1. O'Hagan, Fergal
  2. Thomas, Scott
  3. Julian, Derek

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Cardiac illness is associated with considerable occupational disability and work adjustment difficulties. These have been related to psychosocial factors in numerous studies over the past 20 years. A risk factor approach could be applied to identify variables related to poor work adjustment in the same manner as risk factors have been used successfully in secondary prevention efforts. Identification of psychosocial risk factors underlying poor occupational adjustment is valuable for developing and targeting rehabilitative intervention.



This preliminary study was undertaken to identify the relationships between psychosocial constructs, occupational disability and work adjustment in the cardiac population and to develop a model of work adjustment based on modifiable psychosocial constructs which affect work adjustment. Research in musculoskeletal disability has identified catastrophic thinking, fear of activity and elevated perception of disability as independent modifiable factors affecting occupational disability. Successful interventions have been developed based on these constructs. We assessed these variables in the cardiac population to determine their impact on occupational disability and work adjustment.



Multiple cross-sectional design with questionnaire data collected from patients (72% working; age 57 +/- 10.7 y; 82% male, 73% married or equivalent, median duration of illness 31 weeks, 53% coronary artery bypass grafting, 57% myocardial infarction, 37% experiencing angina) at program entry (N = 126) and 6 to 12 months (N = 88) of CR participation. Individual perception of work readiness and adjustment (WRA) was assessed utilizing a novel visual analogue scale. Structural equation modeling was used to determine an a priori hypothesized 3 factor model impacting on WRA. Latent variables including fear/avoidance of activity and work, perceived disability, catastrophic thinking were assessed through items from the Illness Perceptions Questionnaire, Coping with Health, Injuries and Problems Questionnaire, modified Fear/Avoidance Questionnaire, Duke Activity Status Inventory and SF12. Orthogonal contrast was utilized to correct for skewness and improve the model fit. Logistic regression was used to evaluate model items on disability status.



Univariate analysis indicated significant differences between individuals who had returned to work and those not working on scales of fear/avoidance of physical activity and work, perceived disability and aspects of catastrophic thinking (rumination, magnification, helplessness). Significant correlations were observed between these variables and self-reported work adjustment.


Structural equation modeling revealed an excellent fit for the 3 factor model (GFI =.95, AGFI = .92, Non-formed Fit Index =.91, CFI =.94) with perceived disability mediating the relationship between catastrophizing and fear/avoidance of activity and WRA.


Logistic regression of the factors on work status indicated a significant relationship (Chi square 52.4, P < .0000001) and permitted successful prediction of work status in 75% of cases.



The constructs analyzed in this study have promise in gaining a better understanding of modifiable factors underlying poor work adjustment in cardiac patients and the interrelationship between these factors. Interventions focused on specific aspects of client thoughts and fears relating to their illness and work and their perceptions of disability could be incorporated into existing programs to improve work outcomes.


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