The return to work model for injured workers in Hong Kong

Abstract

Return to work (RTW) after work injuries remains a big challenge among injured workers, employers and rehabilitation professionals. Previous studies have indicated that one of the predictors of successful RTW is work readiness of the workers. The use of Lam Assessment of Stage of Employment Readiness (LASER) for evaluation of work readiness was found to be a valid predictor for workers' RTW. This study therefore aimed to validate the LASER for assessment of work readiness among injured workers in Hong Kong. It was first translated into the Chinese version (C-LASER). The psychometric properties including the content-related, construct and predictive validity and the test-retest reliability were then be testified. The validated C-LASER was used to test the work readiness and psychosocial aspects of the injured workers' RTW in Hong Kong before and after completion of an RTW program. This study was divided into two phases. Phase I of the study focused on validation of the C-LASER which aimed to collect evidence of psychometric properties of C-LASER and to provide a valid assessment tool for measurement of subject's readiness towards employment. Phase II collected evidence of process of RTW of subjects who were injured workers in Hong Kong in order to substantiate the RTW model. In the phase I of the study, the results indicated a two-factor solution by factor analysis. Factor 1 represented those at contemplation and action stages whereas Factor II represented those at the pre-contemplation stage. Further cluster analysis with Ward's method suggested a two-cluster solution. Multivariate analysis showed that participants classified under cluster 1 (Ready for Actioners) had significantly higher Short Form 36 (SF-36) sub-scores than those under cluster 2 (Precontemplators). Results suggested that C-LASER was useful in differentiating workers' work readiness represented by at least two C-LASER profiles. The "ready for action" group of workers was found to have significantly higher physical function, less pain and higher social function than those in the "pre-contemplation" group. Although the ready for action group had a higher rate in RTW, it was statistically insignificant (Chi-square, p=0.17). One of the most significant findings was the combined contemplation and action stages. This could be attributable to the high values which Chinese workers placed on working, the existing workers' compensation and social security system in Hong Kong. However, human capital factors such as educational level and age did not associate with the "pre-contemplation" versus "contemplation and action" effect. Results in Phase II showed that factor 1 sub-score, social functioning and role emotional of SF-36 were found retained in the model by stepwise logistic regression. Further cluster analysis with Ward's method suggested two-cluster solutions based on the factor sub-scores in all three assessment occasions. Significant group effects were identified by multivariate analysis which subjects in cluster 1 had significantly higher sub-scores on factor 1, while they had lower sub-scores on factor 2 than their cluster 2 counterparts in all three assessment occasions. Subjects in cluster 1 had higher RTW rate, as recorded within 6 months after the first assessment, when compared to those of the cluster 2. Results suggested that C-LASER factor sub-scores appeared to be important factors in predicting subjects' RTW status. Through further analysis, subjects' readiness towards RTW seemed to be much affected by their psychosocial factors such as perceived functioning and bodily pain. Franche and Krause's model (2002) had divided the progress into three different aspects: decisional balance, self-efficacy and process of change which could explain the differences by their C-LASER factor sub-scores. The concept of secondary loss (Gatchel, Adams, Polatin & Kishino, 2002) could plausibly explain the contribution of role emotion and social functioning on subjects' decision on RTW.