Alternative models of

return to work

Kath McPherson
Professor of Rehabilitation

Some key questions.

Alternatives to what?

Some key questions.

Alternatives to what?
Clearly worth considering strengths and

limits of dominant approaches

eg Medical versus Social model of disability
A useful argument that helped the move from sole

focus on pathology but

Has an oppositional approach to these paradigms
limited advance in knowledge?

Also
Biopsychosocial model has buy-in but
But - a number of components (particularly the

psychosocial) not well clearly understood or

defined
If they are not clearly defined - how can they be
measured?
A tendency to measure what we can measure
not necessarily what matters?

The meaning of work and

decision making
Its far more complicated for many people

than the things we measure.

Multiple and changing contexts & factors
A focus on work is good has implications for
those who are very expensive to RTW.
Findings from qualitative studies highlight
the complexity
An example in SCI

Fadyl & McPherson (2010). Understanding decisions about work after spinal
cord injury. Journal of Occupational Rehabilitation, 20, 69-80.

A concept of value in
facilitating RTW?
Work ability or - the match between
the physical, mental, social, environmental and
organisational demands of a persons work and his
or her capacity to meet these demands

A concept of value in
facilitating RTW?
Work ability or - the match between
the physical, mental, social, environmental and
organisational demands of a persons work and his
or her capacity to meet these demands

Concept review (using principles of

systematic review)
Identify key factors that contribute to this
match
Fadyl, J. K., McPherson, K. M., Schlter, P. J., & Turner-Stokes, L. (2010).
Factors contributing to work-ability for injured workers: Literature review and
comparison with available measures. Disability and Rehabilitation, 32, 11731183.

Key factors influencing workability?

And measures

And measures

And measures

Some issues
Updated the review recently (other measures

of value found) but

Still none cover all variables highlighted to
influence workability
And still - predominant focus on physical capacity

and symptoms

Still little focus on data from employer or

others

Some issues
Updated the review recently (other measures

of value found) but

Still none cover all variables highlighted to
influence workability
And still - predominant focus on physical capacity

and symptoms

Still little focus on data from employer or

others
Perhaps still a tendency to talk about rather
than formally assess / measure biopsychosical
aspects of importance?

Outcomes of importance addressed

in pain research?
Beale et al Pain 2011 Volume 152, Issue 10, 2283-86

Outcomes of importance addressed

in pain research?
An SF-36
effect??

Outcomes of importance addressed

in pain research?

A concern..
Recent meta-analysis (David Coggans Group)
Rheuatology 2011 early online) Parker et al

Community setting interventions for for MSK

conditions (RTW and sick leave reduction)

27 RTW trials assessed
most appeared beneficial but
Low odds ratio (1.24 (IQR 1.06-1.71)
Low cost effectiveness
Smaller effect size in better studies

Rethinking Self Efficacy ???

Not to discard but to add?
Self regulation as another potentially useful

psychosocial theory
(Locke & Latham, 1990; Carver et al 1992)

Increasingly underpinning rehabilitation (and

self management) interventions

Appears to have particular relevance in
complexity

Self regulation theory

Most human behaviour goal-directed

People strive towards multiple goals

Success in achieving desired goals

determined by own skill in regulating
cognition, emotions and behaviour.

Progress or failure in goal attainment has

affective or emotional consequences

Goal attainment, motivation, affect and

sense of self closely related and will
interact

To finish
A personal take on why we should keep
considering alternate approaches
Still need better concept definition and better

measurement
Potential to enhance our focus on values and meaning
to get better outcomes
May be crucial for engaging people
Skills (for practitioners, clients and employers and)
Perhaps impact on how we work with people
Worth going beyond self efficacy
Multiple influential factors (as yet untested) amenable

to change

Thankyou

Fadyl, J. K., & McPherson, K. M. (2010). Understanding decisions about work after spinal cord
injury. Journal of Occupational Rehabilitation, 20, 69-80.

Fadyl, J. K., McPherson, K. M., Schlter, P. J., & Turner-Stokes, L. (2010). Factors contributing
to work-ability for injured workers: Literature review and comparison with available
measures. Disability and Rehabilitation, 32, 1173-1183.

Fadyl, J. K., & McPherson, K. M. (2009). Approaches to vocational rehabilitation after

traumatic brain injury a review of the evidence. Journal of Head Trauma Rehabilitation, 24,
195-212.

Fadyl, J. K., & McPherson, K. M. (2008). Return to work after injury: A review of evidence
regarding expectations and injury perceptions, and their influence on outcome. Journal of
Occupational Rehabilitation, 18, 362-374.

Wasiak, R., Young, A.E., Roessler, R.T., McPherson, K.M., van Poppel, M.N. and Anema, J.R.,
Measuring return to work. J Occup Rehabil, 2007. 17(4): p. 766-81.

Young, A.E., Wasiak, R., Roessler, R.T., McPherson, K.M., Anema, J.R. and van Poppel, M.N.,
Return-to-work outcomes following work disability: stakeholder motivations, interests and
concerns. J Occup Rehabil, 2005. 15(4): p. 543-56.

Young, A.E., Roessler, R.T., Wasiak, R., McPherson, K.M., van Poppel, M.N. and Anema, J.R. A
developmental conceptualization of return to work. J Occup Rehabil, 2005. 15(4): p. 557-68.