Research short: Mixed opinions
There has been much international discussion (and some complaint) about the certificates doctors write for workers’ compensation claimants and the restrictions they impose on workers attempting to return to work.
Canadian researchers wanted to understand this area better.
In particular, they wanted to know whether, faced with the same medical condition and clinical situation, different doctors would certify in much the same way or vary in their approach.
The researchers asked health practitioners who were working in a rehabilitation facility about how they would certify people according to three particular case studies. Thirty-six health professionals were involved in the study, including five doctors, thirteen physiotherapists, ten occupational therapists and eight exercise therapists.
Interestingly, the researchers found that there was significant agreement in certification when the person had a clear-cut medical condition. When there was a straightforward medical problem such as a fracture, virtually all health practitioners agreed about how the person should be certified.
However, when the problem was less cut and dried—for example, when the health practitioners were assessing an individual with non-specific back pain—there was only about 55% agreement regarding return to work.
Some doctors base their recommendations predominantly or wholly on the person’s medical condition. Other health practitioners take into account the person’s beliefs, their fears, perhaps their perception of the workplace, and are influenced by a broad range of factors.
Beliefs about the person’s condition, workplace issues and fears about whether the problem will be aggravated with return to work, are all important issues to address. However, these issues should not stop a person coming back to work; rather they should be identified and resolved through discussion, advice, and coordinated communication.
If it is medically permissible for someone to return to work, in most instances, they should; but it is up to the workplace, the treating practitioner and the individual worker to make this ideal a reality.
Authors
Ikezawa Y. Battie MC. Beach J. Gross D. .
Authors Full Name
Ikezawa, Yoko. Battie, Michele C. Beach, Jeremy. Gross, Douglas. .
Institution
Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
Title
Do clinicians working within the same context make consistent return-to-work recommendations?.
Source
Journal of Occupational Rehabilitation. 20(3):367-77, 2010 Sep.
Abstract
INTRODUCTION: Healthcare providers play important roles in the process of making return-to-work (RTW) recommendations, which have important consequences for injured workers and their employers. We studied the inter-rater reliability of RTW determinations between clinicians in a specific workers' compensation setting.
METHODS: Three case scenarios were given to clinicians working at one rehabilitation facility to examine consistency between clinicians in RTW recommendations. Additionally, we examined what information clinicians relied on to make decisions. Analysis included percentage agreement and other descriptive statistics.
RESULTS: Thirty-six clinicians (13 physiotherapists, 10 occupational therapists, 8 exercise therapists, and 5 physicians) responded to the questionnaire. Subjects showed a high percentage agreement regarding RTW readiness on fracture and dislocation scenarios (97.2 and 94.4%, respectively), while agreement on a back pain scenario was modest (55.6%). In all cases, more than 50% of clinicians relied on biomedical information, such as physical examination.
CONCLUSIONS: Clinicians demonstrated a high level of agreement (>94%) when making RTW recommendations for injuries with clear pathology. However, a lower level of agreement (56%) was observed for back pain where the etiology of pain and disability is often more complex. Clinicians most commonly recommended RTW with restrictions, underlining the importance of workplace accommodations and modified duties in facilitating resumption of work.