More than medical
Stalled RTW can be a mystery for everyone involved, including, surprisingly, the ill or injured worker.
When RTW is delayed for no apparent reason it might seem logical to investigate the medical issues further, by suggesting that the worker seeks a second opinion, receives additional treatment or goes for another round of tests. However, managing return to work isn’t just about solving medical problems.
“Most people who have a physical injury think that as long as the doctor gets them the right treatment they’ll be ok,” Pam Garton Occupational Therapist and developer of Abilita Program recently told RTWMatters. “If they’re not ok then they start thinking that maybe they were given the wrong treatment or the wrong diagnosis. Often, however, neither the treatment nor the diagnosis is the problem.”
In fact, looking for medical problems and medical solutions can delay rehabilitation further because the reasons for delay may not be medical.
In this Quick Guide we introduce some of the key non-medical issues that impact RTW. Our tour guide through this terrain—sometimes referred to as the ‘biopsychosocial model’—is Pam from Abilita, who has also contributed a case study on the topic.
We’ve asked Pam to draw on her twenty years’ experience in the field to explain why some people find it harder to return to work than others. Below are distilled versions of her answers to the question, “What makes it harder for some people to rehabilitate and return to work?”
They’re afraid of pain
For people who don’t understand it, pain can be very scary. If you don’t understand the basic physiology of the changes happening in your nervous system when you experience pain, then you can actually think that every time you hurt, you’re doing more harm.
If an ill or injured worker expresses resistance to doing certain duties or working certain hours, it may be because they believe that it is going to cause aggravation to their injury. Perhaps the doctor once said something to them that is hanging in their mind and they believe that if they bend over and feel pain, for example, they have injured themselves further.
Receiving a good explanation of what is going on with their injury or illness can reduce a person’s fear of pain. In some cases, a pain management program may be appropriate.
They’re angry or distressed
Anger is one of those things that can hold people down and delay recovery. Since you only see the worker at work, it’s easy to forget that their injury or illness doesn’t only impact on their working life. However, how they see the impact of this injury in terms of their greater life—not just their work but their family, their holidays, their planned future, their finances—has an influence on return to work outcomes.
Maybe they blame their employer for their injury or illness, maybe they’re angry about the impact their medical condition has on their social life, or maybe they’re distressed about having less time to spend with their children. Whatever the cause, learning about what anger and distress do in the body is important, as is learning to manage these difficult emotions.
Mindfulness therapy and Cognitive Behavioural Therapy are helpful in managing anger and distress.
They’ve taken a “boom and bust” approach to pain management
A lot of people, particularly with chronic pain, tend to make a decision: right, I’m not too bad today, I’ll mow the whole lawn. Of course, then for the next three days they can’t do anything. Learning how to maintain a regular level of activity, rather than being over-protective and avoiding activity, or being boom and bust, is vital. A good rehab provider can assist with this.
They’ve lost confidence in the workplace
A person’s beliefs about and perceptions of the workplace can have a huge impact on their RTW prospects. How they see their capacity to manage at work, whether they feel that there are alternate duties for them, whether they think they’re going to be given suitable and meaningful duties, whether they think they’re going to be able to work at a pace that suits them or whether they think they’re going to be able to do enough to not let colleagues down, all impact recovery.
Training supervisors in best practice RTW helps ensure that the workplace is seen as supportive of rehabilitation, rather than jeopardising recovery.
Fortunately, progressive insurers and employers now recognise that is essential to address these barriers in order to achieve the health outcomes that are necessary for successful RTW.