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Medical Factors
What helps people with long-term arm pain return to work?

At a glance:
After treatment for long term arm pain, patients who were working were:

  • More likely to have been working shortly before treatment
  • More confident they could manage their pain
  • More optimistic about being able to work and overcome problems at work
  • More likely to expect support from co-workers
  • More likely to have an employer who responds supportively to their condition
Perspectives:
Employee
Long-term arm pain affects many people. Some studies have indicated that up to 30% of university students experience soreness in one or both arms. Sore arms are a common problem for musicians. The problem is typically troublesome at times and then settles; it may then play up at other times. Various factors affect the pain, including the nature of the repetitive activity and emotional factors such as tension. In the 1980s arm pain was called RSI. Many people stayed off work for long periods as a result of it, with some becoming permanently disabled.

This study looked at the influence of return to work for people who had undergone a treatment program focused on improving their activity and ability to function. Having a greater understanding about the condition, gaining confidence regarding returning to work and having a supportive employer were positive factors enabling a successful return to work.

People become more confident about their abilities when they have a good understanding of the condition. Make sure you understand the nature of your problem. What is the usual course for the soreness, what will stir up the symptoms, what you can do to lessen the problems? Talk to your treater and your employer about these things and what you can do to positively manage the problem while remaining active both at home and work.
Employer
The outcome of a return to work with arm pain is heavily influenced by the individual's understanding of their problem and the level of support provided in the workplace. The individual's confidence that the workplace will look after them has a major bearing on whether they return to work.

What can you do to understand an individual's return to work, their concerns and worries? What can you do to increase their confidence that they will manage and be supported in their return to work? Does their manager understand the nature of the problem, are the duties productive, what can the team do to support their return to work? Return to work outcomes depends more on finding positive solutions to these things than on any medical treatment.
Treater
Management of long term arm problems can be challenging. A variety of studies have indicated that treatment rarely solves the problem, or even makes a significant difference to the symptoms. Treatment tends to lead to expectations that the problem will be fixed, or improved by something being done to the individual.

With respect to a return to work this study indicates that the individual's confidence in being able to manage the condition and feeling supported in the workplace are the major factor influencing a return to work.

Educating the individual about their problem is important. This helps them to understand that it is a common condition, what they can do to self manage and the various factors that will aggravate the problem. This common problem is typically self-limiting.

More substantial problems arise when there is over-reliance on treatment, long periods of time off work, and the consequent health problems that arise through being off work for extended periods while being part of a compensation system.
Insurer
The successful return to work of people with long-term arm pain is more a function of the support provided by the workplace, the person's understanding of their condition, and the level of confidence they have in their abilities to return to work.

Ensure the employer is providing a supportive environment and that the person understands their condition and functional abilities.
Original Article, Authors & Publication Details:
J. H. Adams1 and A. Williams2 (2003).

What affects return to work for graduates of a pain management program with chronic
chronic
continuing a long time or recurring frequently
 upper limb
upper limb
arm
 pain? Journal of Occupational Rehabilitation; 13(2):91-106

1Occupational Therapy, Human Focus Return to Work, Lancastrian Office Centre, Talbot Road, Old Trafford,

Manchester, United Kingdom.

2Department of Psychological Medicine, GKT Medical School, University of London & INPUT Pain Management Unit, St Thomas' Hospital, London.
Background, Study Objectives, How It Was Done:
Disability from arm pain can occur from repetitive strain
strain
Injury to a muscle in which the muscle fibres tear or become irritated as a result of overstretching or wrenching
 from keyboard or industrial work activities. Medical diagnosis
diagnosis
The process of identifying a medical condition or disease by its symptoms, the findings from a medical examination, and from the results of various diagnostic procedures.
 and cause of the condition can be unclear, leaving patients frustrated.

Pain management programs for arm pain aim to change unhelpful and incorrect beliefs in order to reduce stress and change activities that maintain or worsen disability.

 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.
 problems and disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 have been linked to workplace factors such as: perceived workload/conditions, work hours, physical demands of the job, a lack of support from workmates, low job control, low job satisfaction and poor physical organisation of the workplace.

This study investigated the barriers and aids to return to work for people with long-term arm pain.

169 people who had been treated for long term arm pain at the same centre between January 1995 and January 1999 were contacted for the study. Treatment consisted of group training in which exercise, stretching, relaxation, and techniques for changing behaviour were taught. Most patients attended the clinic for 15 days over 4 weeks.

103 participants were interviewed by phone and sent a questionnaire one month after their treatment. Workers and non-workers were sent different questionnaires, but the questions in the two versions were as similar as possible to allow comparison. The patients' ability to function before and after treatment, together with their medical records, were also collected with treatment centre records.
Study Findings:
Work history and current work status:

Current workers were more likely to have been working 3 months before the treatment:

  • 51% worked the same hours before treatment
  • 22% worked fewer hours before treatment
  • 4% worker more hours before treatment
Current non-workers were more likely to have worked consistently for a single employer, and less likely to have worked intermittently:

  • 78% had not worked for at least 2 years when they started the pain management program
  • Others had stopped work during the two years before treatment
Overall, most participants (60%) worked the same amount before and after treatment, while some worked more (30%) and others less (10%).

Return to former occupation:

Some people had difficulty returning to their previous occupation.

The reasons participants gave for not being able to return to their occupation were often physical, for example, being unable to type, sit, travel, or work the length of time required. Current workers were more likely to mention pain or work environment as factors preventing them returning to work.

However, non-workers were more likely to mention psychological
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 factors such as stress, fear of pain and worrying that they wouldn't be able to cope as reasons for not returning to work.

Employer's response:

90% of participants reported their pain to their employer. Most workers said that their employer had been understanding and helpful, keeping their job open or offering retraining. However, most non-workers said their employer had been unsympathetic or disbelieving in response to their pain.

Beliefs:

All participants believed that employers are responsible for workplace safety and that keyboard use or other work demands can cause long term arm pain. Workers believed more strongly than non-workers that:

  • People with long-term arm pain can work without causing harm
  • Help from employers and government/charitable organisations can assist people to return to work
Non-workers were:

  • Less likely to believe they would be supported by their co-workers
  • More worried about being able to meet work demands
  • More worried about losing their job because they took time off
 
This study highlights the importance of support from the workplace and personal beliefs in determining whether people with long term pain will return to work after treatment. About half of the study participants were working at the time of the study. Duration of pain and length of treatment program did not differ between workers and non-workers.

Whether a person returned to work was affected by their work history and their experience of, or expectations about, working with pain. Current workers were more likely to have continued working intermittently after the onset of pain.

People who hadn't returned to work anticipated greater physical and emotional demands from working and worried that they would need work modifications, breaks and time off. They worried about losing their job as a result of inability to perform adequately and didn't expect to be supported by their employer or co-workers. It is possible that these worries came for their experience, as most non-workers reported that their employer had been unsupportive when their pain began.

Participants were more likely to have returned to work after treatment if they believed that people can work with chronic arm pain without causing themselves harm and that employers and outside agencies can help people find a way to return to work. These beliefs may also have been encouraged by experience, as most participants who were working reported a supportive and understanding response from their employer.
References:
PubMed Abstract
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