In a 2010 study of healthcare providers’ agreement related
to return to work (RTW) capabilities, researchers found some areas of
consistency and some, well, not so consistent (Ikezawa, Battie, Beach &
Gross, 2010). The aim of the study was
to determine if there are differences between providers as it relates to the
information providers use to make RTW determinations, and what their RTW
determinations were for three different case scenarios: fracture, dislocation, and low back pain. The survey focused on collecting three types
of information. Participants were asked
to determine the following: if the
person was fit to return to work, assess the physical demands of their job,
address any restrictions due to injury, determine the injured workers’ work
capacity, and make any other recommendations if they were deemed unfit to
work. The second part of the survey
focused on what type of information the participants used to make their
decision, as well as commentary on what type of information would have improved
their ability to make these determinations.
The final section of the survey focused on demographic information about
the participants (specialty, gender, age, years of practice, etc.).
Inquiring minds want to know!
The results indicate that 97% of the providers were in
agreement with each other regarding the RTW readiness case of the fracture (p.
370). This is likely due to fractures being
of clear cut pathology. Similarly, 94%
of the providers agreed with each other related to RTW readiness for the
dislocation scenario (p. 370). For the
low back pain case (a nurse who had back pain for eleven months), providers
were basically split as to whether the injured worker should return to work or
not – 55.6%. Of note, however, with
regards to the back pain case, 56% agreed that RTW with restrictions was appropriate;
whereas 44% believed RTW full duty was appropriate.
What did the
providers rely upon to make these determinations?
Not surprisingly, experience and training will influence a
provider’s recommendations. In this
study, researchers found the providers relying mostly upon physical
examination, current functional status, and occupational status (pp.
370-371). Providers stated that functional capacity exam (FCE) results,
information on availability of modified
duties, and patient participation in
an occupational rehabilitation program would help improve their ability to
accurately address RTW opportunities (p. 371).
Another interesting point made in this study is that only a
small percentage of providers considered the sustainability of RTW, motivation
to RTW, recovery expectations, and guarding movements. Not until more recently are practitioners
focusing on the biopsychosocial, or multi-dimensional, aspects of RTW. These differences in approach will more than
likely yield differing RTW recommendations and should be considered when
evaluating a provider’s recommendations for RTW (p. 372).
Regardless of their agreement, the majority of providers
gave some type of RTW recommendation involving restrictions –so no matter their
perspective (biomedical vs. biopsychosocial), we can expect some type of
restrictions from an injury and prepare for them accordingly.
As noted above, the availability of modified duty was
emphasized as being one of the factors providers are looking at when
determining the injured worker’s release to RTW. If you have modified duty, be sure that the
providers are aware of it! For those
employers that utilized a panel of physicians or a providers list, send them
copies of your modified duty jobs to keep on file in the event one of your
employers visits there. If that’s not
the case, it would behoove you to provide the treating physician with a
pre-injury job description and/or a modified duty job description to keep in the
injured worker’s file. The more informed
provider will more than likely make a more accurate RTW recommendation.
References:
Ikezawa, Y.,
Battie, M. C., Beach, J., & Gross, D. (2010). Do clinicians working within the same context
make consistent return-to-work recommendations?. Journal
of Occupational Rehabilitation, 20, 367-377. doi:10.1007/s10926-010-9230-z
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