Institute for Work and Health, Toronto, ON, Canada.
Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., AHC-5-453, Miami, FL, 33199, USA.
J Occup Rehabil. 2017 Sep;27(3):393-404. doi: 10.1007/s10926-016-9668-8.
Purpose Organizational-level policies and practices that promote safety leadership and practices, disability management and ergonomic policies and practices are considered key contextual determinants of return to work. Our objective was to examine the role of worker-reported organizational policies and practices (OPPs) in return to work (RTW) and work role functioning (WRF) and the mediating role of pain self-efficacy and work accommodation. Methods A worker cohort (n = 577) in Ontario, Canada was followed at 1, 6 and 12 months post injury. Both RTW (yes/no) and WRF (WLQ-16) status (3 levels) were measured. OPPs were measured (high vs. low) at 1 month post-injury. Pain self-efficacy (PSE) and work accommodation (WA) were included in mediation analyses. Results OPPs predicted RTW at 6 months (adjusted OR 1.77; 95 % CI 1.07-2.93) and 12 months (adjusted OR 2.07; 95 % CI 1.18-3.62). OPPs predicted WRF at 6 months, but only the transition from working with limitations to working without limitations (adjusted OR 3.21; 95 % CI 1.92-5.39). At 12 months, OPPs predicted both the transition from not working to working with and without limitations and from not working or working with limitations to working without limitations (adjusted OR 2.13; 95 % CI 1.37-3.30). Offers of WA mediated the relationship between OPPs and both RTW and WRF at 6 months follow-up. PSE mediated the relationship between OPPs and RTW and WRF at 6 months. At 12 months neither mediated the relationship. Conclusions The findings support worker-reported OPPs as key determinants of both RTW and WRF. These results point to the importance of WA and PSE in both RTW and WRF at 6 months.
目的 组织层面的政策和实践，如促进安全领导力和实践、残疾管理和人体工程学政策和实践，被认为是重返工作岗位的关键背景决定因素。我们的目的是研究工人报告的组织政策和实践（OPPs）在重返工作岗位（RTW）和工作角色功能（WRF）中的作用，以及疼痛自我效能感和工作适应在其中的中介作用。
方法 在加拿大安大略省的一个工人队列（n=577）中，在受伤后 1、6 和 12 个月进行了随访。同时测量 RTW（是/否）和 WRF（WLQ-16）状态（3 个水平）。在受伤后 1 个月测量 OPPs（高 vs. 低）。在中介分析中纳入了疼痛自我效能感（PSE）和工作适应（WA）。
结果 OPPs 预测了 6 个月（调整后的 OR 1.77；95%CI 1.07-2.93）和 12 个月（调整后的 OR 2.07；95%CI 1.18-3.62）的 RTW。OPPs 预测了 6 个月的 WRF，但仅预测了从工作受限到无工作受限的转变（调整后的 OR 3.21；95%CI 1.92-5.39）。在 12 个月时，OPPs 预测了从不工作到有工作和无工作受限，以及从不工作或工作受限到无工作受限的转变（调整后的 OR 2.13；95%CI 1.37-3.30）。WA 的提供在 6 个月的随访中，在 OPPs 与 RTW 和 WRF 之间起到了中介作用。PSE 在 6 个月时，在 OPPs 与 RTW 和 WRF 之间起到了中介作用。在 12 个月时，这两者都没有起到中介作用。
结论 研究结果支持工人报告的 OPPs 是 RTW 和 WRF 的关键决定因素。这些结果表明，WA 和 PSE 在 6 个月时对 RTW 和 WRF 都很重要。
