Summary report of action research on occupational rehabilitation and community re-integration of migrant workers with work injuries in Mainland China

This article is a summary of an action research exploring the strategies to initiate the occupational rehabilitation and community re-integration of migrant workers with work injuries in Guangdong Province, China. Using two cases of rehabilitation intervention for workers with work injury, a case management model of occupational rehabilitation and community re-integration was illustrated, in the different phases of rehabilitation. Finally, some key elements in supporting occupational rehabilitation and community re-integration for migrant workers with work injury in China were highlighted.     

Work rehabilitation for migrant workers with work injury--the magic of Chinese paper cutting

As China has gradually transformed from agricultural economy into industrial economy since 1978, occupational injuries and diseases become a serious social problem in China. For occupational rehabilitation professionals, helping workers with occupational injuries and diseases, return to work and re-integrate to community are the ultimate goals of occupational rehabilitation. This article reports a new indigenous initiative with cultural notions in occupational rehabilitation piloted by Guangdong Provincial Rehabilitation Center. Case studies reflected that by learning and practicing traditional Chinese paper cutting, workers with occupational injury and disease could regain their self confidence, identity their strengths, learn more vocational skills as well as to re-integrate into community.     

Work injury rehabilitation in Guangzhou: 380 case cohort study

Work injury rehabilitation is a new concept in Mainland China. In 2001, the first work injury rehabilitation centre was established in Guangzhou under the management of the Guanghzhou Bureau of Labour and Security. This paper reviews the profile of a cohort of workers with injuries who received rehabilitation services at this centre. The changes in the physical capacity, daily function, and quality of life of the workers with injuries before and after the treatment services were also reviewed. A total of 380 were extracted from the database which occupied 79% of the total patient population admitted to the centre between 2003 to 2004. The assessment results suggested that workers with injuries showed increases in physical capacity in terms of the range of motion, muscle strength and walking tolerance. The daily functioning by using Barthel Index was also improved. Quality of life assessed with the WHOQOL also demonstrated an increase in the physical and psychological domains. Work injury rehabilitation in Guangzhou is at its infancy stage. The cooperation between the rehabilitation centre, employers and workers is of the utmost importance for a successful return to work outcome. The workers' compensation and rehabilitation policy also dictates the future of success of the rehabilitation services.     

Effectiveness of problem solving skills in case management on return to work for workers with injuries

The present study aims to explore the case management model by using problem solving skills in assisting workers with injuries in returning to work. A total of five workers with injuries were enrolled and there were four stages during the whole case management process including a medical rehabilitation stage (stage I), a compensation stage (stage II), a return to work stage (stage III) and a follow-up stage (stage IV) respectively. Case managers provided services by using problem solving skills to tackle the problems which workers with injuries may encounter during all four stages. Outcome measurement showed one case return to the same company same job, two returns to different companies and different jobs, the others have self employed work. This study suggested that case management using the problem solving skills of occupational rehabilitation was beneficial to workers with injuries on return to work.     

A return to work program for injured workers: a reassignment model

The current workers' compensation system does not encourage permanently restricted workers who are disabled due to work related injuries to return to work. Workers are often labeled permanently disabled and are released from their positions with their employers. However, according to the Americans with Disabilities Act of 1990, these individuals may be qualified to return to productive employment. This paper will describe a Reassignment Model for occupational therapy supported by the rehabilitation frame of reference. This Model presents reassignment to a vacant position as a reasonable accommodation to return injured workers to productive employment. A case study will illustrate the successful implementation of the model. The potential benefits of using this Model will be described for clients, society, employers, and the occupational therapy profession.     

Trauma symptomatology: implications for return to work

Research has suggested that individuals who experience work related injuries may be at an increased risk for developing trauma symptoms or Posttraumatic Stress Disorder (PTSD). The purpose of this article is to provide a brief overview of PTSD from both a categorical and dimensional perspective and discuss implications for rehabilitation planning with workers with industrial injuries. The negative impact of trauma symptoms and PTSD is profiled according the following four areas that are important for effective career and vocational behavior: (a) making occupational adjustments, (b) adjusting performance to meet specific work demands, (c) utilizing appropriate social and interpersonal skills in the work setting, and (d) meeting the production and time requirements associated with the specific job. Recommendations are then offered to increase the effectiveness of rehabilitation professionals working with industrial injured workers who may be experiencing trauma symptoms or PTSD.     

Job matching and return to work: Occupational rehabilitation as the link

Return to work after injury or illness is important for the worker and the employer. Medical providers manage and treat the worker with the illness or injury. Except in cases of focused specialists, the medical professional's role is to take care of a patient, rather than empower a worker. As much as there is promotion of the workers compensation health care system to be similar to sports medicine, there are significant dissimilarities. One major barrier is that the medical caregivers do not know the demands of jobs as they would know the details of sports. Thus, there is a gap in returning a worker to function as the medical professional cannot accurately match the worker to specific jobs. A new model of job function matching, based on research and skills of occupational rehabilitation professionals, is proposed to bridge the gap between the medical community, the employers and the workers.     

Policy and practice of occupational rehabilitation in Hong Kong and Guangzhou--a comparative study

The objective of this paper is to compare social policy on occupational rehabilitation services in two mega industrial cities in southern China: Hong Kong and Guangzhou. Comparative policy study was employed as the research and analytical method in this paper. Aim, finance, target, coverage, organization and administration, service delivery and provision of the occupational rehabilitation policy and its linkages with industrial injury compensation system and re-employment policy in the two cities were critically reviewed and compared. The results of the study reflect that the Guangzhou policy is more aggressive and more tailor-made to the specific needs of occupational rehabilitation compared to the Hong Kong policy, whereas occupational rehabilitation in Hong Kong has long been developed and knowledge and skills in the occupational rehabilitation service are more mature and fruitful. Based on the research findings, it is concluded that through experience sharing and exchange, there will be more mutual understanding regarding the system, practice, success, faults and limitations in the two cities, as well as awareness of alternative courses of action. These will help in the better development of occupational rehabilitation services with the aims to safeguard the rights and wellbeing of workers in both cities.     

Pilot project in developing community rehabilitation service for migrant workers suffering from pneumoconiosis in Mainland China

Pneumoconiosis is one of the major occupational health problems in China and increasing numbers of migrant workers suffered from this occupational disease after working in a dusty environment for few years. These migrant workers panicked after being diagnosed as suffering from pneumoconiosis and facing physiological disturbances including progressive dyspnea, respiratory failure or complications like silico-tuberculosis after their return to their rural village. This article reviews the preliminary results of a community rehabilitation pilot project conducted in a rural village in Guizhou, one of the provinces in southwest China. It shares the joint effort of professionals from Guangdong Province and Hong Kong SAR on supporting the migrant workers to manage and cope with this occupational disease. Finally, strategies including early intervention were suggested to help migrant workers to manage the disease. Most importantly, occupational health promotion and prevention were urged as the measures of utmost importance in reducing the risk for migrant workers suffering from pneumoconiosis.     

Proprietary rehabilitation: Challenges and opportunities in the new millennium

Proprietary rehabilitation has developed into a distinct professional sector with procedures, practices, and philosophy that differ from those in the public rehabilitation program. As the new millennium commences, proprietary rehabilitation will face a variety of challenges and opportunities that could affect the future of this sector of the rehabilitation profession. Among these issues are changes in occupational information upon which many proprietary rehabilitation practices are based; increased opportunities for early intervention and establishment of disability management programs within industry; adjustment to the movement to a managed health care system; and the necessity to demonstrate fiscal efficacy of rehabilitation services to workers with compensable injuries. This article discusses these issues and suggests some ways in which those involved in proprietary rehabilitation can properly position themselves to address and benefit from these challenges and opportunities.     

Improving work programs' delivery of information and service to workers' compensation carriers

This paper presents the results of a telephone survey of workers' compensation carriers, addressing how occupational therapy work programs can best meet these carriers' needs. Fifty percent of the market share of workers' compensation carriers in Michigan participated in the survey. Survey results indicated that workers' compensation carriers found Functional Capacity Evaluations, job analyses, and work hardening to be important work rehabilitation services. A significant portion of the respondents (88%) stated that they recognized the need for clinically successful work rehabilitation programs and indicated that if they had return to work rates for different providers, they would utilize providers that had the most successful outcome data in a specific geographical area. Occupational therapists can use these survey results to improve their services and communication with insurance to ensure that injured workers will continue to have access to the efficacious interventions occupational therapists provide in work rehabilitation.     

Case report: a work simulation program for a manual worker with a fracture injury

Work rehabilitation programs targeting different client groups are available in nearly all major hospital occupational therapy departments in Hong Kong. Clients receiving work rehabilitation are referred from various out-patient clinics and other occupational therapists. Those clients experience limitation in work after their injuries or diseases and plan to return to work after rehabilitation. Program objectives are 1) to assist clients to reach maximum work capacity as rapidly as possible 2) to ensure clients return to work safely 3) to improve clients' work readiness. This case report describes an individualized work simulation program at a general hospital in Hong Kong provided for a typical client who is preparing to return to his worker role. Specific job analysis, goals and program rationale for the client are discussed.     

Using the ICF as a conceptual framework to guide ergonomic intervention in occupational rehabilitation

Traditional treatment of work-related musculoskeletal disorders focuses on the body functions and body structures aspects of the injury, with little or no attention paid to ergonomics as a form of treatment. The use of ergonomics in preventing disability in injured workers is a relatively new area of study. There are a number of factors that may contribute to the lack of emphasis on ergonomic interventions in the prevention of disability following musculoskeletal injury. For instance, a review of the knowledge base suggests that there is a lack of a formal conceptualization or standardized approach to ergonomics in the return to work process. In part, this lack of consistency may be due to the varied disciplinary backgrounds of ergonomists, leading individuals to view ergonomics from a specific perspective, rather than utilizing a transdisciplinary approach. The purpose of this paper is to introduce a new practice model of occupational rehabilitation ergonomics. The model draws upon the International Classification of Functioning, Disability, and Health (ICF) and merges this with basic ergonomic and rehabilitation principles.     

Death and Work in Britain

Official figures indicate that there were 302 fatal occupational injuries in Britain 1996/97. This paper is a sustained critique of the means by which this 'headline figure' is reached. Drawing upon other, more or less recoverable, officially collected data on fatal injuries it demonstrates that there are at least five times more fatal occupational injuries during this time period. It then considers various anomalies and inconsistencies within the legally constituted (and recently revised) categories of data collection, the effect of which is to exclude indeterminate numbers of occupational fatalities, not least to members of the public, to the self-employed, and to other groups of workers. Finally, the paper considers some social processes of under-reporting, whereby occupational fatalities are not recorded in official data. The paper concludes that: fatal injury data is grossly incomplete, and requires work of reconstruction; the actual number of fatalities incurred through work in Britain at the end of the 1990s represents a largely obscured social problem; while there remain questions about both the reliability and validity of official fatality data, it is important that this data is incorporated within sociological analysis, albeit sceptically.     

Decreasing occupational injury and disability: the convergence of systems theory, knowledge transfer and action research

Many work injuries and their associated disabilities are preventable, but effective prevention requires coordinated action by multiple stakeholders. In trying to achieve coordinated action occupational health practitioners can learn valuable lessons from systems theory, knowledge transfer and action research. Systems theory provides a broad view of the factors leading to injury and disability and a means to refocus stakeholder energies from mutual blaming to effective strategies for system change. Experiences from knowledge transfer will help adopt a stakeholder-centered approach that will facilitate the concrete application of the best and most current occupational health knowledge. Action research is a methodology endorsed by the World Health Organization and the US Centers for Disease Control, which provide methods for successfully engaging stakeholders needed to attain sustainable change. By combining concepts from the three fields we propose MAPAC (Mobilize, Assess, Plan, Act, Check), a five-step framework for developing projects aimed at decreasing occupational injury and disability. Although most practitioners would be familiar with some of the concepts, we believe an explicit framework linked to transferable knowledge from these diverse fields can help design and implement effective programs. We provide examples of model application in workers compensation and in the healthcare workplace.     

Occupational Safety and English Language Proficiency

Recent occupational injury data shows a rising trend, which happens to coincide with both increases in the foreign-born population in the U.S. and changes in its composition. This study aims to explore the presence of a statistical relationship between occupational injuries and the level of English proficiency of foreign-born using cross-sectional data on the rate of injury and count of injury incidents. A cultural gap hypothesis is also examined as an alternative explanation for the rise in work injuries. While there is some support for the adverse effect of inadequate English language proficiency of foreign-born, the results for the cultural gap hypothesis are more robust.     

A return to the worker role after injury: firefighters seriously injured on the job and the decision to return to high-risk work

This paper presents information on occupational choices and behaviors as described by the model of human occupation and the profession of occupational therapy. This project was designed to answer the research question, "Why do people choose to return to the same high-risk careers after sustaining a serious work-related injury?" Two firefighters from a New York metropolitan area were interviewed individually to explore their roles, especially the worker role, their injuries, and their decisions to return to the same high-risk type of work. The results indicate that a strong social support system from co-workers, and the motivation and enjoyment of the job were the common factors that influenced the two participants to return to their jobs.     

Prediction model for the return to work of workers with injuries in Hong Kong

This study attempts to formulate a prediction model of return to work for a group of workers who have been suffering from chronic pain and physical injury while also being out of work in Hong Kong. The study used Case-based Reasoning (CBR) method, and compared the result with the statistical method of logistic regression model. The database of the algorithm of CBR was composed of 67 cases who were also used in the logistic regression model. The testing cases were 32 participants who had a similar background and characteristics to those in the database. The methods of setting constraints and Euclidean distance metric were used in CBR to search the closest cases to the trial case based on the matrix. The usefulness of the algorithm was tested on 32 new participants, and the accuracy of predicting return to work outcomes was 62.5%, which was no better than the 71.2% accuracy derived from the logistic regression model. The results of the study would enable us to have a better understanding of the CBR applied in the field of occupational rehabilitation by comparing with the conventional regression analysis. The findings would also shed light on the development of relevant interventions for the return-to-work process of these workers.     

Spinal Cord Injury

ABSTRACT

This article provides an overview of spinal cord injury (SCI) that is useful and informative for social workers and other health care professionals who work with this population. Social workers new to the specialty of spinal cord injury must expand their knowledge base of this chronic injury. Social workers contribute to the rehabilitation process through assessment, education, and discharge planning. This article also may be used to inform persons with spinal cord injury and their families and to encourage them to engage in dialogue about SCI in the earliest stages of treatment and rehabilitation.     

Work rehabilitation programs: a 1997 survey

By adapting to the changing health care environment, legislative reforms, and consumer needs, work rehabilitation programs have experienced a metamorphosis. This study surveyed occupational therapists currently employed in work programs to ascertain a current demographic profile of work rehabilitation programs. Respondents indicated the delivery of services in the areas of prevention, assessment and rehabilitation. The majority of work rehabilitation programs in this study provide services in the form of ergonomics, education and training, and job analyses at the worksite. The area of work injury prevention services is forecasted for increased growth among work rehabilitation programs.