Managing and Mitigating Suffering in the Return-to-Work Process

Each year thousands of workers experience a serious illness or injury that necessitates time off work and a subsequent re-engagement with the work environment. In Australia, workers’ compensation legislation mandates the return-to-work (RTW) process is formal, structured, and negotiated between the worker, their employer, health care professionals and their RTW coordinator. How this is executed by those parties directly influences whether the RTW process is supportive and successful, or exacerbates the suffering of returning workers by causing them to feel ostracised, exposed, and vulnerable in their workplace. In this article, we examine how the RTW process can cause physical, emotional, social, and existential suffering for returning workers. We then discuss how the suffering that workers experience can be mitigated by five key factors: clarity of roles in the RTW process, alignment of worker and employer expectations, the advocacy provided by the RTW coordinator, the support provided for the worker’s psychological wellbeing, and the RTW literacy of supervisors and colleagues.

Return to Work After Pectoralis Major Repair

Background: Pectoralis major repair (PMR) is an infrequent injury that occurs during resistance training, most commonly during the eccentric phase of muscle contraction. As the incidence of weight training continues to increase, it is important to understand the outcomes after PMR. Purpose: To evaluate the rate and duration of return to work in patients undergoing PMR. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients undergoing PMR from 2010 to 2016 at a single institution were retrospectively reviewed at a minimum of 1 year postoperatively. Patients completed a standardized and validated work questionnaire, as well as a visual analog scale for pain, American Shoulder and Elbow Surgeons survey, Single Assessment Numerical Evaluation, and a satisfaction survey. Results: Of the 60 eligible patients who had a PMR, 49 (81.7%) were contacted at the final follow-up. Of the 49 patients, 46 (93.9%) had been employed within 3 years before surgery (mean ± SD age, 40.4 ± 8.2 years; follow-up, 3.9 ± 2.8 years). Of these, 45 (97.8%) returned to work by 1.6 ± 2.1 months postoperatively, and 41 (89.1%) returned to the same level of occupational intensity. Patients who held sedentary, light-, medium-, or high-intensity occupations returned to work at a rate of 100.0%, 100.0%, 83.3%, and 66.7% by 0.8 ± 1.0, 0.8 ± 1.0, 1.3 ± 2.7, and 3.3 ± 2.7 months, respectively. Five of 6 patients (83.3%) with workers’ compensation returned to their previous occupations by 5.0 ± 1.6 months, while 100% of those without workers’ compensation returned to work by 1.1 ± 1.7 months ( P < .001). Overall, 44 patients (95.7%) were satisfied with the procedure, and 40 (87.0%) would have the operation again if presented the opportunity. A single patient (2.2%) required revision PMR. Conclusion: Approximately 98% of patients who underwent PMR returned to work by 1.6 ± 2.1 months postoperatively. Patients with higher-intensity occupations took longer to return to their preoperative levels of occupational intensity. Information regarding return to work is imperative in preoperative patient consultation to manage expectations.