How well do return-to-work interventions for musculoskeletal conditions address the multicausality of work disability?
BACKGROUND
The best-documented return-to-work rehabilitation programs concern workers with musculoskeletal disorders (MSKD). For this clientele, a global perspective has been adopted which explains the multicausality of work disability. This perspective of work disability proposes that return-to-work interventions should address three central elements: individual psychological factors, work environmental factors and factors related to the involvement of the various stakeholders. Long-term work disability is no longer seen simply as the consequence of impairment, but rather as the result of interactions between the worker and main systems: the health care, work environment and financial compensation systems.


METHODS
This paper presents a descriptive content analysis of return-to-work interventions delivered to workers with MSKD which consider this global perspective and which are found to be effective in systematic reviews of the literature.


RESULTS
The review of programs designed for workers with MSKD showed that eleven programs address the individual clinical and psychological factors, work environmental factors and factors related to the involvement of the various stakeholders, but in different ways. Only two programs met the essential components identified by the literature. These essential components are: centralized coordination of the worker's return to work, formal individual psychological and occupational interventions, workplace-based interventions, work accommodations, contact between the various stakeholders and interventions to foster concerted action.


CONCLUSIONS
Interventions which involve the work environment and concerted action by the various partners seem to require the most investment in terms of energy. The establishment of common principles and shared values regarding work rehabilitation as well as less divided mechanisms for action among the various partners should be considered.
Briand
Catherine
C
School of Rehabilitation, Faculty of Medicine, Université de Montréal, Succursale Centre-Ville, C.P. 6128, Montreal, QC, Canada H3C 3J7. catherine.briand@umontreal.ca
Durand
Marie-José
MJ
St-Arnaud
Louise
L
Corbière
Marc
M
D000062:Accidents, Occupational; D015984:Causality; D006801:Humans; D009140:Musculoskeletal Diseases / Q000534:rehabilitation*; D009141:Musculoskeletal System / Q000293:injuries*; D009784:Occupational Diseases / Q000534:rehabilitation