Take Home Messages:

Assessing the effectiveness of return to work initiatives is difficult.   The research varies in the

• Outcomes assessed;
• The way the research is conducted; and,
• The components of the intervention. Eg one study may assess one return to work initiative and another may include a number of different initiatives in the study.

Why the research matters:

In 2001 8.5% of all workers compensated for musculoskeletal disorders were off work for more than six months.  However, the income replacements paid to this 8.5% of workers accounted for more than 50% of all income replacement payments.

In industrialized countries, the total of the direct and indirect costs associated with musculoskeletal disorders is said to represent approximately 1% of the gross national product.

Getting a handle on what works is important.

What the research involved:

This study looks at the scientific literature over the past 20 years.  The aim of the study was to examine the different objectives pursued through workplace interventions carried out in the context of a rehabilitation program, and to describe the activities involved.

Three research databases were used and the period reviewed was from 1985 to 2005.

The following criteria were used to select the articles:

1. The intervention included at least one visit to the workplace
2. The population under study was at least partially absent from work (i.e. Sick-listed at least 50% of the time) as the result of a musculoskeletal problems involving the spine or limbs
3. The intervention was aimed at worker rehabilitation.

Summary of research findings:

Many scientific studies report that interventions in the workplace help injured workers return to work. However, in the real work environment, rehabilitation has mixed results. This is especially the case with workers with musculoskeletal disabilities.

Three broad categories of interventions were noted:

• Reproducing work demands in a clinical setting
• Gradually exposing workers to the demands of the real work environment
• Permanently reducing the demands of the work environments

Some studies described accident training in the workplace or a clinical setting whilst other described activities particularly related to the process of work situation modification. In order to help injured workers cope with the pain and disruption to their lives and hasten their work return, the studies showed that rehabilitation programmes should offer:

• Early management 
• Work in increasingly close collaboration with the real work environment
• Modified work schedules and workplace intervention

In the majority of the studies, workplace interventions represented one of the components of a broader interdisciplinary rehabilitation program. In six out of 17 studies, the authors were interested in measuring process outcomes which were more directly related to the intervention in the workplace.

Along with variation in actions to assist return to work, the objectives of the workplace interventions varied significantly.  Sometimes work was used as a source of information, sometimes as a therapeutic approach, and sometimes as the main focus of the intervention.

The main process outcome measured was the implementation of modifications of the work situation. However, the method, criteria, and resources used in the evaluations varied between studies. Modifications were:

• Adaptation of working hours
• Adaptation of job tasks
• Adaptation of the workplace physical environment (request by worker, company physician and ergonomic specialist)

In conclusion, the studies analysed varied according to the activities carried out, the resources and the context. However, there was mostly general agreement that in musculoskeletal rehabilitation, some form of intervention in the real work context is necessary.

The authors recommend a greater degree of cooperation and integration between the clinical management of a case and the return to work intervention.  They note that many authors recommend this occur, but there has been little in the way of research to assess how integration of the two elements can best be achieved.

Original research:

Workplace interventions for workers with musculoskeletal disabilities: a descriptive review of content.

Durand MJ, Vézina N, Loisel P, Baril R, Richard MC, Diallo B.

J Occup Rehabil. 2007 Mar;17(1):123-36.

Link to PubMed abstract