Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities. B. Disability Management Programs

04/01/2014

We identified several systematic reviews of DM or workplace disability management (WPDM) interventions. These DM interventions are primarily sponsored by employers and are aimed at employees with work limitations or endangered work tasks, or at individuals who have discontinued work. DM programs vary widely, depending on the employer and the impairment. There are no specific sets of services, and there is no specific model for DM or WPDM, which makes these programs difficult to evaluate through a systematic review. However, Gensby et al. (2012) list a range of components that can be included in DM or WPDM programs:

  • Early contact and intervention: communication and coordination of the RTW process between the employee and the employer.

  • Workplace assessment: a walk-through of the workplace to identify obstacles that might inhibit the absent employee from returning to work.

  • Provision of workplace accommodations: a reorganization of the job, or provision of equipment or other support that will enable the worker to return to the current job.

  • Transitional work opportunities: temporary tasks that can support the worker as he or she returns to full proficiency.

  • Modified and/or tailored work schedule or duties: special or light-duty jobs that enable an absent employee to return to work.

  • Access to alternative placements: assignment of the employee to another position to enable him/her to RTW.

  • RTW coordination or case management: a staff member who facilitates RTW services and functions, provides information, and coordinates services.

  • RTW policies: personnel and other policies that describe the procedures for dealing with sickness absence and the RTW process.

  • Active employee participation: involvement of the employee and co-workers in the RTW decision-making process.

  • Joint labor-management commitment: collaboration between management and employees regarding RTW.

  • Revision of workplace roles in RTW: re-defining tasks and delegating responsibilities to co-workers or supervisors while the employee is on leave.

  • Education of workplace staff: education and training for supervisors, union representatives, case managers, and others about RTW policies. These can be general education programs or they can be education on specific core components, such as how to discuss RTW components with employees, or coordination with medical staff.

  • Preventive strategies to avoid disability occurrence: reduction of workplace hazards that can contribute to disability.

  • Multidisciplinary work-rehabilitation services: vocational training, job replacement, job sharing, and job training; counseling, such as motivational or cognitive therapy; or other interventions, such as work adjustment or pain management.

Gensby et al. (2012) reviewed 13 DM studies published since 2010. Study participants included employees on sick leave who were unable to work due to disability.7 Most participants reported musculoskeletal disorders or low back pain (LBP). Although the 13 studies listed most of the DM components mentioned above, the authors could not determine whether specific DM program components or sets of components were driving effectiveness. They reported that the consistency and quality of the evidence is poor for WPDM interventions and concluded that there is a lack of evidence for determining the effectiveness of WPDM programs.

Another type of DM integrates WPDM with medical or health care interventions. We identified three systematic reviews of such interventions. Franche et al. (2005) conducted a systematic review of ten workplace-based interventions designed to assist workers--including those receiving workers' compensation--with musculoskeletal and other pain-related conditions. The interventions encompassed activities or supports in the workplace, as well as those outside of the workplace that used RTW coordinators as part of the workplace-based intervention. The authors reported strong evidence (based on findings from at least three studies of very high quality) that interventions that include an offer of a work accommodation, such as a change in job duties or work hours, or purchase of adaptive equipment, and early contact between the health care provider and the employer or workplace8 can reduce days on sick leave and workplace absence. The authors found moderate evidence that early employer contact with the absent worker,9 ergonomic visits to the worksite,10 and the presence of an RTW coordinator reduce workplace absence.

Williams et al. (2007) examined recently published research on the effectiveness of workplace-based rehabilitation interventions, including clinical interventions for workers with musculoskeletal work-related LBP. The authors synthesized 15 articles describing ten studies published since 2005 from the United States and other countries. The review included four RCTs and seven cohort studies with control-groups that were rated moderate to high in quality. The authors reported that workers who received the full treatment of clinical and workplace interventions, including fitness development, work hardening,11 and alternating days at the original job with increased tasks and days of functional therapy, as well as an ergonomic evaluation to determine the need for job modification, returned to work 2.4 times faster at statistically significant levels than workers who received usual clinical care. Workers who received early RTW/modified work interventions, defined as prompt assessment, rehabilitation, and treatment through modified work, also returned to work faster. Workers who received workplace site visits that were focused on ergonomic interventions reported a reduction in using sick leave, but the sample sizes were very small.

We found one systematic review of DM programs that occur outside the workplace. van Oostrom et al. (2009) examined the effectiveness of DM interventions at promoting "stay at work" through reducing sickness absence among people with musculoskeletal conditions, mental health problems, and other health conditions. The authors conducted a meta-analysis of six RCTs--from the United States and other countries--that considered several impairment types: LBP, upper extremity disorders, and musculoskeletal impairments. They compared DM interventions, including changes to the workplace or equipment (such as alterations to the furniture or equipment needed to do the job), work design and organization (including changes in duties or tasks), working conditions or environment (such as lighting or noise), and case management with active involvement of the worker and employer (meaning at least one face-to-face discussion between the worker and the employer) to usual care. The authors found five RCT studies on employees with musculoskeletal disorders and one on individuals with mental health disorders. The authors concluded that there was moderate evidence of the effectiveness of workplace interventions to reduce employee absence compared to usual care for musculoskeletal disorders but little evidence for other groups due to the lack of RCT studies.

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