worker characteristics associated with return-to-work outcomes (useful in predicting prolonged disabilities, but generally not amenable to change); the individual-level worker factors that describe the injury; medical and vocational rehabilitation programs; the physical and psychosocial job characteristics; the organizational level employer factors; the employer- or insurer-based disability prevention programs; and the societal level legislative and policy related factors. The factors that most consistently resulted in a shortening of the duration of disability included medical and vocational rehabilitation interventions, organizational level employer factors, and employer- and insurer-based disability prevention and disability management interventions. Each of these three areas provides many opportunities for implementing and evaluating interventions.
However, several challenges must be overcome before researchers can establish which interventions are most effective (Krause et al., 2001b). Researchers need to agree on the best outcome variables to use in return-to-work studies. We need to bring together multidisciplinary teams that can address the social/behavioral, biomedical, and analytic issues in the research. These multidisciplinary teams will need to create new, interdisciplinary conceptual models for the process of returning to work. We need to prioritize among the diverse group of risk factors related to return-to-work outcomes, focusing on those that are amenable to change and relevant to workers and employers. We also need to raise the methodological level of our research, making use of survival models to account for censoring of data and to maximize the efficiency of our modeling (Collett, 1994). That of hierarchical models to simultaneously assess risk factors from several levels, ranging from the individual to the societal (Diez-Roux, 1998).
Of the almost 100 predictors of return-to-work identified in Krause’s (2001a) extensive review of the literature, most were only measured in a handful of studies, but one was repeatedly identified in a variety of different studies. In a detailed review of the literature, Krause and colleagues (1998) found that in 13 high-quality studies, modified work programs facilitated the return-to-work of workers with temporary or permanent impairments. Injured workers who were offered modified work were about twice as likely to return to work as those who were not offered modified work, and they returned to work about twice as quickly. Almost all of these work-modification programs centered on making light duty assignments available to impaired workers. One of these studies presented data suggesting that the light-duty program was cost-effective, but most presented no economic data.