Integrating return-to-work principles in an occupational medicine service

About impact case studies

This impact case study is part of a series that illustrates the diffusion, uptake and outcomes of Institute for Work & Health research, based upon our research impact model. The model differentiates three types of impact:
Type 1: Evidence of diffusion of research
Type 2: Evidence of research informing decision-making at the policy or organizational level
Type 3: Evidence of societal impact

This is a Type 3 case study

Published: November 2018

More than a decade ago, a research team at the Institute for Work & Health (IWH) completed a series of systematic literature reviews of research evidence concerning the most effective workplace approaches to support return to work for injured and ill workers. These reviews—extensively shared in the scientific community and cited more than 500 times—led to the development of the popular and widely used Seven “Principles” for Successful Return to Work.

The Seven Principles guide is far and away the top item downloaded from the Institute’s website. From September  2009 to November 2018, Seven Principles has been downloaded over 20,000 times (total downloads) and the Seven Principles web page has been viewed over 33,000 times, ranking it in the top 20 most-viewed pages in the history of IWH’s website.

The principles defined in the guide have influenced a range of workplace practices and professional standards around the world. This case study illustrates the influence of findings of the original systematic reviews and the companion guide on the introduction of innovative practices in an occupational medicine service in the Canadian province of Ontario. Two of the seven principles are clearly expressed in these program reforms: the designation of an individual responsible for the coordination of return to work (RTW), and strengthened practices to enable communication among healthcare providers, the employer, the worker and the disability insurer concerning opportunities to return to work.

In 2013, the Ontario Workplace Safety and Insurance Board (WSIB) introduced new service elements to existing Regional Evaluation Centres (RECs). Workers with work-related musculoskeletal disorders may be referred to RECs when they are not progressing in their recovery and/or have not returned to work 12 weeks or more from the date of injury. The new service elements were designed to integrate RTW planning into the medical assessment and enhance communication among health-care providers, the WSIB and the employer, with the worker’s participation. A key feature of the new service was the addition of the role of a “work capacity liaison,” who identifies non-medical barriers to return to work and communicates the recommended RTW plan to the WSIB case manager and the worker’s employer.

These facets of the new service elements reflect two of the principles articulated in the seven principles of return to work: someone is responsible for coordinating return to work, and active communication is enabled among health-care providers, the insurer and the workplace.

Peer-reviewed article points to favourable RTW outcomes

An evaluation of the new service elements, published in 2016 in the Journal of Occupational and Environmental Medicine, assessed the impact of the program on the duration of wage replacement benefits, which is often used as a proxy for recovery and return to work. The study design was quasi-experimental, comparing the duration of wage replacement benefits of 1,794 workers who received REC services in the period prior to the introduction of the new service elements to 1,574 workers who received REC services in a 24-month period following the introduction of the new program. The evaluation found a significant impact of the new program on the duration of wage replacement benefits. Adjusting for differences between the two groups in age, gender, injury complexity, industry type, and duration of time between date of injury and date of assessment, the probability of being off wage replacement benefits at any given time following the date of injury for workers assessed in the new program was 33 per cent greater than for workers in the prior program.  Although not formally estimated by the study team, these favourable RTW outcomes among workers receiving services under the new program represent many days of averted disability and associated wage replacement expenditures.

In interpreting the results of this study, a number of potential mechanisms might explain the benefits achieved by the enhanced occupational medicine service. The enhanced service included a protocol for direct consultation between the assessment centre clinician and the worker’s primary health provider that included a discussion about return to work. The introduction of the work capacity liaison role facilitated communication among the worker, the insurer, the employer and health-care providers concerning RTW and accommodation options, and ensured active involvement of the injured worker in the return-to-work decision-making process.

The integration of enhanced RTW supports in a traditional occupational medicine assessment service was informed in part by the research evidence for the effectiveness of RTW coordination and enhanced communication among health-care providers, the insurer and the workplace. The evidence from this high-quality evaluation identifies a significant benefit in a reduction in the duration of wage replacement benefits in the enhanced clinical service that could be generalizable to occupational medicine programs in other work disability insurance settings.

For more information, see the original paper summarized in this impact case study: Thompson AM, Bain D, Theriault ME. Pre-post evaluation of an integrated return to work planning program in workers' compensation assessment clinics. J Occup Environ Med, 2016 Feb;58(2):215-8. doi: 10.1097/JOM.0000000000000610