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Reducing the impact on employers and employees of musculoskeletal disorders: a strategic approach
Article Type: Rewards From: Strategic HR Review, Volume 10, Issue 3
Short case studies and research papers that demonstrate best practice in rewards
Musculoskeletal disorders (MSDs) are major causes of absence from work. They not only affect employees’ health, but also the health of the organization through lost productivity and performance and absence. MSDs refer to conditions such as lower back pain, muscular aches and strains, joint injuries and non specific arm pain or repetitive strain injury (RSI). Physiotherapists help organizations reduce their MSD absence as they can:
Stop people going off work in the first place.
Return people to work on full normal duties.
Ensure alternative or modified duties are appropriate and time limited.
Deliver a cost effective service.
The longer somebody is off work, the less likely they are to return. Those off work with low back pain for six months have a 50 percent chance of returning to work, those off 12 months a 30 percent chance, and those off 24 months a 10 percent chance (Waddell, 1994). As well as the impact on employees’ health, it is important to consider the effect this would have on the organization. In this paper, the authors make a case for a strategic approach to health benefits that is both ongoing and holistic, drawing on the expertise of workplace (occupational) physiotherapy. Occupational physiotherapy is a specialist service that helps businesses reduce the cost of injury and ill health through prevention and effective rehabilitation of work relevant musculoskeletal disorders.
A holistic approach
Work is good for people, providing benefits for physical and mental health and wellbeing. Long-term worklessness has negative health effects (Waddell and Burton, 2006; Shapiro et al., 2010). It is a myth that employees must be 100 percent fit to be at work and the advent of the new “Fit Note” in the UK acknowledges this and caters for those who are “fit for some work.” Specialist workplace physiotherapists can help employers understand what work is appropriate and provide guidance on return to work.
The essence of tackling MSDs is not about the condition, but how to facilitate recovery and return to work. Physiotherapists use a holistic, bio-psycho-social approach to understand employees’ problems. They identify warning signals that psychosocial factors in or around the individual are acting as obstacles to the employees’ recovery and return to work.
A stepped approach to management ensures that employees receive the right help at the right time and that employers receive helpful information and advice on their role to facilitate recovery and a sustainable return to work (Kendall et al., 2008). These services are usually provided in house by employers or purchased from private providers. The stepped approach comprises:
Primary prevention through an ergonomics approach.
Telephone triage for early assessment and advice.
Fast track physiotherapy treatment and work advice.
Functional restoration to restore work capability for those with recurrent and persistent problems.
1. Primary prevention
Suitably trained physiotherapists can work with your organization to undertake ergonomics task analysis to identify areas of risk in the workplace. Known risk factors for MSDs include awkward or sustained postures, use of force, repetitive tasks and exposure to vibration. Findings from the task analysis feed into risk assessments and risk reduction strategies. Advice on improving task design, use of equipment, and good manual handling practice are given. These measures improve safety, comfort and performance and save cost in terms of reduced workplace accidents and errors and associated litigation. Costs are avoided through improved quality, reduced complaints and non-compliance, improved staff availability and increased efficiency and productivity (Beevis, 2003). Studies of office workers given training and provided with ergonomic equipment have reported a 40 percent reduction in MSDs (Rudakewych et al., 2001) and a return on investment of 22:1 realized through reduced MSD symptoms and increased productivity (Amick et al., 2003).
2. Telephone triage
This involves employees calling a helpline number to speak to a chartered physiotherapist about MSDs that are affecting work capability. The physiotherapist carries out a detailed assessment and provides immediate advice on the best management for the employee’s condition. Audit results from an NHS Trust and national rehabilitation provider indicate that 40 percent of those using a triage service recover full work capability with advice only (HSE, 2006). Patient satisfaction is high and comments received indicate this intervention prevents people taking time off.
3. Fast track physiotherapy
A total of 60 percent of employees require face-to-face physiotherapy. Research has shown that people who self-refer to physiotherapy take fewer days off work (on average four versus seven) and are 50 percent less likely to be off work for more than one month when compared with people who visit their GP and are referred via a normal route (DoH, 2008). Audit results from a national rehabilitation provider indicate that 87 percent of employees return to normal work duties following a course of four sessions of physiotherapy (HSE, 2006).
A report by PriceWaterhouseCoopers LLP (2008) found consistent evidence that physiotherapy initiatives by 55 UK employers, in companies ranging in size from 70 to 100,000+ employees, reduced absence rates and improved productivity.
4. Functional restoration
A functional restoration program is a combined physical and psychological program that includes a cognitive behavioral approach and exercise. It is for “difficult cases” and those having difficulty returning to work after four to six weeks. The National Institute of Clinical Excellence guidelines (NICE, 2009) recommend a functional restoration program should be provided for those with lower back pain prior to a medical referral for surgery.
Anglian Water, which provides water and environmental services to customers worldwide, achieved a return on investment of £3 for every £1 spent. In addition, claims for back pain reduced by 50 percent and ill-health retirement by 90 percent (Hunter et al., 2006). Royal Mail, the UK mail services organization, is another company that utilizes a functional restoration program. This has provided a return of approximately £5 for every £1 invested. Absence was cut by 25 percent over three years and 3,600 employees, absent through illness or injury, were brought back into work. Before the program, the estimated cost to the Royal Mail of absence and restricted duties in the study group was £1,384,501. Since the program, this has fallen to £127,738. On the premise that absence and restricted duties would have continued at similar rates without the rehabilitation program, the saving is in excess of £1 million a year (HSE, 2009).
Getting started with physiotherapy
The following four criteria are important for the successful introduction of a work physiotherapy service.
Engagement of managers, unions, employees and occupational health and safety staff is required when introducing the service. Be clear on the scope of the service offered, how it is to be provided and the mechanisms that may need to be established to support employees on restricted hours or duties or a graded return to work, as this is a vital component in reducing overall absence.
2. Confidentiality and consent
Details pertinent to employees’ specific health problem cannot be shared with managers, HR professionals or others without employees’ consent (similar to a consultation with a doctor). This does not prevent information being given on suitable duties and expected timescales for recovery, enabling a plan of action to be agreed between the parties.
3. Resource constraints
Adopting a stepped approach and evaluating the effectiveness and cost benefits will inform decision making as to whether to progress to a more comprehensive service.
4. Sickness absence data
In order to demonstrate the cost benefits of any intervention it is important to have good quality data, enabling pre- and post-intervention comparisons. One of the challenges can be how sickness absence data are recorded within an organization. Businesses should ask the following: “Is absence recorded in days or hours? Are reasons for absence identified?”.
Provision of a work physiotherapy service reduces direct costs of absence and improves employees’ morale and retention through working for a caring organization. Organizations that invest in the health of their staff not only contribute to improved employee health but also to business effectiveness, helping to meet strategic organizational goals.
The Chartered Society of Physiotherapy has produced a number of leaflets as part of its Move for Health campaign aimed at improving workplace health. These can be downloaded free of charge at www.csp.org.uk
Pauline Cole and Nicola HunterMembers of The Chartered Society of Physiotherapy.
About the authors
Pauline Cole is a director of Workplace Health Direct Ltd, delivering an occupational health physiotherapy treatment and prevention service to businesses. She has an MSc in Health Ergonomics and is an executive committee member of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics. Pauline Cole can be contacted at: firstname.lastname@example.org
Nicola Hunter is the Clinical Director of RehabWorks Ltd, a provider of return to work rehabilitation services to business and industry. She has a proven track record in delivering cost effective stepped physiotherapy interventions to businesses. She is currently the chairperson of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics.
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