Summary

An exhaustive and ever-growing body of knowledge exists on work disability. However, the appropriation of knowledge by the various stakeholders in rehabilitation and return to work (RTW) is less than optimal. An essential step in facilitating this transfer of knowledge is that of providing prompt access to evidence-based, pertinent information centralized on one web site. To the best of our knowledge, no such electronic resource is available, without charge, to stakeholders in Québec. The initiative described here seeks to fill this gap by compiling scientifically valid (evidence-based) information on work disability and sustainable and healthy RTW. The target audience consists of various rehabilitation and RTW stakeholders, namely, members of workplaces, including workers and their union representatives, occupational rehabilitation professionals (e.g. clinicians and ergonomists), and insurers. The perspective adopted in this project is that of the organization (company) in the sense that only best practices involving the workplace are described. The health problems taken into account are work-related, specifically, musculoskeletal disorders (MSDs) and common mental disorders (CMDs).

This project is being carried out in two steps: first, developing the content (research activity) and second, posting the web site online (future knowledge transfer activity) and translating it into English. The objective of this project was therefore to develop content for a future web site on disability and RTW, i.e. content consisting of pertinent, evidence-based, synthetic, and plain-language information. This content, which will only be revealed when the web site is posted online, is presented in a complementary document to the research report summarized here and is titled “Contenu d’un site Web portant sur l’incapacité et le retour au travail” [content of a web site on disability and return to work]. The research report details the methodologies used to develop the different types of content, as well as some results that were too exhaustive to include on the web site. The report will serve as a reference document for web site users interested in knowing more than what is provided in the brief explanations on the web site.

A collaborative approach involving researchers and numerous social partners was used throughout the research project. A governance structure was implemented to ensure smooth operations. The criteria applied to form the structures (committees) and the operating mechanisms needed to develop the various sections of the web site were scientific expertise, the parity principle (equal labour/management representation), and the representativeness of different RTW stakeholders. Various committees were involved: a coordination committee; a scientific committee of 10 researchers; a follow-up committee of 12 social partners; and a scientific support committee composed of several IRSST professionals, postdoctoral students, and research officers.

The following four sections were developed, each detailing the objectives, methodologies, and content elements under study (results).

Section I − Impacts of work disability

The objective of Section 1 was to raise user awareness of the issue of work disability prevention and the importance of devoting efforts and resources to it. This section includes an epidemiological component, an economic component, and a component on workers and those around them. The epidemiological component is based on a funnel-like methodological approach that covers the international, national (Canada), and provincial (Québec) aspects. Data were extracted from sources of recurrently produced information (investigations, statistical reports), thus facilitating the long-term sustainability of the web site. The economic impact was estimated for the province of Québec only, and was based on an IRSST-developed methodology that factors in both the financial and human costs of occupational injuries. The impacts on the worker (personal, relational, and organizational) were documented by means of a synthesis that was updated using an overview-type literature review.

Section II − Work disability: determinants, and stakeholders involved

The objective of this section was to provide RTW stakeholders with a definition and reference framework that will foster an understanding of work disability and promote the adoption of a common language. A conceptual framework was chosen for the purpose of defining the work disability field and identifying all its components and the stakeholders involved.

Section III − Modifiable factors that influence work disability and tools for measuring them

The objective of this section was to identify and measure the main modifiable factors likely to influence absence duration or the RTW in order to provide clearer direction for rehabilitation interventions. A scoping review involving a five-step process was conducted to this end, and identified 112 prospective studies published between 1997 and 2017 (20 years). The factors identified were classified in three categories: those related to the enterprise (organizational factors), the worker (personal factors), and his or her health (health factors). They were then qualified as “limited,” “moderate,” “strong,” “inconsistent,” or “insufficient,” depending on the quantity, i.e. the number of studies and consistency of the effects (negative, positive, or nil). Only those factors with a “moderate” or “strong” level of evidence were retained. They were then given short and long definitions and documented in terms of tools for measuring them. Wherever possible, three tools were described for each factor. The total value of each tool was determined and rated using one, two, or three stars, representing a compromise between their scientific and practical values for RTW stakeholders. A descriptive information sheet and the tool itself were prepared for the target users.

Section IV − Processes, interventions, and practices aimed at sustainable and healthy RTW

The objective of Section IV was to guide stakeholders and the organization in the process of facilitating the healthy and sustainable RTW of their workers. Scientific and empirical data were extracted from two integrative literature reviews, as well as from practice guides and recent systematic reviews. The following criteria were applied to select the reviews for analyses: (1) published between 2000 and 2012; (2) had to measure the impact of interventions or programs on the RTW of workers with MSDs or CMDs; and (3) had to have at least one workplace-based component. The quality of the selected reviews was evaluated by two independent experts. The information was sorted into three main parts, beginning with the RTW process as a whole (general principles, essential activities, and approaches). Next, the most effective clinical and non-clinical interventions were identified. Lastly, the empirical data collected was used to describe the RTW or OHS practices to be taken into consideration by the organization, particularly regarding the development of organizational policies, procedures, and strategies, and the accommodations to be provided in the workplace by the stakeholders concerned.

The research report will be published once the web site has been launched in order to provide Quebec RTW stakeholders with a source of up-to-date, credible information that will foster the adoption of best practices in work disability prevention processes and promote the healthy and sustainable RTW of injured workers.