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Posted by Dr. Ahmad Latif in Dr. Latif's articles on February 17, 2016

Fitness to Return to Work, A Practical Recommendations

Dr Ahmad latif

(Employee Health and Wellbeing Conference at the InterContinental Hotel in Doha from 11-13 October 2015)




Return-to-Work (RTW) assessment, by definition, is a proactive approach, endorsed by many health care providers, designed to help restore injured workers to their former lifestyle in the safest and most effective manner possible(1).

     Return to work assessment is to assist the worker achieve a timely and safe return to work in suitable employment.

Defining factors

Factors the outline the level and specifics of the medical assessment are:
Job type, Medical condition, complications
And regulations.


What does the company hope to achieve through the RTW Program?


◦    To reduce the number of days lost to injury or illness
◦    To lessen the financial and emotional impact of the injury or illness on the worker by intervening for an early and safe RTW
◦    To reduce the costs related to work and non-work-related injury or illness
◦    To educate workers on disability management
◦    To comply with all legislations
◦    To reduce the number of future injuries and illnesses through a healthy and safe workplace.

Who Provide the opinion?

- OH practitioners
     - Primary Care physicians are often requested to provide information on a patient’s fitness to return to work following injury or illness.

 In the U.S.(2) primary care physicians Requested to provide opinions on average, in up to 10% of all office visits.


Practical Recommendations

     In practice there are  two extreme approaches to RTW.

    No return to work assessment at all, OR
    Too much medical assessment with unnecessary investigations requested.

There are authors how are against the use of RTW practice; ‘Return to work forms are ‘mythical' and should not be used’(3), on the other hand, many others are backing this practice.
     ' A simple but systematic approach to fitness to work assessments is offered to help facilitate the evaluation process and increase the consistency of clinical decisions'(4).


Flexible approach to RTW

In spite of the fact that there are many against the adoption of rtw assessment it is still widely implemented, and if realistic approach used it can be a helpful Oh tool, here are 5 examples of practical approaches; range from simple to complicated.

1-Telephone’ Consultation

     - Many cases does need any RTW assessment and phone discussion can be enough to make the decision.
     - Works for simple cases; like, common cold and  Hoarseness, voice
     
      

2-Face to Face Consultation, No touch assessment!

      - Joint injury: stiffness of hand joints compromise writing function. Display normal range of motion of hands enough to make the fitness decision.

3-Face to Face Consultation with Light touch.

     Employee with asthma exacerbation, auscultation of chest is sufficient to assess fitness to return to work.
4-Face to Face Consultation with laboratory tests.  Blood test for  employees with diabetes.

5- Complicated cases

-    Specialist Medical Opinion – for example; cardiac cases, when TMT, Bruce protocol is required or when a sophisticated functional capacity evaluation (FCE) systems are used.

Return to Work interview

     Return to work interview is a helpful tool to reduce sickness absence, should take place, at a maximum, within 24 hours of return to workplace.

Purpose of RTW discussion

    To welcome the employee back to work
    To ensure that the employee is fully fit to return to work and identify any additional risks.
    To identify the reason for the absence and confirm the correct dates are recorded
    If adjustment is required

Examples of Temporary Accommodation of employee after ailment.


Light Duties: Request less physical effort than pre-injury job. Worker's duties are limited according to the recommendations of the health care provider.

Lesser Duties: The worker performs reduced duties at a slower pace.

Alternate Tasks: Although the employees may be unable to perform regular duties, they may be able to perform other duties within their  limitations.

Reduced Hours: The number of work hours may be reduced to match the worker's tolerance level.

Temporary Accommodation as Treatment: Work Hardening, Work duties may be used as part of a conditioning and strengthening process. The work is designed to progressively increase the worker's physical ability until he or she is able to perform his or her regular duties. (1)

Phased Return to Work
     If the employee has been away from work for more than four weeks or has been absent with a serious illness, they may benefit from a phased return to work.


Conclusions
•    RTW is a helpful oh tool if used properly,
•    In many cases,  employee does not need any fitness assessment to resume duty.
•    Consider flexible approach and to choose assessment according to factors such as:
job type, Medical conditions, and local regulations.



References:

1-What is Return-to-Work?, Pennsylvania Department of Labor and Industry. From: www.portal.state.pa.us
2- Assessing Medical Fitness to Return to Work, Harvard Medical School. From:
http://online-learning.harvard.edu
3- Pulse today, GPs urge employers to stop demanding ‘fitness to return to work’ forms, from: www.pulsetoday.co.uk/
4- Russi M, etal, Guidance For Occupational Health Services In Medical Centers
American College of Occupational and Environmental Medicine (ACOEM) from; https://www.acoem.org/