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It pays to be nice - employer worker relationships influence back pain return to work

At a glance:
Workers satisfaction with their employer's treatment is important in explaining if they will have multiple periods off work.

Workers satisfaction with their employer is more important than their own expectations about recovery and it is more important than their satisfaction with their health care provider in determining their stability of employment after injury.

Being nice pays off for the firm, by lowering both the likelihood of lost time claims
lost time claims
Claim for financial compensation for lost wages from time off work.
 from injured workers and the likelihood that they will have multiple spells of time off work (after at least one period of time off work).

Workers who are more satisfied with their employer's response to a worker's compensation claim have higher expectations of a good recovery (26.5% versus 17.2%) and less severe pain than those who are dissatisfied.
This study shows that a positive relationship with your employer is the most important influence in your return to work following a low back pain injury. It also influences how your injury will affect your ongoing employment pattern in the future. Being off work is difficult in many ways. It helps if you can talk to your employer so that they understand your situation. Let them know how you are going and keep in touch regularly. It will help them to help you and keep communication channels open.
Responding positively with strong support, being in regular communication and assisting your employee to get the treatment they need for low back pain injuries is the most important factor determining how quickly the person will return to work. Your positive attitude also contributes to how well the worker is able to manage any low back problems in the future. Being nice, respecting and caring for your employees in a personal and professional manner, pays off.
In addition to reassuring the patient, demonstrating suitable stretching exercises and recommending normal activities to people with low back pain who do not display a serious pathology, encouraging positive communication between worker and employer is an important element in treatment of low back pain injuries.
Advising and guiding employers to take a positive, supportive and professional approach to their workers low back injuries results in the earliest return to work and the most stable future employment pattern, with a consequent reduction in the cost of claims.
Original Article, Authors & Publication Details:
R. J. Butler1, W. G. Johnson2 and P. Côté3 (2007).

It pays to be nice: employer-worker relationships and the management of back pain claims. Journal of Occupational & Environmental Medicine; 49(2):214-25.

1Department of Economics, Martha Jane Knowlton Coray University Professor, Brigham Young University, Provo, UT
2School of Computing and Informatics, Ira A. Fulton College of Engineering, Arizona State University Tempe, AZ
3Institute for Work and Health and Department of Public Health Sciences, University of Toronto, Toronto, Ontario Canada.
Background, Study Objectives, How It Was Done:
Over the last twenty years there has been increasing interest in what the workplace can do to help people to recover from injury and return to work. Workplace relations affect an employee's return to work after injury. The researchers in this study sought to better understand the relationship between employers approaches to managing workplace injury and workers employment stability in the 12 months after an injury claim.

The Arizona State University Healthy Back Study investigated back pain claims from five employers with company branches in one or more of 37 states in the US. The subjects were workers aged 18 and older who filed workers compensation claims for work-related back pain between January 1, 1999 and June 30, 2002.The study observed this group of employees over the next year, to see whether their injury continued to affect their employment.

The researchers wanted to know how much influence workers satisfaction with the firms treatment of their disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 claim has on their return to work, compared to satisfaction with health care and expectation of recovery.

The data was collected from workers compensation claim files and health care billing records, supplemented by interviews with workers conducted at the beginning of the claim, and 6 and 12 months later. Of 3,621 claims, 1831 (51%) of the workers agreed to participate in the survey and completed the initial interview. Of these, 87% of were still participating in the study after one month, 62% after six months, and 42% after one year.

The survey obtained detailed information about the workers periods of time at and off work after the back pain claim had been lodged. Four patterns of post injury employment were defined, and workers divided into these groups at 6 and 12 months after their injury claim.
  1. Workers report no time off work following the onset of back pain.
  2. Workers are initially off work for a period but then return to work and have no subsequent absences over the next year.
  3. Workers return to work after an initial absence but experience one or more subsequent work absences related to back pain.
  4. Workers absent from work from the date of onset to the date of interview.
Workers were said to be satisfied with their employer's response if they reported, at the follow-up one month after the claim, that they were “satisfied" or “very satisfied" with how their employer had treated them following their injury.
Study Findings:
At the six month interview, poor employment patterns (patterns 3 and 4) were observed in about 22% of workers who are satisfied with their employer's responses to their claims and 45% or workers who are dissatisfied with their employer's responses. This difference is statistically significant, and therefore suggests that satisfaction with their employer's treatment of them after injury influences workers employment patterns in the future.

The authors of the study used statistical techniques to also take into account the effects of other factors: the severity of the pain, whether the employee was male or female, the employee's expectations of recovery, the employer variables and whether the employee was able to choose their doctor.

The researchers found, after taking these factors into account, that those who were dissatisfied with their employer were 1.5 times more likely to have negative return to work outcomes (i.e. patterns 3 or 4).

Satisfaction with health care also influenced workers future employment patterns: 26% of the workers who were satisfied with their health care one month after their claim and 41% or workers who were dissatisfied with their health care had poor employment patterns when interviewed at six months. This difference is also statistically significant.

Workers who are satisfied with the employer's response to their injury are more likely to only claim medical expenses, and not claim lost time (64% versus 56% for those dissatisfied with their treatment).
The principal finding of this study is that workers' satisfaction with their employers' responses to their claims is the most important single influence on employment stability after the onset of back pain. It is roughly comparable to the severity of back pain itself in explaining differences in patterns of absence from work following injury.

Worker's satisfaction with their employer's treatment is more important than satisfaction with health care or worker's own expectations about recovery in determining whether a worker will return to stable employment. Dissatisfied workers have worse return to work outcomes: they are more likely to make "time lost' claims and are more likely to have multiple spells off work.

Occupational back pain is a common problem, and a target for disability management programs that attempt to reduce workers compensation costs by shortening work absences. The programs, widely practiced among large firms, are most successful when they include good communication and create trust between employers and workers. Workers who are unhappy with their employers reaction to their workers compensation claim will be reluctant to cooperate with disability management initiatives and may be absent from work for a longer period as a result. The effect of employer-worker relationships on the course of work-related back pain is one example of the influence of employer-worker interactions on industrial relations in general.

The results show that the stability of post injury work attendance is greater among workers who are satisfied with their employer's responses to their compensation claims. Workers who are satisfied with their health care are also less likely to have multiple spells off work. However, all else being equal, worker's satisfaction with their employer's behaviour has a much larger impact on employment after injury than does their satisfaction with health care.
PubMed Abstract
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