Predictors and measures of return to work
Background
The National Institute for Occupational Safety and Health (NIOSH) sponsored
a project for the development of a summary of the current knowledge of the predictors
and measures of return to work after work-related injury or illness. Description The project addressed the following questions:
Status The project has been completed. A report entitled "Determinants of Return to Work and Duration of Disability
After Work-Related Injury and Illness: Developing a Research Agenda" was
presented at the annual conference of NIOSH held June 13-15, 1999 in Denver,
Colorado. The conference addressed performance measures for health services
delivered to prevent or treat occupational injury or illness, measures of the
economic and social impact of occupational injury or illness, and research that
integrates these areas. Findings Multifactorial nature of disability and return to work (RTW) Work disability and RTW are processes influenced by a variety of social, psychological,
medico-legal, and economic factors and thus cannot be understood in biomedical
or economic terms alone. About 80 different determinants of RTW outcomes were
identified in this review. Future research needs to be interdisciplinary and
develop a comprehensive conceptual framework to integrate this knowledge. The
report suggests four criteria for prioritizing research in specific risk factor
domains: risk factors under study are (1) amenable to change, (2) relevant to
the users of research, (3) generalizable across health conditions, disability
phases, and settings, and (4) "promising" based on qualitative explorative
studies. For example, availability of modified work is a research subject which
meets all four criteria. Additional research is needed to improve measurement
instruments for both risk factors and outcomes. Phase-specificity of risk factors and intervention programs "Phase specificity" refers to the fact that the impact of risk factors
(or interventions for that matter) varies across different phases of the disablement
process. Some influences on RTW occur only some time after the injury (e.g.,
litigation), change during the course of disability (e.g., mental health), or
may exert a different impact at different phases (e.g., treatment regimes for
acute versus chronic pain). The right timing of intervention programs in terms
of time after the injury can be decisive for the effectiveness of the program.
It is necessary to use appropriate study design and analytic techniques to handle
these complexities. Selection of appropriate outcomes and databases in RTW research. More researchers suggest combining primary data from injured worker and stakeholder
interviews with secondary administrative databases. Such combined databases
enrich our understanding of the full range of risk factors for delayed RTW,
as well as the full burden on health, social and economic consequences of occupational
illness and injury. Further information Determinants of return to work and duration of disability after work-related
injury or illness: Developing a research agenda (publication pending)
What are the primary factors that affect whether workers will return to work
for their pre-injury employers, the time lost from work after the injury, subsequent
employment spells, and changes in occupation?
What are the critical data and research needs in this area?
This project was a collaborative effort by researchers from different disciplines.