An approach to developing a return-to-work program

There is a need for effective return-to-work programs, as the number of injured workers in Ontario who did not return to work after 12 months increased between 1998 and 2005. Customized return-to-work (RTW) plans, when used promptly after injury, have been shown to be twice as effective at returning injured workers than plans that did not consider specific workplace issues or barriers. Such customized plans are workplace-focused, and use principles of participatory ergonomics and return-to-work coordination. However, these plans are challenging to develop. For this study, researchers created a customized RTW plan using intervention mapping (IM). IM is a structured approach to developing an evidence-based health promotion project.

Researchers reviewed the literature and consulted with stakeholders to develop their program. They used intervention mapping to create a six-step RTW program for employees at a large Toronto hospital. Step 1 consisted of a needs assessment, steps 2-4 involved initial program development, step 5 consisted of implementation planning, and step 6 was an evaluation and refinement. The team consisted of researchers, RTW coordinators, a behavioural therapist, an occupational physician, an insurance board physician and physiotherapists.

A detailed RTW program was developed. Its key features were:

• having trained personnel coordinate the RTW process
• identifying and ranking barriers and solutions to RTW from the stakeholders’ perspective
• mediating practical solutions at the workplace
• empowering the injured worker in RTW decision-making.

Researchers found that the intervention mapping process provided a useful template to help create a customized RTW program. It also enabled important discussions between workers and employers, and highlighted the need to identify and tackle RTW barriers outside the workplace. However one obstacle was that intervention mapping was very time-consuming and resource intensive

The study was thorough in identifying the issues surrounding RTW programs. It outlined the intervention mapping process clearly. A weakness is that the evaluation of the benefits of intervention mapping for creating RTW programs has not yet been completed.