Conceptual, Methodological, and Measurement Challenges in Addressing Return to Work in Workers with Musculoskeletal Disorders

Abstract

Traditionally, the problem of return to work for people with musculoskeletal disorders has been viewed primarily from a biomedical or biomechanical/ergonomic perspective. Research on the outcome of treatment, however, has illustrated the powerful influence of psychosocial factors, both clinical and occupational. There has been a similar broadening in focus from that of the individual worker to the workplace and from primary prevention of injury to secondary prevention of work absence and the adopting of integrated approaches to intervention encompassing both work retention and return to work. This review begins with reflections on the nature of the workplace, on the influence of musculoskeletal symptoms, and on the need for an overall conceptual framework for return to work. The Flags framework is offered as a way of identifying and tackling work absence and the determinants of successful return to work, conceptualized from a framework of obstacles to successful reintegration into work as considered both from a worker-centered and from a workplace or organizational perspective. In designing interventions, it is recommended that special attention be directed to the development of appropriate evaluations, the identification of relevant outcomes, and the establishment of workplace policies and practices likely to assist rather than hinder successful and sustained return to work.