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PROTOCOL: Workplace Disability Management Programs Promoting Return‐to‐Work (RTW)

2011; The Campbell Collaboration; Volume: 7; Issue: 1 Linguagem: Inglês

10.1002/cl2.83

1891-1803

Ulrik Gensby, Thomas Lund, Krystyna Kowalski, Madina Saidj, Anne‐Marie Klint Jørgensen, Trine Filges, Ben Amick, Merete Labriola,

Musculoskeletal pain and rehabilitation

Campbell Systematic ReviewsVolume 7, Issue 1 p. 1-56 PROTOCOLOpen Access PROTOCOL: Workplace Disability Management Programs Promoting Return-to-Work (RTW) Ulrik Gensby, Ulrik GensbySearch for more papers by this authorThomas Lund, Thomas LundSearch for more papers by this authorKrystyna Kowalski, Krystyna KowalskiSearch for more papers by this authorMadina Saidj, Madina SaidjSearch for more papers by this authorAnne-Marie Klint Jørgensen, Anne-Marie Klint JørgensenSearch for more papers by this authorTrine Filges, Trine FilgesSearch for more papers by this authorBen. C. Amick, Ben. C. AmickSearch for more papers by this authorMerete Labriola, Merete LabriolaSearch for more papers by this author Ulrik Gensby, Ulrik GensbySearch for more papers by this authorThomas Lund, Thomas LundSearch for more papers by this authorKrystyna Kowalski, Krystyna KowalskiSearch for more papers by this authorMadina Saidj, Madina SaidjSearch for more papers by this authorAnne-Marie Klint Jørgensen, Anne-Marie Klint JørgensenSearch for more papers by this authorTrine Filges, Trine FilgesSearch for more papers by this authorBen. C. Amick, Ben. C. AmickSearch for more papers by this authorMerete Labriola, Merete LabriolaSearch for more papers by this author First published: 11 February 2011 https://doi.org/10.1002/CL2.83Citations: 2 Linked article: Systematic review. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat 1 Background 1.1 DESCRIPTION OF THE CONDITION Workplace inclusion of employees with disabling injury or illness continue to create a great challenge for most industrialized countries, where musculoskeletal disorders, and more recently mental health disorders are conditions contributing to the inability to work (Corbiére et al 2009; Waddell & Burton 2005; WHO 2005; WHO 2003; Elders et al 2000). In particular long-term sickness absence is a challenge associated to a series of negative economic and social consequences with great impact on society (Vingård et al. 2004; Bloch & Prins 2001; Galizzi & Boden 1996). The share of the working-age population relying on disability and sickness benefits as their main source of income has tended to increase in many OECD countries (OECD 2008; OECD 2003). Moreover long-term sickness absence often represents a substantial individual life event (Dembe 2001), where the duration of absence due to injury or illness increases the future risk of receiving disability pension and permanent exclusion from the labour market (Lund et al. 2008; Labriola & Lund 2007). At the employer-level long-term sickness absence may lead to lower productivity and quality, higher employee turnover and reduction in job satisfaction due to the added workload placed on other employees (Whitaker 2001). Facilitating return-to-work (RTW) following work disability therefore receives continued attention from a wide spectrum of research fields and policy- and decision-makers (OECD 2008; Waddell & Burton 2005; Wynne & McAnaney 2004; Thorton 1998). Many employers revise control absence policies to minimise loss in production while governments focus on early return-to-work policies (Cunningham & James 2000; MacEachen et al 2007). What has gained less attention is the actual development of sustainable management and inclusive work environments to prevent exclusion and prolonged absence leading to early retirement. Therefore stimulating Disability Management (DM) and preventing the onset of work disability, by synthesizing research on DM-practices promoting return work (RTW), is needed. DM is a concept which is rapidly emerging in business and industry as well as private and public rehabilitation. However, systematic or comprehensive disability management promoting RTW are relatively recent (Harder & Scott 2005; Habeck & Hunt 1999; Van Hooser & Rice 1989). DM is often a multi-faceted challenge and may vary according to the present injury or illness and the cultural, legal and structural context of the labour market (Loisel et al. 2005a; Krause & Lund 2004; Shrey & Hursh 1999; Høgelund 2003). DM-practices aimed at RTW involves dynamic interactions between the individual's health condition and contextual factors such as the employer and healthcare- and social/compensation systems (Labriola 2008; Schultz et al. 2007; Loisel et al. 2005a; Waddell & Burton 2005; Pransky et al. 2004; Franche & Krause 2002; Friesen 2001). The recognition of the impact of social and contextual factors on RTW is also referred to as a paradigm shift from disease prevention and treatment to disability prevention and management (Loisel et al. 2001; Shrey 1996). Given the multi-faceted nature of DM, concrete interventions on RTW may be delivered by providers, both internal and external to the workplace. This means that inherent interventions related to DM-practices may be directed or initiated at the workplace and that the current implementation of these interventions can take place within the workplace-setting or in settings outside the workplace (van Oostrom et al. 2009; Franche et al. 2005; Harder & Scott 2005). Recent research has highlighted the potentials of a closer linkage between DM-practices and the workplace-level (van Oostrom et al 2009; Franche et al. 2005; Krause & Lund 2004; Krause et al 1998) and the workplace-level is put forward as a decisive arena for the management of RTW (MacEachen et al. 2006; James et al 2006; Franche et al. 2005; Krause & Lund 2004; King 1998; Shrey 1995). This has led to a growing interest in workplace-based DM as an effective effort to promote RTW. DM in the workplace can be seen as organizational practices with the potential to minimize loss in production, reduce the magnitude of work disability, thereby preventing injuries or illnesses from becoming chronically disabling (Brewer et al 2007; Williams & Westmorland 2002; Amick et al. 2000a; Shrey & Hursh 1999; Habeck & Hunt 1999; Akabas et al 1992). This review focuses on the form of DM that takes place within the workplace-setting and is labelled Workplace Disability Management (WPDM) (Williams & Westmorland 2002; Shrey 1995; Akabas et al 1992). Our research interest is to elucidate the role of WPDM-programmes aimed at RTW of sick listed employees. While the term RTW is commonly used, the extent to which it has a shared and agreed upon meaning is small. RTW can be referred to as an intervention, a process and an outcome (Young et al 2005b). In this review we see RTW as an outcome. RTW refers to a variety of outcomes following work disability that describes the duration or extent of an inability to work due to functional limitations (Krause & Lund 2004). Work disability following injury or illness can be wholly or partly work related. Thus the work environment often limits the actual space for recovery, which employees face upon their return (Krause & Lund 2004). In this review the term 'work disability' refers to individuals who have discontinued their participation in occupational activities, and includes time off work as well as any ongoing work limitations. This approach is consistent with the definition of disability advanced by the International Classification of Functioning, Disability and Health (ICF) (Young et al 2005b; WHO 2001). This review considers employees whose ability to perform customary work tasks are endangered when an acquired physical injury (e.g. musculoskeletal disorders; back pain, neck pain or whiplash), illness (e.g. cancer or stroke) or mental health disorder (e.g. stress disorder, depression or anxiety) results in functional limitations and sickness absence. To place our approach to work disability in the larger context of DM, it would be reasonable to argue that the type of components encompassed in workplace disability management have the potential to prevent exclusion and enhance a better understanding of the management of RTW at the workplace. We acknowledged that our demarcation of DM and work disabilities included is less than ideal, given the lack of attention paid to other types of pre-existing disabilities or impairments. Nevertheless, this approach still has considerable value as an, albeit partial, indication of how far employers really are seeking to secure safe RTW through the adoption of WPDM (James et al 1997). 1.2 DESCRIPTION OF THE INTERVENTION On the whole WPDM is defined as a comprehensive and cohesive employer-based approach to managing complex needs of people with work disability within a given work environment (Shrey 1995; Harder & Scott 2005). The aim of WPDM is successful job maintenance and RTW (Akabas et al 1992). WPDM may focus on the disablement process (Verbrugge & Jette 1994) in its earliest stages after the work disabling injury or illness has occurred (secondary prevention) (Frank et al. 1996). Suitable WPDM-practices can also help people manage complicated, long-term or chronic health problems (tertiary prevention) (Garcy et al. 1996). Both secondary and tertiary approaches to RTW may involve interventions at the individual, organizational or structural level or a combination of these (Labriola 2008; Loisel et al. 2005a). In this review 'Workplace Disability Management' is operationally defined as: RTW-related policies and procedures, in which the employer, systematically secure an ongoing, timely and pro-active alertness towards the allocation, organisation and coordination of resources to the practical management of return-to-work within the workplace. By the term workplace emphasis is placed on the domain of the workplace-level. We focus on WPDM in the context of secondary prevention, which in effect concentrates attention on the arrangements that employers have in place to facilitate the return-to-work of employees who are unable to work as a result of injury or illness. To frame the components and arrangements involved in a secondary prevention perspective on WPDM, employers may develop WPDM-programmes to guide their effort in helping sick-listed employees back to work (Williams & Westmorland 2002; Shrey 1995; Akabas et al 1992) (see pg.9 for list of components). WPDM-programmes utilize services, people, and procedures to facilitate safe and timely RTW (Shrey et al. 2006; Williams & Westmorland 2002; Shrey 1995; Akabas et al 1992). This makes WPDM-programmes unique in providing support to workplace practices on RTW, bridging interventions, strengthen corporate culture expectations and collaboration across problems and stakeholders in the workplace (Amick et al. 2000a; Shrey 1995; Van Hooser & Rice 1989). In practice having a WPDM-programme in place may clarify the procedures and activities at hand for both employers and employees when an injury or illness occurs. The employee may, when sick-listed, receive information on how the workplace can support the employee in the progress from injury or illness to safe RTW. This would keep the employee from feeling excluded from the workplace and at the same time secure an ongoing evaluation of their situation and initiatives taken. On the other hand employers will have proper procedures and services installed on how to register, and respond to sick-listed employees and monitor initiatives towards RTW. All WPDM-programmes provide a collective framework for the complex and sensitive issue of RTW that gives the employer and employee a unique opportunity to structure services in relation to the present health condition and achieve consensus on expectations and the possibilities for suitable accommodation opportunities. 1.3 HOW THE INTERVENTION MIGHT WORK In this review, the presence of a WPDM-programme refers to a situation where there exists organizational policies and practices (OPP) in terms of the management of RTW (Amick et al. 2000a; Shrey 1995; Hunt & Habeck 1993). Employer-provided and initiated WPDM can and does rely on policies and procedures for its impact. Interventions and program components come as a result of, and have power because of decisions and procedures within the workplace. This is a major distinguishing feature of WPDM, whereas provider-driven DM must rely only on the impact of interventions and programme components alone as a commodity or services offered to the workplace. This is why this review incorporates workplace organizational policies and practices in its scope, in order to capture the organizationally relevant factors involved in WPDM and RTW outcomes. We conceptualize a WPDM-programme as: an organisational rehabilitation service provided by the employer consisting of an integrated set of interventions/programme components that foster and promote safe and timely RTW within the work environment. A WPDM-programme therefore relates to conditions of the practical implementation of RTW-activities and changes in, who initiates RTW-activities-, how RTW-activities are organised and managed. WPDM-programmes are typically offered by the employer in collaboration with the central key-players in the workplace (e.g. managers, supervisors, labour union representatives, occupational health and safety officers, human resource officers, occupational therapist or rehabilitation service councillors) (Shrey & Hursh 1999). However, the presence, composition and involvement of the workplace key-parties in the RTW-process may vary according to occupational health and safety systems, variations in the extent of worker ill health and injury, work undertaken and cultural context (Shaw et al. 2008; Amick et al. 2000a; Frank 1998; James et al 1997). The duration of WPDM-programmes or specific programme components in a WPDM-programme may vary according to the individual health condition and disability phase (e.g. acute, sub-acute or recovery phase) (Franche & Krause 2002, Frank et al 1996), phase-specificity of the RTW-process (off work, pre-return, post return) (Young et al 2005b), and work environments. Attention to the different phases in the return to work process (i.e. while the employee is off work, when the employee returns back to work, and once back at work during the phase of sustainability of work ability) may seem important when evaluating the scope of WPDM-programs and their inherent programme components (Tjulin et al. 2009). The impact of work environments and their relation to duration of disability often seem to be overshadowed by clinical aspects of RTW. Thus the provision of work environments services (e.g. human resources, labour relations and personnel management services, accommodations, availability of modified work (schedule, duties) and access to alternative placements) is emphasized by ILO and WHO, as factors that may play an equally profound role on work opportunities, where DM and duration of disability also can be considered (WHO 2001; ILO 2002). Components of WPDM-programmes therefore may be aimed at the individual, group and organizational level or a combination of these. WPDM does not imply a unique set of intervention techniques. However multiple programme components have been recognized by research and advocacy groups as established DM-practices on RTW (Franche et al 2005; Shrey 1995; Habeck et al 1991).WPDM-programmes may consist of components such as: ▪ Early contact and intervention ▪ Workplace assessment ▪ Provision of workplace accommodations ▪ Transitional work opportunities ▪ Modified/tailored work (schedule, duties) ▪ Access to alternative placements ▪ RTW-coordination or case-management ▪ RTW-policies ▪ Active employee involvement ▪ Joint labour-management commitment ▪ Revision of workplace roles ▪ Education of workplace staff (e.g. supervisors, OHS-representative, union member or case managers) ▪ Preventive strategies to avoid disability occurrence ▪ Information system that enhances accountability, ongoing monitoring of disability cases and program evaluation ▪ Multidisciplinary work-rehabilitation services; vocational (e.g. job-replacement, job sharing and job training), clinical either psychological (e.g. cognitive therapy, motivation or control exercise) or physical (e.g. graded activity, participatory ergonomics or work hardening). (See Appendix 1 for details of programme components.) 1.4 WHY IT IS IMPORTANT TO DO THIS REVIEW Corporate social responsibilities, in areas such as work disability, are promoted by many parts in society from governments to corporations and many employers recognize the importance of DM in promoting RTW (Williams & Westmorland 2002; Whitaker 2002; Shrey & Hursh 1999). However, many employers face a huge challenge in managing the RTW-process, in a situation where more responsibility for disability management and disability prevention is placed upon employers (Eakin et al. 2002; Frick et al. 2000). Inability and lack of compliance towards RTW may lead to huge variation, in the way DM-practices are conducted in the workplace. This is a challenge that demands more knowledge on the development, implementation and evaluation of successful DM-programmes within the workplace-setting (Krause & Lund 2004; Williams & Westmorland 2002). In spite of the growth in the literature on workplace-based interventions on RTW, WPDM-programmes are only implicitly highlighted, and WPDM-programmes that promote RTW have to our knowledge not been analysed separately in a systematic way. A recent Cochrane review by van Oostrom and colleagues (van Oostrom 2009) evaluated whether effects of workplace based-interventions on RTW differed when applied to musculoskeletal disorders (MSD), mental health problems or other health conditions. The review only included RCTs. Interventions were included as long as they were closely linked or directed at the workplace and there were some sort of collaboration with the employer. This implies that a broader range of clinical interventions, from providers within the healthcare-setting were included. The results of the review show moderate evidence that workplace-based RTW-interventions can reduce sickness absence among workers with MSD disorders compared to usual care (van Oostrom 2009). In their extensive review of workplace-based RTW-interventions on MSD, Franche and colleagues (Franche et al. 2005) found evidence suggesting that workplace-based RTW-interventions on MSD can reduce work disability duration and associated costs; however the evidence regarding their impact on quality of life was weaker. There was moderate evidence for positive effects associated with components such as; early contact, modified work and the presence of a RTW-coordinator. They underline that there is a need for a better understanding related to which organizational factors that promote RTW effectively (Franche et al. 2005). The importance of workplace involvement is also noted by Carroll and colleagues in their review of RTW among employees with low back pain. Stakeholder participation and work modification were more effective at returning employees to work than other workplace-linked interventions (Carroll et al 2010). WPDM is also covered in several non-systematic literature reviews (Krause & Lund 2004; Williams & Westmorland 2002). In their evaluation of employer-based RTW programs Krause and Lund outline, that interventions, that include some form of modified work improved RTW and reduced lost work days after occupational injury. They also highlight that the effect of structural elements of RTW-programs need to be supported by more comprehensive research that focus on the role of the workplace and the interactions between employer and employee in the RTW-process (Krause & Lund 2004). Williams and Westmorland (2002) outline the essential elements of successful WPDM. They suggest that employer participation, supportive work climate and collaboration between labour and management are crucial factors in facilitating RTW (Williams & Westmorland 2002). In contrast to prior systematic reviews, focusing on workplace-based RTW-interventions, we seek to dig further into the role of the workplace by narrowing our focus to DM-practices that are part of an employer provided WPDM-programme. We have accordingly placed a clear restriction on the providers and the content of interventions included in this review, thereby excluding interventions initiated by stakeholders outside the workplace (i.e. community and healthcare-based vocational and clinical interventions directed at the workplace). In doing this, we will capture the organizationally-mediated factors of WPDM-programmes and analyse their effect on RTW outcomes. Our systematic assessment of the studies in the rehabilitation and management literature makes it possible to shed light on a broader area of WPDM-studies than prior more clinical/epidemiological oriented reviews. Although prior reviews have been workplace-based in their approach to the literature, they have included interventions that where provided outside the workplace and did not systematically cover studies within the management literature. Another important aspect of this review is our inclusion of a broader range of study-designs and delineation of components in workplace initiated and provided DM, which makes this review unique compared to prior systematic reviews on WPDM. Focusing on the development and synthesis of knowledge that can assist employers in their DM-efforts has several important payoffs with relevance to policy and decision-makers. Put into practice WPDM-programmes may provide responsive and sustainable organizational policies and practices that can guide "on-site" interventions, internal coordination and bridge collaboration outside the workplace. This may lead to a better use of human resources, reduce dependence on public sickness and disability benefits (sick-leave wages) and contribute to a healthier and more inclusive work-life. Furthermore it is necessary to continue to review the available literature as new research is published. This may strengthen future funding for the development of new research projects on WPDM. This review sets out to serve these purposes. 2 Objective of the review The objective of this review is to assess the effectiveness of Workplace Disability Management Programmes promoting RTW: Compare WPDM-programs to no treatment, treatment as usual or alternative intervention If possible examine components of WPDM-programmes which appear more highly related to positive outcome. Since there is no uniform WPDM the resulting analysis will also assess the effectiveness of constituent components of WPDM, which may also have value Look at the existing literature and get an understanding of the research area and its development, research potentials and needed research areas. 3 Methods 3.1 CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW 3.1.1 Types of studies The study designs included in the review are: Randomised controlled trials (RCTs) including cluster randomisation and quasi randomised study designs (i.e. participants are allocated by means such as alternate allocation, person's birth date, the date of the week or month, case number or alphabetical order). Non randomised control study designs (quasi-experimental designs) such as controlled two group study designs, and study designs using observational data, where statistical methods such as modelling or differences in differences are used to establish a counterfactual and estimate an effect. We suspect that there are not many RCTs and non-randomised control study designs in the field of WPDM for RTW. To give a better sense of what is going on in the field and to capture the major studies in area of WPDM we will therefore also include single group study designs with before and after measures1. Single-subject designs will be excluded. The objectives of this review are to explore both absolute and relative effects, hence eligible comparisons groups are no treatment, treatment as usual and alternative interventions. 3.1.2 Types if participants The following criteria serve as background for the inclusion of participants in the review: ▪ Employees on sick-leave with an inability to work due to physical injury, illness or mental health disorders: ○ Physical injuries may relate to different kinds of musculoskeletal disorders such as; back pain, limb problems, neck and shoulder injuries, rheumatoid arthritis, osteoarthritis, whiplash etc. ○ Mental health disorders may relate to psychiatric or psychosocial illnesses such as; depression, stress, anxiety, somatic illness, fatigue etc. ○ Other illnesses for example cancer, neurological illness, stroke, carpal tunnel syndrome and eye strain. ▪ Employees from the public and private sector Unemployed persons will be excluded as well as persons with a pre-existing permanent or total impairment. 3.1.3 Types of interventions This review will focus on WPDM-programmes that are: ▪ Characterised as an 'onsite' WPDM or RTW-programme; ▪ Provided by the employer or initiated by the employer in collaboration with key-players in the workplace; ▪ Addressing the duration or extent of an inability to work due to physical injury or mental illness; ▪ Implemented within the workplace setting This definition includes only those studies where programme components are linked to a WPDM-programme, provided by the employer and put into practice at the workplace focusing on secondary prevention and the involvement of stakeholders from the work environment. WPDM-programmes may consist of a diverse set of components. In our selection of studies the inclusion of WPDM-programmes is guided by the criteria listed in section 1.3 (pg.9-10, the components are expanded in Appendix 1). This means that we only include WPDM-programmes where at least one of the programme components addresses and modifies features of the workers actual job, work tasks, equipment, work station, work schedule or mode of interaction with key-players in the workplace (e.g. co-workers and supervisors). As long as the WPDM-programme is a structural part of the intervention (with the intention to apply the programme components to all participants in the intervention group) studies that include more components or other components than listed under section 1.3 are not excluded as long as they meet our inclusion criteria. WPDM-programmes that contain clinical components as an integrated part of the programme will only be included if: ▪ The programme is provided by the employer. ▪ The intervention is put into practice within the workplace setting This means that other types of provider-based interventions (provided by health-care or community), that can be described as a DM or RTW programme/intervention, are excluded. Accordingly stand alone individual clinical/medical interventions, that are not part of a WPDM-programme, will be excluded, as they are not primarily initiated by the employer and thus there is minimal or no integration within the workplace. WPDM- programme interventions will be compared with 'usual services,' other interventions, and no intervention. Due to the diversity in types of illnesses and injury that a WPDM-programme has to target, the duration and intensity of specific interventions can vary according to the specific condition and the activities needed. Accordingly there will be no minimum restrictions related to duration and intensity of the programmes. We will record exact details on duration, intensity and frequency of WPDM programmes for each included study. This information will inform and document decisions on how we will deal with expected variations regarding length and intensity of the interventions. 3.1.4 Types of outcomes Successful RTW is traditionally measured as a dichotomous outcome and considered complementary to a question of first RTW. However, RTW may be seen as a time-to-event outcome as the workers RTW status or experience can be measured throughout the RTW-process (Wasiak et al. 2007; Young et al. 2005b). No sickness absence period is alike and employees may experience recurrences of sickness absence and only gradually recover from their injury or illness (Bültman et al. 2007; Krause & Lund 2004; Butler 1995). In order to capture important information about the effects of WPDM-programmes on sickness absence duration and sustainability, RTW therefore needs to be handled as a continuous outcome (Pransky et al. 2005; Amick et al 2000b) Primary outcomes: First return to work, duration of return to work and days lost from work Return to work measured dichotomously as first return to work (This measure is relevant but treated with caution as it neglects episodic nature of work disability); Duration of sickness absence measured continuously via time-to-event data (e.g. periods of sickness absence followed by return to work); Reduction in lost days from work (e.g. defined cumulatively as the duration of all days lost from work beginning with the date of injury). Secondary outcomes: Modification or change of job function and job functioning The functional health consequences (e.g. how an employee's health affects work role functioning and work ability). Examples of validated scales used to measure functional health consequences are: The International Classification of Functioning, Disability and Health (ICF) (WHO 2001), The Work Role Functioning scheme (Amick et al. 2004) or The Finish work-ability index (Ilmarinen 2001). Return to fulltime or part-time work. Whether R