Perspectives on workplace disability management: a review of the literature

Work-related musculoskeletal injuries represent a major source of work disability. While many employers recognize the importance of workplace disability management approaches and are assuming greater responsibility for preventing and minimizing work-related disability, questions about the effectiveness of these interventions exist. The purposes of this article are to: 1) describe the essential components of workplace disability management programs related to musculoskeletal injuries; 2) review the literature on disability management practices based on research evidence by focussing on workplace-based interventions and the role of the workplace; and 3) provide recommendations for disability management in the prevention and reduction of disability, and the rehabilitation of injured workers with musculoskeletal work injuries. The literature suggests that employer participation, a supportive work climate and cooperation between labour and management are crucial factors in facilitating return to work. Given the complexity of the disability management process and the numbers of individuals involved, it is essential that all workplace parties work together to achieve the goal of safe and early return to work.     

The functional IME: A linkage of expertise across the disability continuum

Disability assessment remains a significant challenge especially in welfare systems like workers' compensation and disability insurance. Many of today's managed care strategies do not impact on the seminal issue of return to gainful employment. Employers, insurers, attorneys and case managers routinely request independent medical examinations (IMEs) as a means of determining degree of disability, functional limitations, work restrictions and "estimated" physical capacities. However, this approach is limited because physicians are not trained in the functional model of disability assessment. IMEs address pathology and impairments which represent a portion of the disability continuum described by the World Health Organization, Nagi, Guccione and others [e.g. pathology-impairment-disability-handicap]. Functional capacity evaluations or FCEs are often performed by physical and occupational therapists who are trained in a function-based model of disability assessment. Unlike an IME physician who completes "Estimated Physical Capacities", therapists measure actual physical functioning. The value of both IMEs and FCEs can be enhanced through a "functional IME" that combines both models; medical-based examination and a function-based disability evaluation. This combination enhances the assessment of the relationship of pathology to impairment and impairment to disability status especially, in musculoskeletal disorders which tend to drive costs in workers' compensation.     

The natural history and risk factors of musculoskeletal conditions resulting in disability among US Army personnel

We describe the natural history of 13 musculoskeletal conditions requiring hospitalization and identify demographic, behavioral, psychosocial, occupational, and clinical characteristics most strongly associated with disability discharge from the Army. Subjects included 15,268 active-duty personnel hospitalized for a common musculoskeletal condition between the years 1989-1996 who were retrospectively followed through 1997. Back conditions had the greatest 5-year cumulative risk of disability (21%, 19%, and 17% for intervertebral disc displacement, intervertebral disc degeneration, and nonspecific low back pain, respectively). Cox proportional hazards models identified the following risk factors for disability among males: lower pay grade, musculoskeletal diagnosis, shorter length of service, older age, occupational category, lower job satisfaction, recurrent musculoskeletal hospitalizations, more cigarette smoking, greater work stress, and heavier physical demands. Among females, fewer covariates reached statistical significance, although lower education level was significant in more than one model. Modifiable risk factors related to work (job satisfaction, work stress, physical demands, occupation) and health behaviors (smoking) suggest possible targets for intervention.     

Interdisciplinary team discussion on work environment issues related to low back disability: a multiple case study

From both a social and cost-benefit perspective, disability prevention and associated management strategies for assisting employees with back pain are only successful if they address critical return-to-work (RTW) determining factors present in the workplace, including ergonomic factors. Despite our current knowledge of the importance of an integrated team approach targeting these factors, questions remain regarding the conceptual framework adopted by contemporary rehabilitation teams as it relates to work-oriented interventions to accommodate employees back to work. The purpose of this study was to explore and describe the work environment issues discussed by an interdisciplinary team engaged in the work rehabilitation process of low back disability cases. A qualitative content analysis was conducted for 10 sample cases that underwent a rehabilitation program in Quebec (Canada). Drawing on the results of these analyses, a framework representing a synopsis of practitioners' involvement in the person-environment dynamic is presented and discussed. This study makes a unique contribution to the understanding of the 'real-life' content of an interdisciplinary activity in disability management, thus, helping rehabilitation practitioners to build knowledge on the practical application of a cross-disciplinary framework to address work environment issues during the RTW process of those patients sick-listed due to back pain.     

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.     

Perception differences between groups of employees identifying the factors that influence a return to work after a work-related musculoskeletal injury

Employee health and productivity losses as a result of work-related injury are estimated to be US dollars 1.2 trillion annually to US companies. This is approximately 14.3% of the gross domestic product [6,8,11,35]. Workers' compensation, medical care, and short and long-term disability are a part of these costs. Controlling or eliminating these costs is a problem for US employers [3,6,14,21,29]. The study discussed in this article examined the perceptions of manufacturing employees in identifying factors that influence a return to work after a work-related musculoskeletal injury. The classification of employees who participated in this study were safety professionals, supervisors and workers from the manufacturing industry in central Kentucky. The worker group consisted of material handlers, assembly line workers and quality control inspectors. The participants completed a developed survey instrument, the Return to Work Perception Survey. This survey instrument examined the perception of the participants on factors related to return to work: company policies and procedures, job satisfaction, worker relationships and work environment. The results indicated safety professionals and supervisors perceptions differ from workers on the variables of job satisfaction, worker relationships and work environment. Their perceptions did not differ on the variable relating to company policies and procedures. In addition, the safety professional and supervisor groups rated the items addressing job satisfaction higher than did the worker group. The worker group did not differ from one another on any of the factors. Implications of this study for manufacturing companies suggest (a). identifying those issues contributing to employee job satisfaction, (b). developing a plan for achieving increased job satisfaction and employee recognition at the workplace among all workers, and (c). consider allowing employees to develop new capacities and new learning, thus fostering motivation and job satisfaction [18,20].     

Work-related factors contributing to chronic disability in low back pain

Low back pain is a costly and incapacitating musculoskeletal disorder. Prospective studies documenting the capacity of work-related factors to predict chronicity are few in number, the methodology used is very diversified, and the results obtained diverge. The aim of the present study is to investigate the capacity of work-related objective (non-psychosocial) and psychosocial factors to predict chronic disability related to low back pain. A longitudinal prospective study with two measurement times was carried out. The sample (N = 258) consisted of workers with subacute low back pain who were on sick leave and receiving compensation from the CSST (Quebec Workers' Compensation Board). Of all the work-related variables measured, perceived stress and fears and beliefs about work were associated with return to work status at the six-month follow-up. The results obtained show the importance of considering fears and beliefs about work when identifying people in the subacute phase of low back pain who are at risk of developing chronic disability.     

Significant resources needed for return to work after sick leave

There are increasing numbers of people on long-term sick leave, especially with stress-related ill health and musculoskeletal disorders. The main purpose of this study is to, early on in the sick leave, find predictors of individual resources for a return to work. The study group consists of women and men on sick leave compared with reference groups of healthy persons. A questionnaire was used regarding diagnosis given on the doctor's certificate, self-reported symptoms, residential area, education, and kind of work. It also contained open questions about consequences in daily life and beliefs about future. Checklists concerning life satisfaction, sense of coherence, locus of control, coping resources and sick leave information over a four-year period have been used. Significant differences between the study group and the reference groups were found, relating to sense of coherence, locus of control, life satisfaction and coping resources. More than half of the study group were still on sick leave at a two-year follow-up. Important predictive factors turned out to be: previous sick leave, own belief about future and self-reported symptoms.     

The effect of exposure to a professor with a visible disability on students' attitudes toward disabilities

An exploratory study was conducted on a small convenience sample of undergraduate social work students. The Modified Issues in Disability Scale was used to collect data on attitudes toward disability. There was no statistically significant difference in the attitudes scores among students who had different levels of contact with persons with disabilities. There was, however, a statistically significant difference between students who had a professor with a disability and those who did not. The former had more positive attitudes toward disability. These findings suggest that schools of social work should recruit more professors with disabilities.     

Prediction of vocational outcome of people with brain injury after rehabilitation: a discriminant analysis

Due to advancements in emergency evacuation procedures and neurosurgical techniques, more patients with brain injury (BI) can survive cerebral injury and regain a satisfactory degree of recovery through rehabilitation. Their improvement in physical and cognitive functions can facilitate their reintegration into the community, especially their return to work (RTW). Different factors were reported to affect this rate of RTW in previous studies. This retrospective study thus aimed to investigate the role of demographic data, the severity of injury, residual physical deficits, activities of daily living, and cognitive function using a stepwise discriminant function analysis (DFA). Data sets for 79 persons with BI were retrieved so as to identify predictors of their vocational outcomes upon discharge and during a follow-up period. The stepwise DFA revealed that the discharge score on the Disability Rating Scale (DRS), the attention-subtest of the Neurobehavioral Cognitive Status Examination (NCSE) or Cognistat, and pre-morbid occupation were significant predictors that correctly classified 65.8% of the subjects.     

Low back pain disability and stay at work: contradiction or necessity?

The incidence of occupational diseases in the population is high and factors such as long working hours, poor posture, psychological and physical stress can contribute to its development. Among work-related musculoskeletal disorders, back pain has a high prevalence. The aim of the present study was to quantify and characterize pain complaints and to identify individuals with low back pain, in order to assess the degree of disability. Participated 226 employees of an institution of higher education. They answered a general questionnaire about location and quantification of pain complaints visual analog scale for pain and the Quebec Disability Questionnaire. Of all the workers, 69.60% had some type of musculoskeletal complaint; of those, 15.41% had low back pain. Considering workers who had back pain, 54.9% were female, 52.94% are under 30 years old and 43.14% between 1 and 5 years of work. As for the final score for the degree of disability, 41.17% had minimal disability and 37.25% moderate disability. The present study found large number of pain complaints and high prevalence of low back pain, resulting in individual's inability and difficulties in performing work activities.     

Data entry workers perceptions and satisfaction response to the "stop and stretch" software program

Cumulative Trauma Disorder (CTD) is a collection of chronic musculoskeletal disorders caused by frequent, sustained, and repetitive movements, most notably by computer usage at the workplace. A computer based break reminder program (Stop and Stretch) has been developed and installed to prevent CTDs caused by prolonged computer usage at the workplace. We investigated users' opinions to the Stop and Stretch program at their work place. 19 computer users were recruited as the subjects of the study. We conducted a survey after all the subjects used the Stop and Stretch program for one month. Among the nineteen subjects, 52.5% or 10 noticed a difference of symptoms after using the program; 63.3% or 12 thought the program had positive effect on their productivity; 100% or all 19 thought the program was easy to follow; 100% or all 19 thought it was helpful; 94.7% or18 were satisfied with the program; and the same value would recommend the program to others. When grouped into those who had prior experience with using stretch and exercise as part of their work routine15 subjects had no prior experience; and 14 participants within that group were satisfied or very satisfied with the program; 93.3% or 14 would recommend it to co-workers; and over half of those 15 thought the program is easy to use. The study provided insight to the response to using "stretch break software" and provided indicators of satisfaction with the Stop and Stretch program and that the program had sufficient usability and acceptance within a workplace setting which might be applied in other work settings similar to these.     

Life-threatening disability in adolescence: Adjusting to a limited future

This paper describes a medical social worker's efforts over one and a half years to help a client adjust to a neurological disorder. Prior to social work services, the young woman had never discussed her disability, which began in adolescence, with anyone outside the family, and communication within the family was seriously compromised by their perception of disability as a stigma. Lacking the opportunity to mourn the loss of her physical abilities, she became isolated and depressed, and acted out aggressive thoughts and fantasies within the family system. Social work intervention helped the client to re-work the original trauma of diagnosis, which led to the development of a healthier defensive structure and new coping mechanisms.     

Disability and abuse in relation to substance abuse: a descriptive analysis

This analysis reviewed five years of a state's substance abuse treatment admissions and discharges in order to identify specific patterns among persons who had a disability. Using a series of group comparisons, Chi-squares, and logistic regressions, specific patterns of violence and abuse to this population were identified. Results indicate that persons who had a disability and abused substances were more likely to be victimized by physical abuse and domestic violence when compared with their peers without a disability. A person with a disability had about one-half to one-third the odds of receiving long-term residential, short-term residential and intensive outpatient care when compared with persons without a disability.     

The effects of exercise reminder software program on office workers' perceived pain level, work performance and quality of life

In direct proportion to current technological developments, both the computer usage in the workplaces is increased and requirement of leaving the desk for an office worker in order to photocopy a document, send or receive an e-mail is decreased. Therefore, office workers stay in the same postures accompanied by long periods of keyboard usage. In recent years, with intent to reduce the incidence of work related musculoskeletal disorders several exercise reminder software programs have been developed. The purpose of this study is to evaluate the effectiveness of the exercise reminder software program on office workers' perceived pain level, work performance and quality of life. 39 healthy office workers accepted to attend the study. Participants were randomly split in to two groups, control group (n = 19) and intervention group (n = 20). Visual Analogue Scale to evaluate the perceived pain was administered all of the participants in the beginning and at the end of the study. The intervention group used the program for 10 weeks. Findings showed that the control group VAS scores remained the same, but the intervention group VAS scores decreased in a statistically significant way (p < 0.01). Results support that such exercise reminder software programs may help to reduce perceived pain among office workers. Further long term studies with more subjects are needed to describe the effects of these programs and the mechanism under these effects.     

How was a national moving and handling people guideline intended to work? The underlying programme theory

In healthcare, moving and handling people (MHP) often cause musculoskeletal disorders. To prevent musculoskeletal disorders due to MHP, many national evidence-based guidelines have been developed. However, little is known about how these guidelines were intended to work, i.e. their ‘programme theory’, how implementation by intended users is influenced by contextual factors and mechanisms to produce outcomes. This paper identifies the programme theory of a national MHP guideline (MHPG) using thematic analysis of the MHPG document, three organisational planning documents, and interviews with MHPG developers. The analysis identified the intended users of the MHPG as health and safety managers and MHP coordinators. The programme theory comprised contextual factors, potentially hindering (e.g. budget constraints) or facilitating (e.g. changing demographics) implementation, being influenced by mechanisms mainly based on ethical (quality of care, evidence-based practices), and economic reasoning (reducing cost of MHP, return on investment) to reduce injuries caused by MHP – the intended outcome.     

Therapeutic Return to Work: Rehabilitation in the workplace

Therapeutic Return to Work is a work rehabilitation program linking graded work exposure with functional restoration therapy for chronic low back pain. This study evaluates the impact of the program on stable return to work (RTW) and compares it with the impact on RTW of three frequently used ways of management of back pain (normative comparison). At two year follow-up, 93% of participants of the Therapeutic Return to Work program were working. This rate was higher than in the comparison groups. Although limited by its norm-referenced evaluation design, the results of this study indicate the importance of placing the work site in the center of the of work rehabilitation process. In this program occupational therapists make full use of the client's natural environment.     

Disrupting global disability frameworks: settler-colonialism and the geopolitics of disability in Palestine/Israel

In recent years, Israel has seen an increase in disability studies scholarship and disability rights activism. At the same time, critical disability studies scholars have begun calling attention to the role of colonization and neocolonial powers, too often obscured in disability studies work, in disabling oppressed nations. This article brings these critiques in conversation with disability studies scholarship regarding Occupied Palestine to argue that disability is inextricably intertwined with the settler-colonial project of the Israeli state. By highlighting the geopolitical production of disablement, this work suggests that social approaches to disability have largely effaced disability injustice rooted in geopolitical power imbalances.     

Negotiating disability and colonisation: the lived experience of Indigenous Australians with a disability

Disability among Indigenous Australians lies at a nexus between the ongoing impact of European settlement from 1788 and the social effects of living with a disability. Colonisation, with its political, social, economic and cultural concomitants, continues to impact on Indigenous experience, extending to the institutions and services concerned with disability. There is little attention paid to Indigenous Australian disability in general, and the need to decolonise disability has recently been emphasised. Ethnographic research in Brisbane, Australia among Indigenous people with a disability (mostly related to diabetes) confirms the ongoing impact of colonisation. While this experience pervades all aspects of their lives, it also moderates their experience of living with a disability in positive ways. However, while individuals can negotiate their personal experience of disability, the decolonisation of disability services presents challenges that need to be addressed.     

Child custody placement outcomes for mothers

Internationally there is a broad literature on risks for child custody placements. In contrast, very little is known about their outcomes on parents. The topic is relevant not only for parents themselves but also for children placed outside their homes, as many children keep contact with their birth parents or return to live with them. In a retrospective cohort study setting we analyze child custody placement outcomes (social assistance receipt, unemployment and work disability) for mothers whose children had been taken into custody between 1997 and 2004 in Finland. Data from a child placement register were merged with several administrative social insurance registers. Comparison groups of population mothers are included in the study. The procedure yielded an internationally unique database. According to the results of our study, mothers whose children are taken into custody are more often unemployed and in need of social assistance than mothers in the comparison group. Furthermore, they are also more often on a disability pension, due to mental health problems in particular, than mothers in general. While considering the results, we examine family policy and general welfare policy implications of support to families whose children have been taken into custody.