IWH has a rich history in return-to-work research

Dr. John Frank, one of IWH's first senior scientists, talks about Institute's rich history in return-to-work research.

Published: April 10, 2008

When the Institute for Work & Health was established in 1990, the three senior scientists who were brought on board to lead research projects knew they had to launch an “ambitious, large study” to make the Institute’s mark.

Over the next year, these scientists – Drs. John Frank, Claire Bombardier and Harry Shannon – along with other researchers, began to construct what was one of the largest and most complex occupational health research projects in Canada to date.

Study identified risk factors

The Ontario Universities Low-Back Pain Study examined which factors contributed to low-back pain reports in workers at an auto assembly plant. This study was one of the most in-depth and sophisticated studies ever done on the biomechanical and psychosocial factors affecting back injuries, says Dr. John Frank, the Institute’s first Scientific Director.

The study identified several risk factors that were associated with low-back pain reports from these workers. They included having a physically demanding job, perceptions of a poor workplace social environment, and inconsistency between a worker’s job and education level.

Then, to look at the factors affecting the duration of disability after sprains and strains, Institute researchers initiated the even larger Early Claimant Cohort (ECC) study in 1994. This study also tested the effectiveness of an early, active, exercise and education program for injured workers. The program was sponsored by the workers’ compensation board and was community-based, in physiotherapy and chiropractic clinics across Ontario. The researchers found that there were no health-related or return-to-work advantages with this treatment program, compared with usual care.

These two “flagship” studies became cornerstones of workplace-based studies, as well as return-to-work and work disability prevention knowledge at the Institute.

Communication issues

Frank noted that after a few years of directing the scientific program at the Institute, the scientists were becoming aware of some communication challenges in the occupational health and safety system. By the time we finished the ECC, it was clear to us that the relationship among the workplace, the injured worker and the care system was the critical factor, and that it was frequently dysfunctional, says Frank, now Scientific Director at the Institute of Population and Public Health, Canadian Institutes of Health Research.

This premise led to the development of one of the Institute’s first disability management tools, the Work-Ready Workshop. To create this tool, different stakeholders such as health-care providers, workplace decision-makers, injured worker representatives, and policy-makers came to the same table to discuss return to work. The materials for the workshop were built on a series of case studies that showed situations in which return to work was delayed. Each case study came with an analysis of what happened, and provided recommendations to improve the final outcome, based on scientific evidence. Work-Ready focused on changing what the stakeholders knew and understood to be important, and their attitudes around return-to-work practices, notes Frank.

Primary and secondary prevention

In 2003, Frank co-authored an IWH paper –Preventing Injury, Illness and Disability at Work: What Works and How Do We Know? (later published in the Scandinavian Journal of Work and Environmental Health in 2006) – that aimed at initiating a dialogue about prevention among Ontario occupational health and safety organizations. One of four themes in this paper addressed the merging of primary and secondary prevention approaches. The goal of primary prevention is to protect people from developing an illness or experiencing an injury. Secondary prevention aims to reduce disability and promote recovery after an injury or illness has occurred.

Combining primary and secondary preventive interventions can yield a greater impact than the sum of the impacts from separately implemented interventions, the paper notes.

In fact, Ontario’s Health and Safety Associations (HSAs) are examining how they can embrace secondary prevention initiatives in their work (see HSAs to develop an education role in return to work).

Tool development

More recently, Institute researchers – led by Dr. Renée-Louise Franche – conducted the most sophisticated and comprehensive literature review on workplace-based return-to-work programs to date, says Frank. The results from this review were the basis for several products including the Seven Principles for Successful Return to Work and a draft tool for occupational therapists (see New tool opens dialogue on return-to-work issues).

The research question was structured so broadly and yet appropriately, that it required a transdisciplinary centre to conduct it. You can hardly find a centre like the Institute in the United States or in Europe that can do this type of research, Frank says.