Managing work disability to help patients return to the job
Improving the timeliness and quality of your guidance on work disability lessens the impact of health problems on patients’ lives and livelihoods.
PRACTICE RECOMMENDATIONS
› Set appropriate expectations for the patient at the start of any episode of work disability: Estimate the course of functional recovery over time and the total duration of life–work disruption. A
› Include detailed activity prescriptions in the treatment plan, with stepwise progression over time toward full recovery. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
What does your patient need so that they can recover? Individual and systemic factors must be appropriately addressed to minimize the impact that recovery from a disability has on a person’s life. Successful functional recovery enables the person to self-manage symptoms, reduce disruption-associated stress, preserve mental health, and maintain healthy relationships at home and work. An example is the patient who has successfully coped with the entire predicament that their medical condition posed and resumed their usual daily routine and responsibilities at home and at work—albeit sometimes with temporary or permanent modification necessitated by their specific condition.
Strategies that help patients stay at, or return to, their job
Physicians who anticipate, monitor, and actively manage the duration of a work disability can improve patient outcomes by minimizing life disruption, avoiding unnecessary medical care, and shortening the period of absence from work.
Key strategy: Set expectations for functional recovery early in the episode, including a forecast of how long it will take to get life and work back to normal.26,27 This is similar to discussing expectations about pain before surgery, which has been shown to decrease subsequent requests for opioids.28 It is crucial to educate the patient about timelines, define functional outcomes, and encourage them to set goals for recovery.29
Devise an evidence-based treatment plan. A fundamental way to reduce disability duration is to (1) devise a treatment plan that is evidence based and (2) take the most effective route to recovery. Given the pace with which medical research changes the understanding of diseases and treatments, it is essential to rely on up-to-date, comprehensive, independent, and authoritative resources to support your care decisions.
Aligning clinical practice with evidence-based medicine (EBM) is a good way to accomplish that goal. By definition, EBM practice guidelines recommend the safest and most effective treatments after unbiased assessment of the best available research. Increasingly, EBM is adopted to improve clinical and functional outcomes, establish national standards of care, and set criteria to evaluate clinical performance.30
Continue to: Utilize established guidelines
