You've heard of early RTW, but what about late RTW?

So much of what we hear about return to work focuses on early return to work. The majority of injured workers receive medical care, return to modified duty and then eventually their pre-injury jobs. But there's also a group of injured workers who receive medical care, and are given restrictions that are ultimately deemed permanent.  The injuries are typically more severe, or require more than conservative treatment.  Eventually, disability persists so long that we lose focus on return to work as a treatment goal. As Sullivan and Hyman (p. 1, 2014) put it,

     "Evidence-based clinical guidelines emphasize early return-to-work as a critical          
     treatment objective in the management of recent onset pain conditions.  However, 
     something changes when a pain condition becomes chronic.  For chronic pain        
     conditions, return-to-work is rarely put forward as a primary treatment objective.  
     Consequently, successful return to work is rarely an outcome in the treatment of chronic 
     pain conditions."

In their editorial, the authors emphasize the importance of remaining active in ALL phases of recovery, even after an individual's pain becomes "chronic."  If all the treatment that is provided (primarily prescription pain medications) does nothing to improve the individual's level of function, then they aren't really working, are they?  One can argue that pain medication alleviates the individual's pain, but if that doesn't result in an increase in function, is it worth it?  Why aren't we focusing on function?

There's also an assumption that individuals with chronic pain cannot work.  The authors cite a study in which 40% of chronic pain patients who underwent a return-to-work intervention program were successful in their return to work.  If you don't think it is an option, you will never look for information to prove yourself wrong.  Employers who adamantly proclaim that they don't have modified duty will not then go look for modified duty options.  Injured workers who believe that they will never return to work will most likely not look for opportunities to go back to work. 

"Beliefs are the roadmaps of behavior" (p. 2, 2014).  We must keep return to work on the table.  When I say "we," I mean insurance professionals, case managers, medical providers, employers, and injured workers.  The return to work may not be a pre-injury position, but there is work out there for those who want it.  Take workers' compensation, or any other type of benefits, out of the equation, and focus on the individual.  This is their life, for the rest of their life, not just until their benefits expire or their claims settle.  What are "we" doing to provide the best outcome and what are we doing to return them to wellness via return to work?  Can we really expect an injured worker to stay motivated if their physician has thrown in the RTW towel?

To read the editorial, click here.

References:
Sullivan, M. J. L., Hyman, M. H. (2014).  Return to work as a treatment objective for patients with chronic pain?  Journal of Pain Relief, 3(1).  doi:  10.4172/2167-0846.1000130 







Why employers should support employees before and after a work injury

When employees are treated fairly, they are more likely to have a stronger commitment to their workplace.  When employees feel they are not being treated fairly, they will be less motivated to return to work or put in extra effort to overcome even minor obstacles. 

In a 2006 study of social support as a factor in the return-to-work process, researchers found that social support was reported as a key contributor to a successful work re-integration (Lysaght & Larmour-Trode).  The authors of this study found that the so-called "soft" aspects of the RTW process were relevant to RTW and important to injured workers and supervisors alike. 

Relationships, in and out of the workplace, help us deal with stress.  When you have a work issue, you may confide in someone outside of work, or maybe a co-worker who understands the situation.  When you have an issue at home, a co-worker can be an objective third party to help make sense of things.  These forms of social support also apply to work-related injuries and the RTW process. 

Previous research has identified four sources of support in the workplace (p. 256):

• Informational:  information, suggestions, recommendations

In the RTW context, injured workers need information about how to complete paperwork, what the RTW process involves, as well as advice on what they can and cannot safely do within their work limitations.  While it would appear some that the onus to obtain this information is on the injured worker, supervisors or other parties, can assist injured workers by providing them with information or assisting them with obtaining that information.  Sometimes it just takes a simple conversation to alleviate mounting concerns.

• Instrumental:  compensation/wages, hours, work

Employers can provide instrumental support by providing ergonomic assessments, modifications of job duties, or work schedule accommodations.  Any step that an employer can take to increase an injured worker's sense of autonomy and contribution will aid in their re-integration into the workplace.  Meaningful work duties with a clear business purpose are ideal options for RTW.

• Emotional:  listening, genuine concern and caring about employees

Employees want to know that their employer genuinely cares.  The aforementioned study found that co-worker support was also repeatedly mentioned by the interviewees.  Some reported their coworkers worked to assist them, asked how they were doing, and included them in social activities outside of work before they returned to modified duty.  Others recalled negative experiences of co-workers making hostile comments, or ignoring the injured worker.  Management has a key role to play in addressing negative treatment of co-workers who return to modified duty after a work injury.

• Appraisal:  feedback regarding performance, social comparisons

While this can be a delicate topic, it's important for supervisors to understand an injured worker's need for feedback once they return to work.  This allows for open communication about the injured worker's recovery, the appropriateness of the duties assigned to them, and their overall experience back at work.  Treating employees fairly, whether on restrictions or not is key and should not be overlooked.

An employer's relationship with their employees should provide support in these four areas before an injury occurs.  Work to strengthen these relationships today and it will undoubtedly help when you are working with an injured worker on modified duty.

Source:  Lysaught, R. M., & Larmour-Trode, S. (2006).  An exploration of social support as a factor in the return-to-work process.  Work, 30, 255-266.