title: Returning to work - a long-term process reaching beyond the time frames of multimodal non-specific back pain rehabilitation.
abstract: OBJECTIVE
  To explore and describe health professionals' experience of working with return to work (RTW) in multimodal rehabilitation for people with non-specific back pain.
  
  
  METHODS
  An interview study using qualitative content analysis. Fifteen participants were interviewed, all were working with multimodal rehabilitation for people with non-specific back pain in eight different rehabilitation units.
  
  
  RESULTS
  The participants experienced RTW as a long-term process reaching beyond the time frames of the multimodal rehabilitation (MMR). Their attitudes and, their patients' condition, impacted on their work which focused on psychological and physical well-being as well as participation in everyday life. They often created an action plan for the RTW process, however the responsibility for its realisation was transferred to other actors. The participants described limited interventions in connection with patients' workplaces.
  
  
  CONCLUSIONS
  Recommended support in the RTW process in MMR comprises the provision of continuous supervision of vocational issues for the health care professionals, the development of guidelines and a checklist for how to work in close collaboration with patients' workplaces and employers, the provision of long-term follow-up in relation to the patients' work, and the development of proper interventions in order to promote transitions between all the different actors involved.
  
  
  CONCLUSIONS
  Rehabilitation programs targeting return to work (RTW) for people with non-specific back pain needs to include features concretely focusing on vocational issues. Health and RTW is often seen as a linear process in which health comes before RTW. Rehabilitation programs could be tailored to better address the reciprocal relationship between health and work, in which they are interconnected and affect each other. The RTW process is reaching beyond the time frames of the multimodal rehabilitation but further support from the patients are asked for. The rehabilitation programs needs to be designed to provide long-term follow-up in relation to the patients' work.
authors.affiliation: Unit of Intervention and Implementation Research, Division of Occupational and Environmental Medicine, Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.
authors.forename: Therese
authors.initials: T
authors.lastname: Hellman
authors.forename: Irene
authors.initials: I
authors.lastname: Jensen
authors.forename: Gunnar
authors.initials: G
authors.lastname: Bergström
authors.forename: Hillevi
authors.initials: H
authors.lastname: Busch
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000534:rehabilitation*; D005260:Female; D006282:Health Personnel; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D012050:Rehabilitation, Vocational / Q000592:standards*; D062707:Return to Work; D018582:Sick Leave; D017132:Workplace
keywords: Back pain; return to work; vocational rehabilitation