 The type of work one does during his/her lifetime often defines who they are. According to the American Heritage Dictionary, work is defined as “a physical or mental effort or activity directed toward the production or accomplishment of something”. The benefits of work for the human race have been well recognized throughout the ages:
Furthermore, deleterious effects on health in individuals who do not work have been repeatedly demonstrated in the literature. In 1995, a Canadian review concluded that unemployed individuals have more adverse health outcomes than their working peers. In 1998, an Australian review found that unemployed persons have higher mortality rates, more physical and mental ailments and demonstrate a greater utilization of healthcare services. Recently, a large Swedish study revealed a 50% increase in mortality in unemployed individuals followed over 10 to 17 years when they were compared to their working counterparts. For injured workers, maintenance of work or early return to work, even when symptoms are still present, generally is in their best interest. When medically feasible, a return to modified duty has been shown to decrease a patient’s deconditioning and to lessen the likelihood of psychological behavior patterns that may hinder recovery. On the other hand, extended time away from work often results in suboptimal outcomes as well as a decreased likelihood of a return to work.
Healthcare providers involved in the management of injured workers have several roles outside of diagnosis and treatment. Initial education and reassurance can go a long way in facilitating symptomatic recovery and easing the anxieties which often result in a delayed functional recovery. Injured workers and their employers may lack a full understanding regarding injury management and expected duration of symptoms. Injured workers often believe that activity provoking pain equates with further injury when in fact after most acute injuries have stabilized this is not the case. Two of the most common reasons for a delayed return to work involve the injured worker’s inability to tolerate the recommended job restrictions and/or the employer’s lack of available work modifications.
A return-to-work plan should be discussed early on so that the injured worker understands that healing the injury, if possible, and controlling the associated pain are not the only goals of the recommended treatment. The clinician should also become familiar with the patient’s job requirements and work closely with the employer involved in order to arrange for modified work if possible. When the injured worker is ready to return to work in some capacity, it is the clinician’s, case manager’s and employer’s responsibility to ensure a safe transition for both the worker and his/her coworkers.
It is important for the clinician to realize that once maximal medical improvement has been attained, permanent job restrictions or limitations should be based on decreasing the risk for further injury and not on the worker’s work intolerance. In other words, the clinician should not base restrictions or limitations on the worker’s pain and endurance intolerance in the absence of severe pathology that cannot be effectively treated. Ultimately though, a worker’s success in a return-to-work plan will often depend upon whether the inherent rewards of working outweigh that particular worker’s continuing pain or fatigue experienced during work.
Finally, the astute clinician needs to recognize and manage potential problems that may hinder functional recovery of the injured worker. Fear of re-injury or being “cut-off” are two of the biggest obstacles for the injured worker to overcome. Building a trusting relationship with the injured worker by keeping him/her abreast of the treatment plan in addition to allowing him/her to take an active role in creating such plan will often ease these fears and expedite a safe and effective work return. |