Case managers facilitate successful return to work in difficult cases utilizing return-to-work tools and therapist partnerships.
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Case Management↗
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The work hardening program and subsequent return to work of a client with low back pain.
Billions of dollars are spent annually for the costs associated with workers' compensation cases. Chronic low back injuries have been traditionally the most costly cases. In addition to the physical problems, psychosocial issues emerge which confound conventional treatment and prolong resolution. Work hardening programs were developed to address the many issues of the occupationally injured chronic patient. This case study examines the treatment of a 54-year-old male who sustained an injury to his lumbar spine during employment as a boiler mechanic and subsequently had been out of work for 8 months. The article describes the interdisciplinary work hardening treatment (5-week duration) and the progressive resistive work circuit which preceded the client's return to work. It is concluded that work hardening programs can be cost-effective for insurers, as in this case, saving an estimated $44,000. An aggressive return to work program should also be considered in earlier stages of injury as a way of preventing the development of chronic disability for which the human costs are immeasurable.
Chronic Disease↗
[Effectiveness of interventions for low-back-pain sufferers: the return to work criterion].
BACKGROUND: Return to work is considered as a major effectiveness criterion for interventions dedicated to subacute or chronic low-back-pain sufferers. Moreover, return to work, beyond the economic and social Issues, is regarded more and more as having a therapeutic dimension. This review aims to describe the various interventions which are effective in returning patients to work. METHODS: The presentation is based on existing reviews supplemented by a selection of recent studies. RESULTS: "Cognitive-behavioral therapy", "reassurance" and "back exercises" are some suggested approaches. Some of these techniques are geared specifically towards work. Others, such as "back schools" or "multidisciplinary interventions" combine different approaches. CONCLUSION: Promoting return to work at an appropriate stage (subacute stage) could help low-back-pain sufferers to avoid prolonged disability.
Disability Evaluation↗
Back in the saddle. Everything you ever needed to know about return-to-work programs.
Return-to-work programs and services can be effective methods in returning an injured worker back to their job. The primary objectives of return-to-work programs and services are to prevent work-related injuries and to successfully return an injured worker back to gainful and productive employment.
Disability Evaluation↗
Understanding return to work behaviours: promoting the importance of individual perceptions in the study of return to work.
PURPOSE: The purpose of this paper is to demonstrate and discuss how individuals' subjective perceptions of personal and environmental issues influence return to work behaviour. METHOD: A qualitative design utilizing in-depth interviews and maximum variation sampling of 11 individuals who either returned to work or withdrew from work after a health leave was conducted. Experiences elicited were analysed using the constant comparative method followed by a member check with participants to confirm findings and interpretations. RESULTS: Findings underscored the importance of two key constructs in understanding return to work from the individual's perspective: the personal meaning of disability and return to work relevancy. Throughout the experience of getting better and returning to work participants reflected upon the impact of personal and external factors that contributed to their work disability, sought clarity of their performance capacities and examined the importance of work and the consequences of work disability within their life circumstances. CONCLUSIONS: Insights into an individual's perceptions of their impairment and the personal relevance of work can promote a better understanding of return to work behaviour. Integrating individual perceptions is essential to advancing a multidimensional approach in return to work research.
Adult↗
Determinants of duration of disability and return-to-work after work-related injury and illness: challenges for future research.
BACKGROUND: The purpose of this review was to identify critical data and research needs in addressing the following question: What are the primary factors that affect the time lost from work, return-to-work (RTW), subsequent unemployment, and changes in occupation after disabling illness or injury? METHODS: Review of the literature to identify research challenges originating from the multitude of disciplines, data sources, outcome measures, and methodological and analytical problems. RESULTS: About 100 different determinants of RTW outcomes were identified. Their impact varies across different phases of the disablement process. Recommendations are provided for addressing five selected research challenges. CONCLUSION: Interdisciplinary research needs to develop a comprehensive conceptual framework. Priority should be given to studies on specific domains of risk factors meeting five selection criteria: amenability to change; relevance to users of research; generalizability across health conditions, disability phases, and settings; "degree of promise" as derived from qualitative exploratory studies; and capacity to improve measurement instruments. Combining qualitative and quantitative research methods is necessary to bridge existing knowledge gaps.
Accidents, Occupational↗
The interaction between man-work-environment and the return to work of coronary patients. The philosophical aspects.
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Adult↗
Medical fitness to return to work for disabled workers.
Return to work for the disabled worker is one of the critical issues for both the person himself and his employer. The early return to work is a manifestation of social restoration for the disabled worker as well as an effective way to reduce social cost-related disabilities. Several studies on effectiveness of the formal return to work program have been reported. This program is one of the workplace disability management systems that promote the workplace accommodation for the disabled. The purpose of a medical assessment of fitness for return to work in this program is to make sure that an individual is fit to perform the task involved effectively and without risk to his own or to others' health and safety. Decision-making, the process of assessment of medical fitness, and the design for a return to work are discussed.
Decision Making↗
Return to work among sickness-absent Danish employees: prospective results from the Danish Work Environment Cohort Study/National Register on Social Transfer Payments.
This study investigates the determinants within socio-demography, health behaviour, employer characteristics, and psychosocial and physical work environment for return to work. In 2000, a total of 5357 employees were interviewed regarding age, gender, family status, education, health behaviour, employer characteristics and work environment. They were followed in a national register for 18 months in order to identify subjects with 2 weeks or more of sickness absence. They were followed for an additional 12 months in order to establish associations between baseline measurements and time to first return to work. A total of 930 (17.4%) employees experienced sickness absence in the 18 months after baseline. During the 12-month follow-up, 856 (92.0%) returned to work, the mean absence period being 6.6 weeks. Prolonged time to first return to work was associated with female gender, increased age, no post-school education, being employed by a public employer, working at a workplace with 20 or more employees, high emotional demands in work, high job insecurity and sedentary work. There were no associations between health behaviour variables and return to work. The study indicates a potential for promoting return to work through interventions targeting emotional job demands, job insecurity and decreasing the risks associated with sedentary work.
Denmark↗
Mild traumatic brain injury from motor vehicle accidents: factors associated with return to work.
OBJECTIVES: To describe return to work (RTW) for motor vehicle accident (MVA) survivors with mild traumatic brain injury (MTBI) and to examine relationships between RTW and injury severity, cognitive impairment, social interaction, discharge disposition, and sociodemographics. DESIGN: Inception cohort assessed within 1 month of injury and at follow-up 6 to 9 months (mean = 7.4) after injury, for comparisons on outcome of RTW. SETTING: Tertiary care center in Toronto (time 1); at home for follow-up. PARTICIPANTS: Fifty patients with MTBI resulting from MVA who were consecutively admitted during a 20-month period ending April 1994. Thirteen of 63 eligible patients refused consent or were lost to follow-up. Mean age was 31; 62% were men. ELIGIBILITY CRITERIA: (1) patients had been working; (2) they had no history of head injury, neurologic disease, or psychiatric illness requiring hospitalization; and (3) they had no catastrophic impairment from accident. MAIN OUTCOME MEASURE: Return to work (at premorbid or modified level). RESULTS: Of the 42% who returned to work, 12% resumed their premorbid level of employment and 30% returned to modified work. There were significant differences (p<.05) between the groups in level of social interaction, premorbid occupation, and discharge disposition. On one test of cognitive functioning the difference was at p = .06. CONCLUSION: Social interaction, jobs with greater decision-making latitude, and discharge home were positively related to RTW for this population. Cognitive impairment within the first month was not a reliable indicator of RTW potential.
Accidents, Traffic↗
An application of the Occupation Competence Model to organizing factors associated with return to work.
The variations in return to work outcomes for ill or injured persons experiencing health leaves are complex. However, it is important to comprehend these variations in order to develop evidenced-based practice in work rehabilitation. Currently, a plethora of studies exist in the literature that have attempted to explain the variations in work outcomes. A 20-year review of the literature on work outcomes has revealed several limitations in using this knowledge in occupational therapy. The study of return to work outcomes is, for the most part, atheoretical and the knowledge base is fragmented and disorganized. In addition, the literature does not reflect a consistent understanding of the multidimensional nature of either work disability or the facilitators for return to work. In this paper, the Occupational Competence Model is presented as a framework for filling this gap. This model is used here to organize and synthesize the factors previously studied on work outcomes to foster an understanding of this literature from an occupational therapy perspective and the future study of work outcomes and work rehabilitation.
Employment↗
A developmental conceptualization of return to work.
INTRODUCTION: Although return to work (RTW) is a phenomenon that has been researched for many years, our ability to understand and improve outcomes is still limited. As an avenue for advancing the field, this paper presents an alternative way of thinking about RTW. METHOD: The conceptualization was constructed based on a review of the literature and the comments of RTW and workers' compensation researchers. RESULTS: RTW is presented as an evolving process, comprising four key phases: i.e., "off work," "work re-entry," "retention," and "advancement." In addition, multiple phase-specific outcomes that may be used to evaluate RTW success are advanced. CONCLUSION: Broadening thinking about RTW to take into consideration the complexities of its developmental nature holds promise for understanding and improving RTW, as it not only clarifies the importance of incremental milestones, but also facilitates intervention choice and evaluation.
Community Participation↗
What affects return to work for graduates of a pain management program with chronic upper limb pain?
Chronic upper limb pain often causes work loss, and return to work after pain management is disappointingly low. This study aimed to identify patient characteristics and beliefs contributing to return to work or nonreturn. A total of 103 (66%) ex-patients with CULP, who had completed a pain management program, agreed to telephone interview. Participants were predominantly female and in middle years; 53.4% were working part- or full-time. Their responses were related to pre- and posttreatment psychological and disability variables. Those patients who had returned to work, compared to those who had not, were more likely to have been working shortly before treatment (chi 2 = 36.77, p < 0.00001). They were more psychologically robust and were more confident of managing pain (t = 4.55, p < 0.001), and catastrophized less (t = 2.21, p = 0.029). They were also more optimistic about being capable of work (u = 566, p < 0.0001) and of overcoming obstacles to work (u = 889, p = 0.0103). Workers and nonworkers were not differentiated by expectations of support from their immediate line manager, although nonworkers doubted support available from colleagues. Overall, despite generalization of pain management strategies in nonwork activity, return to work depended on specific beliefs concerning work-relevant strategies.
Absenteeism↗
The Demand-Control-Support model as a predictor of return to work.
The present study investigated work-related determinants of return to work. Our hypothesis was based on the strain hypothesis of the Demand-Control-Support model, which postulates a relation between job demands, job control and support at work on the one hand, and the aetiology of health complaints on the other hand. High demands were hypothesized to obstruct return to work, whereas high control and high support were thought to have a positive effect on return to work. This hypothesis was tested in a population of employees who were sick-listed for 6-8 weeks. Return to work, as operationalized by the categories (i) not working; (ii) return to work with adjustments; and (iii) full return to work, was determined 4 months after the onset of the sick leave. The hypothesis was tested by logistic regression analyses. High job demands were the least predictive of full return to work. However, the likelihood of employees with high job demands returning to work with adjustments was higher than the likelihood of them not working. Therefore, job demands might also work as a pressure to return to work (compare this with Smulders and Nijhuis, 1999). Furthermore, high skill discretion in combination with high job demands predicted working with adjustments in comparison with not working. Finally, high supervisor support was the most predictive of return to work without adjustments, and the least predictive of not working.
Adult↗
Predictors of return to work after anterior cervical discectomy.
Return to previous level of employment after surgery is important to patients. Predictors of return to work have been well described in lumbar disc surgery. However, this information cannot be generalized to the population undergoing cervical discectomy. The authors retrospectively reviewed 67 consecutive patients who underwent anterior cervical discectomy. Strict inclusion criteria were used. Baseline demographics were recorded as well as other potential predictors of postoperative return to work such as number of levels of disease, smoking history, and disability claims. Follow-up information about work status was reviewed with each patient at office visit. Forty-five patients were found eligible for the study. At a mean follow-up of 2.8 years (SD 1.4), 38% had not returned to work by 1 year. Preoperative sick leave in this group was significantly greater than for those patients who returned to work within the year (p = 0.0014). Postoperative neck pain was more common in individuals who did not return to work after surgery (p = 0.01). Increasing age and disability claims also appeared to negatively impact the ability to return to work. Gender, type of work, smoking history, and number of levels of disc disease did not appear to have any association with postoperative return to work. The authors conclude that the duration preoperative sick leave and postoperative neck pain negatively impact postoperative work status in patients undergoing anterior cervical discectomy. Age and disability claims also influence return to work.
Adult↗
Predictors for outcome of a multi-modal cognitive behavioural treatment program for low back pain patients-a 12-month follow-up study.
Low back pain patients (n=142) on sick leave for at least 8 weeks were given a multi-modal cognitive behavioural treatment program (MMCBT) that lasted for 4 weeks. Before treatment, all patients were tested with a comprehensive test battery. The outcome at 12-month follow-up was predictable from the pretest, but only when combining medical and psychological data. Patients who returned to work (Returners, 50%) in the MMCBT group were characterised by less pain, more psychological strength, were evaluated by the physiotherapist as having a good prognosis for return to work, and were less educated. Patients who did not return to work (Non-returners) in the MMCBT group felt tense and unfit, felt hopelessness concerning the future, were less physically active, thought their complaints would worsen if they continued working, and reported fewer difficulties driving a car. Returners to work (58%) in the randomised control group (n=81), who received ordinary physical therapy, were characterised by high levels of energy, less subjective health complaints, less exhaustion for a condition test, and did not work in positions giving a constant load on the back. There was no significant differences between number of patients who had returned to work in the MMCBT and the control group. Non-returners in the control group lacked energy, trained less regularly, worked in occupations that gave an almost constant load on the back, and did not expect to be back to work in the course of a couple of weeks. It seems to be important to develop further diagnostic tools to identify those who might benefit from extensive or specific treatments. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
Journal Article↗
Workers' disability and return to work.
A severe injury on the job often results in a medical recovery period requiring either a temporary or long-term absence from work. Rehabilitation interventions emphasizing return to work may facilitate recovery and prevent workers from becoming unemployed. A review of the current literature suggests a direct relationship between workers' demographic and disability-related characteristics, early referral to rehabilitation and successful return to work. This article describes findings from a research study designed to investigate factors associated with the return to work of injured workers. Data from 200 workers' compensation cases from a large automobile manufacturing employer in the state of Michigan were analyzed in terms of workers' demographics and other characteristics including type and severity of injury, cause of injury, type of medical intervention received, disability status, worker's job experience and wages before injury; disability costs to employer; the provision of vocational rehabilitation services; and return-to-work outcomes. Variables found to be significantly related to return to work outcomes included workers' age, education, wages before injury, job seniority and severity of the injury. Workers who successfully returned to work had higher seniority in their jobs, more education and were paid higher wages. Workers whose injuries were more severe and longer lasting, were less likely to return to work. Back impairments appeared to be a particular risk factor for return to work regardless of vocational rehabilitation intervention.
Accidents, Occupational↗
[Assessing the work-role quality and its significance in predicting return to work].
Non-medical factors such as age, years of schooling, and job satisfaction play an important role in determining whether patients resume their work after rehabilitation treatment. One element is the way the work situation is perceived by the patient. Usually, aspects of strain or job concerns are assessed. But employment does also include positive and rewarding aspects, though, such as meaning or social contact. According to the concept of work-role quality, theoretically these are independent constructs: someone may perceive job concerns and job rewards at the same time. In this study a short questionnaire (FRQ-B), broadly adapted from Barnett, Davidson and Marshall (1991), measuring job concerns and job rewards was developed and administered to a sample of cardiac rehabilitation patients. Psychometric analysis shows the factorial validity, consistency and construct validity of the instrument. Prediction of the return to work status three months after discharge from rehabilitation could be achieved on the item and subscale level. The effect sizes were comparable to other significant variables (e. g. psychological status, NYHA-status, wish to work). Specificities vary from 30 to 60 percent. The best predictor seems to be the Fear Avoidance Belief Questionnaire (FABQ), assuming a causal relationship be-tween work and illness. An analysis of subgroups using the FRQ-B reveals patients who experience little job rewards as well as many job concerns as a group with a high risk of not returning to work. The results of this study demonstrate the importance of assessing work related variables when dealing with return to work after rehabilitation treatment. Interventions to change the perception of the working place situation should be initialized and focussed early in rehabilitation treatment. The need for further research integrating the concept of work-role quality is discussed.
Adult↗