The Role of Employers in the Return to Work of People with Musculoskeletal Pain Disorders: A Systematic Review of the Literature


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Dr Tai Kake
ACC Research New Zealand Accident Compensation Corporation
PO Box 242, Wellington, New Zealand

(P11, Wednesday 26, Civic Room 1, 2.30)

Published in: Health & Medicine, Business
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The Role of Employers in the Return to Work of People with Musculoskeletal Pain Disorders: A Systematic Review of the Literature

  1. 1. The Role of Employers in Return to Work of People with Musculoskeletal Pain A Systematic Review OHSIG Conference 26 th October 2011 Dr Tai Kake ACC Research Manager
  2. 2. Introduction <ul><li>Dr Sarah Clark </li></ul><ul><li>Explores the strength of evidence for a role of the employer in return to work (RTW) interventions and disability management activities aimed at assisting individuals with musculoskeletal disorders (MSD). </li></ul><ul><li>To identify what the specific tasks and components of the employer role are. </li></ul>
  3. 3. Research questions <ul><li>1. What is the evidence that the employer can play an effective role in RTW for people with MSD? </li></ul><ul><li>2. What is the role and what are the activities/components/tasks of the employer’s role? What must the employer do or not do? </li></ul><ul><li>3. When should the employer intervene? </li></ul>
  4. 4. Methods-systematic review <ul><li>Electronic databases searched for studies published after 1990 and in English. 1653 references retrieved. </li></ul><ul><li>174 references critically appraised for quality/relevance (SIGN) </li></ul><ul><li>Qualitative studies included if they investigated the effectiveness of workplace rehabilitation interventions (p38) </li></ul><ul><li>Study participants had to be suffering from MSD in the acute to sub-acute stage and not be chronic. </li></ul><ul><li>Good quality qualitative studies were eligible because they were an important source of information about the needs/behaviours of employers and employees </li></ul><ul><li>Evidence presented by the 22 included studies was synthesized using a best evidence approach which enabled ratings of the strength of evidence ( p21-22 ) </li></ul>
  5. 5. Key Findings <ul><li>There is strong evidence that employers play a key role in the RTW process, and interventions with a workplace-based component involving the employer lead to improved RTW outcomes. The magnitude of the effect is variable but improvements of two-fold are achievable, i.e. RTW can be two times faster. </li></ul><ul><li>2. There is weak evidence (i.e. limited and conflicting) that health outcomes (pain, function) are improved by workplace-based interventions involving the employer when compared to usual care. </li></ul><ul><li>3. There is strong evidence that the four most important tasks of the employer are: </li></ul><ul><li>Keep in contact with the injured workers and assist with an early RTW. </li></ul><ul><li>Agree on a RTW plan and goals with the injured worker. </li></ul><ul><li>Offer workplace accommodation. </li></ul><ul><li>Communicate with the healthcare professionals. </li></ul>
  6. 6. Key Findings <ul><li>Some actions of employers may not facilitate RTW of injured workers and a response/support to address these actions may be required. These include doubting the legitimacy of the injury, creating a poor work match for the injured worker, allowing modified duties to lapse beyond the capabilities of the injured worker, and hindering communication with the other players (e.g. GP, rehabilitation professionals). </li></ul>
  7. 7. Key Findings <ul><li>The precise timing of employer intervention is not entirely clear, but there is strong evidence that it should be within four weeks after worker absence. Some evidence suggests that employers should make initial contact within the first day or two of work absence, but this needs to consider the context of the case. </li></ul>
  8. 8. Key Findings <ul><li>Employer-readiness to come on board with ACC as key players in RTW of workers with MSD depends upon: </li></ul><ul><li>Awareness: employers need to be aware of the importance of their role. </li></ul><ul><li>Resources: employers need the know-how, capacity, injury management systems and resources to be able to assist (SME, Large). </li></ul><ul><li>Motivation/incentive: employers are more likely to assist with RTW if they are motivated. </li></ul>
  9. 9. Limitations of Review <ul><li>Selection bias due to particular focus on post-2005 primary studies and other systematic reviews </li></ul><ul><li>All the studies were selected and appraised by one person </li></ul><ul><li>Only English language studies were included </li></ul>
  10. 10. Resources <ul><li>The report for this research is available on </li></ul>
  11. 11. Resources <ul><li> </li></ul><ul><li>Employers contact: </li></ul><ul><li>an ACC Injury Management Consultant </li></ul><ul><li>or your employee’s ACC case manager/coordinator </li></ul><ul><li>Or 0800 222 776 </li></ul><ul><li>For enquiries about Research contact: </li></ul><ul><li>[email_address] </li></ul>
  12. 12. Stay at Work (SAW) <ul><li>Established in mid-2009, SAW services are delivered by a nationwide network of contracted SAW vendors. They receive referrals from ACC and actively work with the client, their GP and the employer to provide a tailored and coordinated approach to organising services designed to safely keep the patient at work, or return them to work as soon as possible. </li></ul><ul><li>Stage 1 – Early Return to Work </li></ul><ul><li>Stage 2 – Graduated Return to Work </li></ul><ul><li>Stage 3 – Continued Interventions </li></ul>
  13. 13. Stay at Work (SAW) <ul><li>vendors have the flexibility to determine how and when service should be provided (within service guidelines), to meet each patient’s individual needs </li></ul><ul><li>emphasis is on early identification and removal of obstacles preventing early return to work </li></ul><ul><li>early intervention services are delivered quickly, within tight timeframes, to address patient needs </li></ul><ul><li>a collaborative approach is taken, with the SAW Co-ordinator involving the client, employer, primary treatment provider, whanau, GP and others to identify issues and develop solutions that will enable workplace rehabilitation </li></ul><ul><li>there are three different stages within the service, each tailored to meet the differing needs of clients </li></ul>
  14. 14. [email_address] <ul><li>Better@Work offers an early intervention and intense case management workplace rehabilitation service for all injured workers over 16 years of age who are enrolled in participating Primary Health Organisations (PHOs), excluding serious injuries and work place injuries with accredited employers. </li></ul><ul><li>Better@Work is a service prototype which was established in Taupo via Lake Taupo PHO in early 2009. Since then, it has been expanded to include Harbour Health, Waiora Healthcare and HealthWEST PHOs (north and west Auckland), and to the Hawkes Bay through Hawkes Bay PHO. </li></ul>
  15. 15. [email_address] <ul><li>Service is provided by GPs, supported by Better@Work Coordinators employed by, or contracted to, the PHOs. Claims are allocated to the Better@Work service by PHO GPs based on criteria established by ACC. Better@Work Co-ordinators are supported by ACC Case Co-ordinators, who manage patients’ entitlements. </li></ul><ul><li>Better@Work Coordinators bring all parties together to identify suitable duties for injured workers and any supports required to help the patient safely stay in the workplace. They also help those certified as fully unfit to maintain normal routines, including contact with their workplace. The general practitioner sees the client every two weeks, updating their work certificate accordingly. </li></ul>
  16. 16. [email_address] <ul><li>The goal of the service is to use a combination of best practice certification and active liaison between the client, their GP, the Better@Work Coordinator and the employer to keep people at work through the recovery period, or get them back to work as soon as is safe and practicable. </li></ul>