Researchers Recommend Strategy to Develop RTW Program for Back Pain
"Despite over two decades of research, the ability to prevent work-related low back pain disability remains elusive," said a collaboration of Canadian researchers in a recently issued study.
According to the report, funded by the Workplace Safety & Insurance Board of Ontario and spearheaded by the University Health Network in Toronto, there has been an alarming increase in the duration of disability after occupational low back pain. From 1998 to 2005, for example, the WSIB reported a 38 percent increase in the proportion of injured workers who remained on benefits at 12 months, with low back pain being the most common cause of persistent disability claims.
To address these concerns, the researchers set out to develop a workplace return-to-work program for employees suffering from low back pain. To accomplish this, the researchers utilized intervention mapping, a methodology used for designing and implementing complex interventions or programs. This method is typically used to create community health promotion and disease prevention programs, such as AIDS prevention and smoking cessation initiatives.
Use five steps when developing RTW plan.
The end result of the intervention mapping process was a comprehensive five-step RTW program. According to these five steps, researchers urged employers to:
1. Identify barriers. The first task of the RTW program is to identify potential barriers from the perspective of all stakeholders.
"This begins with the RTW coordinator interviewing the injured worker then the other stakeholders," the researchers said.
Prior to the interview, the study concluded that it may be helpful to have the injured worker complete a self-report questionnaire that assesses the individual's pain, disability and potential psychosocial barriers to RTW, such as anxiety and depression. Regardless of how trivial you may see the barrier, document it and make the injured worker feel like you care about his situation. Employers, researchers said, may also want to encourage the injured worker to contact his union representative to involve him in the RTW process.
Next, set up an interview with the third-party payer and get the potential barriers from their perspective. If miscommunication with the injured work is identified, the researchers recommended hosting a teleconference between the two parties and the RTW coordinator.
These should be followed up by interviews with the health care provider, the supervisor and key decision-makers at the workplace. The process is essential so that any issues or potential problems can be addressed from the very beginning, the study concluded.
2.Identify solutions. The next step is to host a meeting at the workplace. During this meeting, the RTW coordinator facilitates and engages communication between each stakeholder member, addressing the prioritized barriers to the RTW process. Each party is then asked to come up with solutions to the barriers and rank them based on importance and feasibility. Researchers said the coordinator should facilitate consensus around practical solutions, and outline who will be responsible for implementing them, as well as draw up a timeline.
Following the meeting, the study recommended hosting a tour of the work site, where the injured workers and other parties discuss the agreed upon modifications and accommodations.
3. Prepare and implement plan. The next step, according to the report, is to have the coordinator write a report that outlines the RTW plan. Provide a copy of the report to all the stakeholders.
According to the researchers, the RTW coordinator must maintain ongoing contact with the injured worker during the preparation and implementation process. If underlying psychological barriers were identified, the study recommended employers provide cognitive behavioral interventions, such as positive reinforcement.
4. Implement solutions. According to the study, the coordinator should then contact the workplace representatives and the injured worker to determine the agreed upon return to the job.
"If necessary, the RTW coordinator provides ongoing reassurance, positive reinforcement and education on self-management skills," the researchers said.
Researchers said staying in contact with the injured workers is also critical during the implementation of the plan so that adjustments can be made to accommodate new information or overcome new barriers. Researchers said that the injured worker is discharged from the program when, from his and the workplace's perspectives, there are not significant barriers preventing sustainable RTW.
5. Evaluate the plan. During the initial follow-up, an assessment should be made from the perspective of the injured worker and the supervisor on whether all of the agreed upon solutions in the RTW plan were fully implemented. Satisfaction with the plan among stakeholders, the report said, should be assessed on a five-point scale ranging from very satisfied to very dissatisfied.
A final report should be sent to all parties.
"Designing RTW programs are inherently challenging because of the complex and multifaceted nature of RTW," researchers said. "We consulted and received feedback from all important stakeholders throughout the development of the RTW program, who contributed practical insight on what works and what doesn't in RTW. This process also ensured that our program was relevant not to one, but to all important stakeholders."
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August 3, 2009
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