In the earliest days of vocational rehabilitation the emphasis on return to work was so intrinsic the terms rehabilitation and vocational rehabilitation were virtually synonymous.

But somehow, over the past few decades the focus on vocation appears to have been lost and subsequently, the rates of successful return to work outcomes have decreased.

This is the trend outlined by Gregory C Murphy, Ph.D. from the school of public Health at LaTrobe University, in his presentation to the 2008 ARPA Conference in Sydney.

Murphy discussed how the earliest rehabilitation authorities as far back as the 1940s were clear on the role of return to work within rehabilitation and it was a primary measure of the efficacy of rehabilitation programs.

During these early years vocational guidance and counseling was considered the “core of the rehabilitation processâ€Â around which all other rehabilitation activities revolved.

Murphy juxtaposed those early years with rehabilitation activities, from the recent past such as the Victorian WorkCare system in the mid to late 1980s.

At this time he reports there were “deficiencies in rehabilitation service delivery and outcomes achieved at the start of the no-fault workers compensation in Australiaâ€Â. This period was characterised by a lack of vocational focus, leading to “unsustainably low return to work rates of 43.8pc.

This downward trend has continued into the recent past, and Murphy further outlined a lack of focus on vocational outcomes worldwide. The impact of this was emphasised by a 2002 UK study which found a causal connection between a decline in vocational rehabilitation services and a significant increase in the cost of disability benefits.

A more recent Australian study (2005) was also reviewed which demonstrated that, despite ever-increasing health budgets, health care and clinical outcomes the rate of return to work was actually declining, with RTW rates failing to surpass 80pc.

This study found it was the duration between clinical recovery and return to work which was most neglected and subsequently fell down.

Murphy stated, that unlike the early days of rehabilitation when vocational outcomes were the most important measurement, clinical outcomes now seemed to be taking precedence.

For Murphy, the current situation represents an opportunity for all stakeholders to move forward and reverse this trend. He said each stakeholder group had individual responsibilities, which could cumulatively place the focus of rehabilitation back onto vocation, hence improving return to work outcomes.

He called on treating practitioners to accept that time away from work was not the best option for the majority of injured workers,. He encouraged them to outline a stated return to work date for all workers, to improve communication with the workplace and to be the lead in an integrated clinical treatment and vocational rehabilitation program.

From rehabilitation providers he requested more vocationally relevant services and plans, more time spent understanding the job and the work environment, less time in formal assessment and reporting and more time spent understanding the other people involved in the worker’s personal life, such as partners, family and friends.

He called on allied health professionals to ensure therapies and interventions contributed to the worker’s functional abilities, including both domestic and work tasks. He also outlined the need for training programs such as coping skills, to enable workers to better deal with setbacks in both the return to work process and daily life.

He called for the curriculum of all health professionals to include topics focused on the relationship between work and health and he also urged educators to ensure students were equipped with an understanding of the importance of community based health services in the worker’s natural setting.

Employers were also called upon, with Murphy encouraging them to adopt a workplace disability management approach and improved mechanisms for ensuring enhanced communication with workers and treating practitioners.

Murphy also saw there were gaps in research and called for further study into the effect of environmental factors in facilitating return to work and the correlation between vocational goal setting with improved vocational outcomes. Most significant, he said, was the need for further study of the behaviour of work supervisors in the facilitation or hindrance of the return to work of injured workers.