Rehabilitation expert David Bingham discusses the role of rehabilitation as an absence management tool, and how companies are becoming increasingly aware of its benefits.
Work-related injuries and time away from the workplace are becoming areas of increasing concern for employers. As a result, many companies are now seeking alternative and proactive ways of managing and reducing their exposure.
Consequently, rehabilitation has become something of a buzz word in both the health insurance and occupational health world. While the word 'rehabilitation' has been wrongly used to describe case management, physiotherapy, telephone management, gym sessions and many other interventions, it is more accurately defined as "restoration of function". Rehabilitation can, when used in conjunction with other appropriate interventions, produce significant results for all stakeholders.
According to the latest figures released in 2007 by the Confederation of British Industry - the national 'barometer' of UK absence - absence cost UK employers £13.4bn in 2006. In a bid to reduce this figure, the Government is forming a vocational rehabilitation task group to help injured people stay in or return to work, and has called on employers to do more to support their employees.
The task group comprises representatives from the Government, businesses and the insurance industry. They will work together to identify what services are currently available, why businesses do not provide more support and what needs to be done to increase understanding and ensure wider provision of occupational health and support services.
Speaking at an event in London in June last year, Department for Work and Pensions Minister Lord McKenzie said: "Rehabilitation is not about forcing people back to work. Work, in fact, is often a crucial step in helping people to return to full health.
"Businesses have much more to gain in terms of reduced sickness absence and improved staff engagement and retention, but very few employers offer occupational health or vocational rehabilitation. This task force will identify why this is the case, what barriers are preventing wider provisions and what needs to be done to change this."
He added: "We cannot do this alone - employers must recognise that rehabilitation is not purely medical, but a management activity, and they must do more to help their employees return to work."
Manual work
Given the physical nature of most manual work, back pain and other musculoskeletal problems are found to be a major cause of short-term absence, and the most significant factor in long-term absence among manual staff. With such conditions difficult to diagnose, employees can often be absent from work for long periods.
Further research published in September 2006 by the Chartered Society of Physiotherapists found that more than one million people in the UK have a musculoskeletal disorder caused, or made worse, by work.
It is no coincidence that the armed forces and professional sports teams have long employed their own rehabilitation clinicians in order to minimise the impact of musculoskeletal disorder injuries. This is due to the fact that these sectors have recognised the limitations of the NHS, and are themselves managing the recovery of their workers as a result.
Some companies and individuals continue to argue for evidence that rehabilitation works, or proof that it is economically viable. However, there is a plethora of clinical evidence confirming the medical reasons behind the benefits of physiotherapy, rehabilitation and, perhaps more importantly, the many different approaches to injury treatment and management.
In addition, rehabilitation companies are providing many examples of the cost benefits associated with their programmes. While there are many ways in which cost benefit can be measured, it comes down to trusting the firm that measures the results.
It is therefore imperative when considering a rehabilitation service provider to consider their previous experience in the market, their published results and the evidence-based medicine upon which they work. This would include the ability to demonstrate clinical pathways and protocols that are practical and yet have a clinical base behind them. Some proactive rehabilitation programmes have been known to reduce return to work time by as much as 70%.
More than treatment
In the past, too many stand-alone rehabilitation products have simply treated the problem, only for an employee to return to work in exactly the same situation and physical shape that triggered the condition in the first place. As such, some providers have developed more effective rehabilitation services that better focus on the health of employees.
For example, the Westfield Restore Health Plan combines rehabilitative treatment for musculoskeletal conditions with access to MRI, CT and PET scanning facilities; specialist consultations; employee assistance programmes; and cash benefits towards optical and dental costs.
It also helps tackle workplace absence, so that injured staff return to good health and work in the shortest and safest time possible. Early intervention is crucial in reducing the number of days lost through illness.
Rehabilitation should follow any extended period of absence in order to re-educate and restore strength to the injured employee. In addition, muscles only take three days to begin to atrophy (waste), meaning straightforward physiotherapy without incorporating active rehabilitation will only deliver partial results.
Furthermore, without the benefit of objective testing to accompany the programme, return to work is purely guesswork.
Professional communication
Following extended periods of absence, it is also important for treating clinicians to liaise with line managers in order to plan an appropriate and graduated return to work even before an individual is ready. In this way, work conditioning and work hardening activities can be incorporated into the final phases of the rehabilitation programme.
Such rehabilitation is not the panacea of absence management, but is a crucial element in the recovery process. Any occupational health or physiotherapy-led absence management programme that does not include functional restorative programmes will not be effective.
Rehabilitation is just one component of managing absence. However, it consistently proves to be one of the most useful tools at an employer's disposal to tackle the issue, and maintain a fit and healthy workforce. n
David Bingham is group chief executive of IPRS
