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Workplace Factors
Components of return-to-work programs that are effective

At a glance:
Return-to-work programs based in the workplace are effective in reducing the length of work disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 and the costs of compensation and health care.

A successful return-to-work program includes the following:

         The workplace contacts the injured worker early in their sick leave absence
         The worker is offered modified work duties to accommodate his or her injury
         Supervisors and managers are educated about ergonomics and safety training 
         The worker's doctor or specialist has contact with the workplace
         There is an ergonomic
ergonomic
Designing activities and the workplace in a way to minimize discomfort. i.e. Adapting work tasks, hours, or workstation to accommodate people. An ergonomic computer workstation allows the person to work in the best position to relieve load on the muscles of the neck and arms.
 worksite visit 
         A return-to-work coordinator is involved
         There is good support from supervisors
         Workers are given clear information about their rights and responsibilities in the return-to-work process
Perspectives:
Employee
Interventions based in the workplace can help people get back to work more quickly after a period of sick leave. This is important because returning to work speeds up recovery and the longer you are off work, the less likely you are to return.

It's important that employers and employees contact each other early on after the injury.  Employees may see this as purely the employer's role, however, by making contact themselves the worker improves their chances of returning to work.

Return-to-work programs are more successful when there is co-operation between employees, employers and supervisors.  It is also important that your doctor and your workplace communicate with each other.

The layout of your workstation might need to be reviewed.  As you have done the job you are in a good position to make suggestions about change.  When suggestions are offered in a positive and constructive way they are more likely to be implemented.
Employer
This paper shows that an effective return-to-work program based in the workplace can reduce sick leave, disability and associated costs.

Effective programs use the following strategies:

The workplace contacts the injured worker early in their sick leave absence

         Contact from the first moment can have the most powerful effect.  The time when a person first reports they have a problem is the best time to communicate effectively.  Dismissing or ignoring the problem sets up a negative cycle. 

         The person's supervisor is usually the best workplace contact to liaise with the employee.  They are familiar with the person and the job they do.

The worker is offered modified work duties to accommodate his or her injury

         Discussion about modified duties can occur while the employee is still unfit for work.  Early planning for return-to-work reduces delays and helps engage the employee. The employee with the condition should be involved in making plans for modified work 

The worker's doctor or specialist has contact with the workplace. 

         Contact with the treating practitioner
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 can be by phone, email, fax, or in person.  Treating practitioners can find management of return-to-work challenging, and employers can help by making constructive suggestions about return-to-work.  Invite the worker's treater to attend the workplace and suggest changes to equipment or work practices that can minimize repetitive strain
strain
Injury to a muscle in which the muscle fibres tear or become irritated as a result of overstretching or wrenching
 to workers.  

An Ergonomic worksite visit can be of benefit 

Involvement of a return-to-work coordinator improves outcomes

         Ensure that all employees are aware of who the return-to-work coordinator is and involve the coordinator in the return-to-work process.

Education of supervisors and managers about ergonomics and safety training 

         A range of studies have shown supervisors have a significant impact on return- to-work outcomes and that training supervisors improves their level of satisfaction as well as improving return-to-work. 
Treater
This study found that employees with 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 returned to work earlier if:

         The worker's doctor or specialist had contact with the workplace
         An ergonomic worksite visit was performed

Try to involve a patient's employer in their return to work and if possible arrange a worksite visit to discuss beneficial ergonomic changes.  Suggest modifications to work duties that could be made to accommodate the patient's injury, as being offered modified work duties also reduces the duration of sick leave.   

Managing return-to-work can be challenging.  Visiting the workplace helps you understand the work tasks being discussed.  A worksite visit also lets you get to know the people involved and offers insight into their perspective and approach. 
Insurer
The studies reviewed in this paper found that workplace-based return-to-work programs were effective in reducing the length of work disability and the costs of compensation and health care. 

Claims managers are able to encourage employers to set up effective systems.  Small employers with infrequent claims generally have less understanding of return-to-work management.  These employers may benefit from an early meeting to discuss approaches that are going to help the most.  Larger employers can be encouraged to have good systems in place, such as supervisor training, expertise to review ergonomic concerns and ways of keeping in touch with employees with an injury. 
Original Article, Authors & Publication Details:
R.-L. Franche1,2, K. Cullen1, J. Clarke1, E. Irvin1, S. Sinclair1,3 and J. Frank1,2.4 and The Institute for Work and Health (IWH) Workplace-Based RTW Intervention Literature Review Research Team5 (2005).

Workplace-based return-to-work interventions: A systematic review
systematic review
A comprehensive review of research studies in a particular area. The review follows guidelines to ensure the studies included are valid.
 of the quantitative
quantitative
A way of assessing a situation that uses direct measurement. The outcome is described as a number. This is in contrast to qualitative
qualitative
A way of assessing a situation without using direct measurement. The outcome is described as a summary in words rather than in numbers. This is in contrast to quantitative assessment, where the result is expressed as a number. A summary of a group of peoples’ beliefs about motivation is qualitative and expressed in words rather than numbers. Average days off work is a quantitative measure as it is expressed as a number of days.
 assessment, where the result cannot be expressed as a number. The average days off work is a quantitative measure, expressed as a number of days. A summary of a group's beliefs about motivation is qualitative, expressed in words rather than numbers.
 literature.
Journal of Occupational Rehabilitation; 15(4):607-631.
Background, Study Objectives, How It Was Done:
Workplace-based interventions help employees return to work after a work-related injury.  These interventions might be part of a broad program that aims to reduce work-disability.  They are carried out in several workplaces at once by a team of specialists, often as part of a research study.  Workplace interventions might also be individual strategies in the workplace that are not part of a planned program.

This review examined the scientific evidence for the effectiveness of workplace-based interventions.  It identified which strategies successfully reduced the length of disability after an injury and the costs of healthcare and missed work.

The studies investigated focused specifically on interventions for employees with pain conditions, who had filed a compensation claim for healthcare costs or lost time from work.  By searching the published research from 1990 onwards, the authors identified 35 studies on the topic, 10 of which were of high enough quality to be included in the review.  They combined and summarized the findings of these studies.
Study Findings:
The studies reviewed investigated the effectiveness of workplace-based return to work programs in reducing the length of work disability, decreasing the cost of compensation and health care and improving the injured worker's quality of life.  Components of effective return to work programs were identified from these studies, and the effects of each on outcomes are summarized below.

There is strong evidence that two components – a work accommodation offer and contact between health care providers and the workplace – significantly reduce work disability, and moderate evidence that these components reduce the costs associated with disability.  

There is moderate evidence that three other components –early contact with the worker by the workplace, ergonomic worksite visits and the involvement of a return to work coordinator – reduce work disability duration and associated costs.  In the studies reviewed, ergonomic visits were conducted by third party specialists such as physiotherapists, ergonomists and occupational therapists. 

There is moderate evidence that educating supervisors and managers reduces work disability duration.  In the studies reviewed, the education was about workplace ergonomic and safety training.

Supernumerary replacements are hired to temporarily fill the role of the injured employee, while the employee is doing modified work.  There is insufficient evidence that supernumerary replacements effectively reduce the duration and cost of disability.

There was mixed or insufficient evidence that each 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.
 component improved the quality of life of injured employees.  This finding is due to the limited number of high quality studies that used quality of life as an outcome measure for the success of an intervention, and small numbers of people followed in the studies. 
Conclusions:
This systematic review shows that workplace-based return-to-work interventions can reduce the length of disability and the associated costs after a workplace injury.

Making contact between healthcare providers and the workplace, and making adjustments in the workplace to accommodate for an employee's injury both result in shorter period of disability and lower costs.

Other strategies that are likely to be effective are: early contact between the employee by the workplace, ergonomic work site visits and the involvement of a return-to-work coordinator.
References:
No PubMed Abstract Available
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