Disability prevention and communication among workers, physicians, employers, and insurers—current models and opportunities for improvement

Injured worker participation in assessment during the acute phase of workers compensation rehabilitation: a scoping review

PURPOSE

Rates of return to work (RTW) are declining in the Australian workers compensation system alongside significant economic and social costs, disputes, and secondary psychological injury. Non-medical assessment of workplace injuries now considers psychosocial and workplace factors, and worker participation in the assessment process is limited. This scoping review examines studies regarding non-medical assessment during the acute phase of rehabilitation in terms of costs, disputes, secondary psychological injury, and worker participation.

METHOD

An electronic and manual search of relevant articles across four databases was conducted using PRISMA guidelines, followed by quality assessment.

RESULTS

Of the 1,630 studies retrieved, 12 met the inclusion criteria with most focused on assessment for risk of obstructed or delayed RTW.

CONCLUSIONS

Non-medical assessment in the acute stage of rehabilitation identifies risk for delayed or complicated RTW, overlooking potential for the process of assessment to contribute to disputes and development of secondary psychological injury. Doubt around the capacity of workers to participate objectively in assessment persists. These are aspects of assessment worthy of further exploration for their impact on RTW outcomes.

Return-to-Work Coordinators' Perceptions of Their Roles Relative to Workers: A Discourse Analysis

PURPOSE

This paper describes how Canadian Return to Work coordinators (RTWC) framed their job roles relative to workers in ways that went beyond the usual professional norms of helping worker recovery.

METHODS

In-depth interviews were conducted with 47 RTWCs across Canada in 2018-2019. We used critical discourse analysis to analyze the way coordinators viewed workers in the complex, multi-stakeholder system of RTW.

RESULTS

We identified four ways that RTWCs positioned themselves relative to workers: as trust builders, experts, detectives and motivators. These roles reflected RTWCs position within the system; however, their discourse also contributed to the construction of a moral hierarchy that valued worker motivation and framed some workers as attempting to exploit the RTW system.

CONCLUSIONS

RTWCs' positions of power in the coordination process warrant further investigation of how they exercise judgement and discretion, particularly when the process depends on their ability to weigh evidence and manage cases in what might be seen as an objective and fair manner.

Aiming at inclusive workplaces: A bibliometric and interpretive review at the crossroads of disability management and human resource management

Inclusive workplaces rely on the joint optimization of disability management and human resource management. However, disability management has been predominantly investigated as an independent issue, overlooking its interplay with human resource management. The article delivers a bibliometric and interpretive review of the scholarly debate falling at the crossroad of disability management and human resource management, mapping the state of the art of this study domain. Departing from a knowledge core of 91 papers, 6 research streams were identified through bibliographic coupling. They account for the evolution of disability management from a fix-it initiative aimed at fostering return to work of people with disability towards a holistic management approach targeted at inclusiveness. Aligning the hard and the soft sides of disability management and embedding it in the organizational culture are crucial to enact inclusive workplaces and make organizations able to engage people with disability at work.

Exploring certified hand therapists’ roles in workplace injury prevention, treatment, rehabilitation and collaboration with occupational safety professionals

BACKGROUND: Certified Hand Therapy is a subset of occupational/physical therapy that is relatively unknown to the common individual. Certified Hand Therapists (CHTs) help those with upper extremity injuries, whether it be those with workplace injuries, those who suffered a traumatic injury or those recovering from major surgery to reach the point where they are able to be independent and back to doing daily life activities. OBJECTIVE: This study aimed to discern the roles that Certified Hand Therapists have in rehabilitating individuals with upper extremity injuries, to assess their participation in work-related injury prevention, to examine with whom CHTs interact with during the rehabilitation process, and to gain insight into how the relationships between CHTs and occupational safety professionals can be improved. METHODS: Structured interviews were conducted with eight occupational therapists who are Certified Hand Therapists or are in the process of being certified. Interviews were recorded, transcribed and analyzed to determine themes relative to the study objectives. RESULTS: Content analyses determined trends in job roles, interactions with occupational safety professionals, the importance of patient education in prevention and rehabilitation and barriers to effective treatment of work-related injuries. CONCLUSION: CHTs shared similar thoughts regarding their profession. CHTs revealed common themes in the eight interviews conducted. Specifically, many CHTs believe education is a vital part of the profession in terms of improving the profession and in the rehabilitation process. In addition, patient compliance and the current workers’ compensation system were seen as challenges when rehabilitating patients.

The Capacity Note: a communication facilitator in the sick leave process of patients with common mental disorders - a qualitative study of user perceptions

OBJECTIVES

To describe the development of a communication facilitator, the Capacity Note, for the sick leave process of patients with common mental disorders (CMDs) in primary care, and to explore users' perceptions of it.

DESIGN

Qualitive study.

SETTING

Primary healthcare in Region Västra Götaland, Sweden.

PARTICIPANTS AND METHODS

The Capacity Note was developed inductively based on data from six qualitative studies of work capacity and CMD and was introduced at primary healthcare centres during 2018-2019. Individual semistructured interviews were performed with 13 informants (8 patients, 2 general practitioners and 3 managers) who had used the Capacity Note at least once. Interviews were audiorecorded and transcribed verbatim and inductive manifest qualitative content analysis was used to analyse the data.

RESULTS

The Capacity Note comprised questions about work situation, work capacity limitations and possible work adjustments. Based on the interviews, four categories relating to its role as a facilitator for communication about work and health were identified: content and format, understanding, legitimacy and action, openness and timing, and time and efficiency. The participants considered the Capacity Note relevant and easy to use, and as having the potential to improve communication about and understanding of the patient's situation. The increased understanding was perceived as contributing to a sense of legitimacy and agency. Achieving these benefits required, according to the participants, openness, an investment of time and using the Capacity Note at the right time in the sick leave process.

CONCLUSION

The Capacity Note was found to be relevant and as having, under the right conditions, the potential to improve communication and facilitate the sick leave process.

The hand therapist's role in the prevention and management of upper extemity injuries in the modern mass production industrial setting

BACKGROUND

This case study presents the role of an onsite hand therapist (Certified Hand Therapist, Occupational Therapist, Physical Therapist) in an industrial setting and the services that can be provided in this comprehensive care model. Onsite hand therapists can impact on Occupational Safety and Health Administration (OSHA) first aid programs and can provide state of the art treatment for the injured worker in both a direct and indirect capacity.

PURPOSE

The purpose of this case study article is to review the many potential services the hand therapist can offer to facilitate the return-to-work of injured employees and provide employers with a proactive case management and state-of-the-art ergonomic prevention, improving profit margins and facilitating safe work environments.

STUDY DESIGN

A Case Study design demonstrating the diverse and positive impact of hand therapy on the mass production industrial setting.

METHODS

Novel to this approach is a description of outcome instruments (QuickDASH) administered in a periodic manner to understand the trajectory of change in patient-level disability throughout the rehabilitation process. The Optimal Screening for Prediction of Referral and Outcome (OSPRO-YF) is utilized to help predict the functional outcome for the injured worker. Case studies on common upper extremity pathologies will be discussed, demonstrating the benefits of onsite hand therapy with enhanced treatment and case management.

RESULTS

The utilization of the QuickDASH and the OSPRO-YF creates a process to determine the progression of injured workers in therapy, the trajectory of change in patient-level disability and to observe when changes occurred. An example of the periodic assessment approach is described in a case study to identify when the most significant change occurred and creating a mechanism to determine if patients were progressing as expected.

CONCLUSIONS

Inherent in this case study process is a fluidity in which the therapist can monitor patient progress and adjust the rehabilitation process that benefits both the patient and the industrial setting. A hierarchical functional level system is presented to describe an appropriate intervention strategy to coincide with a patient's progression of wound healing which can be provided by a hand therapist with specialized knowledge.

Understanding the Process and Challenges for Return-to-Work Post-Hematopoietic Cell Transplantation from a Musculoskeletal Perspective: A Narrative Review

The current paper seeks to inform healthcare professionals on how adapting various components of return to work (RTW) programs that are already in use by other musculoskeletal rehabilitation settings can help optimize return to work process for patients with or without musculoskeletal manifestations, posthematopoietic cell transplantation. Since there is no universally agreed RTW structure for hematopoietic cell transplant patients, a narrative approach has been taken utilizing evidence from the existing musculoskeletal return to work assessment publications to help draw parallel for the hematopoietic cell transplant patients. Databases were searched including PUBMED, CINHAL, AMED, SCOPUS, and Cochrane using keywords RTW, functional restoration program, hematopoietic cell transplant, bone marrow transplant, stem cell transplant, and musculoskeletal functional assessment. The authors have managed to outline and propose a structured RTW assessment and monitoring program which can aid in getting patients back to employment by utilizing the functional capacity and job evaluation to help hematopoietic cell transplantation patients reintegrate socially. Patients undergoing hematopoietic cell transplant require additional support and a robust assessment system to allow safe RTW. The proposed model of RTW assessment can prove to be beneficial in helping patients return to work safely. Clinical Significance. To acknowledge the individuality in functional limitation is important in determining not only the rehab needs but also the RTW capabilities. The proposed RTW plan not only promotes an individualized approach to patients but also provides a structure for return to work assessments for hematopoietic cell transplantation patients, thus, eliminating the need for guess work by healthcare professionals. In line with the International Classification of Functioning, Disability, and Health (ICF) recommendations, a RTW assessment combined with a job evaluation helps healthcare professionals and stakeholders to understand the unique challenges and strengths of a patient and thereby design an individualized therapy approach.

Work disability negotiations between supervisors and occupational health services: factors that support supervisors in work disability management

PURPOSE

A work disability negotiation takes place between a supervisor, the disabled employee and the occupational health service (OHS) to support the disabled employee in returning to their work, often with temporary work accommodation. The objective of this study was to define the factors of a work disability negotiation with OHS that supported or hindered supervisors in their task/role in work disability management.

METHODS

The study setting comprised two parts: the creation of survey questions and the actual survey of supervisors (N = 254) from six public and private organizations in Finland. Of these, 133 (52%) had participated in one or more work disability negotiations. The responses covered about 240 work disability cases and considerably more negotiations.

RESULTS

The study identified four key elements that the supervisors expressed as major success factors in the negotiations. First, it was crucial that the supervisors learned about the employee's health restrictions and understood the issues relating to their work disability. Second, the parties should aim for common solutions and conclusions through collaboration. Third, active participation of all the negotiation parties is important. The supervisors gave a high rating to OHS taking their views seriously. Last, the supervisors appreciated collaboration in a constructive atmosphere.

CONCLUSION

In order for a negotiation to help supervisors in their challenges, it should reach solutions, conclusions and a restructured comprehension of the work disability problem in a constructive atmosphere and with active communication between stakeholders.

Stakeholders' Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review

The lack of knowledge regarding the roles and actions of return to work (RTW) stakeholders create confusion and uncertainty about how and when to RTW after experiencing a common mental disorder (CMD). Purpose The purpose of this scoping review is to disentangle the various stakeholders' role and actions in the RTW process of workers on sick-leave due to CMDs. The research question is: What is documented in the existing literature regarding the roles and actions of the identified stakeholders involved in the RTW process of workers on sick-leave due to CMDs? Methods In conducting this scoping review, we followed Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) methodology, consisting of different stages (e.g., charting the data by categorizing key results). Results 3709 articles were screened for inclusion, 243 of which were included for qualitative synthesis. Several RTW stakeholders (n=11) were identified (e.g., workers on sick leave due to CMDs, managers, union representatives, rehabilitation professionals, insurers, return to work coordinators). RTW stakeholders' roles and actions inter- and intra-system were recommended, either general (e.g., know and understand the perspectives of all RTW stakeholders) or specific to an actor (e.g., the return to work coordinator needs to create and maintain a working alliance between all RTW stakeholders). Furthermore, close to 200 stakeholders' actions, spread out on different RTW phases, were recommended for facilitating the RTW process. Conclusions Eleven RTW stakeholders from the work, heath and insurance systems have been identified, as well as their respective roles and actions. Thanks to these results, RTW stakeholders and policy makers will be able to build practical relationships and collaboration regarding the RTW of workers on sick leave due to CMDs.

Assessment of long-term sickness absence: content and face validity of a new questionnaire based on qualitative data from nominal groups

Background

Increasing rates of long-term sickness absence are a worldwide problem. Belgium is the first country in Europe that aims to screen its entire population of sick leavers (sick leave > 6 weeks) for the risk of long-term sickness absence in order to focus resources on the high-risk group and to provide adequate return-to-work support. Our aim was to investigate content and face validity of a newly designed questionnaire (Quickscan) using item prioritization of patients and professionals in the field of long-term sickness absence. This questionnaire was developed based on a review of the literature and existing instruments (Goorts et al, J Public Health Res 7:1419, 2018).

Methods

Qualitative data were collected using the nominal group technique. The data were gathered exploring factors that influence return-to work restrictions or opportunities.

Results

Participants indicated 20 out of 21 of the questionnaire factors as important reasons that might influence the return-to-work process. Additionally, 16 factors were discussed that were not yet included in the Quickscan but that might provide useful information on return-to-work issues, according to the participants. In the prioritization of items, we found considerable diversity among participants.

Conclusions

Our findings demonstrate the validity of the Quickscan items to ask patients about important return-to-work barriers or opportunities. However, additional factors were identified that may improve the assessment of risk for long-term sickness absence.

Working as a cancer survivor in Romania: an overview of the statutory policies for return to work

Purpose: Over the last several years, the number of working-age patients with cancer in Europe and Romania has consistently increased. Considerable efforts are made to bring cancer survivors back to the workforce, generating remarkable individual and societal benefits. Legislation and policies are essential factors in achieving this goal. The aim of the present article is to analyze the Romanian statutory policies for returning to work after cancer.Methods: A comprehensive search using key terms was carried out on the websites of the Ministry of Labor and Ministry of Health and also within the Romanian Official Gazette, which is the official national paper-based repository of legal documents. Nine work-related policy documents were found, and recurrent themes were identified. Within these themes, the authors synthetized the information on provisions, actors, structures, processes and responsibilities.Results: Three themes emerged from the analysis: (1) General and cancer-specific provisions; (2) The cancer survivor's journey in relation to work; and (3) Work adjustments. The policies contain no measures for incentivising return to work. The mechanisms for collaboration and coordination among stakeholders are not described in the policies.Conclusions: The current policies put an emphasis on compensation but fail to encompass activation measures. Considering that, for several components of the return to work process, the general principles are already stated in the law, it is vital to further develop the policies in the sense of specifying the procedures, roles and responsibilities for the stakeholders involved.IMPLICATIONS FOR REHABILITATIONBeing diagnosed with cancer can result in long-term disability and considerable difficulties to reenter the labor market which policy makers need to address.The legislation should focus on providing work-related activities and physical and vocational rehabilitation services to cancer survivors, as measures for an active labor market.The policy should provide vocational rehabilitation and work-related support groups for working-age patients with cancer, starting at the end of the first year of invalidity pension, thus preparing the transition back to the labor market.There is a pressing need to have a country-specific legislation for employers, as they have a tremendous impact on the return to work process.

An Evidence-Based Care Model for Workers With Concussion

OBJECTIVE

To evaluate the impact of an evidence-based assessment program for people with workers' compensation claims for concussion on healthcare utilization and duration of lost time from work.

SETTING

An assessment program for people with a work-related concussion was introduced to provide physician assessment focused on education and appropriate triage.

PARTICIPANTS

A total of 3865 people with accepted workers' compensation claims for concussion with dates of injury between January 1, 2014, and February 28, 2017.

DESIGN

A quasiexperimental pre-/poststudy of healthcare utilization (measured by healthcare costs) and duration of time off work (measured by loss of earnings benefits) in a cohort of people with workers' compensation claims for concussion in the period prior to and following introduction of a new assessment program. Administrative data were retrospectively analyzed to compare outcomes in patients from the preassessment program implementation period to those in the postimplementation period.

RESULTS

The assessment program resulted in reduced healthcare utilization reflected by a 14.4% (95% confidence interval, -28.7% to -0.8%) decrease in healthcare costs. The greatest decrease in healthcare costs was for assessment services (-27.9%) followed by diagnostic services (-25.7%). There was no significant difference in time off work as measured by loss-of-earnings benefits.

CONCLUSION

A care model for people with a work-related concussion involving an evidence-based assessment by a single physician focused on patient education resulted in significantly decreased healthcare utilization without increasing duration of time off work.

Acceptability and Feasibility of a Shared Decision-Making Model in Work Rehabilitation: A Mixed-Methods Study of Stakeholders' Perspectives

Purpose To establish the acceptability and feasibility of implementing a shared decision-making (SDM) model in work rehabilitation. Methods We used a sequential mixed-methods design with diverse stakeholder groups (representatives of private and public employers, insurers, and unions, as well as workers having participated in a work rehabilitation program). First, a survey using a self-administered questionnaire enabled stakeholders to rate their level of agreement with the model's acceptability and feasibility and propose modifications, if necessary. Second, eight focus groups representing key stakeholders (n = 34) and four one-on-one interviews with workers were conducted, based on the questionnaire results. For each stakeholder group, we computed the percentage of agreement with the model's acceptability and feasibility and performed thematic analyses of the transcripts. Results Less than 50% of each stakeholder group initially agreed with the overall acceptability and feasibility of the model. Stakeholders proposed 37 modifications to the objectives, 17 to the activities, and 39 to improve the model's feasibility. Based on in-depth analysis of the transcripts, indicators were added to one objective, an interview guide was added as proposed by insurers to ensure compliance of the SDM process with insurance contract requirements, and one objective was reformulated. Conclusion Despite initially low agreement with the model's acceptability on the survey, subsequent discussions led to three minor changes and contributed to the model's ultimate acceptability and feasibility. Later steps will involve assessing the extent of implementation of the model in real rehabilitation settings to see if other modifications are necessary before assessing its impact.

"Apping Up": Prospects for Information Technology Innovation in Return to Work Communication

Purpose During return to work (RTW), communication between health care providers and employers largely takes place through standardize paper-based forms. Information technology (IT) platforms may provide advantages in enabling information exchange and decision-making through sharing of guidelines and resources. We investigated stakeholder perspectives on the prospect of IT use for RTW communication in Ontario, Canada. Methods Consistent with the exploratory nature of the questions, qualitative methods were used. Primary data were interviews with health care providers (HCPs), employers, and workers with experience in RTW. The first portion of initial interviews elicited general perspectives and experiences related to RTW communication. Participants were then exposed to a prototype IT communication platform and elicited their feedback. Follow-up interviews with HCP's and EMP's were used to allow further reflection and clarification of data. We used progressive, thematic coding to analyze data. Results 12 HCPs, 7 employers, and 5 workers participated in the study. Five inter-related themes were obtained. Participants expressed no absolute objection to the use of IT for RTW communication but varying degrees of support. Participants revealed how media change depended on a prospective IT innovation's perceived usefulness, fit with current practices, capacity to gain buy-in from other stakeholders, and ability to demonstrate positive performance in actual practice. Conclusions Findings suggest that a transition to an IT-mediated tool for RTW communication is supported in principle; however, major caveats exist in relation to perceived value and fit with stakeholder practice. System support and stakeholder cooperation are likely necessary to adopt the change, yet IT-mediated communication has yet to demonstrate value. To avoid circularity, proof of principal needs to be established through an implementation trial of such technology.

Work disability negotiations: supervisors' view of work disability and collaboration with occupational health services

Purpose: To introduce the Finnish practice of collaboration aiming to enhance work participation, to ask supervisors about its reasons and usefulness, to study supervisors' needs when they face work disability, and to compare the experiences of supervisors whose profiles differ. Materials and methods: An online questionnaire based on the Finnish practice of collaboration between supervisor and occupational health services (OHS) went to supervisors in six public and private organizations. A total of 254 supervisors responded, of whom, 133 (52%) had collaborated in work disability negotiations, representing a wide variety with differing professional profiles. Results: In their role of managing work disability, supervisors appeared to benefit from three factors: an explicit company disability management (DM) policy, supervisors' training in DM, and collaboration with OHS. Reasons for work disability negotiations were long or repeated sick-leaves and reduced work performance. Expectations for occupational health consultations focused on finding vocational solutions and on obtaining information. Supervisors assessed the outcomes of collaboration as both vocational and medical. Supervisors with differing professional profiles prioritized slightly different aspects in collaboration. Conclusions: Collaboration with OHS is an important option for supervisors to enhance work modifications and the work participation of employees with work disability. Implications for Rehabilitation Work disability negotiation between supervisor, employee, and occupational health services (OHS) is an effective method to enhance work participation. Collaboration with occupational health can advance work modifications and also lead to medical procedures to improve work performance. Supervisor training, companies' explicit disability management policy, and collaboration with OHSs all advance employee's work participation. Collaboration with OHSs may serve as training for supervisors in their responsibility to support work participation.

[Interventions to support the return-to-work process after cancer: a literature review]

Returning to work after cancer can be challenging for cancer survivors and little is known about interventions designed to support survivors returning to work.

PURPOSE

The objective of this review was to identify interventions designed to support the return-to-work process after a cancer diagnosis.

METHODS

A literature review was performed mainly done by consulting bibliographical databases. Systematic analysis and interpretation of the results were then performed.

RESULTS

Twenty-two articles were identified. The first finding is that very few interventions are specifically devoted to return to work after cancer and are usually administered in the clinical setting by healthcare practitioners. The activities proposed to support return to work in these interventions are individual counselling, provision of information and support groups. These activities are provided by various multidisciplinary teams composed of one or more professionals: occupational physicians, social workers and nurses. A second finding is that even with the use of experimental and quasi-experimental approaches, no effect was observed on return to work.

CONCLUSION

This integrative review highlights two recommendations for the development of future interventions. First, to improve the efficacy of future interventions on return to work of cancer survivors, these interventions must be developed and supported by an intervention theory. Second, future interventions must include and mobilize workplaces.

Developing a Return to Work Intervention for Breast Cancer Survivors with the Intervention Mapping Protocol: Challenges and Opportunities of the Needs Assessment

Return to work (RTW) is an important step for breast cancer survivors (BCSs). However, they face many barriers that affect particularly women with low socioeconomic status (SES). Health care, workplace, and insurance actors lack knowledge and collaborate poorly. No intervention to date has proven effective to reduce social disparities in employment after breast cancer. The intervention mapping (IM) protocol is being used in France to develop, implement, and evaluate an intervention to facilitate and sustain RTW after breast cancer [FAciliter et Soutenir le retour au TRAvail après un Cancer du Sein (FASTRACS) project]. The research question of this study was to elicit the needs for RTW after breast cancer from various stakeholders' point of view. The aim of this study was to describe the process and the preliminary results of the needs assessment of the FASTRACS project. Different methods were followed to (a) establish and work with a planning group and (b) conduct a needs assessment to create a logic model of the problem. A planning group was organized to gather the stakeholders with the research team. A review of the literature and indicators was conducted to identify the magnitude of the problem and the factors influencing RTW. A qualitative inquiry was conducted with 12 focus groups and 48 individual semi-structured interviews to explore the needs and experience of the stakeholders. The results of these tasks were the proposition of a charter of partnership to structure the participative process, a review of the scientific evidence and indicators, and the description by the stakeholders of their needs and experience. Many stakeholders disagreed with the concept of "early intervention." They advocated for a better support of BCSs during their RTW, emphasized as a process. Anticipation, intersectoral collaboration, and workplace accommodation were mentioned to fit the needs of the BCS and their environment. A logic model of the problem was elaborated from these data. The ability of the model to consider specific characteristics of women with low SES is discussed, with a view to developing the FASTRACS intervention through the next steps of the IM protocol.

Australian general practitioners' perspective on the role of the workplace Return-to-Work Coordinator

General practitioners (GPs) play a key role in the return-to-work process, and yet their experiences working with workplace Return-to-Work Coordinators (RTWCs) have rarely been studied. The aim of this paper is to provide insights from the GP perspective about their experiences with workplace RTWCs and their preparedness for the role. GPs from Australian states and territories where legislation mandates workplaces employ a RTWC were requested to complete a questionnaire on their experiences with workplace RTWCs. Fifty GPs completed a questionnaire on the preparedness of RTWCs in relation to their role, with 58% (n=29) indicating RTWCs require more training. A total of 78% (n=39) of respondents considered RTWCs were important in assisting injured workers return to work, with 98% (n=49) ranking trustworthiness, respectfulness and ethicalness as the most important or an important trait for a RTWC to possess. Interestingly, 40% (n=20) of respondents themselves reported having no training in the return-to-work process. GPs acknowledge the importance of the workplace RTWC in the return-to-work process, and the results highlight the need for RTWCs to possess specific traits and undergo appropriate training for the facilitation of a successful return to work for injured workers.

Insurance workers' and physiotherapists' perceptions of their roles in the management of workers with injuries in the Western Australian workers' compensation system

BACKGROUND

Insurance workers and physiotherapists are important stakeholders in the rehabilitation of workers with an injury and subsequent musculoskeletal pain. Understanding perceptions of roles may facilitate communication between these stakeholders.

OBJECTIVE

Increase knowledge around, (i) the self-perception of and (ii) the external perception of the insurance workers and physiotherapists roles in the management of a worker with an injury in an Australian workers' compensation environment.

METHODS

A cross-sectional study assessed the perceptions of insurance workers and physiotherapists related to the roles of these two professions in managing a worker with an injury via questionnaire. Respondents were also asked about potential communication barriers.

RESULTS

Insurance workers (n = 48) and physiotherapists (n = 80) reported contrasting role perceptions, with their perception of the other profession leaning towards negative attributes. There was greater alignment of their beliefs of roles in the 'ideal' situation. The perception of barriers to communication also differed between the two professions. Effective and efficient communication was identified as a central component of mismatched role perceptions between stakeholders, but recognised as a critical attribute of 'ideal' stakeholder roles.

CONCLUSION

Insurance workers and physiotherapists self-perception of their roles differs from external perceptions. This information highlights the importance of a shared understanding of stakeholder roles in the management of a worker with an injury.

Assessing work disability for social security benefits: international models for the direct assessment of work capacity

PURPOSE

It has been argued that social security disability assessments should directly assess claimants' work capacity, rather than relying on proxies such as on functioning. However, there is little academic discussion of how such assessments could be conducted.

METHOD

The article presents an account of different models of direct disability assessments based on case studies of the Netherlands, Germany, Denmark, Norway, the United States of America, Canada, Australia, and New Zealand, utilising over 150 documents and 40 expert interviews.

RESULTS

Three models of direct work disability assessments can be observed: (i) structured assessment, which measures the functional demands of jobs across the national economy and compares these to claimants' functional capacities; (ii) demonstrated assessment, which looks at claimants' actual experiences in the labour market and infers a lack of work capacity from the failure of a concerned rehabilitation attempt; and (iii) expert assessment, based on the judgement of skilled professionals.

CONCLUSIONS

Direct disability assessment within social security is not just theoretically desirable, but can be implemented in practice. We have shown that there are three distinct ways that this can be done, each with different strengths and weaknesses. Further research is needed to clarify the costs, validity/legitimacy, and consequences of these different models. Implications for rehabilitation It has recently been argued that social security disability assessments should directly assess work capacity rather than simply assessing functioning - but we have no understanding about how this can be done in practice. Based on case studies of nine countries, we show that direct disability assessment can be implemented, and argue that there are three different ways of doing it. These are "demonstrated assessment" (using claimants' experiences in the labour market), "structured assessment" (matching functional requirements to workplace demands), and "expert assessment" (the judgement of skilled professionals). While it is possible to implement a direct assessment of work capacity for social security benefits, further research is necessary to understand how best to maximise validity, legitimacy, and cost-effectiveness.

Gender, Cultural Influences, and Coping with Musculoskeletal Pain at Work: The Experience of Malaysian Female Office Workers

Purpose Workers with musculoskeletal pain (MSP) often continue to work despite their condition. Understanding the factors that enable them to remain at work provides insights into the development of appropriate workplace accommodations. This qualitative study aims to explore the strategies utilised by female Malaysian office workers with MSP to maintain productive employment. Methods A qualitative approach using thematic analysis was used. Individual semi-structured interviews were conducted with 13 female Malaysian office workers with MSP. Initial codes were identified and refined through iterative discussion to further develop the emerging codes and modify the coding framework. A further stage of coding was undertaken to eliminate redundant codes and establish analytic connections between distinct themes. Results Two major themes were identified: managing the demands of work and maintaining employment with persistent musculoskeletal pain. Participants reported developing strategies to assist them to remain at work, but most focused on individually initiated adaptations or peer support, rather than systemic changes to work systems or practices. A combination of the patriarchal and hierarchical cultural occupational context emerged as a critical factor in the finding of individual or peer based adaptations rather than organizational accommodations. Conclusions It is recommended that supervisors be educated in the benefits of maintaining and retaining employees with MSP, and encouraged to challenge cultural norms and develop appropriate flexible workplace accommodations through consultation and negotiation with these workers.

Injured workers' perception of loss and gain in the return to work process

When a worker is injured at work, he has to face a tough decision-making process about when and how to return to work (RTW). This study tests how the prospect theory can be applied to influence the injured workers’ perceptions about this important choice. One hundred forty-one injured workers were presented with wage- and pain-related information in four different message framing (negatively or positively) and precision (smaller or larger number) conditions. After exposure to the specific combination of this wage and pain information, the participants were asked to express intentions to RTW in terms of perceived chance, confidence, and anticipated sick leave duration. When asked to predict their RTW outcome, 101 participants (72.3%) responded favorably, whereas only 40 (27.7%) indicated an expectation for staying on sick leave. The present results did not show significant differences in the participants’ responses to the positively and negatively framed information about wage and pain. However, it was noted that the control group that was presented with positive framing for both “wage” and “pain” information showed higher scores in expectation and confidence for RTW, whereas the Ambivalent Group that had both negative messages showed lower scores. Seventy-nine participants who had ≥60% perceived improvement in condition were selected for further analysis, and those who were presented with “wage loss” information rated significantly higher perceived chance of RTW than those in the “pain gain” group. More in-depth investigation is warranted on this topic, with a larger sample of injured workers to investigate the effects of message framing on the decision-making process about RTW.

Multi-disciplinary Orthopaedics Rehabilitation Empowerment (MORE) program: A new standard of care for injured workers in Hong Kong

BACKGROUND

The objective of this study is to evaluate the effects of the Multi-disciplinary Orthopaedics Rehabilitation Empowerment (MORE) Program on reducing chronic disability among injured workers and improving efficiency of work rehabilitation process.

METHODS

A cohort of patients with workplace injuries in the lower back were recruited from orthopaedics clinics and assigned to either MORE group (n= 139) or control group (n= 106). Patients in MORE group received an early MRI screening and a coordinated multi-disciplinary management, while patients in the control group received conventional care. Outcome variables are time to return-to-work (RTW) from date of injury, waiting time for MRI screening and time to medical assessment board (MAB).

RESULTS

Patients in the MORE Program had significantly shorter duration for RTW (MORE: 6.1 months,

CONTROL

12.8 months, p< 0.01), and more RTW cases (n= 64, 46.0%) compared to CONTROL group (n= 29, 27.4%). The MORE group also had much shorter waiting time for MRI scans (91.85 vs. 309.2 days, p< 0.001) and MAB referral after MRI scans (97.2 vs. 178.9 days, p= 0.001) compared to CONTROL group.

CONCLUSIONS

The MORE Program which emphasizes early intervention and early MRI screening, is shown to be effective in shortening sick leave and improving RTW outcomes of injured workers.

The Added Value of Collecting Information on Pain Experience When Predicting Time on Benefits for Injured Workers with Back Pain

Objectives Some injured workers with work-related, compensated back pain experience a troubling course in return to work. A prediction tool was developed in an earlier study, using administrative data only. This study explored the added value of worker reported data in identifying those workers with back pain at higher risk of being on benefits for a longer period of time. Methods This was a cohort study of workers with compensated back pain in 2005 in Ontario. Workplace Safety and Insurance Board (WSIB) data was used. As well, we examined the added value of patient-reported prognostic factors obtained from a prospective cohort study. Improvement of model fit was determined by comparing area under the curve (AUC) statistics. The outcome measure was time on benefits during a first workers' compensation claim for back pain. Follow-up was 2 years. Results Among 1442 workers with WSIB data still on full benefits at 4 weeks, 113 were also part of the prospective cohort study. Model fit of an established rule in the smaller dataset of 113 workers was comparable to the fit previously established in the larger dataset. Adding worker rating of pain at baseline improved the rule substantially (AUC = 0.80, 95 % CI 0.68, 0.91 compared to benefit status at 180 days, AUC = 0.88, 95 % CI 0.74, 1.00 compared to benefits status at 360 days). Conclusion Although data routinely collected by workers' compensation boards show some ability to predict prolonged time on benefits, adding information on experienced pain reported by the worker improves the predictive ability of the model from 'fairly good' to 'good'. In this study, a combination of prognostic factors, reported by multiple stakeholders, including the worker, could identify those at high risk of extended duration on disability benefits and in potentially in need of additional support at the individual level.

"Dis-able bodied" or "dis-able minded": stakeholders' return-to-work experiences compared between physical and mental health conditions

PURPOSE

This study aimed to explore if and why the return-to-work (RTW) experiences of various workplace stakeholders in the Netherlands and Denmark differ between physical and mental health conditions, and to understand the consequences of potentially different experiences for the RTW process in both health conditions.

METHODS

We studied 21 cases of long-term sickness absence, and held a total of 61 semi-structured interviews with the various actors involved in these cases.

RESULTS

Physical cases were seen as "easy" and mental cases as "difficult" to manage, based on the visibility and predictability of health complaints. On this ground, assessing work ability and following required RTW actions were perceived as more urgent in mental than in physical cases. Despite these perceptions, in practice, the assessment of work ability seemed to impair the RTW process in mental cases (but not in physical ones), and the (non-)uptake of RTW actions appeared to have similar results in both mental and physical cases.

CONCLUSIONS

With these outcomes, the effectiveness of a differential approach is questioned, and the relevance of a bidirectional dialog on work ability and a phased RTW plan is highlighted, regardless of the absence cause. Our study also demonstrates how policymakers need to strike a balance between obligatory and permissive legislation to better involve workplaces in RTW issues. Implications for rehabilitation Both physically and mentally sick-listed employees could benefit from a bidirectional dialog on work ability as well as from a phased RTW plan. A greater role for employers in the RTW process should be accompanied with a support for sick-listed employees, in both physical and mental sickness absence cases. Dutch and Danish RTW legislation could be improved by carefully balancing obligatory and permissive rules and regulations to involve workplaces in RTW matters.

Hospital Qualities Related to Return to Work from Occupational Injury after Controlling for Injury Severity as Well as Occupational Characteristics

We examined associations between hospital quality in the workers' compensation system and injured patients' return to work after controlling for injury severity, occupational factors, and demographic factors. Return to work data of injured workers were constructed from 2 datasets: 23,392 patients injured in 2009-2011 from the Korea Workers' Compensation & Welfare Service and return to work data from Korea Employment Information Services. After de-identifying the data, quality scores were matched for each hospital that cared for injured patients. Injury severity was measured by Abbreviated Injury Scales. Relative risk and 95% confidence interval were calculated using log binomial regression models. After adjusting for age, sex, injury severity, occupation, factory size, city, and hospital type, the relative risk (95% confidence interval) for the total score was 1.04 (1.02-1.06), 1.06 (1.04-1.09), and 1.07 (1.05-1.10) in the 2(nd), 3(rd), and 4(th) quartiles, respectively, compared to the 1(st) quartile. The RR (95% CI) in the 2(nd), 3(rd), and 4(th) quartiles was 1.05 (1.02-1.07), 1.05 (1.02-1.08), and 1.06 (1.04-1.09) for the process score; and 1.02 (1.01-1.04), 1.05 (1.03-1.07), and 1.06 (1.04-1.09) for the outcome score compared to the 1(st) quartile score, respectively. In conclusion, our study design with blinded merge methods shows that total, process, and outcome qualities are related to the return to work of injured workers after controlling for other factors.

The Management of Long-Term Sickness Absence in Large Public Sector Healthcare Organisations: A Realist Evaluation Using Mixed Methods

PURPOSE

The success of measures to reduce long-term sickness absence (LTSA) in public sector organisations is contingent on organisational context. This realist evaluation investigates how interventions interact with context to influence successful management of LTSA.

METHODS

Multi-method case study in three Health and Social Care Trusts in Northern Ireland comprising realist literature review, semi-structured interviews (61 participants), Process-Mapping and feedback meetings (59 participants), observation of training, analysis of documents.

RESULTS

Important activities included early intervention; workplace-based occupational rehabilitation; robust sickness absence policies with clear trigger points for action. Used appropriately, in a context of good interpersonal and interdepartmental communication and shared goals, these are able to increase the motivation of staff to return to work. Line managers are encouraged to take a proactive approach when senior managers provide support and accountability. Hindering factors: delayed intervention; inconsistent implementation of policy and procedure; lack of resources; organisational complexity; stakeholders misunderstanding each other's goals and motives.

CONCLUSIONS

Different mechanisms have the potential to encourage common motivations for earlier return from LTSA, such as employees feeling that they have the support of their line manager to return to work and having the confidence to do so. Line managers' proactively engage when they have confidence in the support of seniors and in their own ability to address LTSA. Fostering these motivations calls for a thoughtful, diagnostic process, taking into account the contextual factors (and whether they can be modified) and considering how a given intervention can be used to trigger the appropriate mechanisms.

Predicting time on prolonged benefits for injured workers with acute back pain

INTRODUCTION

Some workers with work-related compensated back pain (BP) experience a troubling course of disability. Factors associated with delayed recovery among workers with work-related compensated BP were explored.

METHODS

This is a cohort study of workers with compensated BP in 2005 in Ontario, Canada. Follow up was 2 years. Data was collected from employers, employees and health-care providers by the Workplace Safety and Insurance Board (WSIB). Exclusion criteria were: (1) no-lost-time claims, (2) >30 days between injury and claim filing, (3) <4 weeks benefits duration, and (4) age >65 years. Using proportional hazard models, we examined the prognostic value of information collected in the first 4 weeks after injury. Outcome measures were time on benefits during the first episode and time until recurrence after the first episode.

RESULTS

Of 6,657 workers, 1,442 were still on full benefits after 4 weeks. Our final model containing age, physical demands, opioid prescription, union membership, availability of a return-to-work program, employer doubt about work-relatedness of injury, worker's recovery expectations, participation in a rehabilitation program and communication of functional ability was able to identify prolonged claims to a fair degree [area under the curve (AUC) = .79, 95% confidence interval (CI) .74-.84]. A model containing age, sex, physical demands, opioid prescription and communication of functional ability was less successful at predicting time until recurrence (AUC = .61, 95% CI .57, .65).

CONCLUSIONS

Factors contained in information currently collected by the WSIB during the first 4 weeks on benefits can predict prolonged claims, but not recurrent claims.

The role of the Australian workplace return to work coordinator: essential qualities and attributes

INTRODUCTION

In the Australian context, a return to work (RTW) Coordinator assists an injured worker with workplace-based support and regulatory guidance for the duration of their injury. Coordinating the RTW process has been considered an effective approach for managing workplace injuries, however few studies have described the skills, traits or characteristics required to fulfil the role of workplace RTW Coordinator. This study aims to provide insight as to the skills and attributes needed for the role of the workplace RTW Coordinator from their experience and perception.

METHOD

Focus groups were conducted with workplace RTW Coordinators from six major Australian cities. Twenty five participants were recruited through a national RTW Coordinator website, and professional RTW interest groups using a snowballing technique. Participating workplace RTW Coordinators were required to have a minimum 2 years' experience and to have been involved with the development and implementation of workplace policies and procedures. Thematic analysis was performed to identify meaningful patterns and themes.

RESULTS

The data analysed provided clear insight as to the specific role requirements necessary for working as an Australian workplace RTW Coordinator. Three key themes clearly emerged; communication skills, RTW Coordinator characteristics, and managing the RTW process.

CONCLUSION

The findings indicate that RTW Coordinators require a wide range of traits, skills, and attributes to successfully perform this role. Effective management by the RTW Coordinator of the complex RTW process is essential to facilitate a smooth transition for the injured worker, alongside maintaining a professional relationship with the employer and external stakeholders. The results of this study can be utilised to further improve the selection of future RTW Coordinators.

After the storm: the social relations of return to work following electrical injury

In this study, we explored the experiences of 13 individuals who had suffered an electrical injury at work and had subsequently returned to work. In this article, we report on the social, institutional, and relational elements that workers perceived to influence return to work experiences and the provision of workplace accommodations. These elements included (a) worker resources, (b) job characteristics, (c) workplace setting, (d) injury elements, (e) workers' compensation context, and (f) supports and advocacy provided. We conclude that the availability and provision of supportive accommodations are influenced by a multiplicity of interrelated factors including the legitimacy of resulting impairments following electrical injury, institutional structures (e.g., compensation and health care systems), the social relations of work, and broader labor market and economic contexts. Those workers who were vulnerable because of factors such as employment circumstances or labor market conditions were often poorly supported when returning to work following electrical injury.

Communicating with employers: experiences of occupational therapists treating people with musculoskeletal conditions

PURPOSE

Many employed people with musculoskeletal conditions rely on healthcare practitioners, including occupational therapists, for work-related advice and support. Good communication between healthcare practitioners and employers is considered vital in facilitating work retention and return to work. The purpose of this study was to explore the experiences of occupational therapists in communicating with patients' employers.

METHODS

Qualitative data were collected from the responses of occupational therapists to ten statements/open questions in a questionnaire survey of UK occupational therapists. Data were copied verbatim into word documents and analysed thematically.

RESULTS

A total of 649 comments were made by 143 respondents. Five themes were identified that were associated with communicating with employers: patient-dependent; employer-dependent; therapist-dependent; extrinsic factors; methods of communication.

CONCLUSION

This study has identified that communication between occupational therapists and employers is influenced by a number of factors, including those which are outside the therapists' control. These need to be acknowledged and addressed by therapists, their professional organisation, employers, commissioners, therapy service managers, educators and employees in order to support return-to-work and work retention of people with musculoskeletal conditions.

Injured workers' perspectives on how workplace accommodations are conceptualized and delivered following electrical injuries

PURPOSE

Returning to work following an electrical injury can be challenging due to the confluence of physical, cognitive and emotional impairments. Workplace accommodations can facilitate return to work. However, while electrical injuries can have potentially devastating consequences, there is a dearth of understanding of how workplace accommodations are obtained following electrical injury. This paper explores workers' experiences of returning to work and accommodations following an occupation electrical injury.

METHODS

Thirteen semi-structured qualitative telephone interviews were conducted with injured workers recruited from acute and rehabilitation burns programs in Ontario, Canada. Thematic analysis was employed to identify themes related to the request and provision of accommodations.

FINDINGS

Findings reveal that accommodations are most frequently narrowly defined in relation to physical work restrictions, leading to the exclusion of cognitive and psychosocial concerns. Challenges within the accommodations process such as perceived legitimacy, a do-it-yourself approach to accommodations, and concerns regarding job security can also influence workers' decisions to request accommodations. Process elements that facilitate the effective provision of workplace accommodations include: (1) finding a "just right" fit between workers' abilities and assigned tasks and duties (2) establishing effective lines of communication between relevant stakeholders; (3) prompt response to needs; (4) having a knowledgeable individual in a position of power to advocate on workers' behalf.

CONCLUSIONS

Further education regarding electrical injuries and workplace accommodations is warranted to increase workers', employers', health and insurance personnels' knowledge about electrical injury and best practices for providing workplace accommodations.

Topics and trends in research on non-clinical interventions aimed at preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs): a systematic, comprehensive literature review

PURPOSE

This study sought to provide an overview of the main topics and trends in contemporary research on successful non-clinical interventions for preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs).

METHODS

A systematic electronic search (English and French) was performed in ten scientific databases using keywords and descriptors. After screening the identified titles and abstracts using specific sets of criteria, categorical and thematic analyses were performed on the retained articles.

RESULTS

Five main topics appear to dominate the research: (1) risk factors and determinants; (2) effectiveness of interventions (programmes, specific components, strategies and policies); (3) viewpoints, experiences and perceptions of specific actors involved in the intervention process; (4) compensation issues; and (5) measurement issues. A currently widespread trend is early screening to identify risks factors for appropriate intervention and multidisciplinary, multimodal approaches. Morover, workplace-related psychosocial and ergonomic factors are considered vital to the success and sustainability of return-to-work (RTW) interventions. Finally, involving workplace actors, and more specifically, affected workers, in the RTW process appears to be a powerful force in improving the chances of moving workers away from disabled status.

CONCLUSIONS

The findings of this literature review provide with information about the main topics and trends in research on rehabilitation interventions, revealing some successful modalities of intervention aimed at preventing prolonged work disability.

IMPLICATIONS FOR REHABILITATION

Successful intervention for preventing prolonged work disability in workers compensated for WRMSDs address workplace issues: physical and psychosocial demands at work, ability of the workers to fill these demands, work organization and support of the worker, and worker' beliefs and attitudes related to work. Successful intervention promotes collaboration, coordination between all actors and stakeholders involved in the process of rehabilitation. Strategies able to mobilize the employees, employers, insurers and health care providers are still needed to be implemented.

Supporting Workers with Musculoskeletal Conditions: A Survey of United Kingdom Occupational Therapists' Communications with Clients and Their Employers

Introduction:

Musculoskeletal conditions are a common cause of sickness absence and work disability. Little is known about the work-related advice and support that occupational therapists provide to this client group and their employers. The purpose of this study was to report on current occupational therapy practice in this area in the United Kingdom.

Method:

A questionnaire survey was conducted, of United Kingdom occupational therapists treating employed clients with musculoskeletal conditions in community or outpatient settings. Questionnaires were posted to 960 hospitals or units, identified through National Health Service websites to reach as many respondents as possible, and the survey was also available online.

Findings:

257 respondents reported on their provision of work-related advice and support. Of these, over 30% (n = 82) reported that this involved a moderate amount of their time; 60% (n = 154) had experience of contacting employers and 21% (n = 55) had met with clients' employers in the previous year. Time and resources, concern about legal implications, and having the appropriate skills had an impact on communication between therapists and employers.

Conclusion:

The findings demonstrate considerable variations in service delivery, interventions, and the contact made with employers. These need urgent attention if the profession is to meet the challenges of the government's agenda for improving health at work.

Buddies in bad times? the role of co-workers after a work-related injury

INTRODUCTION

Co-workers can play an important role after a work-related injury. They can provide details about the circumstances of an accident, offer emotional support to the injured worker and help with job tasks upon a co-worker's return to work (RTW). Working with an injured co-worker, however, can also strain work relationships and increase workload. The purpose of this study was to determine the role that co-workers play after a work-related injury and during the RTW process in the unionized, electrical construction sector.

METHODS

We conducted two focus groups with injured electricians and union representatives. We also interviewed co-workers who had worked with someone who had been injured in the course of employment. We examined the role that co-workers can play after a work-related injury and some of the factors facilitating and hindering co-worker support.

RESULTS

The structure of work in the electrical sector-a focus on cost-cutting and competition, job insecurity, perceptions of "different camps" among co-workers, little modified work and poor formal communication-can impede co-worker support and contribute to making injured workers' experiences difficult. Management can play an important role in setting an example for how injured workers are regarded and treated.

CONCLUSIONS

Future research should explore how workers can better be supported after a work-related injury and during the RTW process.

Improving work participation for adults with musculoskeletal conditions

The impact of musculoskeletal disorders on work is demanding more attention from clinicians. For many rheumatologists, inflammatory arthritis is the most frequently encountered condition that interferes with work. However, the cumulative burden of non-inflammatory arthropathies and disorders such as back pain, osteoarthritis and limb pain as a whole results in a much greater economic and human cost to society than inflammatory disease. New conceptual approaches and research results support the view that work loss does not need to be a frequent consequence of a musculoskeletal disorder or disability. This is often accomplished through a biopsychosocial and interdisciplinary approach, involving interaction between those with a musculoskeletal condition, their clinicians and employers. This review outlines the challenges and draws on the results of empirical studies to highlight potential opportunities to promote sustained ability for patients to successfully remain on the job. It also outlines future research opportunities.

Policy and practice of work ability: a negotiation of responsibility in organizing return to work

PURPOSE

In welfare policy and practical work it is unclear what the concept of work ability involves and assessments may be different among involved actors, partly due to a lack of theoretical research in relation to regulations and practice. Based on theoretical and legal aspects of work ability the aim of the study is to analyze stakeholders' perspectives on work ability in local practice by studying multi-stakeholder meetings.

METHODS

The material comprises nine digitally recorded multi-stakeholder meetings. Apart from the sick-listed individual, representatives from the public Social Insurance Agency, health care, employers, public employment service and the union participated in the meeting. The material was analyzed using qualitative content analysis.

RESULTS

Three perspectives on work ability were identified: a medical perspective, a workplace perspective and a regulatory perspective. The meetings developed into negotiations of responsibility concerning workplace adjustments, rehabilitation efforts and financial support. Medical assessments served as objective expert statements to legitimize stakeholders' perspectives on work ability and return to work.

CONCLUSIONS

Although the formal goal of the status meeting was to facilitate stakeholder collaboration, the results demonstrates an unequal distribution of power among cooperating actors where the employers had the "trump card" due to their possibilities to offer workplace adjustments. The employer perspective often determined whether or not persons could return to work and if they had work ability.

Management of long term sickness absence: a systematic realist review

PURPOSE

The increasing impact and costs of long term sickness absence have been well documented. However, the diversity and complexity of interventions and of the contexts in which these take place makes a traditional review problematic. Therefore, we undertook a systematic realist review to identify the dominant programme theories underlying best practice, to assess the evidence for these theories, and to throw light on important enabling or disabling contextual factors.

METHOD

A search of the scholarly literature from 1950 to 2011 identified 5,576 articles, of which 269 formed the basis of the review.

RESULTS

We found that the dominant programme theories in relation to effective management related to: early intervention or referral by employers; having proactive organisational procedures; good communication and cooperation between stakeholders; and workplace-based occupational rehabilitation. Significant contextual factors were identified as the level of support for interventions from top management, the size and structure of the organisation, the level of financial and organisational investment in the management of long-term sickness absence, and the quality of relationships between managers and staff.

CONCLUSIONS

Consequently, those with responsibility for managing absence should bear in mind the contextual factors that are likely to have an impact on interventions, and do what they can to ensure stakeholders have at least a mutual understanding (if not a common purpose) in relation to their perceptions of interventions, goals, culture and practice in the management of long term sickness absence.

Supporting return-to-work in the face of legislation: stakeholders' experiences with return-to-work after breast cancer in Belgium

BACKGROUND

The diagnosis of breast cancer increasingly implies a return-to-work (RTW) challenge as survival rates increase. RTW is regarded as a multidisciplinary process and a country's legislation affects the degree of involvement of the different stakeholders. We elucidated on bottlenecks and contributing factors and the relationship between policy and practice regarding RTW of employees with breast cancer as perceived by Belgian (Flemish) stakeholders.

METHODS

Three multidisciplinary groups (n = 7, n = 9, n = 10) were interviewed during a breast cancer conference. Treating physicians (n = 4), employers (n = 6), social security physicians (n = 3), occupational physicians (n = 4), survivors (n = 5) and representatives of patient associations (n = 4) were included. The major theme was the legal and practical role in the RTW process as experienced by the participants. Qualitative thematic analysis was performed to analyse stakeholders' experiences of women's RTW after breast cancer.

RESULTS

The stakeholders reported different perspectives. Employees focus on treatment and feel ill-informed about the RTW options. Treating physicians do not feel competent about advising on work-related questions. Employers have to balance the interests of both the business and the employee. Social security physicians assess ability to work and facilitate RTW options. Occupational physicians see opportunities but the legislation does not support their involvement. Stakeholders expressed the need for coordination and reported finding ways to accommodate the employee's needs by being flexible with the legislation to support the RTW process.

CONCLUSIONS

Two factors might hamper RTW for breast cancer patients: the varying stakeholder perspectives and Belgian legislation which emphasizes the patient or disability role, but not the employee role. When stakeholders are motivated they find ways to support RTW, but improved legislation could support the necessary coordination of RTW for these patients.