title: Identifying barriers to recovery from work related upper extremity disorders: use of a collaborative problem solving technique.
abstract: Improving health and work outcomes for individuals with work related upper extremity disorders (WRUEDs) may require a broad assessment of potential return to work barriers by engaging workers in collaborative problem solving. In this study, half of all nurse case managers from a large workers' compensation system were randomly selected and invited to participate in a randomized, controlled trial of an integrated case management (ICM) approach for WRUEDs. The focus of ICM was problem solving skills training and workplace accommodation. Volunteer nurses attended a 2 day ICM training workshop including instruction in a 6 step process to engage clients in problem solving to overcome barriers to recovery. A chart review of WRUED case management reports (n = 70) during the following 2 years was conducted to extract case managers' reports of barriers to recovery and return to work. Case managers documented from 0 to 21 barriers per case (M = 6.24, SD = 4.02) within 5 domains: signs and symptoms (36%), work environment (27%), medical care (13%), functional limitations (12%), and coping (12%). Compared with case managers who did not receive the training (n = 67), workshop participants identified more barriers related to signs and symptoms, work environment, functional limitations, and coping (p < .05), but not to medical care. Problem solving skills training may help focus case management services on the most salient recovery factors affecting return to work.
authors.affiliation: Liberty Mutual Center for Disability Research, Hopkinton, MA, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Shaw
authors.forename: Michael
authors.initials: M
authors.lastname: Feuerstein
authors.forename: Virginia I
authors.initials: VI
authors.lastname: Miller
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Wood
mesh_terms: D003299:Cooperative Behavior; D006801:Humans; D009784:Occupational Diseases / Q000503:physiopathology* / Q000628:therapy*; D011340:Problem Solving; D020127:Recovery of Function / Q000502:physiology*; D034941:Upper Extremity / Q000293:injuries* / Q000503:physiopathology*