Better understanding of the factors influencing a return to work
Online since 28.02.2022
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As part of a study supervised by its research department, the Clinique romande de réadaptation (CRR) carried out a systematic review of literature in the returning to work after an acute orthopaedic trauma field. The conclusions of this study, carried out for a medical thesis and published in February 2022 on the scientific platform Frontiers, confirm that a biopsychosocial approach is the most suitable.
Refreshing the know-how
As a leading institution in rehabilitation research, the CRR's objective was to provide updated data on the biopsychosocial factors that enable a prognosis of return to work after an acute orthopaedic trauma (fracture, dislocation, sprain, etc.). Indeed, since 2010, no literature review had addressed this important issue.
The biopsychosocial approach is particularly important in the field of rehabilitation and vocational reintegration and requires the active participation of the patient. It is the most successful medical model in terms of its holistic approach to health, taking into account biological, psychological and social factors. This review has thus made it possible to refresh on the knowledge concerning the factors influencing the return to work.
A database of over 2500 studies
Based on some 2500 existing scientific studies, the first step was to search for case studies in working populations (18-65 years) with orthopaedic injuries published between 2010 and 2020. The case studies selected all had to have a prospective follow-up and a sufficient number of people included to allow good quality statistical analyses. The factors involved in the early phase (less than 6 months after the accident) and the late phase (more than 6 months) were also differentiated.
In the end, thirty articles were included with a follow-up between 1 and 58 months after the accident. The quality of the studies was high for the majority of them. Most of them came from European or other Anglo-Saxon countries. The return to work rate varied between 22% and 74% depending on the study in the early phase (less than 6 months), and between 44% and 94% in the late phase (more than 6 months). In the early phase, the main barrier to return to work was the severity of the injury. Beyond 6 months, age, severity of the injury, pain level, sense of self-efficacy, education level, hard labour and financial compensation status (by insurance) were the determining factors for returning to work or not. To a lesser extent, subjective expectations of recovery and the physical workload also had an impact.
Models for predicting the likelihood of returning to work
Based on current levels of evidence, it is noted that the severity of the injury plays a major role in both the early and late phases. These results underline the importance of preventing severe trauma. This review also highlights the multiple facets of the biopsychosocial model that influence the return to work after suffering orthopaedic trauma. Various interventions are possible: promotion of suitable jobs for older workers, improved access to medical care and rehabilitation stays, and adaptation of the job (to reduce physical demand). The practical value of this work in the context of rehabilitation is twofold. On the one hand, it provides up-to-date data and on the other hand, it allows the adaptation of predictive models of return to work, as well as the adaptation of patient management.
Other biopsychosocial factors are likely to have an impact and would require further high-quality studies to define their involvement in return to work situation, also in the early phase.
You can read the article in full (in English) here : https://www.frontiersin.org/articles/10.3389/fresc.2021.791351/full