A Mega-Ethnography of Qualitative Meta-Syntheses on Return to Work in People with Chronic Health Conditions

Abstract

Purpose The aim of this study was to synthesize the findings of qualitative meta-syntheses (QMS) on return to work (RTW) of people with different chronic illnesses and to develop a generic RTW model that can provide advice on how to improve RTW interventions and strategies.

Methods We conducted a systematic literature search in PubMed, Epistemonikos, CENTRAL, and PsycARTICLES to find relevant QMS, published in English or German between 2000 and 2021, and adapted the meta-ethnographic approach of Noblit and Hare to synthesize their findings.

Results Nineteen QMS (five focusing on musculoskeletal disorders or chronic pain, four on acquired or traumatic brain injuries, four on cancer, two on mental disorders, one on spinal cord injury, and three on mixed samples) met our inclusion criteria for the meta-ethnographic synthesis. Through systematic comparison and reciprocal translation of the single QMS findings, we could identify a set of key cross-cutting themes/concepts, which formed the basis for four RTW principles and a generic RTW model.

Conclusions RTW is a multifactorial and highly interactive multistakeholder process, embedded in an individual‘s life and working history, as well as in a determined social and societal context. It runs parallel and interdependently to the process of coping with the disease and realigning one’s own identity, thus emphasizing the significance of RTW for the person. Besides symptoms and consequences of the disease, individual coping strategies, and RTW motivation, the course and success of RTW are strongly affected by the adaptability of the person’s working environment and the social support in their private and working life. Thus, RTW is not only a problem of the individual, but also a matter of the social environment, especially the workplace, requiring a holistic, person-centered, and systemic approach, coordinated by a designated body, which considers the interests of all actors involved in the RTW process.

Zusammenfassung

Einleitung Um zusätzlich zu quantitativen Meta-Analysen und über einzelne Erkrankungsgruppen hinaus übergreifende Erkenntnisse zur beruflichen Wiedereingliederung (Return to Work, RTW) zu gewinnen, wurde eine Zusammenstellung der Ergebnisse qualitativer Meta-Synthesen (QMS) vorgenommen. Ziel war die Erarbeitung eines generischen RTW-Modells sowie daraus resultierender Empfehlungen für die Rehabilitationspraxis.

Methoden Grundlage bildete eine systematische Literaturrecherche in PubMED, Epistemonikos, CENTRAL und PsycARTICLES zur Identifizierung thematisch einschlägiger QMS, die zwischen 2000 und 2021 veröffentlicht wurden. Die Synthese erfolgte auf der Basis des Ansatzes von Noblit und Hare.

Ergebnisse 19 QMS (muskuloskelettale Erkrankungen/chronischer Schmerz: 5, erworbene Hirnschädigung: 4, psychische Erkrankungen: 2, Querschnittlähmung: 1 und gemischte Gruppen: 3) wurden final in die Analyse einbezogen. Im systematischen Vergleich und der wechselseitigen Übersetzung der einzelnen Ergebnisse konnten wir eine Reihe übergreifender Themen/Konzepte identifizieren, die die Grundlage für 4 RTW-Prinzipien und ein generisches RTW-Modell bildeten.

Schlussfolgerungen Der RTW ist als multifaktorieller und hochgradig interaktiver Prozess mit vielen Beteiligten anzusehen, der in eine individuelle Lebens- und Arbeitsgeschichte sowie in einen sozialen und gesellschaftlichen Kontext eingebettet ist. Er verläuft parallel zu und in Wechselwirkung mit dem Prozess der Krankheitsbewältigung und der Neuausrichtung der eigenen Identität. Neben den Symptomen und Folgen der Krankheit, den individuellen Bewältigungsstrategien und der Motivation zur Wiedereingliederung werden der Verlauf und der Erfolg der Wiedereingliederung stark von der Anpassungsfähigkeit des Arbeitsumfelds und der sozialen Unterstützung im privaten und im Arbeitsleben beeinflusst. Der RTW ist kein Problem des Einzelnen, sondern immer auch eine Angelegenheit des sozialen Gefüges und erfordert einen ganzheitlichen, personenzentrierten und systemischen Ansatz sowie eine alle Beteiligten und deren Interessen koordinierende Instanz.

Key words

review - meta-synthesis - return to work - mega-ethnography - qualitative evidence synthesis - chronic illnesses

Schlüsselwörter

Review - Meta-Synthese - Return to Work - Mega-Ethnografie - Qualitative Evidenzsynthese - chronische Erkrankungen

Publication History

Article published online:
21 August 2023

• References

• 1 Eurostat. Self-perceived health statistics (2022). Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Self-perceived_health_statistics#Chronic_morbidity
• 2 Atella V, Piano Mortari A, Kopinska J. et al. Trends in age-related disease burden and healthcare utilization. Aging Cell 2019; 18: e12861 DOI: 10.1111/acel.12861.
• 3 Christensen K, Doblhammer G, Rau R. et al. Ageing populations: the challenges ahead. Lancet 2009; 374: 1196-1208 DOI: 10.1016/S0140-6736(09)61460-4.
• 4 Garin N, Koyanagi A, Chatterji S. et al. Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. J Gerontol A Biol Sci Med Sci 2016; 71: 205-214 DOI: 10.1093/gerona/glv128.
• 5 OECD, Union E. Health at a Glance: Europe. 2016. 2016. DOI: 10.1787/9789264265592-en
• 6 Nexo MA, Carlsen K, Pedersen J. et al. Long-term sickness absence of 32 chronic conditions: A Danish register-based longitudinal study with up to 17 years of follow-up. BMJ Open 2018; 8: e020874 DOI: 10.1136/bmjopen-2017-020874.
• 7 Vuong TD, Wei F, Beverly CJ. Absenteeism due to Functional Limitations Caused by Seven Common Chronic Diseases in US Workers. J Occup Environ Med 2015; 57: 779-784 DOI: 10.1097/JOM.0000000000000452.
• 8 Vuorio T, Suominen S, Kautiainen H. et al. Determinants of sickness absence rate among Finnish municipal employees. Scand J Prim Health Care 2019; 37: 3-9 DOI: 10.1080/02813432.2019.1568710.
• 9 Harber-Aschan L, Chen WH, McAllister A. et al. The impact of longstanding illness and common mental disorder on competing employment exits routes in older working age: A longitudinal data-linkage study in Sweden. PLoS One 2020; 15: e0229221 DOI: 10.1371/journal.pone.0229221.
• 10 Jacobsen PA, Kragholm K, Andersen MP. et al. Voluntary early retirement and mortality in patients with and without chronic diseases: a nationwide Danish Registry study. Public Health 2022; 211: 114-121 DOI: 10.1016/j.puhe.2022.07.019.
• 11 Li Ranzi T, d'Errico A, Costa G. Association between chronic morbidity and early retirement in Italy. Int Arch Occup Environ Health 2013; 86: 295-303 DOI: 10.1007/s00420-012-0765-5.
• 12 Mutambudzi M, Flowers P, Demou E. Association of perceived job security and chronic health conditions with retirement in older UK and US workers. Eur J Public Health 2022; 32: 52-58 DOI: 10.1093/eurpub/ckab170.
• 13 Deutsche Rentenversicherung Bund. Rentenversicherung in Zeitreihen. Berlin: 2022
• 14 Vooijs M, Leensen MC, Hoving JL. et al. Interventions to enhance work participation of workers with a chronic disease: a systematic review of reviews. Occup Environ Med 2015; 72: 820-826 DOI: 10.1136/oemed-2015-103062.
• 15 Campbell R, Pound P, Morgan M. et al. Evaluating meta-ethnography: systematic analysis and synthesis of qualitative research. Health Technol Assess. 2011 15.
• 16 Mohammed MA, Moles RJ, Chen TF. Meta-synthesis of qualitative research: the challenges and opportunities. Int J Clin Pharm 2016; 38: 695-704 DOI: 10.1007/s11096-016-0289-2.
• 17 Ring N, Jepson R, Ritchie K. Methods of synthesizing qualitative research studies for health technology assessment. Int J Technol Assess Health Care 2011; 27: 384-390 DOI: 10.1017/s0266462311000389.
• 18 Thorne S. Qualitative meta-synthesis. Nurse Author & Editor 2022; 32: 15-18 DOI: 10.1111/nae2.12036.
• 19 Tomlin G, Borgetto B. Research Pyramid: a new evidence-based practice model for occupational therapy. Am J Occup Ther 2011; 65: 189-196 DOI: 10.5014/ajot.2011.000828.
• 20 Andersen MF, Nielsen KM, Brinkmann S. Meta-synthesis of qualitative research on return to work among employees with common mental disorders. Scand J Work Environ Health 2012; 38: 93-104 DOI: 10.5271/sjweh.3257.
• 21 Banning M. Employment and breast cancer: a meta-ethnography. Eur J Cancer Care (Engl) 2011; 20: 708-719 DOI: 10.1111/j.1365-2354.2011.01291.x.
• 22 Brannigan C, Galvin R, Walsh ME. et al. Barriers and facilitators associated with return to work after stroke: A qualitative meta-synthesis. Disabil Rehabil 2017; 39: 211-222 DOI: 10.3109/09638288.2016.1141242.
• 23 Toye F, Seers K, Allcock N. et al. Patients' experiences of chronic non-malignant musculoskeletal pain: a qualitative systematic review. Br J Gen Pract 2013; 63: e829-841 DOI: 10.3399/bjgp13X675412.
• 24 Toye F, Seers K, Hannink E. et al. A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain. BMC Med Res Methodol 2017; 17: 116 DOI: 10.1186/s12874-017-0392-7.
• 25 Schwarz B, Streibelt M, Heyme R et al. A meta-ethnography of qualitative meta-syntheses on return to work in people with chronic health conditions. PROSPERO CRD42020149186 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020149186
• 26 Noblit GW, Hare RD. Meta-Ethnography: Synthesizing qualitative studies. Sage; 1988. DOI: 10.4135/9781412985000
• 27 van Vilsteren M, van Oostrom SH, de Vet HC. et al. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database Syst Rev 2015; 2015: CD006955 DOI: 10.1002/14651858.CD006955.pub3.
• 28 Tong A, Flemming K, McInnes E et al. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ (2012). Available from: http://europepmc.org/abstract/MED/23185978 DOI: 10.1186/1471-2288-12-181
• 29 France EF, Cunningham M, Ring N. et al. Improving reporting of meta-ethnography: the eMERGe reporting guidance. BMC Medical Research Methodology 2019; 19: 25 DOI: 10.1186/s12874-018-0600-0.
• 30 Lewin S, Glenton C, Munthe-Kaas H. et al. Using qualitative evidence in decision making for health and social interventions: an approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERQual). PLoS Med 2015; 12: e1001895 DOI: 10.1371/journal.pmed.1001895.
• 31 Whiting P, Savovic J, Higgins JP. et al. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol 2016; 69: 225-234 DOI: 10.1016/j.jclinepi.2015.06.005.
• 32 Mays N, Pope C. Qualitative research in health care. Assessing quality in qualitative research. BMJ 2000; 320: 50-52 DOI: 10.1136/bmj.320.7226.50.
• 33 Flick U. Standards, Kriterien, Strategien: zur Diskussion über Qualität qualitativer Sozialforschung. Zeitschrift für qualitative Bildungs-, Beratungs- und Sozialforschung 2005; 6: 191-210
• 34 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19: 349-357 DOI: 10.1093/intqhc/mzm042.
• 35 JBI-QARI. QARI critical appraisal instrument. In. Adelaide: The Joanna Briggs Institute Reviewers Manual; 2020
• 36 Critical Appraisal Skills Programme. CASP (Qualitative Studies Checklist) (2022). Available from: https://casp-uk.net/images/checklist/documents/CASP-Qualitative-Studies-Checklist/CASP-Qualitative-Checklist-2018_fillable_form.pdf
• 37 Schütz A. On Multiple Realities. In: Schütz A, Natanson M, Hrsg. Collected Papers I: The Problem of Social Reality. Dordrecht: Springer Netherlands; 1962: 207-259 DOI: 10.1007/978-94-010-2851-6_9
• 38 MacEachen E, Clarke J, Franche RL. et al. Systematic review of the qualitative literature on return to work after injury. Scand J Work Environ Health 2006; 32: 257-269
• 39 Esteban E, Coenen M, Ito E. et al. Views and Experiences of Persons with Chronic Diseases about Strategies that Aim to Integrate and Re-Integrate Them into Work: A Systematic Review of Qualitative Studies. Int J Environ Res Public Health 2018; 15 DOI: 10.3390/ijerph15051022.
• 40 Frostad Liaset I, Loras H. Perceived factors in return to work after acquired brain injury: A qualitative meta-synthesis. Scand J Occup Ther 2016; 23: 446-457 DOI: 10.3109/11038128.2016.1152294.
• 41 Grant M, O-Beirne-Elliman J, Froud R. et al. The work of return to work. Challenges of returning to work when you have chronic pain: a meta-ethnography. BMJ Open 2019; 9: e025743 DOI: 10.1136/bmjopen-2018-025743.
• 42 Greidanus MA, de Boer A, de Rijk AE. et al. Perceived employer-related barriers and facilitators for work participation of cancer survivors: A systematic review of employers' and survivors' perspectives. Psychooncology 2018; 27: 725-733 DOI: 10.1002/pon.4514.
• 43 Hilton G, Unsworth C, Murphy G. The experience of attempting to return to work following spinal cord injury: a systematic review of the qualitative literature. Disabil Rehabil 2018; 40: 1745-1753 DOI: 10.1080/09638288.2017.1312566.
• 44 Holland P, Clayton S. Navigating employment retention with a chronic health condition: a meta-ethnography of the employment experiences of people with musculoskeletal disorders in the UK. Disabil Rehabil 2020; 42: 1071-1086 DOI: 10.1080/09638288.2018.1519041.
• 45 Magalhaes L, Chan CY, Chapman A. et al. Successful return to work of individuals with chronic pain according to health care providers: A meta-synthesis. Cad Bras Ter Ocup 2017; 25: 825-837 DOI: 10.4322/2526-8910.ctoAR206.
• 46 Nevala N, Pehkonen I, Koskela I. et al. Workplace Accommodation Among Persons with Disabilities: A Systematic Review of Its Effectiveness and Barriers or Facilitators. Journal of Occupational Rehabilitation 2015; 25: 432-448 DOI: 10.1007/s10926-014-9548-z.
• 47 Neves Rda F, Nunes Mde O, Magalhaes L. Interactions among stakehoklders involved in return to work after sick leave due to mental disorders: A meta-ethnography. Cad Saude Publica 2015; 31: 2275-2290 DOI: 10.1590/0102-311X00029215.
• 48 Schwarz B, Claros-Salinas D, Streibelt M. Meta-Synthesis of Qualitative Research on Facilitators and Barriers of Return to Work After Stroke. J Occup Rehabil 2018; 28: 28-44 DOI: 10.1007/s10926-017-9713-2.
• 49 Snippen NC, de Vries HJ, van der Burg-Vermeulen SJ. et al. Influence of significant others on work participation of individuals with chronic diseases: A systematic review. BMJ Open 2019; 9: e021742 DOI: 10.1136/bmjopen-2018-021742.
• 50 Stergiou-Kita M, Dawson DR, Rappolt SG. An Integrated Review of the Processes and Factors Relevant to Vocational Evaluation Following Traumatic Brain Injury. Journal of Occupational Rehabilitation 2011; 21: 374-394 DOI: 10.1007/s10926-010-9282-0.
• 51 Stergiou-Kita M, Grigorovich A, Tseung V. et al. Qualitative meta-synthesis of survivors' work experiences and the development of strategies to facilitate return to work. J Cancer Surviv 2014; 8: 657-670 DOI: 10.1007/s11764-014-0377-z.
• 52 Wells M, Williams B, Firnigl D. et al. Supporting ‘work-related goals’ rather than ‘return to work’ after cancer? A systematic review and meta-synthesis of 25 qualitative studies. Psycho-Oncology 2013; 22: 1208-1219 DOI: 10.1002/pon.3148.
• 53 Knauf MT, Schultz IZ. Current Conceptual Models of Return to Work. In: Schultz IZ, Gatchel RJ, Hrsg. Handbook of Return to Work: From Research to Practice. Boston, MA: Springer US; 2016: 27-51 DOI: 10.1007/978-1-4899-7627-7_2
• 54 Loisel P, Buchbinder R, Hazard R. et al. Prevention of work disability due to musculoskeletal disorders: the challenge of implementing evidence. J Occup Rehabil 2005; 15: 507-524 DOI: 10.1007/s10926-005-8031-2.
• 55 Hoefsmit N, Houkes I, Nijhuis FJ. Intervention characteristics that facilitate return to work after sickness absence: a systematic literature review. J Occup Rehabil 2012; 22: 462-477 DOI: 10.1007/s10926-012-9359-z.
• 56 Norlund A, Ropponen A, Alexanderson K. Multidisciplinary interventions: review of studies of return to work after rehabilitation for low back pain. J Rehabil Med 2009; 41: 115-121 DOI: 10.2340/16501977-0297.
• 57 Moxley DP. Case Management by Design: Reflections on Principles and Practices. Nelson-Hall Publishers. 1997
• 58 Rose SM, Vl Moore. Case Management. In: Edwards RL, Hrsg. Encyclopedia of social work. 19. Aufl. Washington DC: NASW Press; 1995: 335-340 DOI: none
• 59 Wendt WR. Politik und Ökonomie der Systemsteuerung im Case Management. Available from: http://www.netzwerk-cm.ch/sites/default/files/events_downloads/referat_wendt_f_r_homepage.pdf
• 60 Shaw W, Hong QN, Pransky G. et al. A literature review describing the role of return-to-work coordinators in trial programs and interventions designed to prevent workplace disability. J Occup Rehabil 2008; 18: 2-15 DOI: 10.1007/s10926-007-9115-y.
• 61 Vogel N, Schandelmaier S, Zumbrunn T. et al. Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database Syst Rev 2017; 3: CD011618 DOI: 10.1002/14651858.CD011618.pub2.
• 62 Dol M, Varatharajan S, Neiterman E. et al. Systematic Review of the Impact on Return to Work of Return-to-Work Coordinators. J Occup Rehabil 2021; 31: 675-698 DOI: 10.1007/s10926-021-09975-6.
• 63 Falagas ME, Alexiou VG. An analysis of trends in globalisation of origin of research published in major general medical journals. International Journal of Clinical Practice 2008; 62: 71-75 DOI: 10.1111/j.1742-1241.2007.01590.x.
• 64 Smith AC, Merz L, Borden JB. et al. Assessing the effect of article processing charges on the geographic diversity of authors using Elsevier’s “Mirror Journal” system. Quantitative Science Studies 2021; 2: 1123-1143 DOI: 10.1162/qss_a_00157.