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Research in work disability

Research in work disability

Evidence-based medicine is a worldwide movement to help understand effective prevention, treatment, and management approaches in health.

Evidence-based medicine involves applying meticulous scientific standards so that research is accurate and unbiased. Medical research is not just about finding new cures for diseases; it involves carefully evaluating the treatments we already use to see if they actually work.

Research might also involve investigating populations to see which people are most at risk of a certain problem, identifying risk-factors and ways to decrease them, and analysing the costs of different conditions and the benefits of certain treatments over others. Evidence-based medicine improves public health by informing doctors, patients and other people in the community about the best ways to manage and prevent different conditions.

New research is being performed all the time and our understanding of different conditions and treatments is increasing. Traditional treatments that are common practice, when tested scientifically, are sometimes discovered to be useless or worse, to cause more problems. Bed rest is has been prescribed for many conditions, from colds to back pain, but research has now shown bed rest often does more harm than good.

So how do we really know if treatment is effective or not? Today, medical research focuses on eliminating any bias from the results. It also eliminates confounding, which means making sure that the results seen are really caused by the treatment or intervention
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 being tested.

For example: if researchers find that 75% of people improve after taking a certain medication, that sounds great at first. But if 90% of people with the same illness got better without any treatment at all, it would be clear that the medication was actually delaying recovery. Another study might find that people who drink coffee have a higher risk of lung cancer. Again, this sounds like an important finding – but what if the researchers take a closer look and find out that coffee-drinkers also tend to be smokers?

These are the kind of considerations that researchers need to make. There are lots of claims that certain treatments or preventions are effective, but until they’ve been carefully studied it’s impossible to be sure.

In the area of return to work research can help identify issues such as:
  • The positive or negative health effects of being off work
  • Medical treatment approaches that help return to function and as close as possible the person’s normal life
  • Organisational factors that make a difference
Individuals can also use the research information to develop a better understanding and guide their own behaviour, which can have an enormous impact on their health.

Why invest in work disability
A condition or function that leaves a person unable to do tasks that most other people can do.

Investment in research generally has achieved greater success than all other sources in improving living standards in our time.[1] Research has resulted in significant improvement both in terms of life expectancy and quality of life. This is across a range of health areas from heart problems, to infection, to mental health.[2]

Access Economics studied the return on investment in the health sector. The average rate of return on investment was 240%. There is no reason research in the return to work area should provide a lesser return, and many reasons why the return would be expected to be greater.

Figure 1 – Rates of return on investment in health and medical research6

Research in the area of work disability is about reducing suffering, improving quality of life, and reducing the associated financial burden on the individual, the employer, and the community.

Many who work in this area are dismayed with the treatment outcomes, the failure to achieve good outcomes in return to work and work disability, and the lack of progress that has been made over the last ten to twenty years. Treating practitioners
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
  have a limited understanding of the poor health outcomes associated with work loss and do not feel empowered in dealing with patients in this area.

Advances in clinical treatment have not been matched by improved outcomes for employees and employers and the community.

Research is a labour intensive and lengthy process. In this area research is likely to achieve incremental gains rather than major breakthroughs. However the size of the problem means that even incremental gains can have a substantial impact. Research requires us to take a long term view, looking five to ten years ahead.

The fact that change will not occur rapidly can be a deterrent, where financial and political pressures cause individuals and policy makers to seek short term solutions. However, sustained improvements will only come from quality understanding of the issues, sound assessment of relevant treatments and interventions, and a strong focus on implementing best practice management.

We are not able to implement best practice if we do not have an understanding of what best practice is. The comment by Mary Lasker, a prominent American medical scientist and philanthropist is pertinent – “If you think research is expensive, try disease”.

These issues are highlighted in the area of work disability. The National Occupational Health and Safety Commission (NOHSC) estimated the total economic cost of workplace injuries is in excess of $31 billion annually, or 4.3% Gross Domestic Product.

They also indicated that the degrees of pain, suffering and changed life circumstances of workers and their families are immeasurable.[3]

A symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection. Major depression is likely to interfere significantly with everyday activity, with symptoms including insomnia, irritability, weight loss, and a lack of interest in outside events. The disorder may last several months or longer and may recur, but it is generally reversible in the short run.
 loss of self esteem, long term health issues, and raised mortality with unemployment are all potential consequences of work loss for employees with a work injury.

How can work disability research be used?

The purpose of evaluating health and return to work interventions is to help policy and decision makers, treaters and those involved with return to work to improve decision-making in the following areas

  • Improving health outcomes by use of best practice and appropriate health care
  • Minimising the adverse effects of work disability on the health and financial wellbeing of employees
  • Containing expenditure for employers and the community
  • Promoting an appropriate level of expenditure to improve outcomes within the resource restraints
Some of the challenges for policy and decision makers to use research effectively include:

  • It is time-consuming to identify relevant and applicable research
  • Research results can be difficult to read and understand, the language of researchers is often technical
  • Implementation can be slow and time consuming
However the benefits of implementing improved practices have been well documented and outcomes show that improved practice can be achieved. There are some outstanding examples of quality improvement in health care.

Veteran’s Affairs in the US achieved major improvements in health outcomes for its members, such as improved diabetic control from 51% to 94%, and at the same time reduced per patient costs by 25%.[4] Veteran’s Affairs have invested heavily in research and the implementation of research findings. They “synthesise knowledge about the best clinical approaches and create, implement, and evaluate effective and efficient health care programs”. The Vet Affairs system puts in $50m a year, including support for the Quality Enhancement Research Initiative which links research to clinical care, so that the strategies that are found to be most effective in the research are adopted quickly in practice.

Organisations that lead the way, using up-to-date and best-practice evidence, develop credibility and are respected for their initiatives. They are more likely to be able to engage stakeholders as partners.

An example of this is in the area of work disability associated with back pain. Studies have consistently shown a specific two hour intervention for people off work for 2-3 months can reduce long term disability by 30-50%.[5],[6] Back pain disability costs the community in the order of $8 bill per annum.[7] Even partial implementation of this intervention has the potential to reduce the impact of back pain and back pain disability. Implementation of such a program would require:

    1. Knowledge of the research
    2. The ability to assess that the level of evidence is strong enough to justify a program of implementation
    3. The focus to set up services to provide the intervention
    4. Influence of treating practitioners
To move ahead with the above example requires time, effort, and a coordinated approach. However the potential long term benefits are substantial. The high level of cost effectiveness justifies significant efforts to bring about long term and sustainable improvements.

We hope this site will assist improved understanding and effective management, and in turn improve outcomes for people who experience work related health conditions.

Dr Mary Wyatt - Chair Knowledge Base Project Team.

[1] Access Economics (2003). Exceptional returns: the value of investing in health R&D in Australia. Canberra, Australian Society for Medical Research.

[2] Commonwealth of Australia (2004). Sustaining the Virtuous Cycle: for a Healthy, Competitive Australia. Investment review of Health and Medical Research. Canberra, Australian Government.

[3] Productivity Commission (2004). National Workers’ Compensation and Occupational Health and Safety Frameworks. Canberra, Commonwealth of Australia.

[4] Jonathan Lomas, Health Services Research, (editorial) BMJ 327:1301-1302

[5] Indahl A, Haldorsen E, Holm S, Reikeras O, Ursin H. Five-year follow-up study of a controlled clinical trial using light mobilization and an informative approach to low back pain. Spine 1998;23(23):2625-2630.

[6] Engers AJ JP, Wensing M, van der Windt D, Grol R, van Tulder MM,. Individual patient education for low back pain: A systematic review.
systematic review
A comprehensive review of research studies in a particular area. The review follows guidelines to ensure the studies included are valid.
 In: Low back pain in General Practice. Amsterdam; 2006. p. 125-191.

[7] Walker BF, Muller R, Grant WD. Low back pain in Australian adults: the economic burden. Asia Pacific Journal of Public Health 2003;15(2):79-87.

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