WORKPLACE FACTORS

ARTICLE #1. WORK IS THERAPEUTIC – REHABILITATION AT WORK

At a glance:
‘Therapeutic Return to Work' is a rehabilitation program that arranges modified work duties so that employees can get back to work before they have fully recovered. It recognizes work as therapeutic in itself. This approach to rehabilitation gets people back to work more quickly, and improves the chances that they will eventually resume their normal duties.

PERSPECTIVES:

Employee
This study shows the benefits of returning to activity as part of the recovery process. Sometimes people believe their condition should be better before they take on home or work tasks. This and a number of other studies show that early return to function helps people have better long term outcomes.

Identifying appropriate work tasks, working together with your treaters and employer to coordinate a return to work, and the focus of the rehabilitation system are all important factors in resuming work duties.

Employer
Rehabilitation programs which specifically focus on the return to work can be more effective. An example of one such program identified here helps the injured person return to work by:

- Initially providing modified duties
- Gradually increasing duties to pre-injury levels

This allows the injured person to re-enter the workforce before they have fully recovered, getting them back sooner and increasing their chances of resuming full duties. This approach can be effective even when employees have been off work for a long time.

Treater
Rates of return to work are improved by programs that provide modified duties and a graduated return to pre-injury tasks. This was true of 'Therapeutic Return to Work', even though participants had been off work for a long time.

An individual's reported level of pain and disability did not seem to affect these outcomes. Rather, the structured focus on return to work and provision of appropriate tasks largely determined the outcome. People who underwent functional restoration programs had less successful outcomes.

When rehabilitation is focused on enabling a return to work, outcomes can be improved.

Insurer
Return to work outcomes depend on the approach taken by the employer, and the treatment system in place. In this study, there was an expectation that people would return to normal duties, and a system in place which gradually returned them to these tasks. Not everyone returned to work, but the outcomes were significantly improved. This shows that when stakeholders work together, return to work outcomes are improved.

Original Article, Authors & Publication Details:
Durand M-J, Loisel P.

Therapeutic return to work: Rehabilitation in the workplace.
Work: Journal of Prevention, Assessment & Rehabilitation. Vol 17(1) 2001, 57-64. 2001.

Background, Study Objectives, How It Was Done:
Back pain is a common condition, most sufferers return to their normal activities in one to three months. 5-10% of sufferers, however, develop a long-term disability. This group has the greatest degree of suffering, and accounts for the majority of treatment costs. The author notes that prolonged absence from work leads to physical de-conditioning, anxiety, fear of re-injury, and loss of self-esteem.

When people return to work on modified duties, they can return sooner and are more likely to resume their normal duties in time.

An intervention program known as “Therapeutic Return to Work' was compared with control groups. The study was undertaken in Canada.

The therapeutic return to work program had the following features:

• The rehabilitation program was based at the workplace.
• Modified work duties were agreed on by the rehabilitation team and the employee's supervisor. The worker was typically placed back at work as an extra, to avoid problems associated with reduced productivity.
• Work time and physical load were increased over 4-8 weeks until pre-injury duties were reached.
• The patients in this study had been referred to a hospital-based rehabilitation program for back pain.

Three control groups were chosen:

1. Workers undergoing a functional restoration program
2. A group receiving no rehabilitation
3. Patients who had been referred to the therapeutic return to work or functional restoration programs, but had their access to the programs denied by the relevant compensation authority.

An initial assessment was performed, and a follow-up assessment at least six months after the program was completed. The authors measured the number of patients who had returned to their pre-injury duties.

The authors also asked about quality of life, back disability, pain intensity, and fear avoidance through a series of questionnaires. Information collected was then entered into statistical software for detailed analysis.

Study Findings:
28 people participated in the therapeutic return to work group, all of whom had back pain. The average time between receiving an injury and beginning the program was seven months.

When follow up assessments were conducted:

• 93% of those who participated in the therapeutic return to work program had returned to pre-injury duties. The average time at which these follow up assessments were made was 25 months post-injury.
• Even though most of the therapeutic return to work group was back at work, many still had pain and some degree of disability.
• 73% of workers in the functional restoration group had returned to full duties by the time the follow-up assessment was conducted (28 months post-injury, on average.)
• 72% of the group that did not receive rehabilitation had returned to full duties.
• 33% of the group who had been refused access to the rehabilitation programs had returned to full duties. As with the therapeutic return to work group, a number of people from this group had ongoing pain, fears, and some degree of disability.

Those who participated in the therapeutic return to work program had a substantially higher chance of returning to full duties and staying at work. Return to work rates for this group were especially high given the substantial period of time between receiving an injury and beginning the program, during which participants were not at work.

This study shows that interventions which are strongly focused on returning people to work improve participants' chances of returning to full duties and staying at work.

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