January 31st, 2012

Successful Strategies to Prevent Prolonged Disability for Musculoskeletal Disorders (MSDs)

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[Editor's Note: This article is reprinted with permission from The Ergonomics Report™, where it was originally published on 31 January 2012.]

Work-related musculoskeletal disorders (WRMSDs), which are among the most common types of work injury in industrialized countries and the leading causes of significant human suffering, loss of productivity, and heavy costs to society, constitute a heavy burden due to the constantly growing number of workdays lost by a small percentage of workers being compensated for prolonged disability caused by musculoskeletal disorders (MSDs). The main goal of a recent literature review published at IRSST (Institut de recherché en santé et en sécurité de travail) was to inform stakeholders and practitioners in the field of work disability intervention on some successful strategies for preventing prolonged work disability and promoting sustainable safe return to work (RTW).

The review revealed five key strategies as potentially successful in preventing prolonged disability in workers compensated for WRMSDs. Each strategy is summarized below. A link to download the full report is available at the end of this summary.

One: Early Recognition and Targetted Intervention

Early routine screening for early identification of injured workers at risk of becoming prolonged disabled, followed by appropriate targeted intervention on the specific risk factors identified, are reported as effective ways to prevent the development of prolonged disability in a proactive way. 
 
Two: Multimodal, Multidisciplinary Interventions
 
Different types of interventions or combinations of interventions included in a given rehabilitation program appear to be beneficial in terms of helping prevent prolonged disability. Multidisciplinary multimodal programs are frequently associated with positive outcomes such as workers’ leaving the sickness benefits scheme and getting compensation claimants back to work, and with having a positive impact on the following:
  • sick-leave status;
  • recurrence rates;
  • work disability status;
  • cost-effectiveness;
  • socio-economic impacts
  • pain intensity, disability;
  • depression;
  • cumulative physical capability; and
  • physical performance.

Moreover, early targeted intervention for people who have been screened for psychosocial and ergonomic risk factors appears to be central to preventing prolonged disability and promoting sustainable safe RTW.

Three: Effective Process Management

The practitioners’ and stakeholders’ practices have a great impact on the implementation of these interventions. By their actions and interactions with workers, three categories of actors play an important role in preventing prolonged disability:

  1. physicians and other health care providers;
  2. case manager nurses or insurers; and
  3. workplace actors.

Physicians are mediators in temporary and permanent disability in patients with chronic musculoskeletal complaints. Physicians' recommendations for activity seem to have important health and financial implications. Indeed, patients' desires strongly predict disability recommendations (i.e., physicians often acquiesce to patients' requests). The most successful efforts in influencing physician recommendations seem to be related to mass communication directed at influencing public attitudes, while reinforcing the current standard of practice for physicians. Also, there is good scientific evidence to show that the use of case management practices is cost-effective through reducing time off work and lost productivity, and reducing healthcare costs.

‘Case management’ is a goal-oriented approach to keep employees at work and facilitate early RTW. Case management approaches may involve the use of “treatment”, “programs”, and/or “vocational rehabilitation”. It may deploy some or all of these, or none at all, based on the premise that case managers describe their role as: “Doing whatever it takes, with whatever you’ve got, for as long as it takes, to get the job done” (Missouri Foundation for Health, 2003).

Other key elements of the different actors' practices, including providing early access to appropriate advice, keeping workers at work, or returning them to work as quickly as possible, and the employer and compensation board representatives staying in touch with the individual and the physicians during the work absence also appear to be important, as reported by various authors. Continually providing practitioners with updated guidelines and directives for improving their practices appears to have, at least theoretically, a beneficial impact in terms of helping prevent prolonged disability. Providing them with knowledge about the different outcomes associated with diverse conditions of application could improve their ability to adapt their practices to a specific implementation context. Training was one of the specific strategies associated with achieving a change in the practice behaviour of heath care providers, case managers or occupational practitioners in the workplace accommodation process.

Four: Communication and Collaboration Skills

Improvement in the key practitioners' and stakeholders’ skills, especially in matters of communication and collaboration skills, is reported to enhance the coordination of the actions in the process of rehabilitation, RTW and workplace intervention, and is an essential strategy in preventing prolonged disability. Indeed, recent conceptual models and reviews suggest that optimal relationships among stakeholders constitute an important condition for RTW interventions to be most effective. Improved coordination and collaboration between key stakeholders and in the activity of the different actors involved in the rehabilitation and RTW process is essential to the enhancement of the effectiveness of an intervention in order to prevent prolonged disability in workers with compensated WRMSDs.

As emphasized in a recent literature review on models of disability management and prevention with respect to communication, communication-based interventions may further improve disability outcomes, reduce adversarial relationships, and prove cost-effective. From a different perspective, real and better communication between the main players enables researchers and clinicians to better reproduce the work demands in clinical settings and to come quickly to knowledgeable decisions as to whether to expose workers gradually to the real work environment or permanently reduce exposure to workplace demands.

Five: Effective Information Management

Providing adequate information to the multiple actors and stakeholders involved in the process of rehabilitation and RTW seems to be critical for sustainable and effective RTW of injured workers with compensated WRMSDs. It is related to promoting informed and active commitment of workers in the process of rehabilitation and RTW through clear and transparent shared goals.     

Conclusion

The findings of this literature review provides stakeholders and practitioners with some possible avenues for action essential to the implantation of programs that have the capacity to reach many employees and promote positive outcomes for all workers, especially those who need it most by providing them with potentially successful strategies for preventing prolonged disability and with information about specific areas in need of further research regarding workers compensated for WRMSDs.

Reference

Nastasia, Iuliana; Tcaciuc, Rodica; Coutu, Marie-France, 2011. Strategies for Preventing Prolonged Disability in Workers Compensated for Work Related Musculoskeletal Disorders – A Systematic and Comprehensive Literature Review. Studies and Research Projects / Report  R-719, Montréal, IRSST, 2011, 146 pages. A downloadable version is available at: http://www.irsst.qc.ca/media/documents/PubIRSST/R-719.pdf

 

This article originally appeared in The Ergonomics Report™ on 2012-01-31.



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