RTW Knowledge Base
RTW Knowledge Base
Home Employee Employer Treater Insurer View All Types About Champions Contact
Approaches and Interventions
Common ingredients of successful rehabilitation programs

At a glance:
Treatment programs for back, neck, shoulder, and upper limb
upper limb
arm
 conditions get people back to work more quickly when they address both physical and nonphysical aspects of recovery. The most common elements of such programs are education, physical and psychological
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 treatment, and training in good work practices. Changes to the workplace, or the person's duties also allow them to return to work earlier.
Perspectives:
Employee
Sometimes medical treatment is enough to get back to work, and sometimes it is not. There can be many physical, psychological, and practical barriers to getting back to work after an injury. The more of these factors a treatment program addresses, the more successful it is likely to be.

Medical treatment of your condition is important, but not all the barriers to returning to work are medical. The way you think and feel about your situation is important.  How much you understand about your condition is also important. Sometimes work tasks and techniques can be changed so you can manage them sooner or more comfortably. 
Employer
There are a number of barriers that prevent people getting back to work.  Not all of them can be improved by medical treatment. The most effective rehabilitation
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 programs provide education about the person's condition and how they can continue to work while they recover. They also include physical and psychological treatment.

This gives us an idea of some of the challenges injured workers have to contend with. Keep in mind that an injury, or spending significant time off work, can have a big impact on a person's life.

One of the most helpful things an employer can do is provide modified work duties so that the injured person can get back to work sooner. The longer they are away from work the less likely they are to return, so it's important that rehabilitation programs intervene early, and modified work duties are made available quickly.
Treater
Work injuries often require medical treatment, but there is little evidence that this treatment alone will get people back to work.

Rehabilitation programs get people back to work more quickly when they address the person's knowledge of their situation, provide training in good work practices and offer physical and psychological treatment. There is some evidence that training in relaxation techniques may also be a useful element of such a program.
Insurer
Encourage the injured person to get good advice about their condition and understand the system they are working within. Not all the help they need is medical, and it is unlikely that a doctor can address all the barriers the person needs to clear in order to get back to work.

To address these issues facilitate the person to become an active participant in managing their own rehabilitation, they may need your support to find the appropriate people to help with aspects of the process.
Original Article, Authors & Publication Details:
E. M. Meijer1, J. K. Sluiter1 and M. H. W. Frings-Dresen1 (2005).

Evaluation of effective return-to-work treatment programs for sick listed patients with non-specific musculoskeletal
musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 complaints: a systematic review.
  International Archives of Occupational and Environmental Health; 78:523-532

1Coronel Institute for Occupational and Environmental Health, Academic Medical Center, University of Amsterdam, Research Institute AmCOGG: Amsterdam Centre for Health and Health Care Research, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
Background, Study Objectives, How It Was Done:
Two of the most common health problems in Europe are backache (33% of workers) and neck/shoulder pain (23% of workers). Upper limb pain also affects many workers. Musculoskeletal disorders such as these are a concern since they affect both health and productivity.

Sick leave can make people feel depressed, anxious and dissatisfied. The longer the sick leave, the more difficult it is to get back to work.

This study reviews the effectiveness of interventions to help people with back, neck, shoulder or upper limb pain return to work. The authors also wanted to see if any treatments were more effective for a particular region of pain.

The authors searched for articles published between January 1990 and December 2004 which focused on interventions to return people with musculoskeletal injuries to work. 18 studies of sufficient quality were found and included in the review.

Components of treatment programs were grouped into five categories:

1.       Knowledge conditioning (providing education and information about the condition)
2.       Physical conditioning (providing exercises and graded activity)
3.       Psychological conditioning (teaching coping skills and using cognitive
cognitive
relating to the mental processes of perception, memory, judgment, and reasoning
 behavioural therapy)
4.       Social conditioning (training in social skills)
5.       Work conditioning (changing the worksite or work tasks, and training in good work techniques)

If people who received a treatment returned to work significantly sooner than the control group, the treatment program was said to have a positive effect.
Study Findings:
Effect of treatment programs on return to work:

22 treatment programs were used in the 18 research projects reviewed in this study. Of those studied:

         Seven treatment programs helped people to return to work more quickly.
         Twelve treatment programs had no effect on how quickly people returned to work.
         For three treatments, the programs used helped a subgroup of people to return to work, but had no affect on other participants.
        
Components of effective treatment programs:

All of the effective treatment programs used one of the conditioning components identified above. 

Of the seven effective treatment programs:

         Knowledge conditioning was a part of six 
         Psychological conditioning was a part of five 
         Physical conditioning and work conditioning were a part of six 
         Relaxation was a component of four

The authors noted:

1.       Return to work was faster when physical conditioning was combined with changes to the workplace and work tasks.  
2.       Knowledge conditioning, psychological conditioning and work conditioning were used most frequently in treatments which improved return to work outcomes.  
3.       A combination of knowledge, psychological, physical and work conditioning, and perhaps relaxation exercises, are helpful in enabling return to work.
Conclusions:
The essential components of a successful return to work intervention
intervention
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 appear to be knowledge conditioning, psychological conditioning, physical conditioning and work conditioning, possibly supplemented by relaxation exercises. Treatment programs for musculoskeletal disorders that combine several approaches seem to be more effective.

Knowledge, psychological and work conditioning were the most common components of effective treatments. This could be because they improve participants' expectations of recovery, which has been shown to improve return to work outcomes.
References:
PubMed Abstract
Total Votes for this Article: 13 Average Rating: 2.4
Poor                               Excellent