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Motivational Interviewing and Injured Workers: Facilitating Behaviour Change in Work Rehabilitation Open Access


Other title
Readiness for Work
Motivational Interviewing
Type of item
Degree grantor
University of Alberta
Author or creator
Park, Joanne, Y
Supervisor and department
Esmail, Shaniff (Occupational Therapy)
Gross, Douglas (Physical Therapy)
Examining committee member and department
Norris, Colleen (Faculty of Nursing/Public Health, School of/Medicine & Dentistry Medicine/Surgery)
James, Carole (School of Medicine and Public Health)
Guptill, Christine (Occupational Therapy)
Faculty of Rehabilitation Medicine
Rehabilitation Science
Date accepted
Graduation date
2017-06:Spring 2017
Doctor of Philosophy
Degree level
Background: Work disability research confirms the importance of psychosocial factors and the decision making process of injured workers as determinants of disability from work-related musculoskeletal (MSK) disorders. Development and implementation of intervention programs specifically addressing psychosocial and behavioural risk factors may reduce work disability and increase return-to-work (RTW) rates. Further investigation is required to determine what theoretical models, tools and interventions are appropriate and effective for addressing psychosocial and behavioural factors associated with work-related MSK disorders. Objectives: This thesis examined psychosocial and behavioural factors in work rehabilitation, including: 1) development of a comprehensive theoretical framework that considers injured workers’ decision making processes to inform a specific intervention (motivational interviewing); 2) validation of the Readiness for Return to Work (RRTW) Scale in a work rehabilitation sample; and 3) evaluation of the effectiveness of motivational interviewing to address psychosocial barriers and facilitate behaviour change regarding RTW. Methods: This thesis is comprised of three papers including a theoretical overview, cross-sectional study, and cluster randomized clinical trial. The theoretical overview integrated the Model of Human Occupation (MOHO), a client-centered occupational therapy model, with Motivational Interviewing (MI), a client-centered, directive therapeutic approach within work rehabilitation. Participants in the cross-sectional study and clinical trial were diagnosed with a MSK disorder and participated in a RTW program at an occupational rehabilitation facility in Alberta, Canada. The statistical analysis for the cross-sectional study validating RRTW scale included exploratory and confirmatory factor analyses, reliability analyses, and correlation with related scales and questionnaires. The statistical analysis for the clinical trial evaluating the effectiveness of MI included multivariable logistic regression to obtain the odds ratio for likelihood of RTW at the time of program discharge while adjusting for cluster and potential confounders. Results: All three papers evaluated factors associated with readiness for RTW. MOHO provides a conceptual framework for understanding an injured worker’s decision-making process, while MI can assist in guiding injured workers’ decisions and help them transition back to work. For the validation study, three factors were identified for a non-job attached/not working group within the Readiness for Return-To-Work (RRTW) scale, which included Contemplation, Prepared for Action- Self-evaluative, and Prepared for Action- Behavioural. For a job attached/working in some capacity group, two factors were identified, Uncertain Maintenance and Proactive Maintenance. Expected relationships and statistically significant differences were found among the identified RTW readiness factors and related constructs of pain, physical and mental health, and RTW expectations. The results of the clinical trial found a statistically significant difference in RTW rates at program discharge for non-job attached injured workers favouring the intervention group over the standard care control group. A clinically important difference was observed in RTW rates at program discharge for job attached injured workers favouring the intervention group over the standard care control group. Conclusion: Integrating MOHO and MI provides a comprehensive theory of impairment and RTW change processes. The integration of this model and intervention has the potential to reduce work disability and improve RTW outcomes by encouraging participation of injured workers’ in the RTW decision-making process and providing insight into their level or readiness to RTW. This is an important consideration in work rehabilitation as the construct of readiness for RTW can vary by disability duration. Furthermore, physical health appears to be a significant barrier to RRTW for workers who are job attached or currently working while mental health significantly compromises RRTW with the non-job attached/not-working group. MI integrated into work rehabilitation appears to be more effective than routine rehabilitation programs alone in improving RTW rates among unemployed workers. MI could be an important addition to work rehabilitation programs as there are currently few evidence based, non-physical intervention methods to address psychosocial and behavioural barriers to recovery associated with MSK disorders. While this thesis provided some understanding of injured workers’ level of readiness to RTW and evaluated an intervention specifically addressing psychosocial and behavioural risk factors associated with work-related MSK disorders, further investigation in this area is required. Future research should consider evaluating stage-based interventions that could assist in increasing RTW rates among injured workers who are at various levels of readiness for RTW.
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
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