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Documente Profesional
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Commodia, Ostersund,
Sweden
b
Abstract. In previous studies, internal locus of control (ILC) has been pointed out as a key factor for return to work after vocational
rehabilitation. The aim of the current study was to gain a deeper understanding of the concept of ILC in a Swedish vocational
rehabilitation context. The study was based on data from 347 long-term sick-listed clients collected at the onset of vocational
rehabilitation. A first bi-variate analysis showed that ILC was positively associated with physical functioning and general health,
and negatively associated with bodily pain. The analysis also showed that women, more than men, reported high internal locus
of control. After a second multivariate analysis, only bodily pain remained associated. It is concluded that there exist a strong
and negative association between bodily pain and internal locus of control. Clients with severe pain often also suffer from low
internal locus of control. This should be kept in mind when providing vocational rehabilitation.
1. Background
During latter years in Sweden, a dramatic increase of
people not working due to sick-listing has been noted.
In 2004, roughly 17% of a working age population
(1665 years) was absent long term from work due to
ill health [22]. Similar developments are experienced
in other western countries [7]. In order to reintroduce
people who are sick or injured to a job, increasing
emphasis has been focused on vocational rehabilitation.
In a previous study [25], based on the same material
as the current study, internal locus of control (ILC) was
pointed out as a key factor for return to work after vocational rehabilitation. The study showed that chances
for people with high ILC were roughly 70% better of receiving a positive rehabilitation outcome than for those
with low ILC. The results also showed that the vari Address
Ostersund,
Sweden. Tel.: +46 63 16 57 56; Fax: +46 63 16 56 26;
E-mail: john.selander@miun.se.
1051-9815/08/$17.00 2008 IOS Press and the authors. All rights reserved
150
itation context. Tseng [29] found that under the vocational rehabilitation process, differences occur between clients of internal and clients of external orientation in the areas of self-reliance, reliability, work
tolerance, knowledge and need for achievement, all of
which are important for the outcome of vocational rehabilitation programs. Partridge and Johnston [20] found
that clients with a higher level of internal control had
shorter recovery periods than others. Norman and Norman [19], studying the relationship between progress
in rehabilitation and LOC, found that clients designated as of internal orientation made faster progress then
those designated as of external orientation. Duvdevany and Rimmerman [5] found that clients with disabilities who had an internal locus of control had more
favourable attitudes to work and participation in vocational rehabilitation than counterparts with an external
locus of control. Krause et al. [9] found that locus of
control was correlated with a number of aspects of life
adjustment after spinal cord injury, with internality being positively correlated with subjective well-being and
general recovery. Millet [16] reported that clients with
an external locus of control had a less favourable point
of departure at the start of vocational rehabilitation and
also that internal locus of control had an impact on vocational rehabilitation outcome. Rotter [23] argues that
locus of control is influential in the important area of
problem solving techniques, and thus is related to planning, coping, persistence, practice, and analysis, making the concept a central part of human functioning in
everyday situations that are new or ambiguous, similar
to what many unemployed persons with disabilities experience daily. The conclusion here is that locus of control is a doubly interesting factor for vocational rehabilitation, influencing the clients motivation, resource
mobilisation, learning, and work adjustment.
2. Aim of study
The aim of the current study was to gain a deeper
understanding of the concept of internal locus of control
in a Swedish vocational rehabilitation context.
151
152
Cervical region
Thoracic region
Lumbar region
Men (n
%
47
40
94
= 187)
VAS
46
45
52
Women (n = 160)
%
VAS
59
49
42
44
78
54
3.3. Ethics
4. Results
4.1. Sample data
The sample (n = 347) consisted of 54% (n = 187)
men and 46% (n = 160) women. The mean age was
42 years for men and 41 for women. At rehabilitation
start, 88% of the clients (n = 307) were employed
and had a job to return to after rehabilitation and 12%
(n = 40) were unemployed. All 347 clients undergoing
rehabilitation suffered from long term back pain (see
Table 1).
At the start of rehabilitation, 68% (n = 128) of the
men and 53% (n = 85) of the women received full
sickness allowance. The remaining men and women
received part time allowances. Average total time on
sickness allowance (i.e. days on partial benefits converted to days on full benefit), during a two-year period before the start of rehabilitation, was 13 months for
both men and women.
4.2. Bi-variate analysis
In a first bi-variate analysis, the following variables
showed significant associations to ILC: sex (p = 0.003)
(women reported higher ILC), physical functioning
[from SF-36] (p = 0.011) (positive association), bodily
pain [from SF-36] (p = 0.001) (negative association)
and general health [from SF-36] (p = 0.000) (positive
association).
In the same bi-variate analysis, the following variables showed no significant associations to ILC: age,
working status [employed vs. not employed], previous sickness absence, general fitness, body mass index,
analgesics (yes vs. no), physical role function [from SF36], vitality [from SF-36], social functioning [from SF36], emotional role function [from SF-36], and mental
health [from SF-36].
5. Discussion
The results show a negative association between ILC
and perceived bodily pain. Clients with low ILC experienced pain more often than others. This finding,
although perhaps not so surprising, is still interesting.
Both pain and low ILC are unfavourable factors in relation to vocational rehabilitation and the return to work
process, and when experienced together could very well
constitute a significant problem.
The association between different psychological factors and perceived pain has been extensively examined
in literature, and locus of control has been found to be
one of the key factors involved. In general, a more
internal LOC is associated with higher pain tolerance
and less negative pain response [4,34]. Clients with internal LOC have also been shown to use lower and less
frequent doses of analgesic in the control of pain [21].
The nature of the association is complex [13], but
studies indicate a cause and effect relation, where ILC
has a direct effect on pain [3]. Crisson and Keefe [4]
found that people with pain and high ILC believe that
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154
6. Conclusion
The aim of the current study was to achieve better
knowledge of the concept of internal locus of control
in a Swedish vocational rehabilitation context. Among
other things, this study showed a significant association
between internal locus of control and perceived bodily pain. Clients with low ILC more often than others suffered from pain. In a rehabilitation context this
finding is relevant. In contact with a rehabilitee suffering from bodily pain, the rehabilitation provider should
bare in mind that the client probably experience his/her
internal locus of control as low. Instead of helping
the client by taking over his/her problem, the provider
should instead help the client to help himself.
Appendix 1
Modified version of Wallstons Health Locus of Control scale
1. It mostly depends on my co-workers whether or
not I will get back to work full time.
2. If it is meant to be, I will get back to work full
time.
3. It is mainly what I do myself that affects whether
I get back to work or not.
4. Rehabilitation professionals control my rehabilitation and full return to work.
5. Luck plays a big part in how soon I will be able
to return to work.
6. My own behaviour determines when or if I will
get back to work.
7. No matter what I do Im not likely to get back to
work full-time.
8. Whenever I return to work it will be because other
people have been taking good care of me.
9. Im in control of my rehabilitation and return to
work.
Internal LOC = nr 3, 6 and 9
External LOC (powerful others) = 1, 4 and 8
External LOC (chance/fate/luck) = 2, 5 and 7
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