Disability and Rehabilitation

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International employee perspectives on disability

management

Shannon Wagner, Nicholas Buys, Ignatius Yu, Thomas Geisen, Henry Harder,
Christine Randall, Alex Fraess-Phillips, Benedikt Hassler, Liz Scott, Karen Lo,
Dan Tang & Caroline Howe

To cite this article: Shannon Wagner, Nicholas Buys, Ignatius Yu, Thomas Geisen, Henry Harder,
Christine Randall, Alex Fraess-Phillips, Benedikt Hassler, Liz Scott, Karen Lo, Dan Tang & Caroline
Howe (2018) International employee perspectives on disability management, Disability and
Rehabilitation, 40:9, 1049-1058, DOI: 10.1080/09638288.2017.1284907

To link to this article: https://doi.org/10.1080/09638288.2017.1284907

Published online: 07 Feb 2017.

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DISABILITY AND REHABILITATION, 2018
VOL. 40, NO. 9, 1049–1058
http://dx.doi.org/10.1080/09638288.2017.1284907

RESEARCH PAPER

International employee perspectives on disability management

Shannon Wagnera, Nicholas Buysb, Ignatius Yuc, Thomas Geisend, Henry Hardera, Christine Randalle,
Alex Fraess-Phillipsa , Benedikt Hasslerd, Liz Scottf, Karen Log, Dan Tangh and Caroline Howeb
a
School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada; bGriffith Health Centre, Griffith University, Gold
Coast, QLD, Australia; cHong Kong Occupational & Environmental Health Academy, Tsimshatsui, Hong Kong; dSchool of Social Work, University
of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland; eSchool of Allied Health Sciences, Griffith University, Gold Coast,
QLD, Australia; fOrganizational Solutions, Burlington, ON, Canada; gHong Kong Workers’ Health Centre, Kowloon, Hong Kong; hThe Guangdong
Provincial Work Injury Rehabilitation Centre, Guangzhou, China

ABSTRACT ARTICLE HISTORY

Purpose: To provide an international analysis of employees’ views of the influence of disability manage- Received 11 April 2016
ment (DM) on the workplace. Revised 11 November 2016
Methodology: An international research team with representation from Australia, Canada, China, and Accepted 17 January 2017
Switzerland collected survey data from employees in public and private companies in their respective
regions. Due to lack of availability of current measures, a research team-created survey was used and a KEYWORDS
total of 1201 respondents were collected across the four countries. Physical health; mental
Analysis: Multiple linear (enter) regression was also employed to predict DM’s influence on job satisfac- health; job satisfaction;
tion, physical health, mental health, workplace morale and reduced sickness absence, from respondents’ morale; absenteeism
perceptions of whether their company provided disability prevention, stay-at-work, and return-to-work ini-
tiatives within their organization. One-way ANOVA comparisons were used to examine differences on
demographic variables including company status (public versus private), union status (union versus non-
union), and gender.
Results: The perceived influence of DM programs was related to perceptions of job satisfaction; whereas,
relationships with mental health, physical health, morale, and sickness absence were variable according to
type of DM program and whether the response was related to self or others. Difference analyses (ANOVA)
revealed significantly more positive perceptions for private and nonunion organizations; no gender effects
were found.
Conclusions: There is perceived value of DM from the perspective of employees, especially with respect
to its value for coworkers.

ä IMPLICATIONS FOR REHABILITATION

Rehabilitation efforts should continue to focus attention on the value of disability management (DM).
In particular, DM that is fully committed to the biopsychosocial model would be supported by this
research.

Employees reported the most value in the psychosocial variables addressed by DM, such that rehabili-
tation professionals could focus on these valued aspects to improve buy-in from employees.

The interest in coworker value may provide another avenue for rehabilitation efforts to increase
uptake, by highlighting the value of intervention efforts for employee coworkers.

Rehabilitation professionals in union environments may need to be particularly cognizant of the need
for encouraging psychosocial and coworker value potentially seen by employees in order to increase
acceptance and participation for organizational DM efforts.

International employee perspectives on disability
management
Global costs of injury and illness at work are estimated to be 4%
of GDP [1] which in 2014 equated to US$4.3 trillion. Given the link
between economic competitiveness and safety in an increasingly
globalized economy, countries are seeking to reduce the inci-
dence of workplace injuries and illness. While legislative, regula-
tory, and service delivery practices in industrialized economies
have led to a reduction in injury incidence, the shift of hazardous
industries to Asia has significantly increased the rate of worker
injury in this region. China, for example, experiences one million
work-related injuries and 80,000 work-related deaths each year [2].
As a result, countries are looking for solutions to manage this
problem. One solution has been the introduction of injury preven-
tion and return-to-work (RTW) services, often referred to as disabil-
ity management (DM) programs. While the widespread
introduction of DM programs is to be potentially applauded, there
is little research into the effectiveness of these models of practice.

CONTACT Shannon L. Wagner shannnon.wagner@unbc.ca School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince
George, BC, Canada V2N 4Z9
ß 2017 Informa UK Limited, trading as Taylor & Francis Group
1050 S. WAGNER ET AL.
Furthermore, a number of researchers have emphasized the need
for transnational research in this area to determine what elements
of DM are meaningful and in which contexts [3,4]. In addition,
there is a need to examine the relationship between DM pro-
grams and important elements of organizational culture such as
job satisfaction, workplace morale, and the promotion of physical
and mental health. Promoting a positive workplace culture
through effective organizational leadership has been shown to be
critical to the health of organizations in a range of areas. For
example, in relation to workplace stress, it has been shown that
returning stressed workers to work environments that contributed
to their injuries is ineffective [5].
Despite ongoing interest in DM from the international stage
[6], to our knowledge no previous research has provided inter-
national data regarding the perceived impact of DM on job-
related variables. Given this limitation, our international study was
informed by recent within-country DM research from around the
globe (2000–2015; available in the English-language literature).
Australasia
Bohatko-Naismith et al. [7] used focus groups to provide insight
regarding skills and attributes required for the role of a workplace
RTW coordinator. These authors completed focus groups with
RTW coordinators in six Australian cities who had a minimum 2
years’ experience and had been involved in development and
implementation of RTW policies and procedures. From these inter-
views, these authors determined communication, coordinator
characteristics, and management of the RTW process as the three
key themes contributing to smooth RTW for the injured worker,
and maintenance of relationships with workplace stakeholders.
Another Australian research group [8] used a convenience sample
of 85 people attending an international DM conference and asked
the participants to complete a survey regarding management of
stress in the workplace. The results suggested that employees
were not positive about employer management of stress during
prevention or rehabilitation efforts, especially in smaller workpla-
ces; in addition, a perception of less stress-related compensation
claims was also associated with higher prevention and workplace
environment ratings.
Also from Austrailian researchers [4], an online survey with 149
Australian and 217 German rehabilitation professionals, used prin-
cipal axis factoring to identify three common domains including
vocational counseling, workplace disability case management, and
workplace intervention program management. As a conclusion,
the authors made a call for transnational research to ensure global
consistency in core competencies for rehabilitation professionals.
A separate scoping review [9] concluded rehabilitation services
and DM are poorly developed in Tanzania and require ongoing
development. Finally, one of the few articles [10] specific to the
Asia-Pacific region discusses challenges and opportunities for dis-
ability prevention (DP) and management within the context of
Asia-Pacific economic growth.
Europe
A German study [11] drew a random sample of German employ-
ees, 1463 working men and women, to investigate links between
work stress and workability. These authors concluded a relation-
ship between work stress and restrictions on workability was
explained independently by high job strain or effort reward imbal-
ance. A different German research group [12] considered the
impact of integration agreements in the automotive industry and
suggested that integration agreements have placed responsibility
for injured workers on social partners such as employer represen-
tatives, employee representatives and work councils. This same
research group later asked 217 disability managers/vocational
rehabilitation professionals about DM training core-competencies
in a German context. They determined two areas of responsibility
that included work with the client and organization/managerial
tasks [13]. In a Finnish study [14], the researchers addressed
personal budgeting as a disability service reform into Finnish
municipal districts. These authors collected interviews and
recorded discussions with service users and professionals, and
analyzed the data using discourse analytical methods. They con-
cluded that a change in culture was required in order to allow
individuals with disabilities to participate fully in society and that
current service cultures were not supportive toward achievement
of this value.
A research group in Denmark [15] presented a Campbell sys-
tematic review that concluded the effectiveness of employer pro-
vided workplace DM and RTW programs could not be determined
based on presently available literature. Similarly, Hedlund et al.
[16] completed a focus-group study with health care providers
and case-workers and found that a key complication in the RTW
process was employees becoming stuck within systems of rehabili-
tation. It is important to note that this worker perspective is, in
our opinion, similar with respect to rehabilitation processes in
many, if not all, developed countries. A study from the
Netherlands [17] used population-level data from a major longitu-
dinal survey considering working capacity and RTW to examine
relationships between duration dependence and RTW. These
authors found that workers’ susceptibility to duration-dependence
effects (either positive or negative) should impact choice of RTW
intervention strategy. Also, from the Netherlands, Kopnina and
Haafkens [18] used case study methodology to investigate
whether chronic illness is considered a distinct group for DM prac-
tice. From their data, they determined that chronically ill employ-
ees were largely invisible for DM programs, as well as with
respect to the impact of chronic illness on individuals and
organizations.
A Swedish study [19] investigated individuals with disabilities
who completed entrepreneurial activities. This author found that
for Swedish entrepreneurs with disabilities, most worked part-
time, but overall entrepreneurs with disabilities were roughly as
successful as entrepreneurs without disabilities. Also from Sweden,
Selander [20] provides a fictitious three case example intended to
demonstrate that economic incentives may motivate RTW for
employees and concludes by arguing that stronger economic
incentives may improve effectiveness of DM efforts and prospects
for RTW. Researchers from Belgium [21] considered the ease of
information exchange between social insurance and occupational
physicians. These authors found that inter-physician communica-
tion was initiated for 52% of patients, and that inter-physician
communication for the purpose of DM was facilitated by a simple
information exchange system. Using results from 43 qualitative
cases, a separate Belgian study [22] determined disability case
manager value was evident in the translation of legal framework,
stimulation of network collaboration, and synchronization of work
demands and Belgian employee competency. Finally, Mart
ınez
[23] completed a Spanish study that surveyed individuals with dis-
abilities using the Spanish version of an empowerment scale.
These authors found greater empowerment for individuals with
acquired, motor, and visual disabilities, and suggested that
empowerment is related to type of disability and may be import-
ant when considering choice of intervention.

North America
Canadian researchers [24] completed a large survey with employ-
ees and supervisors from a Canadian insurance company regard-
ing their experience with, and attitudes toward, the organization’s
DM program. The majority of respondents indicated high-level sat-
isfaction with the DM process; however, the identified areas for
potential improvement included case manager–employee inter-
action and RTW support, including modified work situations as
required. In contrast, Franche et al. [25] provide a discussion of
the challenges related to stakeholder involvement in the RTW pro-
cess and suggests that while friction is inevitable, it is possible for
stakeholders to tolerate differences in an effort to problem solve
collaboratively and reach common goals. This same research
group [26] also completed a systematic review of seven databases
between January 1990 and December 2003. From the 10 studies
determined to be of sufficient quality for inclusion, these authors
provided an evidence base that work disability duration and cost
can be reduced via workplace RTW interventions; in contrast, the
evidence was much weaker with respect to quality of life out-
comes. Also from Canada, a preliminary investigation of Canadian
employers [27] determined that company perception about DM
significantly contributes to the presence of an organizational DM
program, and also that DM policies were predictive of employee
RTW outcomes.
An exploratory qualitative study involving semistructured inter-
views with 11 supervisors from medium and large Canadian com-
panies [28] determined that three main categories related to RTW
for situations of common mental health disorder. These three
things, factors related to the worker, work context, and RTW pro-
cess were seen as important for intervention planning; however, it
was further proposed that equal focus must ensure planned inter-
ventions are well received by all stakeholders and can be imple-
mented appropriately. Similarly, a qualitative study intended to
determine stakeholer perceptions in a Canadian health care
organization [29] found that perspectives from workers, as well as
designers and deliverers of the intervention were collected and
discrepant perceptions regarding work disability were revealed.
Specifically, designers proposed both individual and work directed
measures, while the deliverers primarily targeted individual level
measures and workers mostly sought work-level measures. With
respect to outcome, designers sought multiple outcome measures;
whereas, deliverers tended to focus on reduced time lost, and
workers reported short-term benefits, but a lack of benefit
sustainability.
Other Canadian DM research includes a large study with
Canadian long-term care facilities over two consecutive years
(2005–2006) [30]. Using a representative sample of provincial
workers compensation records, the authors found no evidence of
lowered burden of disability in situations of modified duty; how-
ever, the authors suggested a lack of accurately documented
workers compensation records may have been a significant limita-
tion for their findings. A separate research group [31] interviewed
Canadian family physicians to investigate physicians’ views about
the physicians’ role in DM and determined disconnect between
professional experience with DM and the Canadian Medical
Association policy relevant to this area. Finally, Westmorland et al.
[32] interviewed 58 Canadian employees with a work-related
injury or disability, and also asked them to complete a 22-item
questionnaire regarding workplace DM practice. From these data,
the need for job accommodation, importance of meaningful com-
munication, and necessity of job retraining were all emphasized.
Similarly, ergonomic modifications, meaningful and specific DM
policies and procedures, and education about health and safety
INTERNATIONAL PERSPECTIVE ON DISABILITY MANAGEMENT 1051
were all determined as important components of DM intervention.
This same research group also considered DM in Canadian health
care and determined that workplace specifics, such as unioniza-
tion, assistance of policies, and workplace and safety culture were
important for determining the presence of DM interventions.
From work in the USA, Bruy ere [33] discussed the impacts of
an aging workforce on DM and suggested that proactive educa-
tion about maximizing productivity of aging workers, combined
with effective case management and workplace accommodation
can lead to optimal outcomes in retention of an aging workforce.
In a different US study [34], an experimental evaluation of
employer and clinic indemnity, medical, and workers’ compensa-
tion expenses suggested that, employer and clinic interventions
resulted in a 21% decrease in total expenditures. Consequently,
these authors suggest that the coordination of appropriate med-
ical care and workplace accommodations intended to support
early reintegration can lead to substantial organizational cost sav-
ings. An Internet survey [35] with US employer members (N ¼ 650)
found a positive relationship among retention practices, absence
and DM efforts and outcomes. However, the article also high-
lighted that maintenance of employees with acquired disability
appears to be a separate issue from hiring individuals with disabil-
ities. An action research project [36] completed in a multisite
North US health provider used an internal staff member as an
action researcher and recorded both successful and challenging
aspects of the internal DM process. The authors concluded that
action research should be considered a valuable tool when inter-
nalizing DM in large multisite organizations.
Using a random sample of 1500 DM specialists to identify an
empirical basis for DM certification [37], three primary areas of
competency were identified: (a) disability case management, (b)
DP, and (c) program development, management, and evaluation.
Whereas, in contrast to positive moves toward effective DM, Schur
et al. [38] argue that corporate culture creates and reinforces
obstacles to employment inclusion for individuals with disabilities,
and that corporate and societal attitudes must be altered to
accept and incorporate individuals with disabilities into the work-
place in order for these obstacles to be resolved. Additional US
work [39] suggests that satisfaction with DM may depend on
expectations about what constitutes a positive outcome. Finally,
Shrey et al. [40] provide a discussion of best practices for DM and
joint labor–management collaboration. In addition, they propose
ongoing research that reviews evidence of joint commitment to
best practices in DM as well as the extent of best practice DM in
unionized environments.
Research specific to current variables
DM research addressing stakeholder perceptions of job satisfac-
tion, health outcomes, morale and absenteeism is limited due to
the relative newness of the DM field; however, some work has
been completed, in particular with respect to satisfaction, absen-
teeism, and morale. For stakeholder satisfaction, Young et al. [39]
reported that satisfaction with the DM process requires ample
consideration of the various goals of respective stakeholders.
Similarly, Maiwald et al. [29] determined that the value of, and
preferred strategy for, DM intervention differed according to
organizational role. Lemieux et al. [28] continued with the same
theme and reported that satisfaction with DM required support
from all stakeholders, including front-line supervisors. Busse et al.
[41] reported that most employees were positive about DM; in
contrast, Buys et al. [8] found that employees were generally not
positive about organizational efforts toward stress prevention or
1052 S. WAGNER ET AL.
rehabilitation, although employees in smaller organizations were
somewhat more positive than those from larger organizations.
Cunningham and James [42] note that “human resource litera-
ture on absence pays relatively little attention to the management
of genuine injury and illness” (p. 33). These authors state that
much of the literature is focused on unnecessary absenteeism,
with little focus on absenteeism in situations of sincere need.
They further determined that most support for RTW after illness
or injury was provided by larger and/or unionized organizations
and also that reduced absenteeism was evident in situations
where RTW policies exist. Russ [43] found support for DM strat-
egies as a meaningful approach to reducing absenteeism. Joling
et al. [17] considered duration dependence in sickness absence
and concluded that workers susceptibility to duration-dependence
affects should be taken into account to improve RTW rate.
Mustard et al. [30] found mixed evidence for an association
between modified duties and lower burden of disability; however,
these authors determined that modified duty arrangements have
been inaccurately documented in compensation records.
With respect to morale, only a single study was found linking a
construct of workplace morale with stakeholder perceptions for
DM. Specifically, Varekamp et al. [44] considered the construct of
empowerment for employees with chronic disease. These authors
determined that employees with chronic disease required seven
aspects of empowerment and that these empowerment skills can
be trained in order to improve RTW outcomes for employees with
chronic disease.
Conclusions from the literature
According to our review of the English-language international lit-
erature on DM (since 2000), it is apparent that there is a lack of
international research, as well as limited research considering
DM’s impacts on job satisfaction, physical and mental health,
workplace morale, and absenteeism. Consequently, our research
team was created with representation from Australia, Canada,
China, Sweden (intellectual contribution although no data contri-
bution), and Switzerland in order to accomplish truly international
research on DM across countries. Given the lack of transnational
research in the area of DM and associated workplace factors, the
current study was an exploratory study aimed to:
1. Provide a descriptive analysis of our international sample
with respect to demographics, as well as general perceptions
regarding DM in the workplace.
2. Examine the relationship between perceived DP, stay-at-work
(STW), and RTW efforts and job satisfaction, physical health,
mental health, workplace morale, and absenteeism for our
international sample.
3. To compare perceptions of DM in private versus public com-
panies, union versus nonunion companies, and by gender of
our international sample.
Methods
Participants
The international sample included 1201 participants, with the
number of responses varying across items (Australia, n ¼ 365;
Canada, n ¼ 222; China, n ¼ 235; Switzerland, n ¼ 379). The average
age of our sample was 42.36 years (SD ¼11.184), with 45.1%
(N ¼ 542) reporting as male and 53.5% reporting as female
(N ¼ 643). Educational achievement was well distributed with
32.8% (N ¼ 453) reporting secondary level education and 62.6%
(N ¼ 752) having some form of post-secondary education.
The majority of our respondents were married or in a marital-like
relationship (70.9%); however, most of the sample was non-
parenting (58.8%). The socioeconomic status of the sample was
middle-class with an average US dollar corrected family income of
$87,728.92 (SD ¼ $47,775.92). Most respondents reported as man-
agers (23.9%), professionals (18.2%), technicians/associate profes-
sionals (19.0%), and/or clerical support workers (15.2%). Only 78
respondents (6.5%) self-identified as an individual with a disability
and 139 reported migrant working status (11.6%).
Procedure
The representatives from Australia, Canada, China, Sweden (intel-
lectual contribution only), and Switzerland created an international
research team interested in a comprehensive description of DM
perspectives across international boundaries. The team was
unaware of any previously available surveys that would
adequately measure the influence of DM on employee percep-
tions of job satisfaction, physical health, mental health, morale
and sickness absence, across countries. As a consequence, the
research team created and used a team-developed survey that
was pilot tested in each country to ensure its clarity and readabil-
ity for a local population. The pilot testing process included trans-
lation of the instrument into German (Switzerland sample) as well
as both Simple and Traditional Chinese (Chinese sample). The
translations were subsequently translated back into English to
ensure that the meaning of the items was preserved, and to
ensure comparability of findings across the four countries.
Each country independently recruited participant companies
based upon convenience sampling, pre-knowledge of the
researchers, and “cold-calling” possible participant agencies. The
completed data collection included 32 companies, 10 Australian, 6
Canadian, 8 Chinese, and 8 Swiss. Australia’s companies were in
the recruitment, health services, rehabilitation, facility manage-
ment, insurance, telecommunications, public sector, and transpor-
tation industries. Canada’s companies were in the post-secondary,
engineering, industrial construction, health services, and financial
services industries. China’s companies were in the pharmaceutical,
manufacturing, rehabilitation, and health care sectors.
Switzerland’s companies were in the pharmaceutical, public sector,
mail service, insurance, and transport industries. For those compa-
nies that chose not to participate, reasons for nonparticipation
were cited to include restructuring, internal survey activities, and
nonspecific responses such as economic situation. Companies
were not offered any remuneration for participation; however,
they were provided with information about their own company if
desired.
Collection of the survey data was then completed as an aspect
of the larger study that included qualitative interviews with work-
place stakeholders (DM practitioner, human resource representa-
tive, and two employees) as well as survey completion. Participant
workplaces were recruited by convenience within each country
and survey completion was completed online, except in circum-
stances where online data collection was not possible (i.e., in
China workers did not have access to online tools and completed
the survey in pencil and paper format) and only members of the
research team had access to the data. Online surveys were distrib-
uted via the participant organizations and all participation by
organizational employees was voluntary. Criteria for company
inclusion (public or private) included the existence of a DM pro-
gram that had been in use for a minimum of 2 years prior to data
collection and a workforce of 100 or more employees. Australia
completed interview and survey data collection with 10
 INTERNATIONAL PERSPECTIVE ON DISABILITY MANAGEMENT 1053

companies, Canada with 6, China with 8 and Switzerland with 8. Table 1. Sample size (N), means, SD, skewness, and kurtosis for main study
Each countries’ respective national data is reported elsewhere. variables.
Variable N Mean SD Skewness Kurtosis
Company disability prevention program 1199 1.92 0.786 1.05 1.86
Measures Company stay-at-work program 1196 2.03 0.884 0.99 1.28
Company return-to-work program 1194 1.94 0.812 0.96 1.52
Survey questionnaires included demographic information as well
Job satisfaction of self 1194 2.18 0.811 0.40 0.23
as items related to value of DM in the workplace. Sample items Job satisfaction of fellow employees 1190 2.10 0.762 0.52 0.73
included questions such as “The workplace disability management Physical health of self 1192 2.38 0.833 0.25 0.21
program contributes positively to my job satisfaction” and “The Physical health of fellow employees 1190 2.21 0.785 0.53 0.66
workplace disability management program contributes positively Mental health of self 1140 2.34 0.859 0.39 0.18
Mental health of fellow employees 1138 2.26 0.807 0.51 0.57
to the satisfaction of employees”, ranked on a 5-point Likert scale Workplace morale of self 1189 2.34 0.838 0.41 0.31
from strongly agree to strongly disagree and translated into Workplace morale of fellow employees 1188 2.29 0.796 0.40 0.43
German, French, simplified Chinese, and traditional Chinese for Sick time taken by self 1188 2.88 0.934 0.05 0.17
use in non-English-speaking areas. Sick time taken by fellow employees 1187 2.72 0.871 0.01 0.03

Results muted perceived benefit of DM programs in terms of reduced sick

Descriptive analyses
The international sample included 1201 participants, with the
number of responses varying across items. The average age of our
sample was 42.36 years (SD ¼11.184), with 45.1% (N ¼ 542) report-
ing as male and 53.5% reporting as female (N ¼ 643). Educational
achievement was well distributed with 32.8% (N ¼ 453) reporting
secondary level education and 62.6% (N ¼ 752) having some form
of post-secondary education. The majority of our respondents
were married or in a marital-like relationship (70.9%); however,
most of the sample was non-parenting (58.8%). The socioeco-
nomic status of the sample was middle-class with an average US
dollar corrected family income of $87,728.92 (SD ¼ $47,775.92).
Most respondents reported as managers (23.9%), professionals
(18.2%), technicians/associate professionals (19.0%), and/or clerical
support workers (15.2%). Only 78 respondents (6.5%) self-identi-
fied as an individual with a disability and 139 reported migrant
working status (11.6%). The majority of the sample was working
full-time (N ¼ 963, 80.2%). The sample reported moderate to good
physical health (M ¼ 2.30, SD ¼0.891; scale from 1 ¼ very good to
5 ¼ poor) as well as mental health (M ¼ 2.12, SD ¼0.913). Similarly,
our sample missed little work due to disability, illness or health
problems (M ¼ 1.74, 0.992; scale from 1 ¼ none to 6 ¼ 6 months or
more) and had both high job satisfaction (M ¼ 1.93, SD ¼0.779;
scale from 1 ¼ very satisfied to 5 ¼ very dissatisfied) and work-
related morale (M ¼ 1.98, SD ¼0.838; scale from 1 ¼ strongly agree
to 5 ¼ strongly disagree).
Most respondents reported that their company took measures
to prevent disability (M ¼ 1.92, SD ¼0.768; scale from 1 ¼ strongly
agree to 5 ¼ strongly disagree), support staying at work (M ¼ 2.03,
SD ¼0.884), and support RTW (M ¼ 1.94, SD ¼0.812); however,
respondents were more likely to report SAW and RTW initiatives
for their coworkers (Self SAW: M ¼ 2.14, SD ¼0.909; Self RTW
M ¼ 2.11, SD ¼0.928; Co SAW or RTW: M ¼ 1.87, SD ¼0.814).
Similarly, respondents thought the quality of care provided to
coworkers through these initiatives was higher than that received
by the individual (Self SAW: M ¼ 2.26, SD ¼1.033; Self RTW
M ¼ 2.23, SD ¼1.023; Co SAW or RTW: M ¼ 2.00, SD ¼0.920).
Respondents felt that employers should continue to offer DM
programs (M ¼ 1.56, SD ¼0.667). However, despite wanting DM
programs to continue, respondents saw only moderate benefit in
the programs for job satisfaction, physical health, mental health,
and morale (M ¼ 2.18, SD ¼0.811; M ¼ 2.38, SD ¼0.833; M 2.34, SD
¼0.859; M ¼ 2.34, SD ¼0.838); in comparison, respondents saw
benefits for coworkers as slightly more positive than individual
benefits (M ¼ 2.10, SD ¼0.762; M ¼ 2.21, SD ¼0.785; M ¼ 2.26, SD
¼0.807; M ¼ 2.29, SD ¼0.796). Interestingly, respondents reported
times (Self M ¼ 2.88, SD ¼0.934; Co M ¼ 2.72, SD ¼0.871; see
Tables 1 and 2).
Regression analyses
Using the full sample of all countries (N ¼ 1185), multiple linear
(enter) regression was employed to predict DM’s (Disability
Management) influence on job satisfaction, physical health, mental
health, workplace morale, and reduced sickness absence from
respondents’ perceptions of whether their company provided DP,
SAW, and RTW initiatives within their organization (from
1 ¼ “strongly agree” to 5 ¼ “strongly disagree”). It is important to
note that in every case, a DM program existed in participant com-
panies for a period of at least 2 years given that this was a criter-
ion for inclusion (pre-determined at the intake stage for each
organization). Therefore, the following questions reflected partic-
ipants’ perceptions of the DM program that existed within their
workplace:
1. My company takes measures to prevent disability (DP) in the
workplace.
2. My company has a program designed to help workers with
disability, injury, or health problems SAW.
3. My company has a program designed to help workers with
disability, injury, or health problems RTW.
Disability Management program influence on job satisfaction.
Each of DP program, SAW program, and RTW program predicted
perceptions of Disability Management’s influence on individual
and coworker job satisfaction (all at p  0.05). If employees felt
that Disability Management programs (prevention, SAW, RTW)
were available, they also tended to report that these programs
had a positive impact on job satisfaction (see Table 3).
Disability Management program influence on physical health.
Each of DP and SAW programs predicted perceptions of Disability
Management’s influence on individual and coworker physical
health. In contrast, RTW program only predicted perceptions of
Disability Management’s influence on physical health for others,
not for the individual responding. That is, employees felt that the
availability of DP and SAW programs was valuable to Disability
Management’s influence on physical health for both the individual
and coworker; however, there was no significant relationship
reported between RTW program and individual physical health.
Disability Management program influence on mental health.
Each of DP and SAW programs predicted perceptions of Disability
Management’s influence on individual and coworker mental
health. In contrast, RTW program only predicted perceptions of
Disability Management’s influence on mental health for the indi-
vidual, not for coworkers. That is, employees felt that the
1054 S. WAGNER ET AL.

Table 2. Pearson’s correlations between the main study variables of company disability management status and employee outcome variables.
Measure 1 2 3 4 5 6 7 8 9 10 11 12 13
1. Company disability prevention program
2. Company stay-at-work program 0.524
3. Company return-to-work program 0.513 0.785
4. Job satisfaction of self 0.308 0.343 0.366
5. Job satisfaction of fellow employees 0.330 0.349 0.361 0.743
6. Physical health of self 0.257 0.307 0.281 0.665 0.626
7. Physical health of fellow employees 0.310 0.347 0.344 0.598 0.693 0.783
8. Mental health of self 0.290 0.340 0.320 0.656 0.643 0.799 0.733
9. Mental health of fellow employees 0.320 0.358 0.323 0.602 0.689 0.689 0.813 0.827
10. Workplace morale of self 0.309 0.357 0.341 0.706 0.660 0.717 0.690 0.796 0.742
11. Workplace morale of fellow employees 0.314 0.361 0.323 0.616 0.679 0.650 0.734 0.707 0.774 0.818
12. Sick time taken by self 0.217 0.271 0.212 0.436 0.397 0.565 0.501 0.551 0.495 0.537 0.502
13. Sick time taken by fellow employees 0.292 0.319 0.288 0.418 0.448 0.463 0.507 0.498 0.507 0.491 0.511 0.687
p < 0.001

Table 3. Regression of company DM program variables in prediction of employee workplace perceptions.

Dependent variable R2 of model Predictors B SE (B) p
Job satisfaction of self 0.159 Constant 1.280 0.064 <0.001
Company DM program 0.157 0.033 <0.001
Company SAW program 0.097 0.041 0.017
Company RTW program 0.207 0.044 <0.001
Job satisfaction of fellow employees 0.166 Constant 1.241 0.060 <0.001
Company DM program 0.178 0.031 <0.001
Company SAW program 0.105 0.038 0.006
Company RTW program 0.162 0.041 <0.001
Physical health of self 0.112 Constant 1.620 0.068 <0.001
Company DM program 0.135 0.035 <0.001
Company SAW program 0.183 0.043 <0.001
Company RTW program 0.068 0.046 0.144
Physical health of fellow employees 0.153 Constant 1.359 0.063 <0.001
Company DM program 0.160 0.032 <0.001
Company SAW program 0.143 0.039 <0.001
Company RTW program 0.132 0.043 0.002
Mental health of self 0.139 Constant 1.467 0.070 <0.001
Company DM program 0.156 0.036 <0.001
Company SAW program 0.190 0.045 <0.001
Company RTW program 0.099 0.048 0.039
Mental health of fellow employees 0.157 Constant 1.391 0.065 <0.001
Company DM program 0.179 0.034 <0.001
Company SAW program 0.205 0.042 <0.001
Company RTW program 0.057 0.044 0.196
Workplace morale of self 0.157 Constant 1.426 0.066 <0.001
Company DM program 0.168 0.034 <0.001
Company SAW program 0.183 0.042 <0.001
Company RTW program 0.112 0.045 0.013
Workplace morale of fellow employees 0.156 Constant 1.433 0.064 <0.001
Company DM program 0.169 0.033 <0.001
Company SAW program 0.212 0.040 <0.001
Company RTW program 0.056 0.043 0.192
Sick time taken by self 0.084 Constant 2.177 0.077 <0.001
Company DM program 0.132 0.040 0.001
Company SAW program 0.260 0.049 <0.001
Company RTW program 0.042 0.053 0.428
Sick time taken by fellow employees 0.126 Constant 1.858 0.071 <0.001
Company DM program 0.186 0.036 <0.001
Company SAW program 0.189 0.045 <0.001
Company RTW program 0.061 0.048 0.205

availability of DP and SAW programs was valuable to Disability
Management’s influence on mental health for both the individual
and coworkers; however, there was no significant relationship
reported between RTW program and coworkers’ mental health.
Disability Management program influence on morale. Each of DP
and SAW programs predicted perceptions of Disability
Management’s influence on individual and coworker morale. In
contrast, RTW program only predicted perceptions of Disability
Management’s influence on physical health for the individual, not
for coworkers. That is, employees felt that the availability of DP
and SAW programs was valuable to Disability Management’s influ-
ence on morale for both the individual and coworkers; however,
there was no significant relationship reported between RTW pro-
gram and coworkers’ morale.
Disability Management program influence on sick time. Each of
DP and SAW program predicted perceptions of Disability
 INTERNATIONAL PERSPECTIVE ON DISABILITY MANAGEMENT 1055

Management’s influence on individual and coworker sick time. In Table 4. Means, SD, and results of one-way ANOVAs comparing employee work-
contrast, RTW program did not predict perceptions of Disability place perceptions by private versus public companies.
Management’s influence on sick time for either the individual or Private Public ANOVA
coworkers. That is, employees felt that the availability of DP and Measure Mean SD Mean SD F p
SAW programs was valuable to Disability Management’s influence Job satisfaction of self 2.14 0.793 2.20 0.827 1.743 0.187
on sick time for both the individual and coworkers; however, Job satisfaction of fellow employees 2.08 0.757 2.13 0.767 1.617 0.204
there was no significant relationship reported between RTW pro- Physical health of self 2.32 0.787 2.44 0.870 5.923 0.015
gram and sick time. Physical health of fellow employees 2.15 0.778 2.27 0.787 7.051 0.008
Mental health of self 2.29 0.834 2.38 0.881 3.447 0.064
Mental health of fellow employees 2.22 0.814 2.30 0.800 2.867 0.091
Group difference analyses Workplace morale of self 2.29 0.801 2.38 0.869 3.195 0.074
Workplace morale of fellow employees 2.23 0.775 2.35 0.810 7.118 0.008
Public versus private companies. Using one-way ANOVA, compari- Sick time taken by self 2.83 0.921 2.92 0.944 2.587 0.108
sons were made between the international sample’s respondents Sick time taken by fellow employees 2.73 0.897 2.70 0.847 .219 0.640
from public versus private companies on Disability Management’s
influence for job satisfaction, physical health, mental health, mor-
Table 5. Means, SD, and results of one-way ANOVAs comparing employee work-
ale, and reduced sickness absence (for both the respondent and place perceptions by unionized versus non-unionized employees.
the respondent’s perception for coworkers). Using p  0.05 as the
Non-
criteria, differences were revealed for individual [Private (N ¼ 572), Unionized unionized ANOVA
M ¼ 2.32; Public (N ¼ 620), M ¼ 2.44] and coworker physical health
[Private (N ¼ 575), M ¼ 2.15; Public (N ¼ 615), M ¼ 2.27], as well as Measure Mean SD Mean SD F p
coworker morale [Private (N ¼ 575), M ¼ 2.23; Public (N ¼ 613), Job satisfaction of self 2.27 0.853 2.12 0.793 8.213 0.004
Job satisfaction of fellow employees 2.21 0.826 2.05 0.723 12.501 <0.001
M ¼ 2.35]; no other group differences were evident. In each case Physical health of self 2.47 0.879 2.33 0.808 7.889 0.005
where differences were noted, private agencies resulted in more Physical health of fellow employees 2.32 0.812 2.14 0.765 13.662 <0.001
positive responses; respondents from private companies ranked Mental health of self 2.44 0.904 2.29 0.832 8.111 0.004
Disability Management’s influence on their individual physical Mental health of fellow employees 2.38 0.836 2.20 0.788 13.402 <0.001
health and coworker physical health and morale more positively Workplace morale of self 2.45 0.899 2.27 0.802 12.083 0.001
Workplace morale of fellow employees 2.43 0.844 2.22 0.763 18.385 <0.001
than did those from public companies (see Table 4). Sick time taken by self 2.97 0.970 2.83 0.909 6.188 0.013
Union versus nonunion. Using one-way ANOVA, comparisons Sick time taken by fellow employees 2.79 0.893 2.66 0.852 5.518 0.019
were made between the international sample’s respondents from
union versus nonunion work environments on Disability
Management’s influence for job satisfaction, physical health, men- Table 6. Means, SD, and results of one-way ANOVAs comparing employee work-
tal health, morale, and time missed (for both the respondent and place perceptions by gender.
the respondent’s perception for coworkers). For all analyses, Males Females ANOVA
respondents from nonunionized work environments reported Measure Mean SD Mean SD F p
more positive responses. That is, workers in nonunion environ- Job satisfaction of self 2.15 0.787 2.18 0.828 0.510 0.475
ments reported more positive perceptions regarding Disability Job satisfaction of fellow employees 2.11 0.728 2.09 0.788 0.128 0.721
Management’s influence on job satisfaction, physical health, men- Physical health of self 2.42 0.849 2.33 0.817 3.455 0.063
tal health, morale, and reduced sickness absence for both them- Physical health of fellow employees 2.25 0.768 2.16 0.795 3.241 0.072
selves and their coworkers (see Table 5). Mental health of self 2.35 0.832 2.31 0.878 0.632 0.427
Mental health of fellow employees 2.27 0.747 2.24 0.854 0.290 0.590
Gender. Using one-way ANOVA, comparisons were made Workplace morale of self 2.34 0.802 2.31 0.861 0.301 0.583
between self-reported males and females in the international sam- Workplace morale of fellow employees 2.29 0.750 2.28 0.830 0.030 0.863
ple on Disability Management’s influence for job satisfaction, Sick time taken by self 2.91 0.930 2.84 0.936 1.654 0.199
physical health, mental health, morale, and time missed (for both Sick time taken by fellow employees 2.69 0.865 2.73 0.876 0.504 0.478
the respondent and the respondent’s perception for coworkers).
There were no significant differences between the responses of
saw the program as helpful for the coworker, despite their lack of
males and females for any of the variables (see Table 6).
personal experience with the programs. Similarly, respondents
suggested that quality of care related to DM efforts was higher
Summary for coworkers, perhaps again reflecting a bias to believe that the
The present data revealed several interesting patterns with respect respondent would not require such services. Descriptive data sug-
to employees’ perceptions of DM. The international sample’s gested that respondents thought DM efforts should continue, des-
descriptive data indicated that most surveyed employees knew pite the fact that on average it was ranked as only moderately
about DM initiatives in their workplace. This finding suggests that helpful. Again, however, respondents felt the helpfulness of DM
educational efforts regarding DM efforts are reaching the majority, was greater for their coworkers than for themselves.
although not all, of the workers in the respective workplaces. With respect to reduced sickness absence, respondents
Interestingly, respondents were more likely to report RTW and reported only minimal-moderate benefit of DM programs, for
SAW efforts for their coworkers as compared to themselves, per- both themselves and their coworkers. This finding is contrary to
haps reflecting a self-serving bias that RTW and SAW efforts are expectations; however, it should be noted that these results are
not necessary for the responding individual. Alternately, perhaps employee perceptions of impacts of DM on sickness absences and
prevention efforts tend to be most visible within respective work- do not reflect objective absence data. This finding may also reflect
places (e.g., wellness programs, safety posters, etc.) so that work- a perception that DM is a service related more to injury than ill-
ers tend to be more familiar with prevention if they have not ness. Future research that includes employee perceptions and
required the services of SAW or RTW programs. In contrast, they absence data from particular workplaces would be very helpful in
may have known a coworker who accessed these services and determining the consistency of sickness absence perceptions of
1056 S. WAGNER ET AL.
employees with observable workplace absenteeism data. Given
previous literature (e.g., [34]), it is suggested that the employee
perceptions and true absenteeism reductions resulting from DM
programs may be poorly correlated. However, it is interesting and
important to note that DM efforts seem to be valued by employ-
ees for reasons that do not include reduced absenteeism, often
one of the most important outcomes from the perspective of
employers. This is consistent with previous research that found
differences between the reported benefits of deliverers of DM ver-
sus workers [29].
Predictive analyses indicated that according to employee per-
ceptions, DM programs had the most consistent influence on job
satisfaction. For DM’s influence on job satisfaction, employees
reported all program types (DP, SAW, and RTW) positively
impacted job satisfaction for both themselves and their coworkers.
Other findings suggested that employees perceived DP and SAW
efforts as most valuable. Specifically, employees reported DP and
SAW programs were valuable for the physical health, mental
health, morale and attendance of both themselves and their cow-
orkers. In contrast, RTW efforts resulted in variable employee per-
ceptions. Specifically, RTW efforts were reported as valuable for
individual mental health and morale; in contrast, RTW efforts were
seen as valuable to coworkers’ physical health. Similar to findings
from the descriptive analyses, RTW efforts did not predict
employee perceptions of reduced sickness absence for either the
employee or coworkers.
Difference analyses suggested that type of organization and
labor status also impacts employee perceptions about the value
of DM efforts. Employees from private companies reported greater
influence of DM for physical health of both themselves and cow-
orkers; however, with respect to morale, private companies
revealed more position perceptions for coworkers only. Employees
from nonunion environments also reported more benefit from the
influence of DM, as compared to employees from unionized envi-
ronments. Nonunion employees reported greater benefit to job
satisfaction, physical health, mental health, morale, and sickness
absence for both themselves and coworkers suggesting that in
nonunion environments DM has a valuable impact on employee
perceptions. We suspect that in nonunion environments, occupa-
tional health and DM programs may be less common so that non-
unionized employees report greater satisfaction in any existing
program. In contrast to private and nonunion as significant fac-
tors, There were no revealed differences according to respondent
gender.
Implications for rehabilitation
Our international sample revealed that most employees are aware
of DM efforts in their worksites, see value in DP, SAW, and RTW
efforts, and want these types of programs to continue. In general,
however, the value is perceived as greater for coworkers than for
the individual respondent and focused more toward psychosocial
benefits (e.g., job satisfaction, physical/mental health) than toward
traditional employer-focused outcomes such as reduced absentee-
ism. It is also important to note that employees reported most
influence from DM when provided in the form of DP and SAW
efforts, rather than in the form of RTW efforts. Finally, employees
in private, nonunion companies seem to find the most value in
DM interventions. Our findings are consistent with previous
research that suggests satisfaction with DM may be dependent on
individual interpretation of what constitutes a positive outcome
[24,39].
As a whole, these findings suggest that rehabilitation efforts
should continue to focus attention on the value of DM. In
particular, DM that is fully committed to the biopsychosocial
model would be supported by this research. Employees reported
the most value in the psychosocial variables addressed by DM,
such that rehabilitation professionals could focus on these valued
aspects to improve buy-in from employees. Similarly, the interest
in coworker value may provide another avenue for rehabilitation
efforts to increase uptake, by highlighting the value of interven-
tion efforts for employee coworkers. Finally, our results suggest
that rehabilitation professionals in union environments may need
to be particularly cognizant of the need for encouraging psycho-
social and coworker value potentially seen by employees in order
to increase acceptance and participation for organizational DM
efforts.
Limitations
The present study had several limitations. First, survey develop-
ment was internal to the team so that previous data were not
available to support the reliability or validity of our measure.
Similarly, the translated versions of the survey may have resulted
in some differences with respect to interpretation of the survey
questions. Second, the information collected reflected the per-
spectives of employees, and objective data (e.g., absence records)
was not used to supplement the subjective responses. Finally, the
companies and participants self-selected into the study. As a
result, both response bias and selection bias may have occurred.
The data presented are primarily a descriptive analysis and there-
fore, cannot be used to generalize or make assumptions about
causality in determining the benefits of DM.
Acknowledgements
We would like to thank all of the employees who agree to partici-
pate in our survey, in particular those that completed more than
one research component. We would also like to acknowledge
Swiss Network for International Studies who generously funded
this project.
Disclosure statement
The authors report no declarations of interest.
Funding
We like to acknowledge Swiss Network for International Studies
who generously funded this project.
ORCID
Alex Fraess-Phillips http://orcid.org/0000-0001-8604-7640
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