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The effect of early intervention on return to work

At a glance:
This study looked at the effects of taking early action when an employee goes on sick leave after a workplace injury. Acting quickly and focusing on the injured employee can get them back to work earlier. Early 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.
 costs more initially, but creates savings for the employer in the long run.
Perspectives:
Employee
Getting back to work early is the best approach. This Swedish review, developed with relevant parties, looked at job modifications.

You and your supervisor are the best people to identify possible job modifications. Think about simple ways your job can be modified, and provide positive suggestions. Are there other aspects of work you can take on, what can you do to help the productivity of the team, but at the same time care for yourself?

Many people find the workers compensation system challenging. People who have good outcomes often say it was their approach, and looking for ways they could contribute that achieved success.
Employer
This review indicated a high level of cost effectiveness in an early return to work.

Early communication and an early comprehensive review of the person's situation can identify potential return to work barriers at a time when they are simple to address.

Job modifications facilitate early return and are best designed in a partnership between the employer (supervisor) and the employee. The earlier this is done the better the results.

It is important to encourage employees back to their pre-injury duties. Early discussion about this can identify job modifications which promote an early return to work, and lessen the risk of future injuries.
Treater
Treating practitioners know that the workplace approach has a major bearing on outcomes. Encourage the employee to be an active participant in return to work, suggest workplace modifications and discuss the patient's capabilities in the workplace.

Giving people a basic understanding of the restrictions and simple ergonomics can help them identify modifications, and what may be best for their condition.
Insurer
Case managers have long known that an early return to work makes a significant difference. Identifying modifications to the tasks and encouraging all parties to be involved produces significant benefits. The cost effectiveness of this approach is substantial.

In this study the case managers undertook an early comprehensive review of the person's situation. This helps identify barriers to return to work early, and sets up a partnership approach.
Original Article, Authors & Publication Details:
Arnetz BB, Sjogren B, Rydehn B, Meisel R.

Early workplace intervention for employees with musculoskeletal-related absenteeism: a prospective controlled intervention study. Journal of Occupational & Environmental Medicine 2003;45(5):499-506.
Background, Study Objectives, How It Was Done:
Work absence related to 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.
 injuries, is a widespread problem that causes suffering and high costs to workplaces. On average, musculoskeletal injuries are 10 times more costly to workplaces than other types of injury. The longer an employee is absent from work, the greater the costs to the employer, and the less the chance of the employee making a successful return.

This review investigated an alternative to the traditional management of work-related musculoskeletal injuries, involving early and 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.
 interventions (changes to the layout and procedures in the workplace). The review was performed in Sweden, where employers are legally obliged to begin a 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.
 plan if an employee misses more than 4 weeks of work due to work-related injuries. This rehabilitation plan is co-ordinated by the national insurer.

In traditional management, workplace investigations and changes do not usually occur until after medical investigations and diagnoses have been carried out. The early intervention approach focuses on what workers are still able to do, and on returning to work as quickly as possible.

137 individuals diagnosed with a work-related musculoskeletal injury were selected at random from the national insurer, and treated either by this early-intervention approach or traditional methods. The vast majority of subjects (85%) were blue-collar workers, whilst the most common injuries being neck, shoulder and back.

People who were treated by the early intervention approach were interviewed by the insurance company after one week of sick leave. Their social, personal, educational, health history and working conditions were discussed. The person's capacity to work despite their injury was established, along with possible changes to the workplace environment or procedures that could help achieve this. One week later, there was a meeting between the employee, insurance case-manager, workplace health professional, and employee's doctor. Possible changes to workplace layout, procedures and training for the employee were identified and introduced where appropriate. In most cases, several changes over time were necessary to achieve suitable working conditions. Employers were encouraged to keep a diary of the rehabilitation process.

Workers were followed up 6 months after their injury, and again at 12 months.

Results were compared to find whether early intervention affected:

The amount of sick days taken and the likelihood of returning to work
The cost to the employer in terms of lost work time, rehabilitation costs etc
The self-reported quality of health of the employee
The employee's level of satisfaction with the level of service provided by the workplace, insurance company and the healthcare system during their rehabilitation
Study Findings:
Employees who used the early intervention model were more likely to undergo a rehabilitation investigation, than employees who used the traditional method (85% of early intervention employees compared to 28% who had traditional management).

It took less time for this investigation to be completed (an average of 59 days compared to 127) and less time for a rehabilitation plan to be set up (an average of 49 days compared to 184). Work-based rehabilitation was chosen as an appropriate course of action for 37% of the early intervention employees, compared to 21% of traditionally managed cases. This work-based rehab program begun much more quickly in the early intervention group (an average of 88 days after first taking sick-leave, compared to 191 days in the early intervention group).

Compared to traditional management, the early intervention model was found to decrease the number of sick days taken and increase the likelihood of returning to work. This was true at all times throughout the rehabilitation process. The review found:

1. Over the 12 months, an average total of 144 days sick leave was taken by employees who had early intervention, compared to 198 for individuals undergoing traditional treatment.
2. Those who underwent early intervention were more likely to back at work within 6 months.
3. Those who underwent early intervention were 50% more likely to return to work at 12 months.
4. 35% of the early intervention group received paid rehabilitation, compared to 17% of the other employees. There was no significant difference in the amount of paid leave taken specifically for rehabilitation with the average being 50 days.
5. The cost of rehabilitation services was greater for the early intervention group – these services were used in more cases (18% compared to 10%), and were more costly in each case (on average $US6000 compared to $US2800.) On average, early intervention cost the insurer $1410 per employee.
6. However, because of the reduction in sick leave, the insurer paid less reimbursement to employees who undertook early intervention. This was without accounting for indirect savings such as improved productivity. When factoring in the reduced costs for time off work, the overall benefit to cost ratio was approximately seven. This meant for every dollar invested the return on the investment was $7. The intervention also had the additional benefit of identifying and eliminating risks for other employees.

After returning to work, employees who had an early intervention were more likely to feel as though they had fully recovered (22% compared to 9%). 85% of employees said they had returned to work of their own free will, but many also reported being influenced by pressure from their employer (40%) and financial need (36%).

Employees who had early intervention were more positive about the role of the insurer in the management of their injury.
Conclusions:
Early intervention and a focus on returning to work decreased sick leave and increased the likelihood of a return to work. The strategy was found to be cost effective and improved the employee's self-reported health. Co-operation between healthcare providers, insurance companies and employers was found to be efficient in saving time and improving the relationship between the employee and the insurance company. More interventions were introduced (changes to the workplace, rehabilitation and training etc) quickly, increasing upfront costs but providing long-term savings.

There were 3 main aspects to the intervention program:

Early action and a focus on returning to work
A more central role for the case manager
The introduction of an occupational health professional into the program
References:

PubMed Abstract
 
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