The effects of a 'return to work' program for long-term injured workers in Hong Kong : a randomized clinical study

Abstract

A clinical randomized trial was conducted in this study to investigate the effects of a 6-week programme including two phases of training and job placement designed for local long-term sick leave workers due to work injuries on their return to work rate. The aim of phase I study was to investigate the effect of training on job readiness of return to work for injured workers, while the aim of phase II study is to explore the effect of job placement on return to work and to evaluate the combined effect of training and job placement on maintaining return to work. A total of 123 long-term leave workers with musculoskeletal injuries, with an age of 20 to 58 years old, was recruited and randomly assigned into training group and control group in phase I at initial in-taking, with 78 subjects in training group and 45 in control group respectively. All the recruited subjects had completed vocational rehabilitation and left work for at least over 3 months. In phase I, a 3-week training programme focusing on readiness of return to work provided by a multi-disciplinary professional team was given to training group, while control group did not receive training just in a waiting list. In phase II study, 73 subjects in training group were randomly allocated to placement and self placement group. Placement group received 3-week placement services while self placement group was asked to do the self placement in the same period. Some assessment protocols including Spinal Functional Sort(SFS), LLUMC, Lam Assessment on Stages of Employment Readiness (LASER), the Chinese State Trait Inventory (C-STI), General Health Status (SF-36), were adopted to evaluate the training effects. Employment outcome was used to evaluate the effectiveness of combined training and placement. The results of one-way ANOVA showed that there were no significant differents on demographic baselines either between the traing and control groups or between the assisted placement and self placement groups (p>0.1), and no significant difference was found on the results of first assessment between the two groups (p>0.1). For the phase I study, The results of repeated measure ANOVA of the 2nd assessment between training and control groups showed that statistically significant differences were observed on contemplation stage (p<0.04) and action stage (p<0.05) of LASER; C-STAI (p<0.04); sub-scales of physical function (p<0.04), health condition (p<0.02) and body pain (p<0.02) of SF-36 as well as the total score of SF-36 (p<0.03) between the two groups. For the phase II study, chi-square test showed that the return to work rate in placement group was significantly higher than that in self placement group (p<0.03). No significant differences were found on average working hour of each week and monthly job income between these two groups using independent t test. The results of the research showed that the training part of the "Return to Work Programme" could facilitate the behaviour change of job readiness towards return to work for workers with musculoskeletal injuries. The objectives could be reached through solving the problems inhibiting the process of behaviour change of return to work such as chronic pain, stress, anxiety, quality of life. The placement service part of the programme was demonstrated to help achieve the ultimate goal of the programme which was to improve the outcome of return to work rate based on the workers' psychological and action preparation for reemployment. This programme with combined training intervention and placement services was beneficial to facilitate local long-term leave workers with musculoskeletal injuries due to work to get reemployment.