The rehabilitation and return to work (RTW) of workers who sustain occupational injuries pose a major challenge for the organizations and OHS practitioners concerned. In Québec, from 2010 to 2012, we witnessed an annual average of 6,200 CNESST-accepted injuries with rehabilitation, or 7% of all injuries. The average duration of sick leave among workers requiring rehabilitation was thus 12 times longer than that for workers not requiring rehabilitation. Differences were also observed by economic activity sector, gender, and age. It is well established that compensation duration increases with worker age and is longer in men, who account for two-thirds of the cases referred for rehabilitation. All things considered, the rate of referral for rehabilitation is higher among women.
Occupational rehabilitation research helps prevent or reduce the risks of long-term disability in workers who have sustained an employment injury. Using evidence-based data, it supports the safe and sustainable return to work of these workers by studying the individual, organizational, administrative, and healthcare system-related factors that facilitate or hinder a smooth RTW or sustainable job retention (SJR) process. It also looks into methods of intervention for rehabilitating workers and reintegrating them into the labour force.
The research activities conducted under the Occupational Rehabilitation field revolve around the four following orientations:
- Development of tools for assessing the health of workers who have sustained work-related injuries and are at risk of disability
- Study of the personal, clinical, organizational, and administrative determinants of a sustainable return to work
- Development and implementation of rehabilitation and sustainable-return-to-work interventions
- Development and implementation of tools designed for professionals working in the area of rehabilitation and sustainable return to work
The Occupational Rehabilitation research program is the result of in-depth reflection by members of the SPWE team, in conjunction with the Scientific Division and in line with the 2018-2022 five-year scientific and technical production plan, as well as the IRSST’s work of the past few years. Its aim is to find increasingly pertinent ways of addressing workplace needs. Six themes are given priority:
The aims of this research theme are to define the predictors of long-term disability and identify the groups at highest risk. To achieve these goals, it is therefore crucial to acquire knowledge of the main indicators and of the relationship among these indicators and develop prediction tools, ultimately to facilitate a timely, safe, and sustainable return to work.
The aims of this theme are to improve interventions in the healthcare system to ensure the most effective action, and to speed up the rehabilitation process in order to initiate workers’ gradual or full RTW, while ensuring their safety and services better adapted to their specific needs.
When workers are ready to begin a gradual or full return to work, the various stakeholders in the process (e.g. insurer, clinic, and workplace) must be involved in order to facilitate a safe and sustainable return to work. The aim of this theme is therefore to develop interventions and support tools to help each of these stakeholders play their role optimally.
Workers in vulnerable situations include individuals who, based on their sociodemographic or occupational characteristics and the work contexts they may be associated with, run a higher risk of occupational injuries or long-term disability. Three worker populations have been singled out and used to create three distinct program components: (1) immigrant workers and workers from ethnocultural minorities, (2) older workers, and (3) workers with gender-based vulnerability.
Workers who have sustained occupational injuries that leave them with permanent functional limitations sometimes have to change jobs, a particularly difficult challenge when they have to reintegrate elsewhere than at their original employer’s. This finding, which emerged from a study published by the IRSST in 1994, is still applicable today, but has not been the subject of any more specific studies.
The studies related to this thematic program target integrated prevention in small enterprises (SEs). As these studies focus simultaneously on prevention and the return to work, the program is carried out in collaboration with the Sustainable Prevention and Work Environment research field.
The originality of this guide lies in its integrated OHS approach that takes into account, among other things, the need to act not only on the person, but also the work. It incorporates video capsules to make the content more dynamic. One large insurance company disseminated this guide among its representatives.
Webinars for knowledge transfer
The IRSST conducts webinars for members of certain professional orders and associations (occupational therapists, for example), and for the health sector.
A number of studies have confirmed the importance of early case management in preventing long-term disability. They have shown the need for collaboration among the various parties involved, based on a multidisciplinary approach. Guidelines are increasingly orienting new intervention practices in this direction. In fact, a systematic review of the literature on strategies for preventing long-term disability among workers compensated for musculoskeletal disorders provided clear evidence of the effectiveness of these intervention principles.
Traditional medical interventions alone are not always enough to ensure the return to work of injured workers. Research on the occupational rehabilitation process has provided a better understanding of the psychological and social risk factors, as well as the work-related factors, that must be taken into account to promote a safer, more sustainable return to work. One literature review clearly demonstrated the progress under way in the occupational rehabilitation field, with the identification of risk factors that go far beyond the medical issues associated with work-related injuries.
The study of the risk factors associated with long-term disability has made it possible to design tools targeting high-risk cases, and to provide clearer direction for the development of more specific and effective interventions for clinicians. For example, one team of experts developed and validated an early screening questionnaire for long-term disability related to low back pain.