title: Disability prevention and communication among workers, physicians, employers, and insurers--current models and opportunities for improvement.
abstract: OBJECTIVE
  To review prevailing models of disability management and prevention with respect to communication, and to suggest alternative approaches.
  
  
  METHODS
  Review of selected articles.
  
  
  RESULTS
  Effective disability management and return to work strategies have been the focus of an increasing number of intervention programmes and associated research studies, spanning a variety of worker populations and provider and business perspectives. Although primary and secondary disability prevention approaches have addressed theoretical basis, methods and costs, few identify communication as a key factor influencing disability outcomes. Four prevailing models of disability management and prevention (medical model, physical rehabilitation model, job-match model, and managed care model) are identified. The medical model emphasizes the physician's role to define functional limitations and job restrictions. In the physical rehabilitation model, rehabilitation professionals communicate the importance of exercise and muscle reconditioning for resuming normal work activities. The job-match model relies on the ability of employers to accurately communicate physical job requirements. The managed care model focuses on dissemination of acceptable standards for medical treatment and duration of work absence, and interventions by case managers when these standards are exceeded. Despite contrary evidence for many health impairments, these models share a common assumption that medical disability outcomes are highly predictable and unaffected by either individual or contextual factors. As a result, communication is often authoritative and unidirectional, with workers and employers in a passive role.
  
  
  CONCLUSIONS
  Improvements in communication may be responsible for successes across a variety of new interventions. Communication-based interventions may further improve disability outcomes, reduce adversarial relationships, and prove cost-effective; however, controlled trials are needed.
authors.affiliation: Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA 01748, USA. Glenn.Pransky@LibertyMutual.com
authors.forename: Glenn
authors.initials: G
authors.lastname: Pransky
authors.forename: William
authors.initials: W
authors.lastname: Shaw
authors.forename: Renee-Louise
authors.initials: RL
authors.lastname: Franche
authors.forename: Andrew
authors.initials: A
authors.lastname: Clarke
mesh_terms: D003142:Communication; D006233:Persons with Disabilities / Q000534:rehabilitation*; D004651:Employment; D007343:Insurance Carriers; D007400:Interprofessional Relations; D008329:Managed Care Programs; D008962:Models, Theoretical; D010817:Physician-Patient Relations; D010820:Physicians; D012106:Research