therapists and other rehabilitation professionals can enable caregivers with timely education and support as they progress across the disease trajectory. [ABSTRACT FROM AUTHOR]

Objectives Prevailing job stress models encourage a multidimensional view of the psychosocial work environment and highlight the role that multiple co-occurring stressors play in the aetiology of mental health problems. In this study, we develop a latent typology of psychosocial work environment profiles to describe how a comprehensive array of job stressors are clustered in the Canadian labour market. We also examine the association between these latent psychosocial work environment profiles and several indicators of mental health. Methods Data were collected from 6408 workers who completed the Canadian National Psychosocial Work Environment Survey. Psychosocial work exposures were measured using standard items from the Copenhagen Psychosocial Questionnaire. We employed latent profile analyses to identify groups of individuals with similar psychosocial work environment profiles. We used log-linear regression models to examine the association between latent psychosocial work environment profiles and burnout, stress, and cognitive strain. Results Four distinct groups with highly divergent psychosocial work environment profiles were identified. Adjusting for a range of demographic and socioeconomic factors, latent psychosocial work environment profiles were strongly related to mental health. Individuals who reported exposure to a comprehensive array of psychosocial job stressors (11% prevalence) reported the highest probability of burnout (PR: 7.51, 95% confidence interval [CI]: 5.56–10.15), stress (PR: 8.98, 95% CI: 6.20–13.0), and cognitive strain (PR: 7.29, 95% CI: 5.02–10.60). Conclusions Findings suggest that psychosocial work stressors are tightly clustered in the Canadian labour market, and that the clustering of work stressors is strongly associated with adverse mental health outcomes. Future scholarship may benefit from adopting a more comprehensive approach to the assessment of psychosocial job quality as a determinant of health and well-being. [ABSTRACT FROM AUTHOR]

Background: With the aging of populations in many countries, workers are expected to remain employed longer but may struggle with the onset of common, chronic conditions like arthritis. To date, few studies have examined workplace policies and practices that could help accommodate individuals with arthritis, and fewer still have used a sex and gender-based approach to explore similarities and differences between women and men. Objectives: This study compared the health and work contexts of workers aged ≥50 years to better understand similarities and differences between women and men in accommodation availability, need, use, and unmet needs. Methods: A cross-sectional survey of men and women with osteoarthritis (OA), inflammatory arthritis (IA), or both OA and IA was administered online or by telephone and assessed demographics (e.g. age, education), health (e.g. pain, fatigue, workplace activity limitations), work context factors (e.g. job sector, full/part-time work, job control), and workplace accommodations (e.g. health bene- fits, flexible hours, special equipment/adaptations, modified duties). Sex and gender-based analyses examined similarities and differences between men and women and included descriptive statistics, multivariable multinomial analyses, and nested regression analyses. Results: There was a 58.9% response rate and final sample of 463 participants (women, n = 266; men, n = 197; OA = 59.0%; IA/both IA and OA = 23.7%; unsure = 17.3%). Women and men were significantly different in a number of health (e.g. fatigue, health variability, workplace activity limitations) and work context factors (e.g. job sector, part-time work, job stress). However, in other respects, they were similar (e.g. pain, job involving physical demands, size of organization, shift work, union membership, job control). There were no differences between men and women in the availability or use of workplace accommodations. However, women reported significantly more accommodation needs and had greater unmet needs. Multivariable multinomial analyses found male/female as a binary variable did not explain differences in accommodation need, use, and unmet need. Nested analyses highlighted that differences in health variables explained male/female differences in accommodation need, while work context differences explained male/female differences in whether needs were met. Conclusions: The findings highlight that women and men draw on a range of existing accommodation policies and practices to help manage their arthritis and that most have their accommodation needs met. Decomposing the context within which men and women with arthritis work suggests that women may face health and work context challenges that differ from men and that are related to greater accommodation needs and unmet need. This highlights potential vulnerabilities in the work of women that need to be addressed. [ABSTRACT FROM AUTHOR]

Objective. The objective of this study was to examine the extent of workplace activity limitations among persons with lupus and to identify factors associated with activity limitations among those employed.Methods. We conducted a cross-sectional study using a mailed survey and clinical data of persons with lupus who attended a large lupus outpatient clinic. Data were collected on demographics, health, work factors and psychosocial measures. The workplace activity limitations scale (WALS) was used to measure difficulty related to different activities at work. Multivariable analysis examined the association of health, work context, psychosocial and demographic variables with workplace activity limitations.Results. We received 362 responses from 604 (60%) mailed surveys. Among those not employed, 52% reported not working because of lupus. A range of physical and mental tasks were reported as difficult. Each of the physical, cognitive and energy work activities was cited as difficult by more than one-third of participants. Among employed participants, 40% had medium to high WALS difficulty scores. In the multivariable analysis, factors significantly associated with workplace activity limitations were older age, greater disease activity, fatigue, poorer health status measured by the 36-item Short Form Health Survey, lower job control, greater job strain and working more than 40 h/week.Conclusion. People with lupus experience limitations and difficulty at work. Determinants of workplace activity limitations are mainly those related to workplace and health factors. [ABSTRACT FROM PUBLISHER]

Objective. To examine inter-relationships among arthritis (A), work (W) and personal life (P) roles and their reciprocal influences, especially experiences of role balance/imbalance among individuals with inflammatory arthritis (IA) and OA.Methods. Eight focus groups were conducted with 24 women and 16 men (aged 29–72 years). A purposive sample was recruited from community advertising. Eligibility included current employment or having been employed within the previous year. Participants were asked about ways arthritis, work and personal life roles intersected and their impact. A standardized questionnaire collected demographic, symptom and employment data for descriptive purposes.Results. Participants noted that having arthritis affected their identity and intersected with work and personal roles, creating role overload, role conflict, role strain and role facilitation. Role overload highlighted that arthritis both affected and was impacted by work and personal life (A → W; A → P; W → A; P → A). Role conflict focused on A → W and A → P difficulties, whereas role facilitation emphasized the positive impact of work and personal life roles on arthritis (W → A; P → A). Role strain was pervasive and arose from numerous sources. Personal strategies (e.g. positive framing) and contextual factors (e.g. support) were important in contributing to or ameliorating role balance/imbalance.Conclusions. By comprehensively examining multiple types of role balance/imbalance and the context within which it occurs, this study identifies gaps in patient-oriented measurement of the impact of arthritis and areas of need in the development of arthritis intervention. [ABSTRACT FROM PUBLISHER]

The article presents a study which examined the prevalence, accrual over time, and risk factors of work disability in patients with systemic lupus erythematosus (SLE). Researchers in this study observed 432 patients from an inception cohort and work disability was measured from a single self-report question. Researchers found that work disability is frequent in patients with SLE, with a cumulative prevalence of 23%. Discussion on the method used in the study is also offered.

This study evaluated an 8-9 week psychotherapeutic group program designed to help people cope with the difficulties and changes that arise when living with musculoskeletal (MSK) disorders. Also examined were individual differences in client expectations about the benefits of the groups. Participants were 64 community-dwelling adults who completed questionnaires at the beginning, end, and three months after their final group session. Outcomes were mastery, coping efficacy, helplessness, self-acceptance and depression. Significant changes from pre- to post-intervention were found in mastery, depression, and coping-efficacy with effect sizes of .50 or greater. Individuals who had concerns or reservations about participating in the groups gained from the intervention in the same ways as others who were more positive at the outset of the groups. [ABSTRACT FROM AUTHOR]

Presents information on a conceptual model of physical independence and dependence, relevant to chronic physical illness and disability in adults. Examination of the potential determinants of physical independence and dependence; Role of subjective perceptions, demographics and physical and socio-political environments; How the development of chronic physical illness in adulthood affects physical independence.

Background: Families play an important role meeting the care needs of individuals who require assistance due to illness and/or disability. Yet, without adequate support their own health and wellbeing can be compromised. The literature highlights the need for a move to family-centered care to improve the well-being of those with illness and/or disability and their family caregivers. The objective of this paper was to explore existing models of family-centered care to determine the key components of existing models and to identify gaps in the literature.Methods: A scoping review guided by Arksey & O'Malley (2005) examined family-centered care models for diverse illness and age populations. We searched MEDLINE, PsycINFO, CINAHL and EMBASE for research published between 1990 to August 1, 2018. Articles describing the development of a family-centered model in any patient population and/or healthcare field or on the development and evaluation of a family-centered service delivery intervention were included.Results: The search identified 14,393 papers of which 55 met our criteria and were included. Family-centered care models are most commonly available for pediatric patient populations (n = 40). Across all family-centered care models, the consistent goal is to develop and implement patient care plans within the context of families. Key components to facilitate family-centered care include: 1) collaboration between family members and health care providers, 2) consideration of family contexts, 3) policies and procedures, and 4) patient, family, and health care professional education. Some of these aspects are universal and some of these are illness specific.Conclusions: The review identified core aspects of family-centred care models (e.g., development of a care plan in the context of families) that can be applied to all populations and care contexts and some aspects that are illness specific (e.g., illness-specific education). This review identified areas in need of further research specifically related to the relationship between care plan decision making and privacy over medical records within models of family centred care. Few studies have evaluated the impact of the various models on patient, family, or health system outcomes. Findings can inform movement towards a universal model of family-centered care for all populations and care contexts. [ABSTRACT FROM AUTHOR]

Objective: The aims were to validate linguistically British‐English versions of the Perceived Workplace Support Scale (PWSS), Work Accommodations, Benefits, Policies and Practices Scale (WABPPS), and Work Transitions Index (WTI) in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), osteoarthritis (OA) and fibromyalgia (FM). Methods: The three scales were adapted into British‐English and reviewed by an expert panel prior to cognitive debriefing interviews. Participants completed postal questionnaires. Construct validity for the PWSS was assessed using Rasch analysis. Concurrent validity included testing between the three scales and work, job strain and work‐life balance scales. Two weeks later, participants were mailed a second questionnaire to measure test‐retest reliability. Results: The questionnaire was completed by 831 employed participants: 68% women, 53.50 (SD 8.9) years of age, with condition duration 7.70 (SD 8.00) years. The PWSS satisfied Rasch model requirements. Concurrent validity was mostly as hypothesised, that is, weak to moderate negative correlations for the PWSS (rs = 0.07 to −0.61), and weak to moderate positive correlations for the WABPPS and WTI (rs = 0.20–0.52). Some correlations were stronger, mostly in axSpA. Internal consistency (Cronbach's alpha) for all three scales was consistent with group use in all conditions. Test‐retest reliability was generally excellent, with intraclass coefficients (2,1) of 0.80–0.93 for the three scales in the four conditions. Discussion: Reliable, valid versions of the British‐English PWSS, WABPPS, and WTI are now available for use in research, organisational level studies and vocational rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: The aims were to validate linguistically British‐English versions of the Long‐Term Conditions Job Strain Scale (LTCJSS), Long‐Term Conditions Work Spillover Scale (LTCWSS) and Work‐Health‐Personal Life Perceptions Scale (WHPLPS) in rheumatoid arthritis, axial spondyloarthritis, osteoarthritis and fibromyalgia (FM). Methods: The three scales were forward translated and reviewed by an expert panel prior to cognitive debriefing interviews. Participants completed a postal questionnaire. Construct validity was assessed using Rasch analysis. Concurrent validity included testing between the three scales and work (e.g., Workplace Activity Limitations Scale [WALS]) and condition‐specific health scales. Two weeks later, participants were mailed a second questionnaire to measure test‐retest reliability. Results: The questionnaire was completed by 831 employed participants: 68% women, 53.5 (SD 8.9) years of age, with condition duration 7.7 (SD 8.0) years. The LTCJSS, LTCWSS and WHPLPS Parts 1 and 2 satisfied Rasch model requirements, but Part 3 did not. A Rasch transformation scale and Reference Metric equating scales with the WALS were created. Concurrent validity was generally good (rs = 0.41–0.85) for the three scales, except the WHPLPS Part 3. Internal consistency (Person Separation Index values) was consistent with group use in all conditions, and individual use except for the LTCWSS and WHPLSP Parts 1 and 2 in FM. Test‐retest reliability was excellent, with intraclass coefficients (2,1) of 0.80–0.96 for the three scales in the four conditions. Discussion: Reliable, valid versions of the British‐English LTCJSS, LTCWSS and WHPLPS Parts 1 and 2 are now available for use in the UK. [ABSTRACT FROM AUTHOR]

The partnered research method, used routinely in other fields, offers great potential to improve the quality and practical use of applied psychology research. Partnered research integrates the perspectives of researchers, knowledge users, people who have lived experience with the attributes being studied, and other stakeholders in all elements of the research process, from the creation and generation of research questions to the methods used, the data analyzed, and the dissemination, application, and implementation of research results. We explain the concept of partnered research and provide a step‐by‐step roadmap for applied psychology scholars interested in conducting partnered research. In doing so, we also address common challenges with this method and provide advice on how to overcome them. We embed our description of the partnered research approach primarily in the context of research on disabilities and work but also offer examples drawn from other areas of applied psychology. [ABSTRACT FROM AUTHOR]

Objectives Chronic conditions and multimorbidity are increasing worldwide. Yet, understanding longitudinal changes in multimorbidity over the lifecourse is limited. We compared the age-trajectory of multimorbidity by birth cohort and examined effects of socio-demographic (e.g. sex, income) and behavioral risk (e.g. obesity) factors in multimorbidity. Methods Using data from the Canadian Longitudinal National Population Health Survey (1994–2010), we examined 10,186 participants born 1925–1974 grouped in 5 birth cohorts. Data on the number of chronic conditions (up to 17), income, education, and behavioral risk factors were collected biannually. We used multilevel logistic growth modeling techniques for analyses of multimorbidity defined as the presence of 2+ chronic conditions versus 1 or none. Results We found significant cohort differences in the age-trajectory of multimorbidity: at corresponding ages, each succeeding recent cohort had higher odds of reporting multimorbidity than their predecessors. Access to healthcare did not fully explain these differences. Women, having lower income, being obese, smoking, and a sedentary lifestyle had increased odds of reporting multimorbidity. Obese individuals, particularly Gen Xers and younger boomers, reported multimorbidity at an earlier age than those of normal weight. We observed divergent trajectories of greater multimorbidity for lower than higher income individuals. Furthermore, after accounting for age and risk factors there was an apparent increase in reporting multimorbidity over time (period effect) across all ages. Discussion Our findings indicate that multimorbidity is not only becoming the norm, but is emerging earlier in the lifecourse and particularly for low income and obese individuals from more recent cohorts. The findings point to the importance of planning interventions and policies to deal with more recent birth cohorts entering into older age with worse health than their predecessors. [ABSTRACT FROM AUTHOR]

Background: The use of complementary and alternative medicine (CAM) is growing. However the factors contributing to changes over time and to birth cohort differences in CAM use are not well understood. Setting: We used data from 10186 participants, who were aged 20–69 years at the first cycle of data collection in the longitudinal component of the Canadian National Population Health Survey (1994/95-2010/11). We examined chiropractic and other practitioner-based CAM use with a focus on five birth cohorts: pre-World War II (born 1925–1934); World War II (born 1935–1944); older baby boomers (born 1945–1954); younger baby boomers (born 1955–1964); and Gen Xers (born 1965–1974). The survey collected data every two years on predisposing (e.g., sex, education), enabling (e.g., income), behavior-related factors (e.g., obesity), need (e.g., chronic conditions), and use of conventional care (primary care and specialists). Results: The findings suggest that, at corresponding ages, more recent cohorts reported greater CAM (OR = 25.9, 95% CI: 20.0; 33.6 for Gen Xers vs. pre-World War) and chiropractic use than their predecessors (OR = 2.2, 95% CI: 1.7; 2.8 for Gen Xers vs. pre-World War). There was also a secular trend of increasing CAM use, but not chiropractic use, over time (period effect) across all ages. Factors associated with cohort differences were different for CAM and chiropractic use. Cohort differences in CAM use were partially related to a period effect of increasing CAM use over time across all ages while cohort differences in chiropractic use were related to the higher prevalence of chronic conditions among recent cohorts. The use of conventional care was positively related to greater CAM use (OR = 1.8, 95% CI: 1.6; 2.0) and chiropractic use (OR = 1.2, 95% CI: 1.1; 1.4) but did not contribute to changes over time or to cohort differences in CAM and chiropractic use. Conclusion: The higher CAM use over time and in recent cohorts could reflect how recent generations are approaching their healthcare needs by expanding conventional care to include CAM therapies and practice for treatment and health promotion. The findings also underscore the importance of doctors discussing CAM use with their patients. [ABSTRACT FROM AUTHOR]

To characterize the breadth of challenges that people with IBD experience in the workplace and identify supports and accommodations that can help sustain employment. A scoping review was conducted using the Arksey and O'Malley framework. Electronic databases (MEDLINE, PsycINFO, CINAHL, EMBASE) and grey literature websites identified English-language studies published from inception through to June 2020. Studies where details were insufficient to extract the study purpose, sample, methods, and findings were deemed of poorer quality and excluded. Eighteen studies met selection criteria. Studies discussed common workplace challenges, including career planning, work performance, managing physical and cognitive symptoms, social impacts at work, and challenges related to the physical work environment and commuting. The range of workplace supports identified by studies was classified into five categories: flexibility, changes to the physical work environment, social support, self-management strategies, and extended health benefits. IBD research typically has been descriptive and focused on broad characterizations of workplace challenges and supports. Future work needs to examine causal pathways and assess the efficacy of workplace supports, as well as conduct subgroup analyses and develop resources to facilitate communication and accommodation planning between workers living with IBD and their employers. Rehabilitation professionals can play an important role in supporting people working with inflammatory bowel disease (IBD) by identifying accommodations and ways to make work environments more supportive. Providing rehabilitation support to people with IBD goes beyond symptom management and needs to consider the broader social, policy, and environmental challenges of employment. [ABSTRACT FROM AUTHOR]

Background: Growing evidence supports the integration and coordination of occupational health and safety and workplace health promotion activities instead of these coexisting as siloed efforts. Identifying implementation challenges and how these can be overcome is an important step to achieving truly integrated worker health efforts. We conducted a scoping review to identify the barriers and facilitators to integrated worker health approaches and described recommendations for implementing these efforts. Method: Peer-reviewed articles and gray literature from 2008 to 2019 were searched from the following electronic databases: EMBASE, Ovid Medline, PsycINFO, and ABI/INFORM. References from relevant articles and key informant suggestions also were collected. Data were extracted from documents if they focused on the occupational health and safety and health promotion of workers and described outcomes associated with integrated worker health approaches or outlined considerations relevant to the implementation of these approaches. Results: Fifty-one documents met the inclusion criteria and were reviewed. Barriers and facilitators to implementing integrated worker health approaches were found at the extraorganizational, organizational, worker, and program levels, with limited resource availability the most reported barrier and support from leadership the most reported facilitator. Ten broad recommendations were identified and highlighted gaining leadership support, demonstrating leadership commitment, developing worker-centric approaches, and building capacity for workers. Conclusion: In reviewing the literature, we found clear and consistent recommendations relevant for integrated worker health approaches. Further research is needed to better understand how these recommendations apply to diverse workforces and organizations with varied resources. [ABSTRACT FROM AUTHOR]

Background Family caregivers provide invaluable support to stroke survivors during their recovery, rehabilitation, and community re-integration. Unfortunately, it is not standard clinical practice to prepare and support caregivers in this role and, as a result, many experience stress and poor health that can compromise stroke survivor recovery and threaten the sustainability of keeping the stroke survivor at home. We developed the Timing it Right Stroke Family Support Program (TIRSFSP) to guide the timing of delivering specific types of education and support to meet caregivers' evolving needs. The objective of this multi-site randomized controlled trial is to determine if delivering the TIRSFSP across the stroke care continuum improves caregivers' sense of being supported and emotional well-being. Methods/design Our multi-site single-blinded randomized controlled trial will recruit 300 family caregivers of stroke survivors from urban and rural acute care hospitals. After completing a baseline assessment, participants will be randomly allocated to one of three groups: 1) TIRSFSP guided by a stroke support person (health care professional with stroke care experience), delivered in-person during acute care and by telephone for approximately the first six to 12 months post-stroke, 2) caregiver self-directed TIRSFSP with an initial introduction to the program by a stroke support person, or 3) standard care receiving the educational resource "Let's Talk about Stroke" prepared by the Heart and Stroke Foundation. Participants will complete three follow-up quantitative assessments 3, 6, and 12-months post-stroke. These include assessments of depression, social support, psychological well-being, stroke knowledge, mastery (sense of control over life), caregiving assistance provided, caregiving impact on everyday life, and indicators of stroke severity and disability. Qualitative methods will also be used to obtain information about caregivers' experiences with the education and support received and the impact on caregivers' perception of being supported and emotional well-being. Discussion This research will determine if the TIRSFSP benefits family caregivers by improving their perception of being supported and emotional well-being. If proven effective, it could be recommended as a model of stroke family education and support that meets the Canadian Stroke Best Practice Guideline recommendation for providing timely education and support to families through transitions. [ABSTRACT FROM AUTHOR]

Objective: There is increasing recognition of the value of integrating efforts to promote worker health with existing occupational health and safety activities. This paper aimed to identify facilitators, barriers and recommendations for implementing integrated worker health approaches. Methods: Thirteen stakeholders from different job sectors participated in a workshop that targeted key issues underlying integrated worker health approaches in their own and other organizations. Included were participants from human resources, occupational health and safety, government, and unions. Thematic analysis and an online ranking exercise identified recommendation priorities and contributed to a conceptual framework. Results: Participants highlighted the importance of planning phases in addition to implementation and evaluation. Themes highlighted organizational priorities, leadership buy-in, external pressures, training. program promotion and evaluation metrics. Conclusions: Findings provide practical directions for integrating worker health promotion and [ABSTRACT FROM AUTHOR]

Background: Precarious work is an increasingly common characteristic of industrialized labor markets that can widen health inequities, especially among disadvantaged workforce segments. Study objectives are to compare precarious employment in workers with and without disabilities, and to examine the modifying effect of disability in the relationships between age, job tenure and precarious work.Methods: Employed Canadians with (n = 901) and without disabilities (n = 901) were surveyed on exposure to precarious working conditions. Information on age and job tenure were collected from respondents along with sociodemographic, health and work context details. Multivariable logistic models examined the association between disability and precarious work. Also, multigroup probit models examined precarious work for young (18-35 yrs), middle-aged (36-50 yrs) and older adults (> 50 yrs) and job tenure and was stratified by participants with and without disabilities.Results: Almost equal proportions of young, middle-aged and older participants were recruited. Mean job tenure of participants was 9.5 years (SD = 9.0). Close to one-third of participants reported working precariously. At the multivariable level, a disability was not associated with working precariously. However, multigroup modelling indicated that disability was a significant effect-modifier. Older adults with a disability had a 1.88 times greater odds of reporting precarious work when compared to young adults (OR = 1.88, 95%CI 1.19, 2.98). When reporting a disability, longer job tenure was related to a 0.95 times lower odds of precarious work (OR = 0.95 95%CI 0.93, 0.98). The relationship between age and job tenure was not significant for those not reporting a disability.Discussion: Precarious work has the potential to affect workers with and without disabilities. For those with a disability, being an older adult and/or a new worker can contribute to a greater likelihood of being employed precariously. Policies and programs can be recommended to address precarious working conditions and related health inequities for people with disabilities based on life and career phase. [ABSTRACT FROM AUTHOR]

Purpose: To understand the similarities and differences in the employment participation of people living with arthritis across the life course. Method: Focus groups and interviews were conducted with young (ages 18-34 years, n = 7), middle-aged (ages 35-54 years, n = 13) and older adults (>55 years, n = 25) with arthritis. Participants were asked about the impact of arthritis on employment, experiences with health-related changes, career progression and social role involvement. A modified grounded theory approach was used to inductively analyze the data. Results: Young adults indicated the school-to-work transition as being influential in their employment and described the need to direct their time and energy toward finding work that accommodated health and met career aspirations. Middle-aged adults described how the transition from good health to an arthritis diagnosis disrupted involvement in diverse social roles. However, they often downplayed the impact of arthritis on employment. Older adults described the work-to-retirement transition and their decline in physical functioning as contributing to changing involvement in the labor market. Conclusion: Transitions related to health, career progression and social role involvement shaped employment experiences, and represent opportunities for future research and practice that is tailored to life course issues. Implications for rehabilitation: Little is known about the work experiences of young- and middle-aged adults with arthritis and how they compare to their older counterparts. Life course theory offers an important framework for research and practice by providing a perspective to enhance our understanding of how employment participation differs across phases of life. Salient and diverse changes related to health, career and social role involvement were identified at each life phase and shaped employment. Rehabilitation practitioners should pay special attention to a client’s age, life phase and work history as a strategy to enhance the delivery of interventions that promote work participation. [ABSTRACT FROM AUTHOR]

Although pain reduction is commonly the primary outcome in chronic pain clinical trials, physical functioning is also important. A challenge in designing chronic pain trials to determine efficacy and effectiveness of therapies is obtaining appropriate information about the impact of an intervention on physical function. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) and Outcome Measures in Rheumatology (OMERACT) convened a meeting to consider assessment of physical functioning and participation in research on chronic pain. The primary purpose of this article is to synthesize evidence on the scope of physical functioning to inform work on refining physical function outcome measurement. We address issues in assessing this broad construct and provide examples of frequently used measures of relevant concepts. Investigators can assess physical functioning using patient-reported outcome (PRO), performance-based, and objective measures of activity. This article aims to provide support for the use of these measures, covering broad aspects of functioning, including work participation, social participation, and caregiver burden, which researchers should consider when designing chronic pain clinical trials. Investigators should consider the inclusion of both PROs and performance-based measures as they provide different but also important complementary information. The development and use of reliable and valid PROs and performance-based measures of physical functioning may expedite development of treatments, and standardization of these measures has the potential to facilitate comparison across studies. We provide recommendations regarding important domains to stimulate research to develop tools that are more robust, address consistency and standardization, and engage patients early in tool development. [ABSTRACT FROM AUTHOR]

Objective: Examine feasibility of conducting a randomized controlled trial of the Timing it Right Stroke Family Support Program (TIRSFSP) and collect pilot data. Design: Multi-site mixed method randomized controlled trial. Setting: Acute and community care in three Canadian cities. Subjects: Caregivers were family members or friends providing care to individuals who experienced their first stroke. Intervention: The TIRSFSP offered in two formats, self-directed by the caregiver or stroke support person-directed over time, were compared to standard care. Main measures: Caregivers completed baseline and follow-up measures 1, 3 and 6 months post-stroke including Centre for Epidemiological Studies Depression, Positive Affect, Social Support, and Mastery Scales. We completed in-depth qualitative interviews with caregivers and maintained intervention records describing support provided to each caregiver. Results: Thirty-one caregivers received standard care (n=10), self-directed (n=10), or stroke support person-directed (n=11) interventions. We retained 77% of the sample through 6-months. Key areas of support derived from intervention records (n=11) related to caregiver wellbeing, caregiving strategies, patient wellbeing, community re-integration, and service delivery. Compared to standard care, caregivers receiving the stroke support person-directed intervention reported improvements in perceived support (estimate 3.1, P=.04) and mastery (estimate .35, P=.06). Qualitative caregiver interviews (n=19) reflected the complex interaction between caregiver needs, preferences and available options when reporting on level of satisfaction. Conclusions: Preliminary findings suggest the research design is feasible, caregivers’ needs are complex, and the support intervention may enhance caregivers’ perceived support and mastery. The intervention will be tested further in a large scale trial. [ABSTRACT FROM AUTHOR]

Objective: This study compares health and occupational outcomes following a work-related injury for nonstandard and day-shift workers. Methods: National Population Health Survey data were used to explore outcomes 2 years post-work injury. Retrospective-matched cohort analyses examined main effects and interactions of shift schedule and work injury with changes in health, shift schedule, and labor force status. Models were adjusted for respondent characteristics, baseline health status, and occupational strength requirements. Results: Injured nonstandard shift workers reported lower health utility index scores, compared with uninjured and injured daytime workers and uninjured nonstandard-shift workers. No significant interactions between shift and injury were found with schedule change and leaving the labor force. Conclusions: Injured nonstandard-shift workers are as likely to remain employed as other groups, but may be vulnerable in terms of diminished health. [ABSTRACT FROM AUTHOR]

Background: Family caregivers provide invaluable support to stroke survivors during their recovery, rehabilitation, and community re-integration. Unfortunately, it is not standard clinical practice to prepare and support caregivers in this role and, as a result, many experience stress and poor health that can compromise stroke survivor recovery and threaten the sustainability of keeping the stroke survivor at home. We developed the Timing it Right Stroke Family Support Program (TIRSFSP) to guide the timing of delivering specific types of education and support to meet caregivers' evolving needs. The objective of this multi-site randomized controlled trial is to determine if delivering the TIRSFSP across the stroke care continuum improves caregivers' sense of being supported and emotional well-being.Methods/design: Our multi-site single-blinded randomized controlled trial will recruit 300 family caregivers of stroke survivors from urban and rural acute care hospitals. After completing a baseline assessment, participants will be randomly allocated to one of three groups: 1) TIRSFSP guided by a stroke support person (health care professional with stroke care experience), delivered in-person during acute care and by telephone for approximately the first six to 12 months post-stroke, 2) caregiver self-directed TIRSFSP with an initial introduction to the program by a stroke support person, or 3) standard care receiving the educational resource "Let's Talk about Stroke" prepared by the Heart and Stroke Foundation. Participants will complete three follow-up quantitative assessments 3, 6, and 12-months post-stroke. These include assessments of depression, social support, psychological well-being, stroke knowledge, mastery (sense of control over life), caregiving assistance provided, caregiving impact on everyday life, and indicators of stroke severity and disability. Qualitative methods will also be used to obtain information about caregivers' experiences with the education and support received and the impact on caregivers' perception of being supported and emotional well-being.Discussion: This research will determine if the TIRSFSP benefits family caregivers by improving their perception of being supported and emotional well-being. If proven effective, it could be recommended as a model of stroke family education and support that meets the Canadian Stroke Best Practice Guideline recommendation for providing timely education and support to families through transitions.Trial Registration: ClinicalTrials.gov: NCT00958607. [ABSTRACT FROM AUTHOR]

Objective: To examine and compare the sensibility attributes (face/content validity and feasibility) of five at-work productivity measures from the perspective of patients with osteoarthritis (OA) or rheumatoid arthritis (RA). Study Design and Setting: Workers with OA or RA (n = 250) completed a survey that includes five at-work productivity (presenteeism) measures and questions asking about their comprehensiveness, understandability, length, and suitability of response options. A final question asked respondents which single measure was considered "best" overall. Measures compared included the Workplace Activity Limitations Scale (WALS), Stanford Presenteeism Scale, Endicott Work Productivity Scale, Work Instability Scale for Rheumatoid Arthritis (RA-WIS), and Work Limitations Questionnaire (WLQ-25). Sensibility performance was assessed quantitatively (% respondent endorsement) and qualitatively via written feedback. Results: The WLQ-25 was considered most comprehensive (endorsed by 92.8%), the WALS performed best in terms of understandability (97.6%) and suitability of response options (97.9%), and the RA-WIS was favored in terms of length (91.6%). Consistent sensibility performance between OA and RA was found. The WALS (32.6%) and WLQ-25 (30.0%) were moderately preferred in the final overall appraisal. Conclusion: Sensibility criteria were generally met by all five at-work productivity measures. Variable endorsement levels across specific sensibility attributes were also revealed across the measures compared. [ABSTRACT FROM AUTHOR]

Purpose: Family caregivers provide essential support as stroke survivors' return to community living, but it is not standard clinical practice to prepare or provide ongoing support for their care-giving role. In addition, health care professionals (HCPs) experiences with providing support to caregivers have not been explored previously. The objectives of this qualitative study were to: (1) explore the support needs over time from the perspective of caregivers, (2) explore the support needs over time from the perspective of HCPs, and (3) compare and contrast caregivers' and HCPs' perspectives. Methods: A qualitative study with stroke family caregivers (n = 24) and HCPs (n = 14). In-depth interviews were audio taped, transcribed, and analyzed using Framework Analysis. Results: Three main themes emerged concerning: (1) types and intensity of support needed; (2) who provides support and the method of providing support; and (3) primary focus of care. These themes are discussed in relation to the TIR framework. Conclusions: Caregivers' needs for support and the individuals most suited to providing support change across the stroke survivor's recovery trajectory. Changes to service delivery to better support caregivers may include: (1) addressing caregivers' changing needs across the care continuum; (2) implementing a family-centered model of care; and (3) providing 7-day per week inpatient rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: To validate the 23-item Work Instability Scale for Rheumatoid Arthritis (RA-WIS) for use in osteoarthritis (OA) using both classical test theory and item response theory approaches. Methods: Baseline and 12-month follow-up data were collected from workers with OA recruited from community and clinical settings ( n = 130). Fit of RA-WIS data to the Rasch model was evaluated by item- and person-fit statistics (size of residual, chi-sq), assessments of differential item functioning, and tests of unidimensionality and local independence. Internal consistency was assessed by KR-20. Convergent construct validity (Spearman r, known-groups) was evaluated against theoretical constructs that assess impact of health on work. Responsiveness to global indicators of change was assessed by standardized response means (SRM) and area under the receiver operating characteristic curves. Results: Data structure of the RA-WIS showed adequate fit to the Rasch model ( chi- sq = 83.2, P = 0.03) after addressing local dependency in three item pairs by creating testlets. High internal consistency (KR-20 = 0.93) and convergent validity with work-oriented constructs (| r| = 0.55–0.77) were evident. The RA-WIS correlated most strongly with the concept of illness intrusiveness ( r = 0.77) and was highly responsive to changes (SRM = 1.05 [deterioration]; −0.78 [improvement]). Conclusions: Although developed for RA, the RA-WIS is psychometrically sound for OA and demonstrates interval-level property. [ABSTRACT FROM AUTHOR]