Canadian HR Reporter

CANADIAN HR REPORTER April 17, 2017 24 FEATURES Canadian HR Reporter is excited to announce that Paul Burton has joined Thomson Reuters Media Solutions, Canada as Sales Manager. Paul will be handling advertising sales and sponsorships for Canadian HR Reporter, Canadian Occupational Safety and their related properties. Paul brings a wealth of media sales experience to his new role, working with some of the top names and brands in Canada. He can help your firm craft an effective communications strategy and place it in front of employers. You can reach Paul anytime at paul.burton@tr.com or at (416) 649-9928. ANNOUNCEMENT HEALTH & SAFETY Making the best of RTW interventions Multi-faceted programs that package together different components have their advantages By Uyen Vu B y the time an employee with an injury or health condition calls up Janet Marlin, chances are he has been off work for a long time. e person may be experiencing chronic pain — such as low-back pain, migraine or irritable bowel syndrome — or chronic mental health conditions such as de- pressed mood or anxiety. As head of a Burlington, Ont.- based practice, Marlin has worked for nearly 30 years helping these individuals recover their function. She has long believed the most ef- fective approaches are those that bring together diff erent parties to support the injured worker. At her practice, a kinesiologist or cognitive behavioural therapist working on a client's fi le would typically obtain consent to con- tact the client's health-care pro- vider, describe the services being off ered and ask for feedback. e clinician would also contact the client's employer and the case manager to get input on a gradu- ated return-to-work (RTW) plan the client has taken a lead role in developing. " at's the approach that we've always used," says Marlin. " ere has to be a collaborative approach to getting individuals back to work." As a result, Marlin was not surprised to find that a recent systematic review of workplace RTW interventions recommends multi-faceted programs that package together diff erent types of interventions. e systematic review, an up- date by the Toronto-based Insti- tute for Work & Health (IWH) and the Institute for Safety, Com- pensation and Recovery Research (ISCRR) in Melbourne, Australia, found strong evidence for the ef- fectiveness of workplace-based RTW programs in reducing time away from work due to muscu- loskeletal disorders (MSDs) and other pain-related conditions when they incorporate practices in at least two of the three follow- ing areas: • health services for injured work- ers provided at work or in settings linked to work (such as physical therapy, occupational therapy, psychological therapy, medical assessments, graded-activity ex- ercises or work hardening) • RTW co-ordination (such as case management, RTW plan- ning or improved communica- tion with health-care providers) • work modifi cations (such as job accommodations, ergonomic or other worksite adjustments or supervisor training on work modifi cations). " ere's something about the grouping together of interven- tions that address diff erent facets that makes the interventions ef- fective," says Kim Cullen, asso- ciate scientist at IWH and lead author of the article "Eff ective- ness of Workplace Interventions in Return-to-Work for Musculo- skeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners" in the Journal of Occupational Rehabilitation. Even when workplace RTW programs package together dif- ferent components that all ad- dress the same domain — for ex- ample, all relate to health services or work modifi cation — the evi- dence shows these have no eff ect, says Cullen. The only exceptions to this fi nding are work accommodation and graded activity — a moder- ate level of evidence shows these stand-alone interventions have an eff ect on RTW. (Graded activity is an exercise or occupational ther- apy aimed at restoring a patient's function on specifi c work tasks by modifying the tasks according to levels of diffi culty.) "If a workplace has to imple- ment any one intervention as a stand-alone, I would recommend one of these two interventions — work accommodation or graded activity," she says. Cullen has a few theories as to why the multi-faceted programs are eff ective. "It may be because the multi- domain programs are about using diff erent perspectives in thinking about what injured individuals need," she says. "Or it may be that these packages of interventions cover more ground and are more likely to include the interventions that can help." Marlin, who makes a point of keeping up on the research in her fi eld of disability management, says the key to success in her team's approach is the buy-in that results from having diff erent par- ties provide their input. "When we develop a draft of a graduated return-to-work plan with the patient, we ask the health- care provider if there's anything that's contraindicated from a men- tal or physical health perspective," says Marlin. "And then it goes to the case manager and employer so that each can look at it from their own perspective. For the most part, the claimants whom we work with fol- low through with that plan. at's because everyone has been in- volved in developing it. e claim- ants are on board because, in fact, they're the ones that draft it in the fi rst place." Uyen Vu is a communications associ- ate at the Institute for Work & Health (IWH), a Toronto-based not-for-profi t research organization that conducts research into workplace injury and disability prevention. She is also edi- tor of the institute's quarterly news- letter At Work, found at www.iwh. on.ca/e-alerts. Key fi ndings In looking at the return-to-work systematic review update, there's strong evidence that: • for MSDs and pain disorders, implementing a multi-domain intervention (with components in at least two of the following domains: health services, case co-ordination or work modifi cation) can help reduce lost time • for mental health conditions, implementing a work-focused cognitive behavioural therapy (CBT) intervention can help reduce lost time and costs associated with work disability • for mental health conditions, a traditional CBT intervention has no effect on reducing lost time. There's moderate evidence that: • graded activity and work accommodations can help reduce lost time • for MSD conditions, multi-domain interventions can improve work functioning and lower costs • for mental health conditions, work-focused CBT can help improve work functioning. There's not enough evidence to guide current practices and policies on: • work hardening alone • physician training alone • return-to-work plans alone • case management alone • worker education/training alone • supervisor training alone.

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