Study: Factors that can affect a person's ability to return to work

Refers to psychological and social factors involved with injured workers
returning to work.

Examples of psychosocial factors that affect return to work area
include:

A personâl belief about how they will cope with their condition,
the attitude of the injured worker's family to their condition and return to work,
the employer's return to work policy and the influence of the WorkCover
system on a person. factors that can influence the self-assessment of function.
(Journal of Occupational Rehabilitation; 14(3):197-206Department of Psychiatry,
The University of Texas Southwestern Medical Center at Dallas, Dallas,
TexasBackground, Study Objectives, )

How It Was Done:

This paper's author suggests that many factors can influence the assessment
of a person's level of pain and their ability to function. Therefore, it is best to
approach assessment by taking into account this broad range of factors, rather
than using one simple measure.The aim of this paper is to better understand
the factors that can influence assessment of function and recovery. The paper
reviews some evidence from previous studies, and then recommends an
approach for assessing a person's ability to function after sustaining injury.

Study Findings:

The following factors can influence a persons beliefs and approach to recovery
and in turn can affect their return to work. Each factor needs to be understood
in order to be addressed. While this can be difficult it can make a significant
difference.Secondary loss issuesSecondary loss can be a barrier to recovery.
Some types of loss that can be caused as a secondary result of injury are:

Economic loss

Loss of relationships at work

Loss of social support networks

Social stigma of being disabled, or on workers compensation

Guilt about disability

Loss of recreational activities

Loss of respect from family and friends

The papers author indicates that these losses can have a cascade effect,
leading to significant emotional distress. This then complicates the physical
problem. Effective management of return to function acknowledges
secondary loss, and assists the patient to address these problems positively.

Secondary gain:

Secondary gain has been defined as "the interpersonal or social advantage
obtained by the patient as a consequence of illness". Secondary gain is a
normal facet of life. For example, a person with a headache may not have
to do the dishes, and someone with a cold may spend a day at home rather
than at work. It is a normal for people to experience secondary gain.

Secondary gain:

Any indirect gain that occurs as the result of an injury or illness.

For example, financial gain (in the form of compensation), not having to
work, sympathy or attention. in a modest way.However in some circumstances
the secondary gain becomes a significant issue, and can interfere with return to
function. Secondary gain can range from fulfilment of token needs and wishes
(such as to be taken care of, to change family dynamics or to get even when
blame is involved) to more material issues (such as financial gain, or avoiding
work while maintaining income).It is often said that financial compensation
encourages disability.

Disability:

A condition or function that leaves a person unable to do tasks that most
other people can do. If patients are paid to be sick, they may learn to continue
to seem to be sick, as using this behaviour brings them reward. It is often
expected that people will return to normal functioning when they are no
longer receiving compensation for their injury. However, when the financial
reward stops, the authors of this paper suggest that the behaviours often do
not change. People can continue to behave in a way that allows them to avoid
activity.The authors also go on to suggest that treating practitioners shouldn't
assume that patients with financial secondary gain issues cannot be treated
effectively.

Studies have shown that even in the presence of unresolved financial gain
claims, treatment outcomes can be positive. One of the risks of focusing on
secondary gain is that it deters the treater from appropriate treatment,
may result in poorer outcomes.It is recommended that the treating
practitioner

Treating practitioner:

A health professional that treats patients. In return to work this may
include doctors, physiotherapists, chiropractors, osteopaths, psychologists,
masseurs, etc. take into account the persons situation and any barriers to
recovery, and focus on improving their level of function. The focus should not
be on freeing the patient from pain, but rather on supporting active
rehabilitation.

Management of this situation includes:

Defining a medical endpoint:

Arranging a treatment plan in communication with all parties, with the
aim to return to as normal a life as possible. This may involve family
members, other health care providers, claims managers, and employers.

The team should:

Establish trust and rapport with one another

Plan the return to work

Address any financial issues, including secondary gain, and provide the
person with an understanding of the financial implications

Set goals, including the injured person in this process

After trust has been established, educate the patient about their
reasonable expectation for recovery.

Emotional distress:

Changes in a person's mood often accompany pain and in turn this
affects function. Studies have indicated that 40 to 50% of all chronic
pain patients experienced some form of depression.

Continuing a long time or recurring frequently pain patients:

Experience some form of depression, Anxiety is also common.

People who are fearful of pain avoid activity that they think may cause pain.
They often experience more distress and secondary loss.

Secondary loss:

Any indirect loss that occurs as the result of an injury or illness.
For example, loss of social contact with work friends, loss of status,
financial loss from reduced income. issues. The fear of pain prompts
avoidance behaviour and retreat from normal daily activities. In turn
this leads to increased social isolation, inability to return to function and
prolonged disability.Anger is also becoming recognised as an emotional
state that can affect function. Anger may be directed at persisting
symptoms, unsuccessful treatment, a person blamed for the injury, the
workplace where the injury has occurred, the workers' compensation
system, any delay in management, or family, or colleagues who may be
unsympathetic. Anger that is not expressed is associated with increased
intensity of pain and perceived interference with activities of daily living.
People who are angry seem to be less motivated to respond to assessment
or treatment.

Other factors the author notes influence a persons level of distress are:

Uncertainty about:

How they should manage the condition
The likely outcome (how long the condition will take to improve and
whether the condition is likely to leave them with long-term problems)
The best treatment
Feelings of being misunderstood
Lack of understanding about their entitlement, such as delays in being paid,
difficulties in sorting out the level of pay, etc.Symptom magnification. It is
rare that a patient is consciously faking functional disability. Symptoms
may be exaggerated consciously, or unconsciously, as a way of expressing
the person's illness.

Compliance and resistance issues:

Fear and trust can be major issues for some people, and can interfere with
their willingness, or motivation to participate in a rehabilitation

Rehabilitation :

The process of helping a person back to their former abilities and quality of
life (or as close as possilble) after injury or a medical condition. program.
These issues need to be dealt with in a supportive and educational manner.
It may take some time to develop a level of trust that supports a collaborative
working relationship to overcome these barriers.

Patient Comprehension:

Practitioners tend to assume that patients understand discussions and any
reading material. However, some information needs to be presented a
number of times, or in different ways for patients to fully grasp its meaning.
It is important that the treating practitioner recognise when a patient does
fully understand the information and advice given about their condition.

Iatrogenic effect :

An unwanted negative health effect that occurs as a result of treatment.
E.g. side effects of medication, the problems that can occur from a person
being told to rest, a complication from surgery. An iatrogenic effect it is an
unwanted effect inadvertently introduced by a health care professional, or
treatment. For example, after being advised to rest to relieve pain a person
may continue to rest for longer than necessary. In turn this can change the
person's behaviour, or beliefs in response to their condition and alter their
routine. It is important that treating practitioners understand this issue,
so that appropriate advice is given.

Conclusions:

This study notes that there are many factors that influence a patient's
return to function and their assessment of their own ability and recovery.
Acknowledging and dealing with secondary loss and secondary gain issues,
emotional distress, and the potential for treatment to cause unwanted effects
is needed to accurately assess function. These issues can be complex, but the
authors indicate that they can be effectively addressed with adequate time,
& communication and the development of trust.

Original Article, Authors & Publication Details:
R. J. Gatchel1 (2004).


Psychosocial factors that can influence the self-assessment of function.
J Occup Rehabil. 2004 Sep;14(3):197-206. Review.
PMID: 15156778 [PubMed - indexed for MEDLINE]

New Inspectors To Improve Outcomes For Injured Workers

27 February 2007

New State Return to Work Inspectors will be visiting Victorian employers
with WorkCover claims for compensation from this month.

The Minister for WorkCover, Tim Holding, says the visits are part of the
Victorian WorkCover Authority's commitment to help injured workers return
to work, and to provide greater support to employers in understanding their
return to work obligations.“The Victorian WorkCover Authority is committed
to doing everything it can to ensure injured workers receive the care and
support they need to re-enter the workplace,” Mr Holding said.“This includes
building awareness among employers about their legal obligations to support
injured workers, and providing advice about the best way to help rehabilitate
injured workers.”

WorkCover figures show that more than 158,000 claims for workplace injuries
have been made in the past five years at a cost of more than $5 billion in
compensation and rehabilitation.

The new Return to Work Inspectorate will focus on how the State’s employers
are performing in helping these injured workers return to the workplace.

Specifically, the Inspectors will:

Look for the presence of a nominated Return to Work Coordinator (where required)
and the nature of the role being undertaken by the Coordinator;

Ensure Return to Work plans are being developed in consultation with the
injured worker;

Ensure Return to Work plans contain the necessary information, including
an Occupational Rehabilitation Program and the Offer of Suitable Employment,
where required;

Ensure employees and employers are provided with up-to-date public
information on their rights and obligations if they suffer a workplace injury;
and make sure risk management programs are in place.

While the primary focus of the visits is around return to work issues,
the Return to Work Inspectors will retain their OHS Inspector powers.

A Return to Work Inspector will contact an employer via letter or telephone
prior to any visit with the details of the visit and what to expect.

WCV's: by calling or writing to the employers prior to the visit just
allows the employers more time, to doctor up their books, policies and do repairs
they already should have done as the new VWA add clearly depicts and shows.

What will this prove Mr Holding? The employers should already be worksafe
compliant ,that means already be providing a return to work!

Will this cover all workers from 1997 onwards or are you going to pick and
choose again, whom will be included? or maybe you will create another black
hole theory?

What about the workers who have already not been provided a return to work?
Will their claims be re-accessed by this newly formed department of the VWA?

Many of the stories I hear here at WCV's, are about workers being sacked before
they have been provided a return to work and the VWA have been ignoring this
fact for 9 years that I know of now so, why are you worried now Mr Tweedly
and Mr Holding? Do you need brownie points?

I myself have complained to you many times about this very issue, and it has
taken you 9 years that I know of to act on them, so why now? Are you going to
resolve my partners return to work issues too?

Injured workers get help to get back to work

VWA Announcement - April 9, 2002 Injured workers get help to get back to work.

Mr Bob Cameron, has today launched a new campaign aimed at improving
return to work outcomes for Victoria’s injured workers. He was joined by
the CEO of VECCI, Mr Neil Coulson, and Trades Hall Assistant Secretary,
Nathan Niven, along with the CEO of the Victorian WorkCover Authority,
Bill Mountford.Mr Cameron said the time for better injury management
had come with more than 30,000 Victorians being compensated for
workplace injuries each year. “This information campaign introduces
new return to work guidelines which come into effect on July 1 this year
and are designed to ensure injured workers receive the support they need,”
he said. “A CD-ROM will be sent to 180,000 Victorian employers and all
employers will be encouraged to learn more about their return to work
obligations through print, radio and television advertisements.

“The campaign features an injured worker frustrated and stuck at home
just wanting to be back at work.“The message to employers is to work with
their injured worker and treating doctor and develop a return to work plan
as soon as possible. “On top of the moral obligation to do the right thing by
an injured worker, there is a strong financial, business and legal case to do so.
“Employers who actively support a worker’s recovery will benefit from improved
staff morale, retain job skills and stem productivity losses. “Further more,
improved health outcomes and return to work results lead directly to lower
premiums and reduced claim costs.” VECCI CEO, Neil Coulson, welcomed the
return to work guide as an initiative that will help employers meet their obligations.
“We have an enormous opportunity to improve our return to work rates in
Victoria,” he said. Trades Hall, Assistant Secretary, Nathan Niven also
commended the guide and employer CD as an easy to use source of practical
advice. “It is in everyone’s interest for workers to get back to work as soon as
possible. “Trades Hall and affiliate unions look forward to developing return
to work plan enforcement protocols with the VWA to back up the clear
commitment to returning injured workers to work,” he said.Victorian WorkCover
Authority Chief Executive, Bill Mountford, said employers had always had
obligations to their injured workers but under the new return to work laws the
specifics of those obligations had been made clearer. “We’re doing this to help
improve average return to work rates in this state,” Mr Mountford said.
“By July 1 employers must meet basic standards in occupational rehabilitation
policies, individual return to work plans for injured workers and risk
management programs. “After an injury, the best results are achieved
if workers have regular contact with their workplace and a plan is put
in place early to help get staff back to work as soon as medically possible.”