Useful research to aid return-to-work programs

For disability management and occupational health professionals looking to improve their return-to-work (RTW) programs, research can be a best friend in pointing the way forward. The Institute for Work and Health (IWH) — an independent, not-for-profit organization based in Toronto — has been conducting research into disability prevention for more than 20 years. It has amassed evidence about the workplace and work-related factors that can help and hinder return to work.

What helps?
In 2007, the Institute published the Seven Principles for Successful Return to Work. Based on a 2004 systematic review of good quality studies on workplace-based RTW programs, the lead researchers — Renée-Louise Franche (now an IWH adjunct scientist) and IWH scientist Ellen MacEachen — found the following characteristics have a positive effect on the duration and costs of work disability:

• the workplace has a strong commitment to health and safety, which is demonstrated by the behaviours of the workplace parties
• the employer makes an offer of modified work to injured/ill workers so they can return early and safely to work activities suitable to their abilities
• RTW planners ensure the plan supports the returning worker without disadvantaging co-workers and supervisors
• supervisors are trained in work disability prevention and included in RTW planning
• the employer makes an early and considerate contact with injured/ill workers
• someone has the responsibility to co-ordinate RTW
• employers and health-care providers communicate with each other about the workplace demands as needed, and with the worker’s consent.

Because new studies have been published since the systematic review was conducted about a decade ago, IWH has collaborated with colleagues at Australia’s Institute for Safety, Compensation and Recovery Research to update this review. Due to be completed later this year, the updated review should provide the latest evidence on effective workplace-based RTW interventions.

Given that offering accommodated work affects RTW outcomes, knowing what makes work accommodation effective is important.
A study led by Franche, published in 2009, found work accommodations are more likely to be offered by workplaces with strong disability management policies and practices. These practices include:

• contacting workers shortly after injury or illness to express concern and offer help
• working with physicians to develop return-to-work plans
• following up after injured workers return to adjust the work situation as needed
• providing retraining when injured workers can’t return
• having labour and management work together as partners in returning injured workers.

Organizational policies and practices also matter in another way when it comes to return to work. They appear to predict the likelihood of injured workers returning and, more importantly, if these workers will function well once back in their jobs, according to a 2011 research from IWH associate scientific director Ben Amick.

Research results indicate workers who gave their organizations high marks in terms of policies and practices were 2.3 times more likely to be back at work and functioning well at six months, and 2.2 times more likely at 12 months than those who gave their organizations low marks. The policies and practices in question promoted a people-oriented, trusting and co-operative work culture, a safe work environment, ergonomically designed jobs and strong disability management practices.

Some types of workplace-based RTW programs seem to be particularly effective. IWH scientist Ivan Steenstra found that workplace-based programs in which workers and supervisors jointly identify and solve return-to-work barriers help workers with low-back pain return to their jobs more quickly. These workers returned 30 days earlier, on average, than those who received usual-care, and at only a slightly higher cost.

These programs are based on the “Sherbrooke model,” which refers to a program developed in Canada by Patrick Loisel and his fellow researchers at Quebec’s Sherbrooke University. The programs involve the worker and supervisor, with the help of an occupational health professional or ergonomist, identifying and solving RTW barriers, and then implementing the solutions in the workplace.

What hinders?
In the 2009 publication, Red Flags, Green Lights:  A Guide to Identifying and Solving Return-to-Work Problems, IWH’s MacEachen and her team describe the problems that can complicate recovery and return to work, including problems related to the workplace:

• a worker returning to work too early, before being well enough to manage modified work
• a worker’s injury complicating his or her commute, even though modified work may be available
• a worker doing modified work not suited to her physical restrictions or where the danger that caused the injury continues to exist
• a worker’s workstation, health-care needs or injury not being sufficiently accommodated
• a worker doing “embarrassing” modified work of little productive value.

For each potential work problem, the guide points to warning signs and helpful practices. It does the same in the areas of vocational rehabilitation, health-care and claims processing.

More recent research also looked at the key role of co-workers in the RTW process. It turns out co-workers are not a neutral party when it comes to injured workers’ RTW. They can make all the difference to the success — or failure — of a return, yet can also be negatively affected by the challenges involved.

This was made clear in two recent qualitative studies both published within the last year. One study was led by Debra Dunstan of the University of New England in Australia, who co-authored the study with IWH’s MacEachen. The other study was led by former IWH scientist Agnieszka Kosny, now a research fellow at Australia’s Monash University.

These studies found co-workers can be barriers to a colleague’s return to work when:

• they don’t already have a good relationship with the returning worker
• the work culture is competitive, has little modified work available, is characterized by poor com­munications and precarious work  and/or offers little job security
• the returning worker requires support for too long — because worker goodwill can wear thin over time.

The researchers suggest communicating effectively so co-workers understand the injury, are consulted about RTW plans and receive guidance on how to assist.
If possible, hire replacement staff to ease the workload on co-workers. Acknowledge and recognize the contribution of co-workers, via monetary or in-kind payments such as extra holidays.

Is it worth it?
RTW is beneficial for both workers and the workplace. Getting back to work after an injury or illness can improve the health of workers, according to a 2012 systematic review conducted by researchers, including IWH president Cameron Mustard, at the Health Research Initiatives at the Ontario HIV Treatment Network. The review found a significant improvement in health after re-employment and a significant decline in health attributed to continued unemployment.

A systematic review published in 2008 by IWH’s Amick found strong evidence RTW programs have a positive effect on workers’ compensation claims costs and on the frequency and severity of injuries and illnesses.

Visit for more RTW data.

Cindy Moser ([email protected]) is the communications manager at the Institute for Work and Health in Toronto. Dwayne Van Eerd ([email protected]) is an associate scientist at the Institute and member of the research team updating the systematic review of workplace-based return-to-work interventions.