Do workplace disability management programs promote return to work?

The effectiveness of workplace-based disability management programs in promoting return to work is unclear, according to a review by the Campbell Collaboration that nevertheless provides important insights into the components of these programs.

Published: April 23, 2013

It’s proving difficult to determine if employer-provided workplace disability management programs promote injured workers’ return to work (RTW). This was confirmed in a Campbell Systematic Review published last November.

Because we found so few studies that met our criteria, we cannot draw firm conclusions on the effectiveness of these programs or on the program components that drive effectiveness, says Ulrik Gensby, a PhD fellow at Denmark’s Roskilde University and lead author of the review. The review team included two researchers from the Institute for Work & Health: Emma Irvin, director of research operations, and Dr. Ben Amick, associate scientific director.

Previous research has indicated that workplace-based RTW interventions can reduce work disability absences, their duration and their associated costs. But this previous research included programs directed at workplaces that may have been initiated and/or delivered by outside parties, such as community, health-care and workers’ compensation vocational and clinical service providers.

This review wanted to look exclusively at the effectiveness of disability practices included in employer-provided programs. It set out to compare the effectiveness of workplace programs promoting return to work with no treatment, treatment as usual or an alternative program, and to determine which parts of workplace programs in particular bring about the best results.

Gensby and his team searched 12 databases for studies published between 1948 to July 2010 on workplace programs provided by employers to employees who were re-entering their workplaces with work- or non-work-related injuries or illnesses. In the end, 13 studies met the criteria needed to be included in the review.

Because too little high quality information was available in these studies, the researchers were unable to determine the effectiveness of workplace disability management programs on RTW, or find out which specific program components most effectively promoted RTW.

Program characteristics identified

However, by closely examining the workplace programs described in the research (all based in companies in Canada and the U.S.), the reviewers did learn a number of important things about program components, procedures and the human resources involved. For example, the programs:

  • focused largely on the off-work and pre-return phases of RTW, with little focus on the post-return phase and no focus on the sustainability of work;
  • offered a suite of policies and practices, with 15 program elements being most common (see the table on this page, with the elements listed from most to least common);
  • were developed to manage mainly musculoskeletal disorders, with only two developed to manage common mental health problems such as stress and depression;
  • involved a multidisciplinary team with people from several corporate departments, such as occupational physicians, physiotherapists, occupational therapists, ergonomists, RTW coordinators/case managers, union representatives, supervisors and managerial human resources staff;
  • were administered internally by the medical, benefits, health and safety, or human resources department, and were supported by senior management and a joint labour-management committee; and
  • used outcome measures primarily related to costs savings, time lost from work and time until RTW, with limited or no focus on work-role functioning, job satisfaction, well-being and job retention.

Based on these findings and what the research already tells us about workplace disability management programs , the researchers suggest current programs are potentially lacking in a number of key areas. These include the education and training of key personnel in RTW and job accommodation, the active involvement of employees in RTW procedures and practices, the early contact with workers when they go off work, the post-return and stay-at-work phases of RTW, and the use of health and job-retention measures to determine program outcomes.

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