Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US. Manage at work: a randomized, controlled trial of a self-management group intervention to overcome workplace challenges associated with chronic physical health conditions Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Improving employment outcomes for persons with severe mental illnesses. Job Terminations Among Persons with Severe Mental Illness Participating in Supported Employment Client Predictors of Employment Outcomes in High-Fidelity Supported Employment: A Regression Analysis Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. The Effect of a Job Placement and Support Program for Workers with Musculoskeletal Injuries: A Randomized Control Trial (RCT) Study The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Randomized comparison of a multidisciplinary job-retention vocational rehabilitation program with usual outpatient care in patients with chronic arthritis at risk for job loss. Determinants of disability after a work related musculetal injury. Assisting Social Security Disability Insurance beneficiaries with schizophrenia, bipolar disorder, or major depression in returning to work. Supported employment for Irish adults with intellectual disability: the OPEN ROAD experience. A randomized controlled trial of a supported employment program for persons with long-term mental illness in Hong Kong. Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness. Components of Initial and Residual Disability After Back Injury in Nurses Randomized trial of supported employment integrated with assertive community treatment for rural adults with severe mental illness. The impact of work environment on mood disorders and suicide: Evidence and implications Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. A comparison of competitive employment outcomes for the clubhouse and PACT models. The impact of enhanced incentives on vocational rehabilitation outcomes for dually diagnosed veterans. Cognitive training and supported employment for persons with severe mental illness: one-year results from a randomized controlled trial. Effects of resource-building group intervention on career management and mental health in work organizations: randomized controlled field trial.
While review s of controlled studies of the Individual Placement and Support ( IPS ) model of supported employment for clients with severe mental illness have documented its effectiveness in the US , its generalizability to other countries has not been systematic ally evaluated . This is the first review to compare US to non-US studies . We identified 15 r and omized controlled trials of IPS programs , 9 in the US and 6 outside the US . We examined competitive employment outcomes , including employment rate , days to first job , weeks worked during follow-up , and hours worked . We also considered noncompetitive employment , program retention , and nonvocational outcomes .  IPS programs had significantly better outcomes across a range of competitive employment indicators and higher retention in services than control groups . The overall competitive employment rate for IPS clients in US studies was significantly higher than in non-US studies ( 62 % vs. 47 % ) . The consistently positive competitive employment outcomes strongly favoring IPS over a range of comparison programs in a group of international studies suggest that IPS is an evidence -based practice that may transport well into new setting s as long as programs achieve high fidelity to the IPS model , but further research is needed on international adaptations Background The percentage of older and chronically ill workers is increasing rapidly in the US and in many other countries , but few interventions are available to help employees overcome the workplace challenges of chronic pain and other physical health conditions . While most workers are eligible for job accommodation and disability compensation benefits , other workplace strategies might improve individual-level coping and problem solving to prevent work disability . In this study , we hypothesize that an employer-sponsored group intervention program employing self-management principles may improve worker engagement and reduce functional limitation associated with chronic disorders . Methods In a r and omized controlled trial ( RCT ) , workers participating in an employer-sponsored self-management group intervention  will be compared with a no-treatment ( wait list ) control condition .  Volunteer employees ( n = 300 ) will be recruited from five participating employers and r and omly assigned to intervention or control . Participants in the intervention arm will attend facilitated group workshop sessions at work ( 10 hours total ) to explore methods for improving comfort , adjusting work habits , communicating needs effectively , applying systematic problem solving , and dealing with negative thoughts and emotions about work . Work engagement and work limitation are the principal outcomes . Secondary outcomes include fatigue , job satisfaction , self-efficacy , turnover intention , sickness absence , and health care utilization . Measurements will be taken at baseline , 6- , and 12-month follow-up . A process evaluation will be performed alongside the r and omized trial . Discussion This study will be most relevant for organizations and occupational setting s where some degree of job flexibility , leeway , and decision-making autonomy can be afforded to affected workers . The study design will provide initial assessment of a novel workplace approach and to underst and factors affecting its feasibility and effectiveness . Trial registration Clinical trials.gov : NCT01978392 ( Issued November 6 , 2013 Abstract Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention ( WDP ) interventions in workers with neck pain , whiplash-associated disorders ( WAD ) , or upper extremity disorders . Methods We search ed electronic data bases from 1990 to 2012 . R and om pairs of independent review ers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria . Scientifically admissible studies were summarized and synthesized following best- evidence synthesis methodology . Results Of the 6,359 articles retrieved , 16 r and omized controlled trials were eligible for critical appraisal and five were admissible . We found that a return-to-work coordination program ( including workplace-based work hardening ) was superior to clinic-based work hardening for persistent rotator cuff tendinitis . Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain . Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints . Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms . Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers ’ recovery from recent work-related neck and upper extremity complaints . Conclusions At present , no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain , WAD , and upper extremity disorders . Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening . Also , adding computer-prompted breaks to ergonomic and workplace interventions benefits workers ’ recovery . The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions BACKGROUND Unemployment remains a major consequence of schizophrenia and other severe mental illnesses . This study assesses the effectiveness of the Individual Placement and Support model of supportive employment relative to usual psychosocial rehabilitation services for improving employment among inner-city patients with these disorders . METHODS Two hundred nineteen out patients with severe mental illnesses , 75 % with chronic psychoses , from an inner-city catchment area were r and omly assigned to either the Individual Placement and Support program or a comparison psychosocial rehabilitation program . Participants completed a battery of assessment s at study enrollment and every 6 months for 2 years . Employment data , including details about each job , were collected weekly . RESULTS Individual Placement and Support program participants were more likely than the comparison patients to work ( 42 % vs 11 % ; P<.001 ; odds ratio , 5.58 ) and to be employed competitively ( 27 % vs 7 % ; P<.001 ; odds ratio , 5.58 ) . Employment effects were associated with significant differences in cumulative hours worked ( t(211 ) = -5.0 , P = .00000003 ) and wages earned ( t = -5.5 , P = .00000003 ) . Among those who achieved employment , however , there were no group differences in time to first job or in number or length of jobs held . Also , both groups experienced difficulties with job retention . CONCLUSIONS As hypothesized , the Individual Placement and Support program was more effective than the psychosocial rehabilitation program in helping patients achieve employment goals . Achieving job retention remains a challenge with both interventions For persons with psychiatric disabilities , maintaining a job is often more difficult than acquiring a job . A large proportion of jobs end unsatisfactorily . This study explored job terminations among 63 persons with severe mental illness who participated in competitive jobs through supported employment programs .  More than half of the job terminations were unsatisfactory , defined as the client quitting without having other job plans or being fired . Baseline ratings of demographic and clinical characteristics , preemployment skills training , and early ratings of job satisfaction and work environment did not predict unsatisfactory terminations . Clients with better work histories were less likely to experience unsatisfactory terminations . In addition , unsatisfactory terminations were associated retrospectively with multiple problems on the job that were related to interpersonal functioning , mental illness , dissatisfaction with jobs , quality of work , medical illnesses , dependability , and substance abuse . These results suggest that supported employment programs need to address job maintenance with interventions that identify and address different types of difficulties as they arise on the job Research on vocational rehabilitation for clients with severe mental illness over the past 2 decades has yielded inconsistent findings regarding client factors statistically related to employment . The present study aim ed to eluci date the relationship between baseline client characteristics and competitive employment outcomes —job acquisition and total weeks worked during an 18-month follow-up — in Individual Placement and Support ( IPS ) . Data from 4 recent r and omized controlled trials of IPS were aggregated for within-group regression analyses . In the IPS sample ( N = 307 ) , work history was the only significant predictor for job acquisition , but receiving Supplemental Security Income — with or without Social Security Disability Insurance — was associated with fewer total weeks worked ( 2.0%–2.8 % of the variance ) . In the comparison sample ( N = 374 ) , clients with a diagnosis of mood disorder or with less severe thought disorder symptoms were more likely to obtain competitive employment . The findings confirm that clients with severe mental illness interested in competitive work best benefit from high-fidelity supported employment regardless of their work history and sociodemographic and clinical background , and highlight the needs for changes in federal policies for disability income support and insurance regulations CONTEXT Although guideline -concordant depression treatment is clearly effective , treatment often falls short of evidence -based recommendations . Organized depression care programs significantly improve treatment quality , but employer purchasers have been slow to adopt these programs based on lack of evidence for cost-effectiveness from their perspective . OBJECTIVE To evaluate the effects of a depression outreach-treatment program on workplace outcomes , a concern to employers . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial involving 604 employees covered by a managed behavioral health plan were identified in a 2-stage screening process as having significant depression . Patient treatment allocation was concealed and assessment of depression severity and work performance at months 6 and 12 was blinded . Employees with lifetime bipolar disorder , substance disorder , recent mental health specialty care , or suicidality were excluded . INTERVENTION A telephonic outreach and care management program encouraged workers to enter outpatient treatment ( psychotherapy and /or antidepressant medication ) , monitored treatment quality continuity , and attempted to improve treatment by giving recommendations to providers . Participants reluctant to enter treatment were offered a structured telephone cognitive behavioral psychotherapy . MAIN OUTCOME MEASURES Depression severity ( Quick Inventory of Depressive Symptomatology , QIDS ) and work performance ( World Health Organization Health and Productivity Question naire [ HPQ ] , a vali date d self-report instrument assessing job retention , time missed from work , work performance , and critical workplace incidents ) . RESULTS Combining data across 6- and 12-month assessment s , the intervention group had significantly lower QIDS self-report scores ( relative odds of recovery , 1.4 ; 95 % confidence interval , 1.1 - 2.0 ; P = .009 ) , significantly higher job retention ( relative odds , 1.7 ; 95 % confidence interval , 1.1 - 3.3 ; P = .02 ) , and significantly more hours worked among the intervention ( beta=2.0 ; P=.02 ; equivalent to an annualized effect of 2 weeks of work ) than the usual care groups that were employed . CONCLUSIONS A systematic program to identify depression and promote effective treatment significantly improves not only clinical outcomes but also workplace outcomes . The financial value of the latter to employers in terms of recovered hiring , training , and salary costs suggests that many employers would experience a positive return on investment from outreach and enhanced treatment of depressed workers . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00057590 Background This is a r and omized clinical trial ( RCT ) to investigate the efficacy of a job placement and support program design ed for workers with musculoskeletal injuries and having difficulties in resuming the work role . The program was planned to help injured workers to successfully return to work ( RTW ) by overcoming the difficulties and problems during the process of job seeking and sustaining a job using a case management approach . Methodology A total of 66 injured workers were recruited and r and omly assigned into the job placement and support group ( PS group ) or the self-placement group ( SP group ) . A three-week job placement and support program was given to subjects in the PS group while subjects in the control group ( SP group ) were only given advice on job placement at a workers ’ health center . The PS program was comprised of an individual interview , vocational counseling , job preparation training , and assisted placement using the case management approach . The Chinese Lam Assessment of Stages of Employment Readiness ( C-LASER ) , the Chinese State Trait and Anxiety Inventory ( C-STAI ) , and the SF-36 were the outcome measures for the two groups before and after the training program to observe the changes in subjects ’ work readiness status , emotional status and their health related quality of life pre- and post-training program . The rate of return to work was measured for both groups of subjects after the training program . Results The results indicated that the rate of success in RTW ( 73 % ) was significantly higher in the job placement ( PS ) group than that of the self-placement ( SP ) group ( 51.6 % ) with P < 0.05 . Significant differences were also found in C-STAI ( P < 0.05 ) , SF-36 ( P < 0.05 ) and C-LASER scores on action ( P < 0.05 ) between the two groups . Conclusion The job placement ( PS ) program appeared to have enhanced the employability of injured workers . Workers who participated in the program also showed higher levels of work readiness and emotional status in coping with their work injuries STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers OBJECTIVE Work disability is a major consequence of inflammatory rheumatic conditions . Evidence regarding the effectiveness of interventions aim ed at the prevention or reduction of work disability in rheumatic diseases is limited . We conducted a r and omized controlled trial to investigate the effectiveness of a multidisciplinary job-retention vocational rehabilitation ( VR ) program in patients with a rheumatic condition who were at risk for job loss . METHODS A total of 140 patients with a chronic rheumatic condition were r and omly assigned to either a multidisciplinary job-retention VR program ( n = 74 ) or usual outpatient care ( UC ) ( n = 66 ) . Patients in the VR group were assessed and guided by a multidisciplinary team , whereas patients in the UC group received care as initiated by their rheumatologist , supplemented with written information . The main outcome measure was the occurrence of job loss ( complete work disability or unemployment ) ; additional outcome measures included job satisfaction , pain , functional status , emotional status , and quality of life . RESULTS There was no difference between the 2 groups regarding the proportion of patients having lost their job at any time point , with 24 % and 23 % of the patients in the VR and UC groups , respectively , having lost their job after 24 months . Over the total period of 24 months , patients in the VR group had a significantly greater improvement of the fatigue visual analog scale and of emotional status ( all P values < 0.05 ) . CONCLUSION A job-retention VR program did not reduce the risk of job loss but improved fatigue and mental health in patients with chronic rheumatic diseases at risk for job loss OBJECTIVE Musculoskeletal soft tissue injuries consume considerable re sources in personal suffering , medical care , work absenteeism , and compensation benefits . Our aim was to determine specific clinical and behavioral factors that prognostically influence return to work following musculoskeletal work related injuries . METHODS A longitudinal cohort study was conducted on 148 r and omly selected workers who had not returned to work in 3 months following musculoskeletal soft tissue injury . The cohort was identified from the files of the Workers ' Compensation Board of Ontario , Canada . The workers were interviewed and assessed at 3 , 9 , 15 , and 21 months after injury . The WHO Classification of Impairment , Disabilities and H and icap was used as the conceptual framework . The analysis employed a proportional hazards regression model with allowance for time dependent covariates . RESULTS The rate of return to work for men was 1.5 times that for women , and 20 % less for every 10 year increase in age . Controlling for sex and age , psychological distress and functional disability were associated with a slower rate of return to work . The rate of return to work for workers who were provided with modified jobs was 2 times higher than for those with no such accommodation in employment . CONCLUSION The negative effect of psychological distress and functional disability on return to work rates must be considered in the design and delivery of rehabilitation programming for workers with musculoskeletal soft tissue injuries . The employer 's provision of a " modified job " is important in the prevention of continued disability OBJECTIVE People with psychiatric impairments ( primarily schizophrenia or a mood disorder ) are the largest and fastest-growing group of Social Security Disability Insurance ( SSDI ) beneficiaries . The authors investigated whether evidence -based supported employment and mental health treatments can improve vocational and mental health recovery for this population . METHOD Using a r and omized controlled trial design , the authors tested a multifaceted intervention : team-based supported employment , systematic medication management , and other behavioral health services , along with elimination of barriers by providing complete health insurance coverage ( with no out-of-pocket expenses ) and suspending disability review s. The control group received usual services .  Paid employment was the primary outcome measure , and overall mental health and quality of life were secondary outcome measures . RESULTS Overall , 2,059 SSDI beneficiaries with schizophrenia , bipolar disorder , or depression in 23 cities participated in the 2-year intervention . The teams implemented the intervention package with acceptable fidelity . The intervention group experienced more paid employment ( 60.3 % compared with 40.2 % ) and reported better mental health and quality of life than the control group . CONCLUSIONS Implementation of the complex intervention in routine mental health treatment setting s was feasible , and the intervention was effective in assisting individuals disabled by schizophrenia or depression to return to work and improve their mental health and quality of life Supported employment is an approach to ensuring the vocational and social integration of persons with intellectual and other disabilities by placing and then training them to carry out real jobs in the regular workplace , supported by staff members or co-workers . This article focuses on the actual employment outcomes for participants in OPEN ROAD , a three-year innovative project which introduced adults with moderate and severe levels of intellectual disability in Dublin , Irel and to ordinary jobs . Supported workers ( n = 24 ) were men and women aged between 19 and 49 years who obtained part-time jobs chiefly within the financial and food service and retail sectors of an economy marked by high rates of long-term unemployment . Effective job-finding and support strategies as well as individual outcomes are described . Priorities for those at national and agency levels planning for meaningful , sustainable employment for persons in this population are suggested OBJECTIVES Supported employment is an evidence -based practice that has proved to be consistently more effective than conventional vocational rehabilitation in helping people with severe mental illness find and sustain competitive employment . Most research on the effectiveness of supported employment comes from the United States . This study examined the effectiveness and applicability of a supported employment program based on the individual placement and support model in a Hong Kong setting . METHODS Ninety-two unemployed individuals with long-term mental illness who desired competitive employment were r and omly assigned to either a  supported employment program or a conventional vocational rehabilitation program  and followed up for 18 months . Both vocational and nonvocational outcomes were measured . RESULTS Over the 18-month study period , compared with participants in the conventional vocational rehabilitation program , those in the supported employment group were more likely to work competitively ( 70 % versus 29 % ; odds ratio=5.63 , 95 % confidence interval=2.28 - 13.84 ) , held a greater number of competitive jobs , earned more income , worked more days , and sustained longer job tenures . Repeated- measures analysis of variance found no substantive differences between participants in the two groups and no significant change from baseline over time for psychiatric symptoms and self-perceived quality of life . CONCLUSIONS Consistent with previous research findings in the United States , the supported employment program was more effective than the conventional vocational rehabilitation program in helping individuals with long-term mental illness find and sustain competitive employment in a Hong Kong setting . The supported employment program based on the individual placement and support model can thus be recommended for wider use in local mental health practice Effects of co-occurring disorders on work outcomes were explored among individuals with severe mental illness who were participating in a multisite r and omized study of supported employment . At seven sites , 1,273 people were r and omly assigned to an experimental supported employment program or a control condition  and followed for 2 years . Multivariate regression analysis examined work outcomes including earnings , hours worked , and competitive employment , as well as whether psychiatric disability was disclosed to coworkers and supervisors . Individuals with any comorbidity had lower earnings and were less likely to work competitively . Those with physical comorbidities had lower earnings , worked fewer hours , and were less likely to work competitively . Disclosure was more likely among those with both cognitive and physical comorbidities , as well as those with learning disabilities . Competitive employment was less likely among those with intellectual disability , visual impairment , and human immunodeficiency virus/acquired immuno-deficiency syndrome . The experimental condition was positively related to all outcomes except disclosure . The results suggest that , with some exceptions , comorbidities affect employment outcomes , requiring tailored services and supports to promote vocational success Study Design . A pre‐ versus postintervention with concurrent control group design was used to investigate the effect of a workplace‐based early intervention program on perception of disability in nurses with low back injury . Objectives . This report examines changes over time in the components of the Oswestry Low Back Pain and Disability Question naire in two groups of back‐injured nurses‐those who received the early intervention program ( study ) and those who were not offered the program ( control ) . Summary of Background Data . Early intervention programs can decrease morbidity , time lost from work , and compensation costs . Although perception of disability decreases , some residual disability remains , the nature of which is not clear . Methods . The Oswestry Low Back Pain and Disability Question naire scores of 40 study nurses and 118 control nurses at time of injury and at 6 months after injury were examined . Analysis of variance was used to compare changes in mean overall scores over time . The proportion of nurses reporting disability on individual components of the Oswestry Low Back Pain and Disability Question naire at each time period was compared with the results of a chi‐square test . Results . Overall Oswestry Low Back Pain and Disability Question naire scores were similar between study and control nurses at time of injury , but were significantly lower in study nurses at 6 months after injury . However , scores of individual Oswestry Low Back Pain and Disability Question naire components that related to job dem and s increased over time ; this was most apparent in lifting , particularly in study nurses . Conclusions . Although overall perception of disability decreased 6 months after injury , particularly in study nurses , disability in job‐related activities persisted . Residual disability after back injury should be addressed in workplace‐based prevention programs Urban-based r and omized clinical trials of integrated supported employment ( SE ) and mental health services in the United States on average have doubled the employment rates of adults with severe mental illness ( SMI ) compared to traditional vocational rehabilitation . However , studies have not yet explored if the service integrative functions of SE will be effective in coordinating rural-based services that are limited , loosely linked , and geographically dispersed . In addition , SE 's ability to replicate the work outcomes of urban programs in rural economies with scarce and less diverse job opportunities remains unknown . In a rural South Carolina county , we design ed and implemented a program blending Assertive Community Treatment ( ACT ) with an SE model , Individual Placement and Support ( IPS ) . The ACT-IPS program operated with ACT and IPS subteams that tightly integrated vocational with mental health services within each self-contained team . In a 24-month r and omized clinical trial , we compared ACT-IPS to a traditional program providing parallel vocational and mental health services on competitive work outcomes for adults with SMI ( N = 143 ; 69 % schizophrenia , 77 % African American ) . More ACT-IPS participants held competitive jobs ( 64 versus 26 % ; p < .001 , effect size [ ES ] = 0.38 ) and earned more income ( median [ Mdn ] = 549 US dollars , interquartile range [ IQR ] = 0 - 5,145 US dollars , versus Mdn = 0 US dollars , IQR = 0 - 40 US dollars ; p < .001 , ES = 0.70 ) than comparison participants . The competitive work outcomes of this rural ACT-IPS program closely resemble those of urban SE programs . However , achieving economic self-sufficiently and developing careers probably require increasing access to higher education and jobs imparting marketable technical skills The purpose of this paper is to review the evidence estimating an impact of occupational factors on  mood disorders and suicide  , and the efficacy of interventions . This review is based on literature search es using Medline and Psych INFO from 1966 to 2007 ( keywords : work stress , job insecurity , job strain , shift work , violence , occupational health , mood disorders , depression , and suicide ) . To establish the relationship between occupational variables and mood disorders , we focused on clinical ly significant disorders rather than depressive symptoms . During the last decade , prospect i ve epidemiological studies have suggested a predictive association between the work environment and mood disorders . Recently , increasing numbers of clinical trials have shown favorable effect size of intervention and suggested preferable return-on-investment results . However , low awareness and social stigma still decrease workers access to treatment . Mental health professionals in conjunction with employers have to devise a creative system to make the quality care being offered more accessible to employees . In addition , further outcome data is needed to evaluate the benefit of managing mood disorders in the workplace , and to foster awareness of positive implication s for employees , employers , their families , and the society at large . In addition , the work environment , with its chemical ( e.g. chemosensory factors , pollutants ) , physical ( e.g. lighting , noise , temperature , outdoor views and activities ) , biological ( e.g. , chronobiological factors , allergens , infectious agents ) , psychological ( e.g. dem and -control , effort-reward balance ) , social ( e.g. cohesiveness , support ) , and organizational ( e.g. leadership styles ) component should meet minimal st and ards , and may improve with striving towards the optimum BACKGROUND CONTEXT Low back pain ( LBP ) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses . A common intervention for LBP is spinal manipulation , a technique that is not specific to one scope of practice or profession . PURPOSE The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain . METHODS A search of the current literature was conducted using PubMed , CINAHL , SPORTD iscus , Pro Quest Nursing and Allied Health Source , Scopus , and Cochrane Controlled Trials Register . Studies were included if each involved : 1 ) individuals with LBP ; 2 ) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations ; 3 ) measurable clinical outcomes or efficiency of treatment measures , and 4 ) r and omized control trials . The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Data base ( PEDro ) . RESULTS Six r and omized control trials met the inclusion criteria of this systematic review . The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes . Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events result ing from this intervention . Additionally , the manipulation group in one study reported statistically significantly less medication use , health care utilization , and lost work time . CONCLUSION Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice . Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain OBJECTIVE This study determined whether the clubhouse model of community support and psychiatric rehabilitation can produce competitive employment outcomes that are comparable or superior to those of the Program of Assertive Community Treatment ( PACT ) model . METHODS This longitudinal study followed a group of 170 individuals with severe mental illness who were r and omly assigned either to the experimental design , a clubhouse program ( N=86 ) , or to the control design , a PACT team ( N=84 ) . Study participants were tracked for 30 months , and employment outcome data were collected . RESULTS After 30 months , 72 clubhouse and 76 PACT participants remained active in the project . After 30 months , 74 percent of PACT participants and 60 percent of clubhouse participants had been placed in at least one job . The average clubhouse participant worked 21.8 weeks per job and earned $ 7.38 per hour , whereas the average PACT participant worked 13.1 weeks per job and earned $ 6.30 per hour . CONCLUSIONS Participants from both the PACT and clubhouse models  achieved high employment levels , with no significant differences in weekly employment or 30-month job placement rates over the course of the study . During this time , clubhouse participants earned significantly higher wages and remained competitively employed for significantly more weeks per job than PACT participants This study evaluated the efficacy of adding contingency management techniques to  vocational rehabilitation  ( VR ) to improve treatment outcome as measured by entry into competitive employment .  Nineteen dually diagnosed veterans who entered VR in the Veterans ' Administration 's compensated work therapy ( CWT ) program were r and omly assigned to CWT ( n = 8) or to CWT with enhanced incentives ( n = 11 ) . Over the first 16 weeks of rehabilitation , those in the incentives condition could earn up to dollar 1,006 in cash for meeting two sets of clinical goals : ( a ) remaining abstinent from drugs and alcohol and ( b ) taking steps to obtain and maintain a competitive job . Results indicate that relative to participants in the CWT-only group , those in the incentives condition engaged in more job- search activities , were more likely to remain abstinent from drugs and alcohol , were more likely to obtain competitive employment , and earned an average of 68 % more in wages . These results suggest that rehabilitation outcomes may be enhanced by restructuring traditional work-for-pay contingencies to include direct financial rewards for meeting clinical goals This study examined the effectiveness of cognitive training ( the Thinking Skills for Work Program ) for improving competitive employment outcomes in persons with severe mental illness who have a history of job failure . Forty-four clients receiving services at 2 inner-city community mental health agencies were r and omly assigned ( within each site ) to receive either cognitive training and supported employment ( CT + SE ) or supported employment only ( SE Only ) . Retention in the CT + SE program was high ( 91 % ) . Baseline to 3-month assessment s showed significantly greater improvements in neurocognitive functioning , depression , and autistic preoccupation on the Positive and Negative Syndrome Scale for the CT + SE set compared to the SE Only group . Employment outcomes over 1 year showed that clients who received CT + SE were significantly more likely to work ( 69.6 versus 4.8 % , respectively ) , worked more jobs , worked more hours , and earned more wages than clients with SE Only . The findings provide support for the feasibility of implementing the Thinking Skills for Work Program in the context of supported employment and its beneficial effects on cognitive functioning and competitive employment in persons with severe mental illness A re source -building group intervention was developed to enhance career management , mental health , and job retention in work organizations . The in-company training program provided employees with better preparedness to manage their own careers . The program activities were universally implemented using an organization-level , 2-trainer model with trainers from the human re sources management and occupational health services . The study was a within-organizations , r and omly assigned field experimental study ; it investigated the impacts of the intervention on immediate career management preparedness and later mental health and intentions to retire early . A total of 718 eligible individuals returned a question naire in 17 organizations and became voluntary participants . The respondents were r and omly assigned to either an intervention ( N = 369 ) or a comparison group ( N = 349 ) . Those in the intervention group were invited to group intervention workshops , whereas those in the comparison group received printed information about career and health-related issues . The 7-month follow-up results showed that the program significantly decreased depressive symptoms and intentions to retire early and increased mental re sources among the group participants compared to the others . The mediation analyses demonstrated that the increase in career management preparedness as a proximal impact of the intervention mediated the longer term mental health effects . Those who benefited most from the intervention as regards their mental health were employees with elevated levels of depression or exhaustion and younger employees , implying additional benefits of a more targeted use of the intervention . The results demonstrated the benefits of the enhancement of individual-level career management and resilience re sources as career and health promotion practice in work organizations
The DM program has shown to be effective and efficient .
Nevertheless , some components are emphasized more than others ; job accommodation , facilitation of transitional duty , communication between all stakeholders , health care provider advice , early intervention , and acceptance , goodwill and trust in the stakeholders , in the organization , and in the disability management process
BACKGROUND Disability management ( DM ) is a systematic method to ensure job-retention and job-reintegration in competitive employment for individuals with a disability .
There is evidence that ' returning to work ' has a positive impact on the individual , the company and on the society .
However , a clear overview of the efficacy and efficiency of the DM programs is scarce .
OBJECTIVE To systematic ally review the efficacy and efficiency of the disability management programs .