Getting the at risk patient back to work: A strategy

Abstract

BACKGROUND Achieving best outcomes in occupational injury management requires an emphasis upon identifying and managing those factors which - in addition to the medical condition - lead to progression to chronicity. The most studied common musculoskeletal workplace injury is low back pain. OBJECTIVE While the majority of patients resume working with minimal medical intervention, this article highlights the early identification and management of factors in the workplace that can result in poorer outcomes for patients. DISCUSSION After exclusion of serious red flag conditions, the majority of patients with musculoskeletal injuries can resume suitable work. Factors impacting adversely upon the likelihood of a durable return to work include poor quality workplace relationships, lack of a return to work culture, patient distress regarding their condition, behaviours and beliefs about the injury such as activity avoidance, reliance on passive treatment modalities, pain focus, and time off work. It is acknowledged that workplace factors may appear beyond the influence of general practitioners, but their role is crucial to preventing chronic disability, facilitating patient self management and engaging with the workplace.