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.     

Return to work still possible after several years as a disability pensioner due to musculoskeletal disorders: a population-based study after new legislation in Sweden permitting "resting disability pension"

Different strategies have been used to stimulate a return to work (RTW) among individuals suffering from long-term ailments. In Sweden a new law on "resting disability pension" permits disability pensioners to go back to work without jeopardising their benefits. In this study different variables related to RTW during 2000 by means of this legislation were identified among disability pensioners with musculoskeletal disorders. Individuals in the study group, when compared to a control group, had more often been disability pensioners for several years, had additional education, estimated their previous job to have been physically strenuous to a lesser degree, were more satisfied with the treatment at the social insurance office and had a more positive self-image. This study shows that it may be meaningful to continue/resume rehabilitation efforts and to try to motivate an individual suffering from musculoskeletal disorders to return to work even after several years as a disability pensioner.     

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.     

Disability management and functional capacity evaluations: A dynamic resource

Functional capacity evaluation (FCE), as an objective resource for disability managers, is an invaluable tool in the return to work process. Effective communication of expectations between the employee, employer, medical providers, disability management team, and the FCE provider contributes to enhancing the benefits of the FCE to all participants. Careful review of the results of the FCE as compared to the employee's other pertinent medical/functional information provides clarity for that person's rehabilitation goals and RTW potential. Finally, future opportunities and proactive uses for the FCE are shared.     

An Empowerment Approach in Teaching a Class about Autism for Social Work Students

Social workers are being asked to respond to the rapidly increasing number of individuals and families affected by Autism Spectrum Disorders (ASD). However, the curricula in schools of social work have limited content on disabilities. This article describes a course which prepares social work students for work with individuals with ASD through an empowerment approach in an ever-changing socio-cultural and political environment. This approach changes the focus of disabilities from a narrow perspective on particular services and rehabilitation to a broader concern with human rights, social inclusion and quality of life. The article describes the development of the course in collaboration with a university disability program, the areas of emphasis for the course (family focused, interdisciplinary, lifespan) and the multiple modes of delivery. The implications of teaching the course as an elective or as integrating it further into the curriculum are discussed.     

Personnel Development in the Field of Disability with a Focus on Employment Outcomes

The author discusses the key considerations for personnel development in the disability field with a focus on employment outcomes. The author emphasizes the role of support and facilitation by rehabilitation personnel as structures for inclusion. He discusses the fact that disabilities, like learning and change, are lifetime experiences for all of us. Accordingly, comprehensive personnel development must be attentive to the constituencies and the environment. It must be value based. Finally, comprehensive personnel development must address the present and future needs of all constituencies in the field of disability to achieve successful employment outcomes. The author presents the context for an educational framework for rehabilitation personnel. This framework is based on four pillars-formal education, professional certification, continuing education and self-directed learning. The synergistic relationship among these pillars, and the constituency groups provides the framework for effective disability policy and positive employment outcomes for persons with disabilities.     

Disclosure of mental health

As today's workplaces strive toward a climate of inclusiveness for persons with disabilities, much work remains for employers in developing a process to achieve this ideal. While survivors of mental illness are encouraged to disclose related concerns to their employer, such sharing of personal information remains daunting. Similarly, employers attempting to assist the process are often awed by the extent of collaborations involved in integrating employees with mental health issues back to work as well as concern about compliance with human rights legislation. Needed accommodations in terms of approach to the work itself are often simple; however substantiating the need for adjustments is more complex. This case study introduces a model to support the development of shared goals and shared understandings for return to work (RTW) among workers with mental health concerns, employers, co-workers and therapists. The model of occupational competence is used as a basis to guide dialogue, identify challenges and generate solutions that take into consideration a worker's preferences, sensitivities, culture and capacities in relationship to the occupational demands in a given workplace environment. A case study is used to demonstrate the potential utility of the model in assisting stakeholders to strengthen collaborations and partnering to achieve a shared understanding of worker and workplace needs.     

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.     

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.     

Child Welfare Workers’ Perspectives on Contributing Factors to Retention and Turnover: Recommendations for Improvement

Rates of turnover are high in child welfare settings, impacting the organization, remaining workers and the children and families under their care. A number of demographic, psychological, social and organizational features have been associated with increased staff turnover, although we have limited understanding about how and why these factors are important; differences in influence at varying levels of seniority and career duration; and workers’ perspectives on how to address workplace issues. This qualitative study assessed how factors impact employee retention and turnover in focus groups with 25 employees at different stages of employment: resigned case managers, case managers employed for less than one year and more than three years, and supervisors. Results suggested few differences in themes identified by groups. Two broad themes emerged for retention: supportive environment (including themes relating to children/parents, co-workers, and the organization) and opportunities within the agency (including new positions, experience and knowledge and job security). Two broad themes emerged for turnover: organizational issues (including themes about low compensation, challenging work demands, and system issues) and stress. Workers’ perspectives and recommendations on how to address workplace problems were reported. Results are consistent with the existing literature, although a number of unique issues were identified, including workers’ desire for clear communication flow through hierarchies, increased collaboration, and revisions to the way data is used/integrated. Workers expressed a strong desire to be heard by management, and this study reflects an important effort to provide feedback. These findings are relevant for informing organizational policy in child welfare agencies.     

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].     

The challenge of interdisciplinary collaboration in addressing the social determinants

The importance of professional disciplines working together to address the critical social and health issues facing society today cannot be overstated. Policy makers, service providers and researchers have long been calling for greater interdisciplinary collaboration. Despite this there has been little systemic analysis of the constraints involved in such collaboration. Far too often disciplines continue to work in silos. This paper aims to analyse the barriers to interdisciplinary collaboration through a case study of the relationship between social work and public health. These two disciplines have a lot more in common than might first appear. There is real potential for social work and public health to work together and enhance each other's efforts to address their common goal of greater social equality. However, this will require a genuine commitment from both disciplines to develop a shared political analysis, common language and a framework for action, which utilises their respective strengths.     

An investigation of a workplace-based return-to-work program for shoulder injuries

The purpose of this study was to investigate and evaluate the current workplace management of rotator cuff injuries in a manufacturing plant. The secondary aims were to examine the impact of the company's return-to-work processes, compare outcomes to current industry standards for work (re)entry and to identify the components that characterized this workplace-based return-to-work (RTW) program. This investigation involved a case study approach comprised of an examination of the program context using interviews, onsite visits, a document review and a retrospective analysis of the RTW experiences of 184 workers with shoulder injuries. Findings revealed that the workplace-based RTW program was consistent with and shaped by the organizational culture of problem solving, knowledge exchange and equitable participation of workers, supervisors and health professionals. These components contributed to the program in achieving the following outcomes for workers with shoulder injuries. One-third of workers were placed on modified duties within three days, 56% of workers who engaged in an early RTW program returned to work within one month. Overall, 87.8% of workers with rotator cuff injuries successfully returned to pre-injury work. The implications of developing capacity for workplace-based programs to manage injuries at work are discussed.     

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.     

Factors contributing to low back pain among professional drivers: a review of current literature and possible ergonomic controls

It is suggested that professional drivers are at an increased risk for low back pain and injury due to a variety of factors such as whole body vibration, prolonged sitting, awkward postures, lifting and carrying, and psychosocial issues. Ergonomics can play an important role in the reduction of risk of injury to the professional driver by implementing modifications to the work place (engineering controls), changes in administrative and management practice (administrative controls), and education of the worker (work practice controls). A review of the literature of the etiology of low back pain and injury among professional drivers is presented, and possible ergonomic controls have been recommended.     

What makes age diverse teams effective? Results from a six-year research program

Based on a new model of productivity in age diverse tams, findings from a six-year research program are reported in which data from more than 745 natural teams with 8,848 employees in three different fields (car production, administrative work, financial services) were collected. Moreover, central assumptions of this model were tested with a representative survey of the German workforce (N = 2,000). Results support both significant advantages and disadvantages for age-mixed teams. Based on the findings, the following preconditions for the effectiveness of age diverse teams are identified: high task complexity, low salience and high appreciation of age diversity, a positive team climate, low age-discrimination, ergonomic design of work places, and the use of age differentiated leadership. Based on these insights, we developed a new training for supervisors, which addresses the aforementioned aspects and seeks to improve team performance and health of team members. It was found that the training reduces age stereotypes, team conflicts and enhances innovation. Thus, we can conclude that effective interventions for a successful integration of elderly employees in work groups are available and that combinations of measures that address ergonomic design issues, team composition and leadership are to be strongly recommended for practice.     

Yoga for stress reduction and injury prevention at work

At work employees face numerous psychological stressors that can undermine their work performance. These stressors, stemming from a variety of possible causes, have enormous health and financial impacts on employees as well as employers. Stress has been shown to be one of the factors leading to musculo-skeletal disorders (MSDs) such as: include back pain, carpal tunnel syndrome, shoulder or neck tension, eye strain, or headaches. Yoga is an ancient form of exercise that can reduce stress and relieve muscular tension or pain. Practicing yoga at the workplace teaches employees to use relaxation techniques to reduce stress and risks of injury on the job. Yoga at the workplace is a convenient and practical outlet that improves work performance by relieving tension and job stress.     

Low back pain in physical therapists: a cultural approach to analysis and intervention

Low back pain is one of the most prevalent work related injuries in the physical therapy profession. New graduates and therapists working in rehabilitation and acute care hospitals are at the highest risk for developing low back pain [9]. Although physical therapists are trained in maintaining proper body mechanics and preventing work related injuries, between 30% and 63% of therapists will experience low back pain at some point in their careers [2,4,9]. The culture of physical therapy is one of the primary factors contributing to this problem, with many therapists reporting that their decision to use back pain preventive strategies depends on their colleagues' use of these strategies. The authors will use Green and Kreuter's PRECEDE-PROCEED model to identify behavioral, environmental, educational and ecological factors contributing to the problem; then will propose a health promotion intervention using the social action theory at the community level to decrease work-related low back pain in physical therapists while simultaneously addressing the culture of physical therapy.     

A framework of operating models for interdisciplinary research programs in clinical service organizations

A framework of operating models for interdisciplinary research programs in clinical service organizations is presented, consisting of a "clinician-researcher" skill development model, a program evaluation model, a researcher-led knowledge generation model, and a knowledge conduit model. Together, these models comprise a tailored, collaborative approach to enhancing research-informed practice in community-based clinical service organizations. The models place different degrees of emphasis on the development of research-related skills in practitioners, the generation of knowledge tailored to clinical practice, and knowledge sharing. The nature, philosophical basis, roles of research staff members, outputs and impacts, and strengths and limitations of each model are described, in the context of a long-standing, interdisciplinary research program in a children's rehabilitation service organization. The use of the model framework as a tool for the design of interdisciplinary, community-based research programs is discussed.