Kath McPhersonProfessor of Rehabilitation

Alternative models ofreturn to work

Some key questions.

Alternatives to what?

Some key questions.

Alternatives to what?

Clearly worth considering strengths and limits of dominant approaches

eg Medical versus Social model of disability A useful argument that helped the move from sole

focus on pathology but Has an oppositional approach to these paradigms

limited advance in knowledge?

Also Biopsychosocial model has buy-in but

But - a number of components (particularly the psychosocial) not well clearly understood or defined

If they are not clearly defined - how can they be measured?

A tendency to measure what we can measure not necessarily what matters?

The meaning of work and decision making

Its far more complicated for many people than the things we measure.

Multiple and changing contexts & factors A focus on work is good has implications for

those who are very expensive to RTW. Findings from qualitative studies highlight

the complexity An example in SCI

Fadyl & McPherson (2010). Understanding decisions about work after spinal cord injury. Journal of Occupational Rehabilitation, 20, 69-80.

A concept of value in facilitating RTW? Work ability or - the match between

the physical, mental, social, environmental and organisational demands of a persons work and his or her capacity to meet these demands

A concept of value in facilitating RTW? Work ability or - the match between

the physical, mental, social, environmental and organisational demands of a persons work and his or her capacity to meet these demands

Concept review (using principles of systematic review)

Identify key factors that contribute to this match

Fadyl, J. K., McPherson, K. M., Schlter, P. J., & Turner-Stokes, L. (2010). Factors contributing to work-ability for injured workers: Literature review and comparison with available measures. Disability and Rehabilitation, 32, 1173-1183.

Key factors influencing workability?

And measures

And measures

And measures

Some issues Updated the review recently (other measures

of value found) but Still none cover all variables highlighted to

influence workability And still - predominant focus on physical capacity

and symptoms

Still little focus on data from employer or others

Some issues Updated the review recently (other measures

of value found) but Still none cover all variables highlighted to

influence workability And still - predominant focus on physical capacity

and symptoms

Still little focus on data from employer or others

Perhaps still a tendency to talk about rather than formally assess / measure biopsychosical aspects of importance?

Outcomes of importance addressed in pain research?

Beale et al Pain 2011 Volume 152, Issue 10, 2283-86

Outcomes of importance addressed in pain research?

An SF-36 effect??

Outcomes of importance addressed in pain research?

A concern..

Recent meta-analysis (David Coggans Group) Rheuatology 2011 early online) Parker et al

Community setting interventions for for MSK conditions (RTW and sick leave reduction)

27 RTW trials assessed most appeared beneficial but Low odds ratio (1.24 (IQR 1.06-1.71) Low cost effectiveness Smaller effect size in better studies

Rethinking Self Efficacy ???

Not to discard but to add? Self regulation as another potentially useful

psychosocial theory (Locke & Latham, 1990; Carver et al 1992)

Increasingly underpinning rehabilitation (and self management) interventions

Appears to have particular relevance in complexity

Self regulation theory Most human behaviour goal-directed

People strive towards multiple goals

Success in achieving desired goals determined by own skill in regulating cognition, emotions and behaviour.

Progress or failure in goal attainment has affective or emotional consequences

Goal attainment, motivation, affect and sense of self closely related and will interact

A personal take on why we should keep considering alternate approaches Still need better concept definition and better

measurement Potential to enhance our focus on values and meaning

to get better outcomes May be crucial for engaging people Skills (for practitioners, clients and employers and) Perhaps impact on how we work with people

Worth going beyond self efficacy Multiple influential factors (as yet untested) amenable

to change

To finish

Thankyou Fadyl, J. K., & McPherson, K. M. (2010). Understanding decisions about work after spinal cord

injury. Journal of Occupational Rehabilitation, 20, 69-80.

Fadyl, J. K., McPherson, K. M., Schlter, P. J., & Turner-Stokes, L. (2010). Factors contributing to work-ability for injured workers: Literature review and comparison with available measures. Disability and Rehabilitation, 32, 1173-1183.

Fadyl, J. K., & McPherson, K. M. (2009). Approaches to vocational rehabilitation after traumatic brain injury a review of the evidence. Journal of Head Trauma Rehabilitation, 24, 195-212.

Fadyl, J. K., & McPherson, K. M. (2008). Return to work after injury: A review of evidence regarding expectations and injury perceptions, and their influence on outcome. Journal of Occupational Rehabilitation, 18, 362-374.

Wasiak, R., Young, A.E., Roessler, R.T., McPherson, K.M., van Poppel, M.N. and Anema, J.R., Measuring return to work. J Occup Rehabil, 2007. 17(4): p. 766-81.

Young, A.E., Wasiak, R., Roessler, R.T., McPherson, K.M., Anema, J.R. and van Poppel, M.N., Return-to-work outcomes following work disability: stakeholder motivations, interests and concerns. J Occup Rehabil, 2005. 15(4): p. 543-56.

Young, A.E., Roessler, R.T., Wasiak, R., McPherson, K.M., van Poppel, M.N. and Anema, J.R. A developmental conceptualization of return to work. J Occup Rehabil, 2005. 15(4): p. 557-68.

Slide Number 1Some key questions.Some key questions.AlsoThe meaning of work and decision making Slide Number 6A concept of value in facilitating RTW?A concept of value in facilitating RTW?Key factors influencing workability?And measures And measuresAnd measuresSome issues Some issues Outcomes of importance addressed in pain research?Outcomes of importance addressed in pain research?Outcomes of importance addressed in pain research?A concern.. Rethinking Self Efficacy ??? Self regulation theoryTo finishThankyou