Maintaining a focus on return to work

• Communicate the importance of a timely return to work for the injured worker's rehabilitation and recovery, and discuss the physical and emotional benefits of returning to work.
• Educate the injured worker about the expected recovery time for their injury.
• Discuss expected return to work timeframes.
• Convey to the worker (where appropriate) that return to work is often safe and beneficial even before they have fully recovered.
• Provide information about strategies to prevent re-injury or aggravation ^[3]. Note that an injured worker's anxieties about return to work can potentially be reinforced when a health provider catastrophises injury or pain, or emphasises biomedical processes ^[4].

The beliefs and expectations of an injured worker are known to affect health outcomes. Understanding the workers expectations and perceptions provides useful information to inform clinical and return to work treatment planning. When an injured worker predicts he or she will not return to work, they are unlikely to do so ^[5]. Poor expectations about returning to work are predictive of a longer time to return to work ^[6,7].

An injured workers negative or uncertain expectations may indicate the need to screen for and address psychosocial factors in order to facilitate recovery ^[6].

Ask the injured worker about their expectations for recovery and return to work. If they express the view that they will not be able to return to work in a timely manner, attempt to establish why they have this belief. A worker's expectations can be modified by giving them evidence-based information about the injury, treatment, typical recovery times, and information about preventing aggravation and/or re-injury.

Employers are highly influential stakeholders in influencing return to work. Recovery and return to work outcomes often depend on how employers respond to and support injured workers in the workplace ^[8,9].

Health providers have the capacity to positively influence the way in which a workplace responds to the worker. Research demonstrates that when a health provider contacts the workplace, the injured worker is twice as likely to return to work ^[3]. An employer is twice as likely to respond to suggestions regarding possible job or ergonomic changes when this information is personally conveyed by a health provider ^{[3, 10, 11]}.

Where possible, telephone the employer or return to work coordinator, or arrange a case conference to discuss ways to prevent re-injury or aggravation of an injury, or to discuss suitable duties and return to work planning ^[8].

1. Cotton P. Occupational wellbeing--management of injured workers with psychosocial barriers. Aust Fam Physician 2006 Dec;35(12):958-61.
2. Health Services Group. Clinical framework for the delivery of health services. Melbourne: Transport Accident Commission and WorkSafe Victoria July 2008.
3. Kosny A, Franche RL, Pole J, Krause N, Cote P, Mustard C. Early healthcare provider communication with patients and their workplace following a lost-time claim for an occupational musculoskeletal injury. J Occup Rehabil 2006 Mar;16(1):27-39.
4. Dasinger LK, Krause N, Thompson PJ, Brand RJ, Rudolph L. Doctor proactive communication, return-to-work recommendation, and duration of disability after a workers' compensation low back injury. J Occup Environ Med 2001 Jun;43(6):515-25.
5. Heijbel B, Josephson M, Jensen I, Stark S, Vingard E. Return to work expectation predicts work in chronic musculoskeletal and behavioral health disorders: prospective study with clinical implications. J Occup Rehabil 2006 Jun;16(2):173-84.
6. Cole D, Mondloch, MC., Hogg-Johnson, S. Listening to injured workers: how recovery expectations predict outcomes - a prospective study. Canadian Medical Association Journal 2002;166(6).
7. Gross DP, Battie MC. Work-related recovery expectations and the prognosis of chronic low back pain within a workers' compensation setting. J Occup Environ Med 2005 Apr;47(4):428-33.
8. Franche RL, Cullen K, Clarke J, Irvin E, Sinclair S, Frank J. Workplace-based return-to-work interventions: a systematic review of the quantitative literature. J Occup Rehabil 2005 Dec;15(4):607-31.
9. Nordqvist C, Holmqvist C, Alexanderson K. Views of laypersons on the role employers play in return to work when sick-listed. J Occup Rehabil 2003 Mar;13(1):11-20.
10. Franche RL, Severin CN, Hogg-Johnson S, Cote P, Vidmar M, Lee H. The impact of early workplace-based return-to-work strategies on work absence duration: a 6-month longitudinal study following an occupational musculoskeletal injury. J Occup Environ Med 2007 Sep;49(9):960-74.
11. Krause N, Dasinger LK, Neuhauser F. Modified Work and Return to Work: A Review of the Literature. Journal of Occupational Rehabilitation 1998;8(2):113-39.