Exploring the role of mindfulness in vocational rehabilitation

Abstract

Background Vocational rehabilitation is increasingly used to facilitate a successful return to work (RTW) after long-term sick leave. Some vocational rehabilitation programs incorporate mindfulness training, suggesting that mindfulness is an effective tool for successful RTW. However, whether mindfulness enhances work ability (WA) and RTW rates has not yet been investigated. Main aims To investigate whether mindfulness is a predictor of increased WA and successful RTW after a multidisciplinary vocational rehabilitation program (MVRP), and to explore the mediating influences of mindfulness in the relationship between personal health factors and WA. Methods The project featured one retrospective cohort study and one prospective cohort study. The retrospective cohort study included 80 former participants (from 2008 to spring 2011) in the MVRP. Self-report measures were used to measure work status, WA, quality of life (QOL), and mindfulness. The prospective cohort study was conducted with 74 active participants in an MVRP in the period autumn 2011– autumn 2012. Self-report measures of functional health and psychological functioning were collected. In addition to a standard logistic regression analysis procedure, a bias-corrected bootstrapping technique was used to test the hypothesized indirect effects. Main results Results from the retrospective cohort study suggested that mindfulness was indirectly related to RTW through QoL. The covariates WA and education level significantly predicted RTW. Furthermore, mindfulness significantly predicted successful RTW but only for the “high-educated” participants. Results from the prospective study suggest that the outcome of an MVRP is affected by pain intensity and sense of mastery at baseline. High pain intensity and low sense of mastery significantly predicted an unsuccessful WA response to the MVRP. Furthermore, the results revealed that enhancement of mindfulness during the course of the program significantly predicted a successful WA response. In addition, decreased personal burnout and enhanced self-esteem were both unique predictors of a positive WA response. Mediation analysis showed that mindfulness mediated the effects of personal burnout and self-esteem on the participants’ WA response. Conclusion The data in the retrospective cohort study demonstrate that mindfulness may be a usefull tool applied in the context of vocational rehabilitation, suggesting that mindfulness may enhance RTW and WA via QOL. Furthermore, for “higheducated” participants, mindfulness independently predicts RTW. We conclude that enhancement of education and qualifications for the labor market should be the highest priority for “low-educated” people on long-term sick leave. Data from the prospective cohort study indicate that enhancing the skills of mindfulness may be useful when aiming to increase WA. However, not all individuals respond positively to the MVRP in terms of improved WA. In particular, unfavorable WA responses were detected in participants who reported high pain intensity and a low sense of mastery at baseline. We conclude that it still is a challenge to understand the factors that distinguish responders to MVRPs from nonresponders, and thus, further research is required.