From The Ergoweb® Learning Center

Study Identifies Key Features of Effective Return-To-Work Strategies

Ergonomic worksite evaluations, health care practitioner advice regarding re-injury prevention, and employer offering/employee accepting workplace accommodations were significant predictors of fewer time-loss days among employees with disabling work-related musculoskeletal disorders according to a 2005 prospective, cohort study involving over 400 workers.
Work injuries that involve lost work time lead to substantial employer costs and marked employee physical/emotional/financial disruption. Return-to-work (RTW) interventions have been recognized as effective in reducing the duration of work absence, but studies have not identified the specific effectiveness of different, commonly applied case management approaches.
In their 2005 investigation, Franche et al. compared several RTW interventions utilized one month after injury to the amount of work absence that occurred during the time period six months post injury. Strategies that were not found to have a significant impact on the number of lost workdays included:
  • Early contact made by the employer to the employee
  • Communication between the health care provider and the employer
  • The existence of a RTW coordinator
The study revealed that at one-month post injury, only 8.1% of the disabled workers stated their work area had received an ergonomic evaluation with recommendations. The authors note that research findings relative to ergonomic assessments may be skewed by the process that determines who receives a review (potentially insurance carrier ordered) and the impact of an assessment (a potential cut in time-loss benefits by the insurance carrier).  
Study Design

Volunteers were identified through a weekly review of claims made to the Ontario Workplace Safety and Insurance Board (WSIB) in Ontario, Canada.
Included subjects had to have an accepted/pending work-related upper extremity or low back musculoskeletal injury that involved at least 5 lost workdays within 14 days after the injury.
Exclusion criteria included those who:
  • were less than 15 years old
  • had challenges in speaking/understanding English
  • sustained a fracture, amputation, burn, concussion, electrocution, head injury, hernia, cut, crush injury (without broken bones)
  • were a security concern
  • had a history of incarceration or institutional treatment
Of 1,038 potential subjects who were eligible and successfully contacted by the interview team, 632 and 446 completed the one-month and six-month surveys, respectively.
Experiment Procedure/Measurements
At one-month post injury, a telephone interview with the subjects elicited information involving:
  • Employer contact with the injured worker
  • Work accommodation offer by the employer and acceptance by the worker
  • Communication between the employer and the health care provider
  • Health care provider recommendations regarding re-injury prevention
  • Ergonomic worksite evaluations with recommendations
  • The existence of a RTW coordinator
At the six-month point, subjects were interviewed again via telephone to report the number of injury related lost workdays. This information was matched with WSIB lost workday data for each consenting subject.
Analysis was performed from two sets of dependent variables: (1) self-reported number of full workdays absent from the date of injury to the six-month interview and (2) WSIB data of the number of compensated days receiving full disability wage replacement benefits from injury date to six-months post injury. 
Twenty potential confounders were identified and evaluated including age, gender, marital status, level of education, annual income, children/grandchildren under 18 years of age, workplace size, union status, workplace sector, occupational classification, functional/pain status, comorbidities, employment status at time of injury, physical work demands, psychological work demands, job security, and depression.
Selection, attrition and consent bias were assessed.
Other Comments and Findings
Ergonomic worksite evaluations were found to be significantly related to fewer time-lost work days using the WSIB data.   Employer offering/employee accepting workplace accommodations and health care practitioner advice regarding re-injury prevention were significant predictors of fewer time-loss days with both the WSIB and self-reported data.
At one-month post injury, reporting by subjects indicated that:
  • 60.3% had been contacted by their employer
  • 55.5% had received a work accommodation offer of which 73.2% accepted the offer
  • 38.4% knew there had been communication between their health care provider and their employer while 38.8% knew there had been no communication
  • 17.6% knew their health care provider gave guidance to the employer regarding re-injury prevention or recurrence; 45.2% stated their health care provider did not offer advice
  • 8.1% received an ergonomic evaluation with recommendations; 66.7% indicated that the recommendations were applied
  • 73.9% reported there was a specific individual coordinating their return to work
Study Concerns/Limitations
The authors point out:
  1. The existence of a selection bias whereby subjects had a higher rate of being older, female, having a longer duration on wage replacement benefits, and having a higher rate of wage replacement re-instatement.
  2. Combined strategies (i.e., early employer contact, work accommodation offer/acceptance, contact between health care provider and employer, advice from health care provider to employer, ergonomic assessments, and RTW coordinator) may be effective but were not evaluated in this study.
  3. The Self-report data may have measurement error due to not being tested for validity and reliability.
  4. Over emphasis may become placed on a specific RTW strategy by a worker who successfully returned to work. The worker, because of his/her positive work outcome, may be more likely to recall the tactic applied.
Article Title: The Impact of Early Workplace-Based Return-to-Work Strategies on Work Absence Duration: A 6-Month Longitudinal Study Following an Occupational Musculoskeletal Injury
Publication: Journal of Occupational and Environmental Medicine 49, 960-974, 2007
Authors: R L Franche, C N Severin, S Hogg-Johnson, P Côté, M Vidmar, and H Lee

This article originally appeared in The Ergonomics Report™ on 2007-11-28.