RTW Knowledge Base
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The issue for treaters

The issue for treaters

Return to work

“...long term worklessness is one of the greatest risks to health in our society. It is more dangerous than the most dangerous jobs in the construction industry, or the North Sea, and too often we not only fail to protect our patients from long term worklessness, we sometimes actually push them into it, inadvertently... [1]

Professor Gordon Waddell, CBE DSc MD FRCS, summarizing from the evidence review “Is work good for your health and well being? [2]

Long-term sick leave is associated with a decrease in physical, mental and social health. Families are affected and the healthcare costs are extensive. An early return to work has been found to be an essential part of rehabilitation, and decreases the risk of chronic
continuing a long time or recurring frequently
A condition or function that leaves a person unable to do tasks that most other people can do.
 Return to work needs to be a key focus of treatment.

The severity of the condition is not a strong predictor of return to work outcomes. The approach to treatment, the patient's expectations, psychosocial
Refers to psychological and social factors. Examples of psychosocial factors that affect return to work area include: a person's beliefs about how they will cope with their condition, the attitude of the inured worker's family to their condition and return to work, the employer's return to work policy and the influence of the WorkCover system on a person.
 and workplace factors and compensation issues are some of the important factors. Treating practitioners play a major role in the outcomes, through treatment and by influencing others.

Managing return to work is difficult. People don't seem to get better in the same way, dealing with the system is frustrating and time consuming and there are many factors that seem beyond the treating practitioner's influence.

This area needs positive leadership and doctors and health professionals can provide this for patients. Frank discussions built from evidence-based medicine allow doctors to say clearly that:

1. A patients' health is worse by staying off work in the long term

2. Activity is an integral and important part of rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 and should be prescribed

3. People are best off when they return to productive work in a supportive environment

4. Employers should train their staff in how to manage return to work, particularly supervisors.

5. Senior leaders in organisations should be responsible for ensuring that appropriate systems are in place to manage return to work.

6. Distressed patients do worse. They need more advice, explanations and help.

Doctors and treating professionals can influence the system by providing clear messages. Outcomes for people who have a compensated injury are worse. They can be improved by health professionals being champions for change.

This website is a synthesis of the evidence that helps treating practitioners
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 provide advice to those involved in return to work. To the patient, the employer, and those involved in case and claims management.

It contains translated summaries of clinical guidelines, systematic reviews
systematic review
A comprehensive review of research studies in a particular area. The review follows guidelines to ensure the studies included are valid.
 and individual studies. The clear writing style is intended to make evidence-based knowledge accessible to patients, insurers and employers as well as doctors.

Dr Mary Wyatt - Chair Knowledge Base Project Team.

[1] Work, good for your patient's health and well being – Professor Gordon Waddell presentation.

[2] Is work good for your health and well being? Gordon Waddell, Centre for Psychosocial and Disability Research, Cardiff University,UK A Kim Burton, Centre for Health and Social Care Research,University of Huddersfield,UK

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