RTW Matters!

My copy of the weekly update from RTW Matters has arrived with some great new articles for people working in the field of helping others return to work.
If you haven’t been there before, head on over to take a look at the free stuff, then if you’re excited by it, think about subscribing. It’s well worth it with some of the most prominent researchers and workers in the field contributing from their experience.
Some of the articles this week:

  1. Comparing Australian and New Zealand rates and duration of durable and non-durable RTW over time
  2. Early intervention and good communication: everyone’s responsibilities. The top points from the Dr William Shaw interview.
  3. oh, and yes there’s one from me! New Zealand’s Bronnie Thompson looks at the next steps back to work – looking broadly at the path forward.

Why should we look at return to work for people with chronic pain?
Well, lots of reasons actually, but some of the most consistent findings are that people who return to work are healthier than those who don’t. In fact, being off work increases the risk of ill health (Waddell & Burton, 2006).

The link between work disability and receiving compensation means that those who continue to be off work are often still engaged in a health care system such as insurance or ACC (in NZ) that means the person has to maintain ‘disablement’ or illness behaviour to retain compensation – this means repeated assessments, programmes and justification to both health providers and the compensation provider that the person is still unfit. This isn’t conducive to people living a full and healthy life. (Hadler, 2006)

Is return to work a legitimate part of pain management? Well, apart from the need to specifically address it as an outcome for general health reasons, many people give poor pain management as their reason for not returning to work. There is no doubt that for some people, functional limitations do prevent their return to specific tasks permanently. For many, however, it’s the sense of self efficacy, or confidence to reliably manage their pain and function at work that limits their actual return.

While authors like Gordon Waddell, Kim Burton & Nick Kendall (Vocational Rehabilitation: What works, for whom, and when? 2008) suggest that ‘Vocational rehabilitation [is] defined as whatever helps someone with a health problem to stay at, return to and remain in work: it is an idea and an approach as much as an intervention or a service’, and needs to start immediately, they also state that ‘the evidence in this review shows that effective vocational rehabilitation depends on work-focused healthcare and accommodating workplaces. Both are necessary: they are inter-dependent and must be coordinated.’

I’d suggest that separating vocational management efforts from health care and especially pain management (as has happened over the past few years in New Zealand) is not effective. Both elements need to be integrated, so that the two efforts support each other.  If that means pain management needs to learn about how people experience the workplace and help them develop effective coping skills that can be used at work, then so be it! Similarly, if vocational providers need to learn about effective chronic pain management so they can provide a consistent message that hurt does not equal harm and pain should not be a guide – then so be it.

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