How Do Organizational Policies and Practices Affect Return to Work and Work Role Functioning Following a Musculoskeletal Injury?

Abstract

Purpose Organizational-level policies and practices that promote safety leadership and practices, disability management and ergonomic policies and practices are considered key contextual determinants of return to work. Our objective was to examine the role of worker-reported organizational policies and practices (OPPs) in return to work (RTW) and work role functioning (WRF) and the mediating role of pain self-efficacy and work accommodation. Methods A worker cohort (n=577) in Ontario, Canada was followed at 1, 6 and 12months post injury. Both RTW (yes/no) and WRF (WLQ-16) status (3 levels) were measured. OPPs were measured (high vs. low) at 1month post-injury. Pain self-efficacy (PSE) and work accommodation (WA) were included in mediation analyses. Results OPPs predicted RTW at 6months (adjusted OR1.77; 95% CI 1.07-2.93) and 12months (adjusted OR2.07; 95% CI 1.18-3.62). OPPs predicted WRF at 6months, but only the transition from working with limitations to working without limitations (adjusted OR3.21; 95% CI 1.92-5.39). At 12months, OPPs predicted both the transition from not working to working with and without limitations and from not working or working with limitations to working without limitations (adjusted OR2.13; 95% CI 1.37-3.30). Offers of WA mediated the relationship between OPPs and both RTW and WRF at 6months follow-up. PSE mediated the relationship between OPPs and RTW and WRF at 6months. At 12months neither mediated the relationship. Conclusions The findings support worker-reported OPPs as key determinants of both RTW and WRF. These results point to the importance of WA and PSE in both RTW and WRF at 6months.