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People Factors
Knowing the return to work expectation of an injured worker is an important first step

At a glance:
  • An individual's own prediction about their ability to return to work has a strong correlation with the outcome, particularly if their view was negative.
  • Assessing a person views about their future return to work can help ascertain if they are ready for rehabilitation, or need help to improve motivation and self confidence before 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.
     will be useful.
Perspectives:
Employee
Having a long-term medical condition can be difficult, particularly if it interferes with your ability to function at home or at work. An individual's desires and motivation play an important role in their return to work. In turn the person's motivation will depend on their understanding of their problem, its physical restrictions and how changes and improvements can be made.

If you think this is an issue for you, talk to your doctor about setting goals for recovery and return to work, and ask them what you can do to better understand your problem and regain function.
Employer
Asking your employee when they expect they will return to work can provide useful information. It would be worthwhile asking them what they think would help them get back into work.
Treater
Talking to people about their beliefs is an important aspect of management, particularly when an individual has been off work of some time. If they don't see themselves as returning to work, then the focus needs to be on advice to help them better understand their condition, increase their level of confidence, improve goal setting ability and motivation.

There are people who are not physically able, and motivational discussions will not help them to return to work. However, a number of people who get caught up in the system have a condition that in itself should not stop them returning to work, but they develop beliefs, habits, or attitudes, that make returning to work difficult. Giving an employee in this group appropriate advice regarding their condition, and supporting them to increase their level of functional ability will help.
Insurer
Return to work is an integral part of the management of workplace injury. This study suggests that learning what the injured person's opinion is regarding their likelihood of returning to work is important. If they have a negative prediction, then it may be sensible to initially focus on improving their motivation, provided it is generally thought that their medical condition should not prevent them from returning to work.
Original Article, Authors & Publication Details:
B. Heijbel1, M. Josephson2, I.Jensen1, S. Stark2, E. Vingard2 (2006).

Return to work expectation predicts work in chronic
chronic
continuing a long time or recurring frequently
 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.
 and behavioral health disorders: prospective study with clinical implications.
Journal of Occupational Rehabilitation; 16(2):173-184.

1Section for Personal Injury Prevention, Karolinska Institutet, Box 12718, SE-112 94 Stockholm, Sweden
2Department of Medical Sciences, Akademiska sjukhuset, Uala University
Background, Study Objectives, How It Was Done:
While the vast majority of people return to work quickly after an injury, some people remain off work for long periods of time. Over a hundred different factors have been shown to influence how soon a person will return to work after an injury. A great deal of research done to understand the level of influence of each of these factors.

The recovery expectations of patients who are off work with health problems have been recognised to be important for the improvement of their condition. The aim of this study was simple: the researchers wanted to find out if people's own predictions of their future return to work were accurate.

The study was done in Sweden, and involved sending a questionnaire to people who had been off work for more than 90 days. The participant's answers to the questions were compared to their work status 18 months later. People with advanced cancer, pregnancy complications, and serious mental illness were not included in the study.
Study Findings:
476 people completed the full-length questionnaire and 54 people answered a shorter version. 69% of people sent the questionnaire completed it, and the majority of these were female.

The company's Human Resources department provided the persons occupation and work status 18 months after the questionnaire was completed. The researchers were able to obtain information about 508 people, and that group was included in the research analysis. A few people had retired, three had died, and others were not able to be contacted at the follow-up 18 months after the initial questionnaire.

The questions included what the person's occupation was and whether the job was physically strenuous or not. The individual was asked when they predicted they would return to work and their opinion about their work ability in the long term. They had five options to choose from in answering this question:

  1. I will be working in my profession with the same working hours as before.
  2. I will be working in my profession but with reduced working hours.
  3. I will be working in another profession but with the same working hours as before.
  4. I will be working in another profession but with reduced working hours.
  5. The fifth alternative was a negative prediction: I will not be able to work anymore.
The results of the study found that only six out of 162 people (4%) with a negative prediction about their return to work did return to work. (In statistical terms, the predictive value of the person's own negative outlook regarding return to work was 96%, meaning that 96% of people who predicted that they couldn't return to work didn't return to work.)

Of the 323 with a positive prediction of their future return to work, 123 (38%) did return to work.

The researchers went on to look at other factors that might influence return to work. Not surprisingly they found that people who were off work for a shorter period of time were more likely to return to work, as were younger people, those whose complaints were not from more than one group of symptoms, those with a less physically strenuous job, and people who thought they were welcome back at work.
Conclusions:
The authors found clear evidence that when people predict they will not return to work, they are unlikely to. This may be because their physical problems are substantial and they are not able to work. However, other factors such as the focus or motivation to return to work may also contribute to making the negative prediction accurate.

The research also suggests that focusing on return to work without dealing with the individual's beliefs about their ability to work is likely to be counter-productive and not cost-effective. The main task before assisting with job seeking or returning to work is to change the person's negative view of their future ability to return to work to a positive one. This may involve exploring the individual's motivation, self-confidence, and workplace connections.

The authors conclude "According to the result in this study, it seems that one question to persons on long-term sick-leave about their appraisal of their future return to work, can work as a dividing line between a group ready for rehabilitation and a group who first need motivational help and improvement of self-confidence to change their view."
References:
PubMed Abstract
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