Effective return-to-work programs incorporate health services, case co-ordination, work modification

Systematic review finds practices can reduce MSDs, other pain-related conditions

Effective return-to-work programs incorporate health services, case co-ordination, work modification

To effectively help injured and ill workers return to their jobs, workplaces should offer different kinds of help that simultaneously aim to improve worker health, co-ordinate return-to-work activities and modify the work.

This is according to a systematic review of the research on the effectiveness of workplace-based programs designed to help injured and ill workers return to work, published in the Journal of Occupational Rehabilitation. The review was co-led by the Institute for Work & Health (IWH) based in Toronto and the Institute for Safety, Compensation and Recovery Research (ISCRR) based in Melbourne, Australia.

The review found strong evidence for the effectiveness of workplace-based return-to-work programs in reducing time away from work due to musculoskeletal disorders (MSDs) and other pain-related conditions when they incorporate practices or interventions in at least two of the three following areas:

•health services for injured workers provided at work or in settings linked to work (such as physical therapy, occupational therapy, psychological therapy, medical assessments, graded-activity exercises, work hardening)

•return-to-work co-ordination (such as case management and return-to-work planning and improved communication with health-care providers)

•work modifications (such as job accommodations, ergonomic or other work site adjustments, supervisor training on work modifications).

“Developing integrated programs will be a better investment than stand-alone programs, because this systematic review indicates that the grouping or packaging of interventions from the different domains makes them effective in a way that stand-alone interventions are not,” said Kim Cullen, an associate scientist at IWH and lead author of the review. “Even groups of interventions that are only from the same domain — for example, a package of health-focused services — are found in this review to have limited or no effect.”

The review also found strong evidence for the effectiveness of work-focused cognitive behavioural therapy (CBT) and strong evidence for the ineffectiveness of traditional CBT in reducing the lost time associated with mental health conditions.

“The key message when it comes to mental health conditions is that generic CBT doesn’t improve return-to-work outcomes,” said Cullen. “What does work is cognitive behavioural therapy that addresses the specific difficulties that the worker faces in returning to his or her job.”

The findings from the systematic review are based on the evidence found in 36 medium- and high-quality studies published between January 1990 and April 2015. The studies address the effectiveness of workplace-based interventions in the return to work of workers with MSDs, other pain-related conditions or mental health conditions.