Return to Work

Original Editor - Vidya Acharya

Top Contributors - Vidya Acharya  

Introduction[edit | edit source]

Health conditions that affect working-age people can have a significant impact on their ability to maintain or find employment, which could put the families' financial security at risk.[1] Chronic diseases (cardiovascular diseases, diabetes, cancer, musculoskeletal diseases), accidents and injuries and mental diseases may result in absenteeism and reduced productivity, persistent disability and reduction of income, social exclusion and material deprivation for the families involved.[2] And a negative impact on work life or unemployment can negatively affect physical and mental health needing more medical consultations.

Work is an important component of quality of life. Studies show that not having a job or experiencing work-related issues are associated with lower self-esteem, less self-efficacy, and a weaker belief in one’s ability to perform or return to the workplace. In contrast, engaging in work life provides many benefits: improved mental and physical health, better social support and financial independence; it is a source of identity and contributes to peoples’ social status.[1] Return to work (RTW) aims at facilitating the injured, temporarily impaired, or disabled worker to return to work as soon as it is medically safe.

Challenges[edit | edit source]

People who are recovering from an illness and returning to work after sick leave may face many challenges. Many continue to experience ongoing negative consequences of the illness itself or the treatment (including pain, fatigue, and low mood), which may, in turn, affect their daily functioning, including work-related aspects.[1]

Factors negatively associated with work participation of workers with a chronic disease were[3]

  • Health-related factors: injury type and severity, comorbidity and experiencing motor control problems (body function/structure dimension); inability to ambulate (activity dimension)
  • Environmental factors living in an urban area, workplace environment and financial considerations (environmental dimension) were reported to be associated with work retention.
  • Personal Factors:
    • age( older age) and gender (female). However, multiple studies suggests there is conflicting evidence on the role of age and sex as risk factors for delayed RTW and work participation following injury.[4]
    • negative prediction: patient's beliefs, There is strong evidence of patients beliefs, perceptions, and motivations regarding illness/injury impacting the course of recovery and RTW[4].
    • education: lower educational level. However, there is conflicting evidence[4] about the relationship between level of education and delayed RTW.

So, the ability to maintain or return to work (RTW) depends on the health conditions and also is importantly influenced by a person’s physical, social, attitudinal and political environment. [1] It is essential to understand the work environment resources which could facilitate or hinder the success of the professional transitions since they represent potentially challenging periods in workers’ careers.[5]

Factors impacting the Work-Life[edit | edit source]

In an online survey[1] conducted in seven European countries, the following factors were identified to have a Negative Effect on the work were:

  • Work-related aspects:
    • Career development: lack of development when having a chronic health condition;
    • Stress: most frequently impacting the work;
    • Work structure, schedule: Having no breaks leads to stress and worsening of symptom;
    • Workload and work pace: too many duties, high pressure responsibility set by employer.
  • Health-related aspects: Problems with concentration; Emotional issues such as anxiety that the person may not be able to perform duty well.
  • Stigma: Stigmatization makes it hard to deal with at the workplace. Lack of understanding by the employers, managers or colleagues led to discrimination and conflicts at workplace.

And the factors which Positively impacted the Work-Life:

  • Work-related aspects:
    • Having a standard salary,
    • Employment status (permanent contract/stable position),
    • Flexible work schedule or regular working hours, breaks and working patterns enabled structured daily routine,
    • Short commute time,
    • Job autonomy/diverse job role.
  • Person-related aspects: Thoughts, beliefs and motivation were important for coping with a chronic condition (being creative, being calm, positive thinking, self-discipline
  • Interpersonal relationships: Relationships with colleagues and supervisors play an important role in the integration in the workplace.

Interventions[edit | edit source]

Facilitators and Barriers in the Implementation of Interventions[edit | edit source]

Facilitators in the implementation of interventions facilitating work participation of employees with chronic health problems[2]

  • Employer’s motivation to foster work participation
  • Information available on best practices
  • Funding
  • Designating the responsibility for designing support practices to a certain quarter at the workplace
  • Finding flexible solutions for performing work tasks
  • Educating managers and teams
  • Culture of openness
  • Respect and trust in employees and their work ethic
  • Involving employees in planning work adaptations
  • Employees stating their needs clearly

Barriers in the implementation of interventions facilitating work participation of employees with chronic health problems[2]:

  • Lack of motivation among managers
  • Lack of knowledge among managers on
    • employees having health problems
    • the capability of individuals with chronic health problems to continue working
    • to what extent workplace can intervene in employees’ health concerns
  • Lack of funding and resources
  • Lack of communication within work community
    • Prejudice and stigma associated with health problem
    • Employees fear sharing their health problems
  • Supporting RTW/work participation difficult if disease is not detected or treated early on

Strategies for Integration and Reintegration at Work[edit | edit source]

The problems and challenges faced by people with chronic diseases should be considered when drafting legislation and company regulations that to help formulate innovative and person-centered responses to effectively manage the workforce and ensure employee wellbeing while ensuring continued employer productivity.[2] Implementing initiatives promoting social inclusion depend on the employers, human resources managers, set of legislative and political rules. Investing in healthcare and welfare policies is necessary to ensure the long-term viability of social security systems for the working-age population[2].

Policies[edit | edit source]

Effective management policies and supportive legislation are necessary to support chronically ill workers and help them return to work. Many countries have a "quota system" that allocates a percentage of jobs to people with chronic diseases to help employees retain their jobs if they develop an illness while employed. At certain places, the private sector providers like NGOs and communities help people with decreased ability to reintegrate into workforce.[2] There should be a smooth co-ordination and active co-operation between the health system (treating people and managing their condition through medical rehabilitation), the benefit system (providing income support when needed) and the national employment system (helping those with sufficient remaining work capacity to find a job) would improve employment outcomes for the people with health problems[2].

Policy-makers should implement measures that promote job retention among people with reduced work capacity. There is a need for good incentives to work for people with health issues or disabilities and for the public authorities to provide the necessary employment support and enhance the workers' employability.

Employers are vital players in preventing health problems at work and facilitating swift return to work for people absent due to sickness. Financial incentives are needed for the employer to retain people with illness. Policies should include professional education and retraining for workers who need to change their roles or duties. [2]Programs to help people return to work should include inclusion, maintenance of their health, and return to work.

The role of medical professionals and workers' representatives influence the return to work. Multidisciplinary RTW interventions, especially at the workplace provides access to multiple resources including health and occupational professionals who can deliver a combination of interventions [6] Important components of RTW interventions are RTW coordinator, occupational training or conditioning, workplace-based interventions, work accommodations, and contact between the various stakeholders[6] According to a latest research, hospital-based RTW program adopting a multi-disciplinary approach to facilitate early and safe return to work was effective in promoting an increase in self-perceived overall health and work ability across the duration of the program.[7]


Common principles for successful return to work[edit | edit source]

They are:[9]:

  • Workplace has a solid commitment to health and safety, which is demonstrated by the behaviors' of the workplace parties.
  • Employer modifies work (also known as work accommodation) for injured/ill workers so they can return early and safely to work activities suitable to their abilities. For instance, work without interruption, flexible working models, working hours and fixed or flexible breaks, reduced workload (for less stress and less pressure), workplace to be adapted to the needs of people with health problems (possibility of home office or transportation to and from work), Workplace adaptation to the needs of persons with chronic health conditions (less responsibility, having a choice, no lifting of heavy weights or no external working tasks)[1]
  • RTW planners ensure that the plan supports the returning worker without disadvantaging co-workers and supervisors.
  • Supervisors are trained in work disability prevention and included in RTW planning.
  • Employer makes early and considerate contact with injured/ill workers.
  • RTW coordinators to coordinate RTW.
  • Employers and health-care providers communicate with each other about the workplace demands as needed, and with the worker’s consent.
  • Employee has access to multidisciplinary resources (including clinical interventions for the management of pain, disability, depression and poor expectations for recovery), where necessary, working in combination with the other stakeholders.

Research suggests interventions aiming at one’s ability to cope with pain or disability early on, changing the attitudes of supervisors and co-workers to counter the stigmatization of persons, recognizing the efforts of employee, financial support may additionally help to improve RTW outcomes[9]. There is a need for developing new strategies of integration and reintegration at work for persons with chronic health conditions[1].

Role of Physiotherapy[edit | edit source]

Physical therapists (PTs) play a crucial role in the rehabilitation and return to work of injured workers, and they can prevent or shorten absenteeism. Occupational Health Physiotherapist assesses if an individual is fit to return to work and provides ongoing support in the workplace, such as ‘hands-on’ physiotherapy treatment, ergonomic assessment, and review[10]. Research findings show that multidisciplinary rehabilitation programs helped to recover from pain, and disability with a successful return to work following a shoulder injury.[11] See:

Resources[edit | edit source]

Clinical Guidance to Optimize Work Participation After Injury or Illness:The Role of Physical Therapist

Migraine, Guide at work: guidance for managers

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Foitzek N, Ávila CC, Ivandic I, Bitenc Č, Cabello M, Gruber S, Leonardi M, Muñoz-Murillo A, Scaratti C, Tobiasz-Adamczyk B, Vlachou A. What persons with chronic health conditions need to maintain or return to work—Results of an online-survey in seven European countries. International journal of environmental research and public health. 2018 Apr;15(4):595
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Silvaggi F, Eigenmann M, Scaratti C, Guastafierro E, Toppo C, Lindstrom J, Rantala E, Imaz-Iglesia I, Barnfield A, Maassen A, Leonardi M. Employment and chronic diseases: Suggested actions for the implementation of inclusive policies for the participation of people with chronic diseases in the labour market. International Journal of Environmental Research and Public Health. 2020 Feb;17(3):820.
  3. Vooijs M, Leensen MC, Hoving JL, Daams JG, Wind H, Frings-Dresen MH. Disease-generic factors of work participation of workers with a chronic disease: a systematic review. International archives of occupational and environmental health. 2015 Nov;88(8):1015-29.
  4. 4.0 4.1 4.2 Daley D, Payne LP, Galper J, Cheung A, Deal L, Despres M, Garcia JD, Kistner F, Mackenzie N, Perry T, Richards C. Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2021 Aug;51(8):CPG1-02.
  5. Figueredo JM, García-Ael C, Gragnano A, Topa G. Well-being at work after return to work (RTW): a systematic review. International Journal of Environmental Research and Public Health. 2020 Oct;17(20):7490.
  6. 6.0 6.1 Cancelliere C, Donovan J, Stochkendahl MJ, Biscardi M, Ammendolia C, Myburgh C, Cassidy JD. Factors affecting return to work after injury or illness: best evidence synthesis of systematic reviews. Chiropractic & manual therapies. 2016 Dec;24(1):1-23.
  7. Tan ML, Eu E, Da Yap BW, Er WX, Tan SX, Lim JW, Gan WH. A hospital-based return-to-work programme in Singapore. Industrial Health. 2022.
  8. Workplace Safety and Health CouncilReturn to Work Programme. Available from
  9. 9.0 9.1 Cancelliere C, Donovan J, Stochkendahl MJ, Biscardi M, Ammendolia C, Myburgh C, Cassidy JD. Factors affecting return to work after injury or illness: best evidence synthesis of systematic reviews. Chiropractic & manual therapies. 2016 Dec;24(1):1-23.
  10. Return to Work Advice. ACPOHE. PhysiosforworkandHealth. Accessed on 2/7/22
  11. Bean A, Edmonds C, Lin T, Davis R, Hopcroft L, Savona A, Singh G, Boccia K, Leming K, Mann H, Razmjou H. Effectiveness of a multidisciplinary rehabilitation program following shoulder injury. The Open Journal of Occupational Therapy. 2017;5(3):4.