Adebate is emerging regarding the best way to ensure the timely and efficient return to work (RTW) of workers who have become long term absent (LTA) for health reasons. Elements of this debate center on the roles of the individual, the rehabilitation agent, the employing organisation and the rehabilitation and reintegration system. Recent years have seen the emergence of new approaches to managing LTA, mostly focusing on disability management and on amendments to welfare and rehabilitation systems. This paper discusses these trends in the light of a 6-year research programme carried out in Ireland, involving both national and transnational studies which have sought to identify the key elements of successful LTA policies and practices. It also reviews recent international work in the area in order to assess the relative importance of systemic, organisational and individual factors in ensuring timely and effective LTA policies and practices.

This paper reports the results from a qualitative study aimed at identifying the factors influencing the rehabilitation experience of people living with an amputation in a rural setting. Following the conduct of an initial focus group, 24 rural-based individuals responded to an invitation to participate in the study's in-depth interviews. Fourteen of those interviewed lived in a ‘regional’ setting (the regional group) and the other ten lived in more remote locations (the ‘distant’ group). Consistent with this population's demography, the sample was comprised mainly of older people (mean age of 66.8 years) who had suffered their amputation as a result of vascular disease. While the groups differed with respect to two aspects of their rehabilitation experience (with the distant group reporting more problems with accommodation and access to health services), many common themes emerged from the interviews, including an overall positive acceptance of the surgical intervention, the call for increased post-operative counselling services, and an endorsement of the usefulness of peer-support (and more generally of social support) services. Results are discussed in terms of their implications for service delivery and endorsement is made of the suggestion that rural health planning be more community-focussed.

Audiometric tests do not adequately reflect the hearing handicap experienced by individuals with hearing loss and account for only part of the variance in hearing handicap perceptions (Weinstein & Ventry, 1983). The present study investigates the relationship between degree of hearing impairment, psychosocial factors and hearing handicap in a New Zealand war veteran sample. Forty-seven veterans (Mean age = 77.51, SD = 5.99) with some degree of hearing impairment completed a questionnaire which included the Hearing Handicap Inventory (HHI) (Newman et al., 1990), the SF36 sub-scales for general health and mental health (Ware, Kosinski & Keller, 1994), questions relating to hearing aid use and demographic details. Audiometric test information for each veteran was accessed through the national war pensions organisation. Analyses revealed no significant relationship between percentage hearing loss and perceptions of hearing handicap. Those who reported lower satisfaction with their hearing aids, those in poorer physical health and those who had been using hearing aids for a longer time reported higher scores on the HHI. These findings suggest that aspects of the rehabilitation process are important factors in the individual's experience of hearing handicap and that non-auditory factors (such as general health) may be essential considerations in this process.

Disability is commonly viewed as permanent loss of physical, cognitive and social aspects of self. Rehabilitation interventions are aimed to return the individual to full health by either restoration of past physical, cognitive or social capabilities or strengthening aspects of self to counter such loss. However, rehabilitation interventions do not result in a complete return to past physical, mental or social health. Does this mean that people with disability can never be healthy? Or does it indicate that our perception and definition of health does not reflect the essence of health? We argue that when people with disability redefine themselves in terms other than levels of physical, social and cognitive functioning, good health is an attainable goal. We discuss evidence that suggests why spirituality could be a primary determinant of health.

It is estimated about 200,000 Americans have been diagnosed with Muscular Dystrophy (MD), a neuromuscular disease characterized by gradual degeneration and atrophy of the muscle cells and fibers (Siegel, 1999). Functional limitations associated with MD include cognitive, social, physical/vocational, and emotional functioning. Rehabilitation counselors are advised to use a holistic approach to serving clients with MD. Compassion is key to building a meaningful professional relationship between the client and the rehabilitation counselor. However, rehabilitation counselors should neither communicate an overly pessimistic outlook nor raise false hope.