Return to work - Issue 27 (Apr 2006)

Issue 27: April 2006

On this page

  1. The Benefits of Early Return to Work
  2. Introduction
  3. Treatment and rehabilitation factors
  4. Reduced period of incapacity
  5. Avoidance of the consequences of long term unemployment
  6. Job retention and minimised economic loss
  7. Improved access to treatment, rehabilitation and support networks
  8. Provider intervention
  9. ACC resources
  10. Conclusion
  11. References

The Benefits of Early Return to Work

  • An early Return to Work (RTW) following an injury is an integral part of the rehabilitation process.
  • The most serious risk from delayed RTW is loss of the job held prior to the injury. The employment status of a person has been linked to that individual’s sense of well-being and view of their own health status.
  • An injured worker has much to gain from maintaining his or her employment status, ie improved rehabilitation benefits, additional support networks, and reduced risk of chronic pain states.
  • Early RTW will prevent adverse consequences of unemployment. These include mental, physical, and economic health effects.
  • A US study has found that if people do not RTW within six months there is only a 50% chance of them returning. After a year, the probability reduces to 10-25%.Introduction

Introduction

The benefits of early return to work cannot be over-emphasised. Lengthy and unnecessary periods off work can damage the employer-employee1 relationship, and cause adverse physical, mental and economic health effects on the injured individual. Some practitioners and patients still perceive incorrectly that rest and reduced activity will hasten recovery in all instances of injury, and that work is harmful after sustaining an injury. Evidence now indicates that prolonged rest may instead be harmful.2 In cases of temporary and minor disability, the focus should move from what cannot be achieved to that which can. The benefits of early return to work discussed below are summarised from ACC’s Return to Work Guide.3

Treatment and rehabilitation factors

An early return to work following an injury should become an integral part of the rehabilitation process. Early return to work:

  • promotes physical activity
  • enhances functional capacity
  • reduces risk of chronic pain and psychosocial issues
  • reduces recovery time
  • helps maintain a normal lifestyle.

Reduced period of incapacity

In some situations, individuals are unable to resume their pre-injury work duties. Providers should encourage return to work as soon as individuals are able to work in some capacity. This may require:

  • modifying work hours
  • suitable and/or alternative work duties being available
  • modifying the work area.

Avoidance of the consequences of long term unemployment

Long periods off work may damage relationships with employers and, as a consequence, jeopardise long-term employability prospects. Reluctance to return to work correlates with the length of time away from work, ie if people do not return to work within six months they have only a 50% chance of ever returning. After a year, the probability reduces to 10-25%.4

Job retention and minimised economic loss

The most serious risk from delayed return to work is loss of the job held prior to the injury. An injured person, especially with residual functional loss, is at high risk of long-term unemployment.5 Economic loss, and the anxiety resulting from the loss, may be considerable. ACC weekly compensation is limited to 80% of a claimant’s pre-injury earnings rate.

Improved access to treatment, rehabilitation and support networks

Larger organisations may provide treatment and rehabilitation services, ie medical and nursing services, physiotherapy services, and access to gymnasiums and exercise therapists. Collegial interaction may speed recovery through psychosocial benefits, make individuals feel less marginalised from society, and remove the ill-effects of vulnerability experienced with social isolation.

Provider intervention

A person’s employment status has been linked to that individual’s sense of well-being and view of their own health status.6 Adverse mental health effects generally occur as a result of the loss of psychosocial benefits gained from working, ie security, identity, job satisfaction and self-esteem. Some individuals assume the ‘sick role’, or demonstrate ‘abnormal illness behaviour’7 in the way they perceive, evaluate, and react to their symptoms. Early detection by providers may prevent progression of this behaviour to chronic disability states, and provide better results when reinforcing the importance of the ‘work role’.

An holistic approach will better identify the barriers to work experienced by patients. In some instances these barriers may be unrelated to an injury disability and stem instead from a patient’s lack of confidence in his or her ability to manage regular duties, an inability to cope with home and family demands, or a workplace that lacks a supportive environment.8 A negative attitude to the work ethos may be prevented from the outset of treatment if rehabilitative efforts from providers, employers and ACC are early, timely and co-ordinated. Collaborative communication of a rehabilitation plan, which lays down realistic timelines for expected return to work, can help promote early return to the workplace. Evidence now supports the fact that co-ordinated care is an important facilitator of job retention and successful vocational rehabilitation.9

The initial rehabilitation pathway chosen, or the decision to certify time off work after an injury, can have a major impact on the future employment status of an individual. Unnecessarily long duration claims (time off work) with subsequent loss of employment, can lead to dependence on unemployment or sickness benefits (which generally pay less) when entitlement to ACC weekly compensation ceases.

A survey of ACC claimants who worked prior to their injury, but were out of work at least three months after coming off weekly compensation, showed that 92% were earning less than at the time of their injury.10

ACC resources

ACC has vocationally-based early intervention contracts for return to work. Providers can liaise with their ACC case managers to initiate these programmes. These include workplace assessments by occupational therapists and physiotherapists, and Graduated Return To Work Programmes with supervision from appropriate therapists in the workplace. Employment Maintenance Programmes are also available where an employer cannot readily provide alternative work duties for an employee following an injury. ACC can also facilitate transport in cases where travel to work after an injury becomes problematic.

Conclusion

Early provider intervention and a multi-disciplinary team approach are important determinants in effecting successful rehabilitation. This increases the likelihood of early return to work which in turn confers the benefits of employment. As noted in the Australasian Faculty of Occupational Medicine (2001), “Unemployment is in itself, a risk factor for poor health.”11 Evidence also supports the fact that “unemployment is at least as important as disability in health outcomes of claimants.”12

Changing the rehabilitation focus to the benefits, rather than the drawbacks, of early return to work is an important change imperative. Providers, together with ACC support and work programmes, can be important facilitators and mediators of this change process.

References

  1. Ratliff John C, Grogan Terry. Early return to work profitability. Professional Safety. Health and Medical Complete. March 1989; 34:3.
  2. (Advice to stay active as a single treatment for low-back pain and sciatica) [Review] Hilde G, Hagen KB, Jamtvedt G, Winnem M. Cochrane Database of Systematic Reviews. Date of Most Recent Update: 23 August 2005. Date of Most Recent Substantive Update: 31 January 2002 {Cochrane Back Group}.
  3. Return to Work Guide, ACC; due to be published April 2006.
  4. US Department of Labor. Industry Injury and Illness Data 2002. Available online at: www.bls.gov/iif/oshsum.htm. Wisconsin Department of Workforce Development, Best Practices for Early Return To Work. 2002 http://www.dwd.state.wi.us/wc/employers/early_rtw.htm. Working Balance. Work practices: absenteeism. http://www.workingbalance.co.uk/sections/work_practices/article_display.php?id=1721.
  5. Michael Robbins, OH and S Canada. Don Mills. Dec 2000; Vol.16, Iss. 8.
  6. Young AE, Murphy GC. A Social Psychology Approach to Measuring Vocational Rehabilitation Intervention Effectiveness. Journal of Occupational Rehabilitation. September 2002; 12(3): 175-89.
  7. Mechanic D, Volkart EH. Stress, Illness Behaviour and the Sick Role. American Sociologist Review. 1961; 26: 51-58.
  8. Paton N, O’ Driscoll E. Getting back on the job. Occupational health. Sutton. Jan. 2005; pg. 10.
  9. Job retention and vocational rehabilitation: The development and evaluation of a conceptual framework. Research Report 106. Prepared by the Middlesex University Business School and the University of Strathclyde for the Health and Safety Executive 2003. Available online at: http://www.hse.gov.uk/research/rrpdf/rr106.pdf.
  10. BRC Marketing and Social Research and Accident Compensation Corporation. Sustainability of Return-to-Work. Benchmark Final Report. Wellington. July 2004.
  11. Compensable Injuries and Health Outcomes. The Australasian Faculty of Occupational Medicine. The Royal Australasian College of Physicians. Health Policy Unit. 2001.
  12. The Royal Australasian College of Physicians (1999). Wilkinson and Marmot (1998). Sanderson et al (1996), and Jackson et al (1997).

©ACC Provider Development Unit, 2006