Greg Murphy is Associate Professor in the School of Public Health at Melbourne's LaTrobe University. He is in involved with research into the rehabilitation outcomes for people in rural communities and return to work following spinal cord injury. RTW Matters asked Greg if we could pick his brains for our readers' pleasure. His interview follows.

You've been looking at rehabilitation in rural communities. How does this differ from rehab in urban areas? Are there particular challenges and how they might be overcome?
Rural communities may have certain health-service lacks, however rural communities generally have greater opportunities for practical social support. While large city-based insurance organisations or government departments take months to finalise decisions about potential entitlements, local community organisations can move into action and provide quick solutions to problems, be these in the areas of home modifications or assistance with return-to-work arrangements.

You also supervise degree students in the area of RTW – are there any new focuses that are emerging from new studies into RTW?
Too many research studies in the area of RTW have examined psychological variables associated with the injured employee. More studies are needed on the characteristics of the local workplace that encourage higher rates of return to work, and more durable RTWs. Particularly important are studies of the attitudes and behaviours of the immediate work supervisor and the attitudes and behaviours of co-workers.

What do you consider are the key rehabilitation policy implementation issues that should be addressed in terms of occupational rehab at this point?
The main barriers to effective occupational rehabilitation service delivery are essentially the same today as they were when summarised two decades ago in a report to the Victorian Parliament by the committee chaired by Mr B. Rowe: insufficient weighting given by service providers to workplace matters. Policies and procedures that encourage greater and more effective communication between workplace representatives and medical and allied health provider staff need to be developed or strengthened.

What are some of the particular rehab policy implementation issues surrounding occupational rehab after spinal cord injury?
Effective rehabilitation for those suffering a traumatic spinal cord injury will (for the overwhelming majority of individuals) involve return to some amount of paid work. As most Australians who suffer a traumatic SCI will be employed at the time of injury, services to maintain the bond between the employer and the person injured need to be a priority.

What do you see as the three best rehab initiatives introduced over the last ten years?
A couple of very impressive initiatives have been introduced in military and veterans' rehabilitation. One initiative I encountered was developed by the British Ministry of Defence whereby a new class of “Rehabilitation Instructors” was introduced. These physical-fitness-oriented instructors were employed half time by the Ministry working in Defence settings and half time in private enterprise settings, often in elite professional sporting clubs. Their use was associated with faster progress through rehabilitation. Another useful development was the rapid provision of prostheses, manufactured on-site in workshops of a Rehabilitation Centre whereby artificial limbs were produced in a couple of days rather than in months, as used to occur when limb-making was organised via an external government department who used contracted manufacturers. Again, much faster and improved return to work outcomes were associated with this initiative.