Assessment of Fitness for Return to Work
Current Musculoskeletal Trends[edit | edit source]
Musculoskeletal pain is very common with prevalence rates of around 30% per year (ranging from 14-47%) and incidence rates of 8.3% per year.[1] It tends to affect an individual at least once in his or her lifetime.[2] It is a major cause of disability, resulting in absence from work or functional limitations at work, as well as a general reduction in ability to undertake normal activities.[1][2]
At present, there is a trend towards increasing disability from musculoskeletal conditions. However, while disability increases, prevalence rates for these conditions are static. There are also ever increasing treatment options and reduction in workloads because of greater regulation.[3]
It is thought that this increase in disability may, therefore, be due to factors such as:[3]
- Obesity
- Ageing populations
- Sedentary behaviour
Impact of Musculoskeletal Conditions on Work[edit | edit source]
The impact of a musculoskeletal condition on a worker is variable and affected by a number of factors. Patients who have chronic musculoskeletal conditions are more likely to be absent from work (i.e. 40% can work full time) than people with other medical conditions such as diabetes, heart and lung conditions (i.e. 50% can work full time).[3] It is thought that this difference in working rates for individuals with musculoskeletal conditions may be related to the fact that people are more likely to connect their health condition to work than individuals with other health conditions.[3]
However, each individual’s unique response to his / her pain will influence his / her prognosis. Depression, anxiety, psychosocial factors (including how well an individual deals with pain, fear of movement, pain catastrophisation, low self-efficacy and passive pain coping mechanisms) are important areas to consider when assessing these patients’ fitness to return to work.[1] If an individual fears that work will worsen his / her condition, it may have an impact on his / her ability to return to work.[3]
De Vries and colleagues report that, in general, patients who have chronic nonspecific musculoskeletal pain and who remain at work report poor to moderate work ability and performance.[4] However, they found that a subgroup of workers are able to remain at work and achieve high performance and ability. These individuals tend to have high levels of pain self-efficacy. Thus, it appears that personal and work-related factors affect work ability and performance rather than pain alone.[4]
Why is Work Important?[edit | edit source]
Work is considered an essential part of life and an inability to work due to disability or other health issues has a negative impact on an individual.[5] Five percent of all sickness absences will become long term (ie they will last more than 4 weeks).[6] These long term absences account for almost half of the total working days lost each year.[6] The more time off an individual has, the greater the risk that she / he will not return to work.[7] For instance, if an individual is absent from work for six months, there is an 80% chance that s/he will be out of work for five years.[8]
There are various reasons why work is important:[7][3]
- It increases physical and mental health
- It enhances a worker’s sense of purpose, confidence, self-worth, independence and fulfilment[7]
- Physical activity aids recovery - people are more likely to be sedentary at home
- Social isolation increases during periods of absence from work
- Individuals are more likely to return to their hobbies and sports when they return to work, which increase satisfaction
- Relationships at home can become strained with role reversals during long term absence from work[3]
Role of the Occupational Health Physiotherapist[edit | edit source]
Occupational health physiotherapists help to manage musculoskeletal injuries in the workplace.[3] They perform impartial and objective assessments in order to ensure the best outcome for both the worker and the employer.[9] A key part of their roles is to provide guidance about when an individual is ready to return to work after an injury or other absence.[3]
The primary aim for occupational rehabilitation professionals is to enable an individual to return to his / her existing job. If this is not possible, the focus is on returning to the same job, but with some adjustments. Alternatively, they may return to a different job with the same employer. If none of these scenarios are appropriate, the goal would be to find work with a different employer.[3]
Key information that occupational physiotherapists provide to the employer and employee include:[3]
- Advice about what jobs the worker can or cannot do
- Advice about what adjustments might be needed in terms of the demands of the job, so that the worker can manage his or her role
A fitness to work assessment will assess a worker’s ability. If the worker’s ability matches the demands of the job, then she / he will likely have a successful job placement. However, in situations where the worker’s ability and job demands are incompatible, occupational health interventions will be necessary. These include:[3]
- Ergonomic technology
- Altering job demands (eg reduced lifting requirements)
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Sleijser-Koehorst MLS, Bijker L, Cuijpers P, Scholten-Peeters GGM, Coppieters MW. Preferred self-administered questionnaires to assess fear of movement, coping, self-efficacy, and catastrophizing in patients with musculoskeletal pain-A modified Delphi study. Pain. 2019;160(3):600-606.
- ↑ 2.0 2.1 Gouttebarge V, Wind H, Kuijer PP, Sluiter JK, Frings-Dresen MH. How to assess physical work-ability with Functional Capacity Evaluation methods in a more specific and efficient way?. Work. 2010;37(1):111-115.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 Albert C. Assessment of Fitness to Return to Work Course. Physioplus. 2020.
- ↑ 4.0 4.1 de Vries HJ, Reneman MF, Groothoff JW, Geertzen JH, Brouwer S. Self-reported work ability and work performance in workers with chronic nonspecific musculoskeletal pain. J Occup Rehabil. 2013;23(1):1-10.
- ↑ Wind H, Gouttebarge V, Kuijer PP, Sluiter JK, Frings-Dresen MH. Complementary value of functional capacity evaluation for physicians in assessing the physical work ability of workers with musculoskeletal disorders. Int Arch Occup Environ Health. 2009;82(4):435-443.
- ↑ 6.0 6.1 Black C, Frost D. Health at work - an independent review of sickness absence. London: Department of Work and Pensions; 2011. Available from: http://www.dwp.gov.uk/policy/welfare-reform/sickness-absence-review [Accessed 13 April 2020]
- ↑ 7.0 7.1 7.2 Department of Work and Pensions. Department of Health and Social Care. Health in the Workplace- Patterns of Sickness Absence, Employer Support and Employment Retention. 2019. Available from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/817124/health-in-the-workplace-statistics.pdf. [Accessed 13 April 2020].
- ↑ Chartered Society of Physiotherapy. Physiotherapy Works: Occupational Health. United Kingdom; 2010. Available from https://www.csp.org.uk/publications/physiotherapy-works-occupational-health (accessed 13 April 2020).
- ↑ Roberts, K. An Introduction to Occupational Health. Physioplus. 2020.
