The research, led by G. Bravo and colleagues including H.I. Castellucci and Martin Lavallière, comes at a moment when the demographics of work are shifting worldwide. By 2050, the United Nations projects that 16.4 percent of the global population will be 65 or older, and by 2030 roughly 20 percent of the labor force in many countries will consist of older adults. Transport is no exception. Commercial driving is physically and cognitively demanding, involving prolonged sitting, irregular schedules, sustained vigilance, and split-second decisions, all of which interact with the gradual sensory, motor, and cognitive erosion that accompanies aging. Understanding whether older professional drivers can still meet the demands of the job is therefore not an abstract question but one with direct consequences for road safety, workforce planning, and retirement policy.

The study team recruited every driver employed at two transport companies in central Chile, one passenger transport firm in Rancagua and one freight company in Concón. Of 811 drivers invited, 226 volunteered. All were men, with an average age of 51.2 years, and the sample was divided into three stages of working life: 58 younger drivers aged 30 to 44, 125 drivers aged 45 to 59 approaching retirement, and 43 older drivers aged 60 to 76. The researchers assessed body composition, grip strength, lower-limb endurance, and cardiorespiratory fitness, then administered a standardized psychotechnical test battery of the same type used by Chilean municipal transit authorities when issuing and renewing professional licenses. Work ability was measured with the Work Ability Index, a validated seven-item questionnaire that scores a worker’s capacity to meet job demands on a scale from 7 to 49.

The work ability results were striking in their uniformity. Among the 160 drivers who completed the questionnaire, 83 percent rated their work ability as good or excellent, with a mean score of 41.3. Contrary to expectations, the oldest group posted the highest average score at 42.50, compared with 41.45 for the middle group and 40.46 for the youngest. Neither simple nor covariate-adjusted regression models found a statistically significant association between age group and work ability. The authors suggest that a strong local cultural value attached to employment, providing purpose, social belonging, and family income, may help explain why older drivers perceive themselves as fully capable. The finding also aligns with prior reviews showing that age alone does not reliably predict declining work ability among professional drivers, particularly where workplace health and safety protocols are well established.

The psychomotor tests told a more nuanced story. In the lever test, which requires both hands to guide a needle along a track as quickly as possible, older drivers committed significantly more errors than their younger colleagues, averaging 6.70 errors versus 3.24, and their maximum error time was more than twice as long. After adjusting for body composition and fitness covariates, drivers aged 60 to 76 still showed an average increase of 3.19 errors and 0.69 seconds of maximum error time compared with the reference group. The bimanual coordination test, in which participants use rotary controls with both hands to steer two points along separate paths, revealed the largest gaps: older drivers averaged 35.02 errors versus 25.81 for the youngest group, an adjusted difference of 8.22 errors and 4.50 additional seconds of error time, both statistically significant.

The Lahy Dotting Test, which measures visuomotor coordination, rhythm, and concentration by requiring participants to touch black circles appearing on a rotating disk, produced a curious pattern. Older drivers achieved significantly fewer correct responses, 33.19 on average versus 37.31 for the youngest group, but they completed their correct responses faster, taking 11.22 seconds compared with 14.30 seconds for the young group. The authors interpret this speed-accuracy trade-off as consistent with age-related changes in executive function and visuospatial processing, where older participants may sacrifice thoroughness for pace. Meanwhile, the two tests most directly tied to emergency driving responses, the braking reaction time test and the speed anticipation test, showed no significant differences across age groups at all, with average braking reaction times hovering around 0.30 seconds in every group.

The absence of reaction time differences deserves particular attention. Laboratory studies of the general population consistently show that older adults react more slowly to visual stimuli, with one cited analysis finding older drivers display roughly 17 percent longer reaction times and make more than twice as many pedal errors as younger drivers. The authors suggest several explanations for the discrepancy. Professional drivers benefit from training and experience that shortens perception-to-braking latency. The controlled testing environment, in which participants knew exactly which signal to expect, may have minimized the mental load that typically exposes age-related slowing. In real traffic, where drivers must monitor intersections, pedestrians, and overtaking maneuvers simultaneously, the cognitive demands are far higher, and prior simulator studies have shown older drivers’ reaction times lengthen under mental load. The authors also note that obstructive sleep apnea, which is highly prevalent among professional drivers and increases with age, can impair vigilance and psychomotor performance, though it was not assessed in this study.

Importantly, the authors caution against interpreting poorer coordination scores as evidence of unsafe driving. All participants were active professionals who had recently passed Chile’s mandatory medical and psychotechnical licensing examinations, meaning the sample reflects a healthy-worker population. The magnitude of the observed differences was generally small, and the oldest group showed greater variability, suggesting that some older drivers perform as well as or better than younger peers while others lag further behind. Because the study did not measure on-road performance or collision outcomes, it cannot establish whether these psychomotor differences translate into safety risks. Safety managers in the transport sector often value older drivers for their work ethic, loyalty, superior trip management, and compensatory strategies such as driving more cautiously and avoiding high-demand situations, behaviors that may offset modest declines in raw processing speed.

The findings point toward targeted rather than blanket interventions. At the organizational level, the authors advocate a systemic approach built on the Total Worker Health framework, integrating health promotion, risk assessment, worker participation, and the Work Ability Index as a screening tool to monitor capacity over time. At the individual level, they propose that future studies test whether physical training targeting flexibility, coordination, and movement speed can improve performance on the specific tests that showed age-related declines, and whether educational programs combining theory with on-road practice can strengthen attention and situational awareness. The study’s limitations, including its cross-sectional design, convenience sample, all-male cohort, differential questionnaire completion across age groups, and unrecorded testing times, mean the results are hypothesis-generating rather than definitive. Still, the central message is clear: aging does not uniformly erode the capacities that matter for professional driving, and individualized monitoring, rather than age-based generalizations, is the path to keeping experienced drivers safely on the road.

Subject of Research: Age-related differences in work ability and psychomotor skills among professional heavy vehicle drivers

Article Title: Age-related differences in work ability and psychomotor skills among professional heavy vehicle drivers in Chile: A cross-sectional study

Article References: Bravo, G., Campos, A., Lavallière, M., & Castellucci, H. (2026). Age-related differences in work ability and psychomotor skills among professional heavy vehicle drivers in Chile: A cross-sectional study. Heliyon, 12(15), Article e45564. https://doi.org/10.1016/j.heliyon.2026.e45564

Image Credits: AI Generated

DOI: 10.1016/j.heliyon.2026.e45564

Keywords: work ability, psychomotor skills, aging workforce, professional drivers, heavy vehicles, occupational health, Chile, reaction time, visuomotor coordination, Work Ability Index, road safety, cross-sectional study

The research team, led by Suzanne Johanson Sturesson of the University of Gothenburg, set out to investigate what women in menopause experience as supporting and hindering factors in their work environment. The motivation is grounded in stark statistics. At the end of 2024, the Swedish Social Insurance Agency reported 201,462 ongoing cases of sickness benefit, and women constituted 65 percent of them. Within that cohort, 28 percent were aged between 50 and 59, roughly the age at which menopause typically arrives in western countries, where the average age of the transition is 50 to 51 years. The predominant reasons for sick leave were psychiatric diagnoses, including fatigue syndrome and depression, while musculoskeletal diagnoses were notably more prevalent among those aged 50 to 59.

Although women in menopause can end up on sick leave because of severe symptoms, reliable statistics on how many absences are actually driven by menopause are difficult to obtain, since the same symptoms can stem from other causes. What is well established is the dose-response relationship: research shows a negative correlation between the severity of menopausal symptoms and work ability, meaning that as symptoms intensify, the capacity to work declines and the risk of sick leave rises. Studies have also found that up to one in four women report severe menopausal symptoms, and that symptoms negatively influence women’s self-rated productivity. Some women respond by temporarily reducing their working hours, even while worrying about the consequences for their careers. Others practice presenteeism—working despite diminished capacity—which carries substantial risks, including long-term impairments in work ability.

To capture the lived experience behind these numbers, the researchers used a qualitative design with an inductive approach, conducting semi-structured interviews with six women aged between 46 and 58 who were active in the Swedish labour market with employment rates of at least 50 percent and who reported at least one self-perceived symptom linked to menopause. Participants were recruited through targeted sampling from a closed Facebook forum called Stark genom klimakteriet—Strong through menopause—with roughly 13,000 members. Four of the six women were undergoing menopausal hormone therapy at the time. Five worked full-time and one part-time, and their workplaces spanned occupational health, primary health care, industry, state-level academic activities and municipal administration. Five interviews took place digitally and one physically, each lasting between 39 and 79 minutes, and the transcripts were analysed using qualitative content analysis according to Graneheim and Lundman.

The analysis yielded two main categories: the necessity for enhanced awareness and education regarding menopause, and adaptations and recovery opportunities in the work environment. The first category describes how a general lack of knowledge about menopause ripples through organisations, social spaces and individuals. Several informants initially lacked knowledge about menopause altogether, which led to unrecognised symptoms and increased suffering, including sick leave due to exhaustion and depression. Only through personal insight and their own research did they come to understand that their symptoms were menopause-related, and only after making changes or starting hormone therapy were they able to resume working. One informant described the anxiety plainly: feeling insecure about both her body and her mind created stress when she feared she might not be able to cope with her job.

The study also documented a heavy stigma. Several informants felt that menopause was treated as something that should simply pass by unmentioned, and they found it uncomfortable and embarrassing to raise the topic with human resources or their managers. Being treated with understanding, it turned out, was largely a matter of chance—hinging on whether managers happened to have personal experience of menopause. One participant described the relief of having a boss in the same situation, which removed stress and pressure. Where workplaces lacked forums for disseminating information about health issues, women were forced to advocate for changes themselves, a burden that was particularly heavy during periods of reduced energy. Not being believed by a manager when describing symptoms left informants feeling diminished.

The second main category mapped the concrete adjustments that made work sustainable. Flexibility emerged as central: the ability to take a break when needed, visit the toilet, regulate emotions, interrupt work for shorter rests, or work at times of day when they felt alert. Organisations that failed to offer this flexibility were perceived as obstacles. The physical environment cut both ways. Too few toilets, dark spaces, workplaces that increased sedentary time, poor ergonomics and poor seating were hindrances, while bright light, height-adjustable desks, exercise bikes and standing mats supported the increased need to move. Cognitive symptoms—mental fatigue and difficulty focusing—made stimulus-heavy open offices punishing. One informant recounted how, with a brain exhausted by concentration difficulties, she could never have coped with twenty people talking, drawers banging and phones ringing all at once; a separate or closed room was perceived as a decisive support.

Recovery opportunities proved equally important. Mindfulness and short breaks in peace and quiet helped informants balance mood during stress attacks and worrying, but the lack of a physical place for such recovery was described as an obstacle. Working from home was repeatedly praised as a valuable adjustment: it made necessary breaks easier, increased sleep by removing commutes, and, as one informant noted, made work more efficient. The social environment, meanwhile, functioned as a powerful buffer. Safe relationships with close colleagues allowed women to be open about how they felt, which created security, improved well-being and even increased performance. One informant described how a colleague’s openness about her own menopausal symptoms made it easier for everyone in the group to admit being exhausted after a bad night. Conversely, the absence of an open atmosphere left women feeling alone, which made them feel worse than their symptoms alone warranted.

The authors interpret these findings through the Model of Human Occupation, which explains how individuals generate and modify actions through interactions with their social, institutional and physical environments, and through the concept of occupational adaptation—modifying one’s performance or environment when abilities change. Resilience, in this framing, rests on three components: knowledge of the change, skills to solve the problems that arise, and surrounding support. All three appeared in the data. The researchers also frame the results in terms of menopausal health literacy, arguing that the suffering described by participants could have been reduced had they received support to understand their condition earlier. Because health literacy depends on context, the authors argue it is a societal issue—not merely an individual or healthcare concern but essential in the work environment as well.

The study’s conclusions carry practical weight for employers. Individual adaptation is crucial because the impact of the work environment is personalised, but awareness and knowledge about menopause, together with an open and flexible organisational culture, facilitate the necessary adjustments. Recognising the social environment as a supportive factor is essential, and occupational therapy interventions that consider the individual in relation to the workplace can contribute to sustainable change. The authors emphasise a preventive approach: since menopause is a transition rather than an illness, workplace adjustments should aim to stop symptoms from developing into ill-health and future sick leave. The researchers acknowledge limitations, including the small sample of six informants, recruitment through a forum whose members may have had more severe symptoms, and a sample dominated by office-based work, which limits transferability. They call for further research into menopausal women’s experiences in welfare and service professions, and into the incentives and obstacles employers face in implementing the changes women say they need. With women making up nearly two-thirds of Sweden’s ongoing sickness cases, the message from this study is difficult to ignore: the work environment is not a backdrop to menopause—it is an active force in determining whether women in midlife stay well and stay working.

Subject of Research: The impact of the work environment on work ability in women experiencing menopause

Article Title: Women’s experience of the impact of work environment during menopause – A qualitative interview study

Article References: Johanson Sturesson, S., Löfgren Bergérus, M., Arvidsson, L., & Andersson, C. (2025). Women’s experience of the impact of work environment during menopause – A qualitative interview study. Scandinavian Journal of Occupational Therapy, 32(1), Article 2519241. https://doi.org/10.1080/11038128.2025.2519241

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2519241

Keywords: menopause, work environment, occupational health, women's health, qualitative research, work ability, workplace adaptation, occupational therapy, health literacy, stigma, organisational culture, Sweden

The Assessment of Work Performance, or AWP, was originally developed in Sweden and has now been translated into ten languages, with Finnish being the most recent addition. Unlike interview-based instruments, the AWP relies on direct observation. An occupational therapist watches a client carry out a real or simulated work task and rates fourteen distinct observable skills on a four-point scale, from incompetent to competent performance. These skills fall into three domains: motor skills such as mobility, coordination, and strength; process skills such as time management, planning, and adaptation; and communication and interaction skills such as social contact and information exchange. Crucially, the instrument is not tied to any particular diagnosis. Because it measures the interaction between person and environment, it can be applied to clients with mental health conditions, musculoskeletal problems, or any other work-related challenge, in genuine workplaces or constructed assessment settings.

In the new study, a team led by Jennie Nyman of Metropolia University of Applied Sciences, together with colleagues at Linköping University in Sweden, put the Finnish translation, the AWP-FI, through a demanding statistical technique known as Rasch analysis. Seventeen occupational therapists across Finland, all trained in a one-day session and two follow-up meetings, collected ninety-four assessments as part of their routine clinical work. The clients ranged from 18 to 60 years of age, and a majority of those with reported diagnoses had mental or behavioural disorders. Most assessments were conducted through direct observation, and the overwhelming majority, 84 percent, took place in simulated settings, with tasks such as book binding, household chores, and arranging and indexing magazines standing in for real jobs.

Rasch analysis is a form of modern psychometrics that converts ordinal rating-scale data into interval-level measurements. The method estimates two quantities simultaneously: the ability of each person and the difficulty of each item, placing both on a common scale. If the data behave as the model expects, the instrument can be said to measure a single coherent underlying trait, in this case work performance, in a way that is fair and comparable across individuals. The researchers structured their evaluation around three questions drawn from established psychometric guidance: whether the scale’s difficulty range matched the abilities of the sample, whether a reliable measurement scale had been constructed, and whether the individuals in the sample were being measured reliably and meaningfully.

The headline result was encouraging. The AWP-FI showed an overall fit to the Rasch model, with a non-significant chi-square test indicating that observed responses aligned well with model expectations. Individual items performed within acceptable statistical limits, and, importantly, no item behaved differently for different groups. Tests for differential item functioning, which detect whether an item is biased, for example by being harder for women than for men at the same underlying ability level, came back clean across gender, across direct versus participatory observation, and across simulated versus genuine work tasks. This stability suggests the Finnish instrument can be used confidently with men and women alike, in real workplaces or assessment laboratories, and whether the therapist watches from the side or joins the work activity as a participant.

The analysis was not without complications. Five of the fourteen items showed disordered thresholds, meaning that adjacent response categories were not being used in a consistent, ordered way. In practice, the middle rating of the four-point scale was rarely the most probable response for those items, likely because the observed clients clustered at similar performance levels and the full range of the scale was seldom used. The researchers collapsed the affected categories and reran the analysis, a standard corrective procedure, but they caution that any permanent change to the rating scale should wait for confirmation in larger and more varied samples.

Two deeper issues also emerged. First, targeting was suboptimal: the mean person location of 1.6 sat well above the item mean of zero, and the item difficulty range, spanning roughly from minus 1.3 to 0.9 on the logit scale, was narrow. In plain terms, the clients assessed were generally more capable than the hardest items could measure, leaving the scale without items at the demanding end of the work-performance continuum. The authors attribute this largely to the tasks chosen: most assessments used simulated, non-work-specific activities with relatively low demands. Their clinical recommendation is that assessors think carefully about task selection, since the nature and demands of the chosen task directly shape what the assessment can reveal. Adding harder items could widen the measure, but the authors urge caution, because new items must remain faithful to the instrument’s theoretical foundation in the Model of Human Occupation, and expanding item counts carries its own psychometric risks.

Second, the analysis flagged local dependency among items and indications of multidimensionality. Twenty-four of ninety-one residual correlations exceeded the statistical cut-off, and these correlations clustered neatly within the three AWP domains, suggesting that items within a domain share information beyond what the single underlying trait of work performance can explain. When the researchers compared person estimates derived from different domains, between 11 and 17 percent of respondents fell outside the range expected for a truly unidimensional scale, well above the 5 percent benchmark. Notably, this finding diverges from an earlier evaluation of the Swedish original, which found no multidimensionality. The authors suggest the clinical impact may be minimal, since the domain structure reflects the deliberate theoretical architecture of the Model of Human Occupation, but they recommend that future studies with larger samples apply multidimensional or testlet-based Rasch approaches to confirm the pattern.

On the reliability front, the news was solid. The person-separation index reached 0.83, comfortably above the 0.8 benchmark, indicating the scale can distinguish roughly three clinically meaningful groups of clients. Only four participants, about 4 percent, showed erratic response patterns outside acceptable fit limits, meaning nearly everyone was measured in a statistically coherent way. Taken together, the results provide an initial validation of the AWP-FI and support its use as a valid and reliable observational tool for assessing work performance in Finland, where the Finnish Institute for Health and Welfare has explicitly called for more reliable and valid vocational assessment practices. Used alongside the interview-based Worker Role Interview, whose Finnish version passed a similar evaluation in 2023, the AWP-FI can contribute to the kind of holistic, multi-source assessment that sickness insurance and vocational rehabilitation systems increasingly demand.

The study’s limitations are candidly acknowledged. The sample of ninety-four assessments is modest, the DIF analysis suffered from very unequal group sizes, with simulated tasks dominating at 84 percent, which raises the risk that genuine item bias could have gone undetected, and the narrow spread of client performance likely constrained several of the analyses. The authors therefore frame this as a first step rather than a final verdict, recommending further testing with larger and more diverse samples to resolve the local dependency and targeting issues. For clinicians, the practical message is immediate and actionable: the AWP-FI works, but its usefulness depends on choosing work tasks demanding enough to reveal the full range of a client’s capability, and on remembering that the fourteen observed skills are organised into three theoretically distinct domains that should inform, not obscure, the interpretation of results.

Subject of Research: Psychometric validation of the Finnish version of the Assessment of Work Performance using Rasch analysis

Article Title: Psychometric evaluation of the Finnish version of the Assessment of Work Performance (AWP-FI)

Article References: Nyman, J., Sandqvist, J., Pihlava, J., Ekbladh, E., & Yngve, M. (2025). Psychometric evaluation of the Finnish version of the Assessment of Work Performance (AWP-FI). Scandinavian Journal of Occupational Therapy, 32(1), Article 2555182. https://doi.org/10.1080/11038128.2025.2555182

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2555182

Keywords: psychometrics, Rasch analysis, occupational therapy, work ability, vocational rehabilitation, AWP-FI, construct validity, differential item functioning, Model of Human Occupation, Finland, assessment tools, work performance

The scale of the problem is considerable. The Organization for Economic Co-operation and Development estimates that roughly forty million people across its 38 member countries are unemployed. Finland, a nation of 5.6 million, reported 311,100 unemployed individuals in August 2025, of whom 129,200 had been out of work for twelve months or longer, the threshold the International Labour Organization uses to define long-term unemployment. That gives Finland the second-highest unemployment rate in the European Union, and the number of unemployed people grew by more than 30,000 during the very period in which the study was conducted.

Despite this, occupational therapy research has largely ignored the situation. A 2018 search of a dedicated occupational therapy database found only ten articles with unemployment as their primary focus, and a repeat search for the present study added just five more. The authors, T. Turtiainen, L. Rosenberg and I. Jansson, note that most existing work concerns people returning to jobs they already have, or supporting those with disabilities into employment. People who have no job to return to have remained, in their words, somewhat neglected.

To fill the gap, the team adopted a phenomenographic approach, a qualitative method designed to map the different ways professionals understand and experience their own practice. Nine occupational therapists from three different regions of Finland and a range of organisational settings took part. Data were gathered through one focus group, two dyadic interviews and two individual interviews, with each participant or group meeting twice during April and May 2024 in sessions lasting 60 to 90 minutes. Analysis followed the established seven-step phenomenographic procedure of familiarisation, condensation, comparison, grouping, articulating, labelling and contrasting, with translation into English occurring only at the articulation stage to preserve original meaning. Participants were given the chance to comment on preliminary results, and all who responded approved them.

The analysis produced six categories of description, organised into two sets of three. The first trio captures how therapists currently work with unemployed people: Assessing, Coaching and Collaborating. The second captures how they believe the work should develop: Adapting to new ways of working, Increasing awareness of occupational therapy, and Advocating for better opportunities to participate in working life. Assessment emerged as the dominant activity. All participants assessed work ability and occupational functioning, and most described it as their main task, typically across one to seven meetings using interviews, standardised tests, self-assessments, observation and questionnaires.

Yet the assessment process itself revealed a structural paradox. Because unemployed clients have no workplace, therapists had nowhere to observe work-related performance directly, so evaluations were usually carried out in clinical settings, sometimes supplemented by visits to rehabilitative work placements. More strikingly, the therapists reported that assessments were frequently commissioned not to move clients toward rehabilitation or employment, but to determine eligibility for benefits, disability pensions or assistive devices, often because a physician’s medical statement was too thin to satisfy the authorities. One participant described seeing rejected statements and immediately understanding why: they simply lacked adequate descriptions of work ability, meaning the entire assessment had to be redone.

Coaching, by contrast, was a goal-oriented practice aimed at enhancing work ability at a pace suited to each individual, whether by practising job interviews, building social skills, establishing daily rhythms or finding training placements. Some therapists used the Individual Placement and Support model and worked directly with employers, intervening early whenever a job was at risk. But coaching also exposed how alien the world of work had become for many clients. Some had never worked or had been away from employment for years, and therapists described clients who were strikingly unaware of their own rights, responsibilities and opportunities within the unemployment and social insurance systems. As one participant put it, the role of worker is one of the roles of adulthood, yet healthcare services often speak only of inability, never of what work could mean.

Collaboration was described as essential but chronically underdeveloped. Therapists contributed expertise on work ability and human occupation to multiprofessional and multisectoral networks spanning health, social and employment services, yet many reported being invited only occasionally, or forgotten altogether when meetings were arranged. Participants described services as fragmented, with professionals rarely talking to one another and clients often unaware of who was even part of their own support network. One participant called collaboration the most important part of occupational therapy practice with unemployed people, while another summed up the consensus bluntly: no one knows these things alone. With only about seven occupational therapists per 10,000 inhabitants in Finland, the profession’s low visibility outside healthcare compounds the problem.

The deeper tension the study uncovers is a conflict of roles. Therapists want to be advocates, pushing for earlier interventions, employment services that employ occupational therapists directly, and more humane labour markets that see people’s capacities rather than their diagnoses. But because their assessments feed decisions about benefits and rehabilitation eligibility, they also function as gatekeepers, categorising clients as worthy or unworthy of support. Drawing on the capability approach, the authors argue that this individual-level focus risks adapting people to a flawed system rather than challenging the system itself, echoing warnings in the literature that occupational therapy can become an agent of maintenance for existing social inequities. The participants themselves were not satisfied with the status quo: they called for assessments to move out of clinics and into real work environments, for unemployment and work ability to feature in professional education, and for the profession to shift from last resort to preventive measure. The authors conclude that occupational therapists could serve as a bridge between health, social and employment services, but caution that their insights rest on practitioner perspectives alone. Including the voices of unemployed people themselves, they write, is the crucial next step.

Subject of Research: Occupational therapy practices with unemployed people in Finland

Article Title: Occupational therapy practices among unemployed people in Finland

Article References: Turtiainen, T., Rosenberg, L., & Jansson, I. (2025). Occupational therapy practices among unemployed people in Finland. Scandinavian Journal of Occupational Therapy, 32(1), Article 2585856. https://doi.org/10.1080/11038128.2025.2585856

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2585856

Keywords: occupational therapy, unemployment, Finland, work ability, phenomenography, long-term unemployment, rehabilitation, capability approach, multisectoral collaboration, labour market, welfare services, occupational science

The trial, led by Fiona Starke of the Federal Institute for Occupational Safety and Health in Berlin together with colleagues at Maastricht University and a network of German psychiatric clinics, evaluated a program called RTW-PIA, short for Return to work-Psychiatrische Institutsambulanz. The intervention was designed to fill a well-recognized gap: in Germany, aftercare programs aimed at maintaining recovery and minimizing relapse among employees moving from psychiatric outpatient treatment back to their jobs are scarce. RTW-PIA combined medical and psychotherapeutic care with work-oriented components over an eighteen-month period, making it a genuinely multimodal approach rather than a single-focus therapy.

To test the program rigorously, the researchers conducted a multicenter randomized controlled trial embedded in psychiatric outpatient clinics. They enrolled 484 employees who were on sick leave with a diagnosed mental disorder. Half of the participants, 240 in total, were randomly assigned to receive RTW-PIA in addition to usual care, while the remaining 244 received care as usual alone. Randomization of this kind ensures that differences in outcomes between the groups can be attributed to the intervention itself rather than to pre-existing differences in illness severity, motivation, or workplace circumstances.

The primary outcome was what the researchers call sustainable return to work, defined in a deliberately demanding way. A participant counted as achieving sustainable return to work only if, after fully returning to work, they accumulated no more than six weeks of additional sickness absence during the following twelve months. This definition matters because simply going back to work once is not the same as staying there; relapse and renewed absence are common among people with recurrent mental health conditions. Outcomes were measured at baseline and then at six, twelve, eighteen, and twenty-four months, giving the team a long observation window.

When the intention-to-treat analysis was complete, the headline finding was negative. Employees who received the intensified aftercare were not significantly more likely to achieve sustainable return to work than those receiving usual care. The odds ratio was 1.38 with a 95 percent confidence interval running from 0.89 to 2.12, an interval that crosses the threshold of statistical significance. In practical terms, the point estimate hinted at a possible advantage for the intervention group, but the data could not rule out that the true effect was absent or even slightly unfavorable.

The secondary outcomes told a similar story. The researchers examined measures such as return-to-work self-efficacy and work ability, and here again no significant differences emerged between the groups. What they did observe, however, was a consistent pattern of slight improvements favoring RTW-PIA across these measures. That consistency is worth noting: while none of the individual effects reached statistical significance, the direction of the results was uniform, which sometimes suggests that a real but modest effect may be diluted in an averaged analysis of a heterogeneous population.

The team took methodological rigor seriously. They complemented the primary intention-to-treat analysis with prespecified sensitivity analyses, including per-protocol and complete-case approaches, and these analyses led to the same conclusion as the main result. Latent growth curve models were used alongside logistic regression to track how outcomes changed over time, and missing data were handled under a missing-at-random assumption. The trial was also prospectively registered in the German Clinical Trials Register on September 1, 2021, before the first participant was enrolled, and ethical approval was obtained from the Ethics Committee at Hanover Medical School.

The most interesting findings emerged from the subgroup and moderator analyses. In diagnostic subgroup sensitivity analyses, employees with recurrent depressive disorders showed significant improvements in several secondary outcomes when they received the intensified aftercare. Prespecified exploratory moderator analyses suggested potential benefits for two further groups: employees without a recognized degree of disability, and those reporting low social support at work. After the researchers applied multiplicity adjustment to guard against false-positive findings, only recurrent depressive disorder still moderated the treatment effect, specifically on work ability. These patterns remain hypotheses rather than proven effects, and the authors are careful to state that they need to be tested in independent samples.

Why might an eighteen-month multimodal program fail to move the needle on sustainable return to work overall? The answer likely lies in the complexity of the problem itself. Returning to work after a mental disorder involves the interplay of clinical recovery, workplace conditions, social support, insurance and disability status, and individual circumstances that no single intervention can fully address. The moderator findings support this interpretation: employees who lacked workplace social support, who did not carry a formal disability designation, or who struggled with recurrent depression may represent subgroups where the added clinical and work-oriented components could genuinely tip the balance, while for others usual care may already suffice or other barriers may dominate.

The authors conclude that, on average, RTW-PIA did not significantly improve sustainable return to work or secondary outcomes, and they direct future research toward two priorities: testing the identified subgroup hypotheses in independent samples and studying how such an intervention could be implemented in practice. The trial was funded by the Innovation Fund of the Federal Joint Committee, Germany’s key health care decision-making body, between January 2021 and June 2025, with the funder having no role in the design, analysis, or interpretation. For a health system searching for ways to keep people with mental illness attached to the labor market, the study is a reminder that well-intentioned, resource-intensive aftercare is not automatically effective, but also that carefully designed subgroup research may yet reveal who benefits most and how support should be targeted.

Subject of Research: Effectiveness of intensified clinical aftercare for sustainable return to work among employees on sick leave with mental disorders

Article Title: Intensified return to work clinical aftercare for sick-listed employees with diagnosed mental disorders in Germany: effects of a multicentre randomized controlled trial

Article References: Starke, F., Zimmermann, J., Sikora, A., Houkes, I., Schulz, A., Stegmann, R., Seufert, L., Schmitz, E., Buntrock, C., Szycik, G. R., Borgolte, A., Unger, H.-P., Schumacher, J. O., Stark, H., Schneller, C., Unterschemmann, S.-L., de Rijk, A., & Wegewitz, U. (2026). Intensified return to work clinical aftercare for sick-listed employees with diagnosed mental disorders in Germany: effects of a multicentre randomized controlled trial. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08639-0

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08639-0

Keywords: return to work, mental disorders, aftercare, randomized controlled trial, sickness absence, recurrent depression, work ability, occupational health, psychiatric rehabilitation, Germany, sustainable employment, clinical trial