Return to Work      

This section is compiled by Frank M. Painter, D.C.
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Workers' Compensation and Chiropractic
A Chiro.Org article collection

Studies going back to the 1980s reveal that chiropractic care gets workers back to work faster and cheaper than standard medical care. Drop by and enjoy this new topical collection.

Chiropractic Care For Veterans
A Chiro.Org article collection

Review this collection of studies detailing the slowly expanding use of chiropractic care for vererans and active military.

Chiropractic Care and Quality of Life Among
Office Workers With Nonspecific Pain:
A Cross-Sectional Study

J Chiropractic Medicine 2022 (Sep); 21 (3): 157-167 ~ FULL TEXT

World Health Organization Quality of Life short version survey (WHOQoL-BREF) scale scores after chiropractic care (mean ± standard deviation) were

71.21% ± 7.91% (total score),
81.49% ± 14.43% (general health),
80.38% ± 10.49% (physical health),
73.16% ± 11.68% (psychological),
70.41% ± 12.43% (social), and
65.58% ± 10.91% (environment).

Numeric Pain Scale scores decreased in a statistically significant way when compared with baseline (P ≤.05). The descriptive statistical analysis of WHOQoL-BREF dimensions revealed that women had significantly higher scores than men, the 18-to-35 age group had higher scores compared with the 50-to-65 age group, and those married had significantly higher scores than those who were not married (P ≤.05).   The findings of our study suggest that chiropractic care had positive effects on the quality of life of office workers.

Guideline Adherence and Lost Workdays for
Acute Low Back Pain in the California
Workers' Compensation System

PLoS One 2021 (Jun 17); 16 (6): e0253268 ~ FULL TEXT

When workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers.

A Prospective Cohort Study of the Impact of
Return-to-Work Coordinators in Getting
Injured Workers Back on the Job

J Occup Rehabil. 2018 (Jun); 28 (2): 298–306 ~ FULL TEXT

The findings suggest that workplace-based RTW Coordinators are an effective intervention for improving RTW outcomes among injured workers. Their functional activities appeared beneficial for shorter-duration claims, while interpersonal activities appeared beneficial for longer-duration claims. Therefore different Coordinator activities may be more effective depending on injured worker trajectory. However, a large proportion of participants had not been contacted by a Coordinator nor had RTW plans, despite requirements for both.

Effectiveness of Integration and Re-Integration
into Work Strategies for Persons with Chronic
Conditions: A Systematic Review
of European Strategies

Int J Environ Res Public Health. 2018 (Mar 19); 15 (3): E552 ~ FULL TEXT

Due to low employment rates associated to chronic conditions in Europe, it is essential to foster effective integration and re-integration into work strategies. The objective of this systematic review is to summarize the evidence on the effectiveness of strategies for integration and re-integration to work for persons with chronic diseases or with musculoskeletal disorders, implemented in Europe in the past five years. A systematic search was conducted in MedLine, PsycINFO, CDR-HTA, CDR-DARE and Cochrane Systematic Reviews. Overall, 32 relevant publications were identified. Of these, 21 were considered eligible after a methodological assessment and included. Positive changes in employment status, return to work and sick leave outcomes were achieved with graded sickness-absence certificates, part-time sick leave, early ergonomic interventions for back pain, disability evaluation followed by information and advice, and with multidisciplinary, coordinated and tailored return to work interventions. Additionally, a positive association between the co-existence of active labour market policies to promote employment and passive support measures (e.g., pensions or benefits) and the probability of finding a job was observed. Research on the evaluation of the effectiveness of strategies targeting integration and re-integration into work for persons with chronic health conditions needs, however, to be improved and strengthened.

Effects of the New York State Workers
Compensation Board Medical Treatment
Guidelines on Return to Work

J Occup Environ Med. 2018 (Jul); 60 (7): 617–621

Guidelines use positively influenced return-to-work after acute occupational low back injuries. Inconsistencies in following Guidelines were observed for diagnostic tests, having a potential paradoxical effect on lost time. Further studies are necessary to test for additional hypotheses.

Who will have Sustainable Employment
After a Back Injury? The Development
of a Clinical Prediction Model
in a Cohort of Injured Workers

J Occup Rehabil. 2017 (Sep); 27 (3): 445–455

Our analysis suggests that using information gathered during the initial clinical encounter may assist health care practitioners to better predict an injured worker’s post-back injury employment pattern. We created a promising clinical prediction model to predict sustainable employment following a work-related back injury. Our models suggest that clinicians might gain insight about sustainable employment approximately 1 month after claim-initiation by measuring back pain intensity, mental health-related quality of life (SF-12), claim litigation and type of employer. Similarly, examining physical and mental health-related quality of life (SF-12), claim litigation, and type of employer are adequate for predicting those with a sustainable employment pattern approximately 6 months post-injury.

Factors Affecting Return To Work After Injury
Or Illness: Best Evidence Synthesis
of Systematic Reviews

Chiropractic & Manual Therapies 2016 (Sep 8); 24 (1): 32 ~ FULL TEXT

Of the 36,193 titles screened and the 94 eligible studies reviewed, 56 systematic reviews were accepted as low risk of bias. Over half of these focused on musculoskeletal disorders, which were primarily spine related (e.g., neck and low back pain). The other half of studies assessed workers with mental health or cardiovascular conditions, stroke, cancer, multiple sclerosis or other non-specified health conditions. Many factors have been assessed, but few consistently across conditions. Common factors associated with positive return-to-work outcomes were higher education and socioeconomic status, higher self-efficacy and optimistic expectations for recovery and return-to-work, lower severity of the injury/illness, return-to-work coordination, and multidisciplinary interventions that include the workplace and stakeholders. Common factors associated with negative return-to-work outcomes were older age, being female, higher pain or disability, depression, higher physical work demands, previous sick leave and unemployment, and activity limitations.

Workers' Compensation, Return to Work,
and Lumbar Fusion for Spondylolisthesis

Orthopedics. 2016 (Jan); 39 (1): e1–8 ~ FULL TEXT

In this study, researchers reviewed the files of 686 workers who underwent fusion surgery for spondylolisthesis between 1993 and 2013, revealing that only 29.9% of them ever returned to work (for at least 6 months). The failure rate (meaning return-to-work) was 70.1%.

Association of Worker Characteristics and Early
Reimbursement for Physical Therapy, Chiropractic
and Opioid Prescription With Workers' Compensation
Claim Duration, For Cases of Acute Low Back Pain:
An Observational Cohort Study

BMJ Open. 2015 (Aug 26); 5 (8): e007836

Our analysis found that early WSIB reimbursement for physiotherapy or chiropractic care, in claimants fully off work for more than 4 weeks, was not associated with claim duration, and that early reimbursement for opioids predicted prolonged claim duration. Well-designed randomised controlled trials are needed to verify our findings and establish causality between these variables and claim duration.

The Importance, Measurement and Practical
Implications of Worker's Expectations for
Return to Work

Disabil Rehabil 2015; 37 (20): 1808–1816 ~ FULL TEXT

To date there has been a lot of inconsistency in the way that workers' expectations for RTW have been measured. In addition, most previously used measures have wording difficulties that limit application and interpretability. However, it would seem that these can be overcome with relative ease, and with further development, we will have access to a tool that can provide an opportunity to start a conversation that could help identify problems that might not otherwise be identified. This, in turn, has the potential to facilitate triage, and ultimately, help those involved in RTW management to help their clients achieve their RTW goals.

The Chiropractic Hospital-Based Interventions
Research Outcomes Study: Consistency of Outcomes
Between Doctors of Chiropractic Treating Patients
With Acute Lower Back Pain

Spine J 2010 (Dec); 10 (12): 1055–1064

This is the first reported randomized controlled trial comparing evidence-based clinical practice guideline treatment (CPGs) (which includes reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar chiropractic spinal manipulative care, and return to work within 8 weeks), to family physician-directed UC in the treatment of patients with AM–LBP. Compared to family physician-directed UC, full CPG–based treatment including CSMT is associated with significantly greater improvement in condition-specific functioning.

Nonspecific Low Back Pain and Return to Work
Am Fam Physician. 2007 (Nov 15); 76 (10): 1497–1502 ~ FULL TEXT

As many as 90 percent of persons with occupational nonspecific low back pain are able to return to work in a relatively short period of time. As long as no "red flags" exist, the patient should be encouraged to remain as active as possible, minimize bed rest, use ice or heat compresses, take anti-inflammatory or analgesic medications if desired, participate in home exercises, and return to work as soon as possible. Medical and surgical intervention should be minimized when abnormalities on physical examination are lacking and the patient is having difficulty returning to work after four to six weeks. Personal and occupational psychosocial factors should be addressed thoroughly, and a multidisciplinary rehabilitation program should be strongly considered to prevent delayed recovery and chronic disability. Patient advocacy should include preventing unnecessary and ineffective medical and surgical interventions, prolonged work loss, joblessness, and chronic disability.


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Updated 12-30-2023

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