Workplace program speeds return of workers with low-back injuries

According to new IWH research, workplace-based programs in which workers and supervisors jointly identify and solve return-to-work barriers help workers with low-back pain return to their jobs more quickly — especially workers who are often considered the most challenging return-to-work cases.

Published: July 17, 2009

Here’s the good news: Implementing a workplace-based program for workers who are absent due to low-back pain will help them return to work faster.

Here’s the even better news: That same program will be particularly effective for workers often considered hard to return — older workers and those who have previously been off sick.

These are the findings of Institute for Work & Health (IWH) Scientist Dr. Ivan Steenstra, published in the May 2009 issue of Spine (vol. 34, no. 12, pp. 1243-1249). He came to these conclusions based on a study he carried out in the Netherlands while earning his PhD and then continued as a researcher at IWH.

The results suggest a lot of progress can be made helping injured workers return to their jobs with a good workplace-based intervention, especially among those workers usually considered challenging cases, says Steenstra.

Worksite program beats usual care

So what, exactly, does this return-to-work (RTW) program for workers with non-specific low-back pain look like? As Steenstra explains, it’s based on the “Sherbrooke model,” which refers to a program developed in Canada by Dr. Patrick Loisel and fellow researchers at Sherbrooke University. It involves the worker and the supervisor, with the help of an occupational health professional or ergonomist, identifying and solving RTW barriers, and then implementing the solutions in the workplace.

RTW program for workers with low-back pain

STEP 1: A worker who has been off work due to low-back pain for two to six weeks sees an occupational health physician, who stresses the importance of keeping up or returning to normal activities, including work. This physician keeps in touch with the worker’s family physician to ensure they are in agreement with respect to recovery advice and the importance of returning to work.

STEP 2: The occupational health physician refers the worker to an ergonomist or occupational health nurse (further references to an ergonomist below also refer to an occupational health nurse). The ergonomist meets with the worker at the worksite to learn about his or her workstation, job tasks and perceived RTW barriers. The ergonomist then meets with the supervisor to get his or her perspective on RTW barriers.

STEP 3: Based on the information collected from the worker and supervisor, the ergonomist prepares an inventory of RTW barriers with respect to the low-back pain. The three then sit down together to reach a consensus on the top three or four RTW barriers. Disagreements are mediated by the ergonomist. In a brainstorming session, they identify as many solutions as possible to these barriers. The solutions are evaluated and chosen, with preference for solutions that are easy to implement at little to no cost (e.g. lifting aids are preferred over a complete workplace redesign).

STEP 4: The ergonomist, worker and supervisor agree on a plan for implementing the chosen solutions, identifying who is responsible for each solution and within what timeframe. As much as possible, the worker or supervisor is held responsible (e.g. if a solution calls for a new ergonomic chair, the worker or supervisor will be asked to order and test the chair, not the ergonomist).

STEP 5: A month after the plan is agreed upon, the occupational health physician evaluates the degree to which it has been successfully implemented. Solutions and other workplace adjustments are fine-tuned at this point, if necessary. The implementation plan is called successful when the worker returns to the same job he or she held before the low-back injury (or to an equal job at the same pay) and remains in that job for at least four weeks.

Steenstra initially compared the results of this program with “usual care” among workers who had been off work for two to six weeks due to low-back injury. “Usual care” referred to being under the care of an occupational health physician only, without the worksite intervention.

The results were definitive. The workers in the worksite-based program returned to work faster than those who received usual care only. They returned to work 30 days earlier, on average, than the usual-care group and at only slightly higher cost.

Older and previously sick workers best served

This led Steenstra to wonder, “Does this workplace intervention work better for some rather than others?” So he dug deeper into his findings. He discovered that factors such as gender, functional status, pain and heavy work did not make a difference to the program’s effectiveness. However, two factors did — age and sick leave taken in the previous year.

Workers aged 44 years and over who took part in the workplace-based program returned to work 2.5 times faster than workers the same age in the usual-care group. Workers who were sick in the previous year who took part in the program returned to work 2.8 times faster than workers who had been sick and received usual care.

There might be a tendency to not bother investing in older and previously sick workers because they’re considered too difficult to return to work, Steenstra says. But according to this study, that’s the wrong way to think. This analysis suggests a lot of progress can be made with a good intervention, especially among those considered challenging cases.

For a summary of the original study, visit www.iwh.on.ca/highlights/workplace-program-speeds-rtw.

Workplace program speeds return of workers with low-back injuries

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