Return to Work

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Introduction

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. 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. 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.

Challenges

The persons who are recovering from an illness and returning to work after the 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.

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

• Health-related factors: 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 WR.
• Personal Factors: age( older age); gender (female); prediction (person's own negative prediction; education (lower educational level)

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. It is important 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.

Factors impacting the Work Life

In an online survey conducted in seven European Countries the following factors were identified to have a Negative Effect on the Work Life were:

• Work-related aspects:
  • Career development: having difficult advancement opportunities or lack of development when having a chronic health condition;
  • Stress: most frequently impacting the work;
  • Work structure, schedule: Having no breaks leading 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, belief and motivation were important for coping with 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

Facilitators and Barriers in the Implementation of Interventions

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

• 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:

• 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

The problems and challenges faced by people with chronic diseases should be considered when drafting legislation and company regulations which are designed to help formulate innovative and person-centered responses to effectively manage the workforce and ensure employee wellbeing while ensuring continued employer productivity. 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.

Policies

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. 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.

Policy makers should implement measures that promote job retention among people with reduced work capacity. There is 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 key players in preventing health problems at work and facilitating swift return to work for people who are absent due to sickness. Financial incentives are needed for the employer in order to retain the people with sickness. Policies should include professional education and retraining for workers who need to change their roles or duties. Programs to help people to 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. A multidisciplinary RTW interventions, especially at the workplace, providing access to multiple resources including health and occupational professionals who can deliver a combination of interventions when and to whom it is required; of particular importance is ensuring these resources are available for conditions with a less favorable prognosis. Important components of RTW interventions are RTW coordination, occupational training or conditioning, workplace-based interventions, work accommodations, and contact between the various stakeholders

Common principles for successful return to work:

• Workplace has a strong commitment to health and safety, which is demonstrated by the behaviors' of the workplace parties.
• Employer modifies work (also known as work accommodation) to injured/ill workers so they can return early and safely to work activities suitable to their abilities.
• 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.
• Worker 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.
  

Interventions to targeting one’s ability to cope with pain or disability early on, regardless of the contributing disease-specific factor, may ultimately help to improve RTW outcomes. Likewise, identifying and managing depression (regardless of the initial source of depression) in ill or injured workers, irrespective of the traceable disease-specific factor, may additionally lead to improved RTW outcomes. Research suggests the need of changing the attitudes of supervisors and co-workers to counter the stigmatization of persons with chronic health conditions at work. There is a need for developing new strategies of integration and reintegration at work for persons with chronic health conditions. 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)
• Financial support, Support of others such as coworkers and supervisors and Service-related support (job-benefits)
• Attitude of colleagues and recognizing the efforts of employee needed to solve the problem stigmatization, discrimination and isolation.

• Changing the attitudes of supervisors and co-workers to counteract the stigmatization of persons with chronic health conditions in the workplace.

Physiotherapy Relevance

See: Assessment of Fitness for Return to Work

Functional Capacity Evaluation

Work Conditioning

Return to Work Advice for Physiotherapists