Current Conceptual Models of Return to Work

Abstract

Over two-thirds of poor-health retirement, long-term absence due to sickness, and disability bene-fi ts arise from "common health problems"-i.e., mild/moderate musculoskeletal and cardiorespira-tory symptoms and mental health (Waddell and Aylward 2005 , 2010). Within the workplace, mus-culoskeletal pain disorders-which involve injury disorders of muscles, ligaments, tendons, joints, cartilage, and/or spinal disks-represent the most costly, disabling, prevalent, and commonly researched conditions (Schultz et al. 2007 ; U.S. Department of Labor and Bureau of Labor Statistics 2010). Despite the urgency and contributions from many researchers and clinicians in various fi elds (e.g., occupational medicine, nursing, rehabilitation medicine, physical therapy, exercise physiology, physical and occupational therapy, ergonomics, engineering, psychology, vocational counseling, economics, and public health), a single theoretical framework unifying these fi elds remains missing. Comprehensive reviews of existing models were recently published (e.g., Kirsh et al. 2010 ; Schultz et al. 2007); however, only modest changes have been proposed since then. 2.2 Defi nitions Although much research has centered on return to work (RTW) in the fi eld of occupational disability , a clear RTW defi nition remains elusive (Young et al. 2005). A number of investigators have tried to identify a RTW defi nition, but differences still remain in how researchers understand and operationalize the terms "disability" and "RTW." Schultz et al. (2007) observed that while occupational or work disability has been operationally defi ned as "time off of work, reduced productivity, or working with functional limitations as a result (outcome), of either traumatic or nontraumatic clinical conditions, the term 'return to work' is utilized as both a process and outcome measure" (p. 329). Looking more closely at defi ning RTW, Krause and colleagues (Krause et al. 2001a , b) further proposed that RTW could be a: (1) process , such as graduated return to work; (2) working status, considered a fi nal, measurable outcome related to disability, and its nuances