Interventions on cognitions and perceptions that influence work participation of employees with chronic health problems: a scoping review

Background Cognitions and perceptions, such as motivation and return to work (RTW) expectations, can influence work participation of employees with chronic health problems. This makes these cognitions and perceptions important factors for occupational health professionals to intervene upon in order to increase work participation. There is, however, no overview of interventions that influence these factors and are aimed at increasing work participation. Therefore, the purpose of this scoping review is to explore available interventions that are focused on cognitions and perceptions of employees with chronic health problems and aimed at increasing work participation. Methods A scoping review was carried out following the framework of Arksey and O’Malley. Ovid MEDLINE and PsycINFO were searched for original papers published between January 2013 and June 2020. We included studies that describe interventions that focus on at least one of ten cognitions and perceptions and on work participation. The risk of bias of the studies included was assessed using quality assessment tools from the Joanna Briggs Institute. Results In total, 29 studies were identified that studied interventions aimed at changing at least one of ten cognitions and perceptions in order to change work participation. The interventions that were included mainly focused on changing recovery and RTW expectations, self-efficacy, feelings of control, perceived health, fear-avoidance beliefs, perceived work-relatedness of the health problem, coping strategies and catastrophizing. No interventions were found that focused on changing motivation or on optimism/pessimism. Four interventions were judged as effective in changing coping, self-efficacy, fear-avoidance beliefs, or perceived work-relatedness and work participation according to results of randomized controlled trials. Conclusions This review provides an overview of interventions that focus on changing cognitions and perceptions and work participation. Evidence was found for four effective interventions focused on changing these factors and increasing work participation. Occupational health professionals may use the overview of interventions to help employees with chronic health problems to increase their work participation.


Short inpatient program
D: 4+4 days with 2 weeks at home in-between S: Individual and group sessions P: Coordinators with diverse backgrounds (physical therapy, psychology, exercise physiology, nursing or other) M: -Group discussions based on acceptance and commitment therapy -Psychoeducation on stress -Meetings with coordinators and physicians -Mindfulness sessions -Individual and group based supervised training sessions -Creating a RTW plan -Meeting with employer Long inpatient program D: 3.5 weeks S: Individual and group sessions P: Coordinators with diverse backgrounds (physical therapy, psychology, exercise physiology, nursing or other) M: -Group discussions based on acceptance and commitment therapy -Psychoeducation --Expectations about length of sick leave (one question: "For how long do you believe you will be sick listed from today?")

months
Moderate -Expectations about sick leave duration significantly changed after the programs (p = .01). 56 (33%) participants improved their expectations, 32 (19%) participants reduced their expectations and 80 (48%) participants did not change their expectations. -At 9 months follow-up, sustainable RTW was achieved by 69 participants (41%) and the median of work participation days was 113. No information on significance of increase of work participation is provided. -A positive change in expectations was associated with sustainable RTW (p < .01) and work participation days (p < .01).
-Meetings with coordinators and physicians -Mindfulness sessions -Individual and group based supervised training sessions -Walking to work -Creating a RTW plan -A day with outdoor activities -Network day in which participants bring persons to gain insight in the rehabilitation process Moderate -Fear-avoidance beliefs decreased after 6 weeks with -3.2 (5.5) in the home exercise group and -3.1 (7.8) in the supervised exercise group. No information on significance of within-group difference is provided. There were no significant differences between the groups. -At 6 weeks, 7 of the 21 participants in the home exercise group were on sick leave and in the supervised exercise 10 of the 23 participants were on sick leave. At 26 weeks, 4 of the 18 participants in the home exercise group and 3 of the 21 participants in the supervised exercise group were on sick leave. No information on significance of within-group difference is provided. There were no significant differences between the groups.

12, 24 months
Low -Perceived health did not change after the intervention.
-Self-efficacy did not change after the intervention.
-At two-year follow-up, 64% of the intervention group returned to work in comparing to 48% in the reference group. The odds for RTW were higher in the intervention group at two-year follow-up (p < .05), but there was no difference at one-year follow-up. -Mean duration of sick leave at one-year follow-up was significantly lower in the intervention group (28.9 weeks) as compared to the reference group (34.0 weeks) at one-year follow-up (p < .05), but there was no difference at two-year follow-up.

4, 12 months
Moderate -Fear-avoidance beliefs for work improved in 26% of the patients in the intervention group and in 20% of the patients in the control group, but no information on significance of within-group difference is provided. There were no significant differences between the groups. -Improvement in fear-avoidance beliefs for work was a positive predictor for RTW (p = .023). The odds for RTW increased to 4.0 (p = .015) for the group with improved fear-avoidance beliefs for work scores. -Participation in the work-focused intervention was not a significant predictor for RTW within 12 months. Moderate -Internal locus of control changed from 22.0 at baseline, to 23.0 at 3 months follow-up to 24.0 at 6 months follow-up in the intervention group. No information on significance of within-group difference is provided. -Internal locus of control was higher for the intervention group at 3 months follow-up (median 23.0) than for the control group (median 20.0) (p < .001) and was higher for the intervention group (median 24.0) than for the control group (median 21.0) at 6 months follow-up (p < .001). There were no differences for the other three locus of control variables (chance, doctors, other people).
N: 215 A: 43.9 (9.9) G: 60 males, 155 females H: Anxiety, depression, other mental illness, stress and burnout, musculoskeletal disorders -Session with relatives to hear about mental health problems and sickness absence -Perceived health did not differ between the groups at 3 months or 6 months follow-up. -At 3 months more participants in the control group had full RTW than in the intervention group (28% vs 19%), but there were no significant differences at 6 or 12 months. -For first RTW, there were no significant differences between the groups at either time points.
Pietilä-Holmner E. Moderate -Catastrophizing decreased with -5.0 after 3 months, with -7.5 after 6 months and -5.0 after 1 year in comparing with baseline catastrophizing. No information on significant within-group difference is provided. -Catastrophizing decreased more in the intervention group after 6-months follow-up (-7.5 points) than in the control group (-2.0), (p = .04), but there was no difference in decrease in catastrophizing between the groups at 3 months and one-year follow-up. -At one-year follow-up 42% of the CBT group had resumed work. No information on significant withingroup difference is provided. RTW rate and sick leave during the first year did not differ between the groups at one-year follow-up.  .3) at 18 months after the program (p < 0.05). However, there was no significant difference between perceived health in the MD group and the CAU group. There was no significant increase in perceived health in the AE group. -Hours of sick leave decreased significantly from 9.2 (1.0) to 1.2 (0.8) hours of sick leave 18 months after the program in the MD group (p < 0.001). Between the MD group and the CAU, the difference was not statistically significant. There was no significant decrease in hours of sick leave for the AE group. -Contractual hours paid work did not change for the AE group or the MD group.

3, 12 months
Moderate -Fear-avoidance beliefs for work decreased more for the CB-CFT group (from 14.1 to 8.3) than for the MT-EX group (from 19.1 to 17.4) after 3 months (p < .001). Fear-avoidance beliefs for work also decreased more for the CB-CFT group (from 14.1 to 7.7) than for the MT-EX group (from 19.1 to 16.6) after 12 months (p < .001). No information on significant within-group difference is provided. -In the CB-CFT group number of people with more than 7 sick leave days changed from 23 at baseline to 10 at 12 months. No information on significant within-group difference is provided. -The number of sick leave days after 12 months was lower in the CB-CFT group than in the MT-EX group after 12 months (p < .01), with 20.4% in the CB-CFT group with more than 7 sick leave days versus 42.5% in the MT-EX group with more than 7 sick leave days.