The Vocational Rehabilitation Index: a guide to accident victims' requirements for return-to-work assistance

The Vicissitudes of Life: Some Effects of Injuries on Career Development

The purpose of this paper is to examine four case studies on the effects of injuries on adult career development. The four cases are taken from published judgements in the New South Wales and Australian Capital Territory Supreme Courts. Each case is analysed in terms of the person's background, the key issues and the demonstrable impact on educational and vocational development. As expected, these selected cases highlight the catastrophic effects of injuries on expected career development. This was viewed as a function of the person's background and the type of accident and the associated injuries. Sometimes there is evidence of a return to work but it is qualitatively and quantitatively different from what might be expected had the accident not occurred.

Predictors of occupational low back disability: implications for secondary prevention

Over the past decade, studies have identified a combination of demographic, physical/medical, ergonomic, and psychosocial factors in the development of work disability related to occupational low back pain. Using such data on disability risk factors, investigators have begun to develop risk identification and disability prevention programs. As part of an ongoing effort to develop a secondary prevention program, the present case-control study identified the relative contribution of demographic, physical demand, physical fitness, as well as occupational and individual psychosocial variables to back-related work disability in the US Army. Soldiers (n = 174) diagnosed with a lumbosacral strain and medically discharged from the Army were compared with non-disabled controls (n = 173). Dependent measures were obtained from the US Army Health Risk Appraisal (HRA). For cases, these data pre-dated disability determination by 1 to 3 years. For controls, the HRA was completed during the same time period. Significant predictors of low back disability were: age (odds ratio [OR] = 1.13 per year), lower rank (E2/E3) (OR = 4.08/OR = 3.02), infrequent aerobic exercise (OR = 2.2), higher work stress (OR = 2.71), worries (OR = 2.17), and lower social support (OR = 5.07). The model correctly classified 73.13% of all subjects. These results highlight the importance of considering age, status level in the organization, frequency of aerobic exercise, occupational stress, general worries, and social support for the early detection of soldiers at increased risk for back-related disability. Additionally, the findings support past research indicating the multivariate nature of work disability and emphasize the importance of considering such factors in future secondary prevention efforts.

Factors related to outcome following a work hardening program

The purpose of this study was to determine factors related to a return to work following the completion of a work hardening program. Data from the Workers' Compensation Board of Alberta Millard Rehabilitation Centre for 1527 discharges, collected over 22 months, were examined retrospectively. Factors related to return to work were compared bivariately using logistic regression procedures. A multiple logistic regression model for return to work was also determined. The principle predictor of return to work was job-attached status to the pre-injury employer. Other factors related to return to work were education, primary diagnosis, injury to admission time, job attachment to the pre-accident employer, employer's annual payroll, and vocational direction. Due to the strength of the association between job-attached status to the pre-injury employer and a return to work, it was concluded that attempts to maintain this relationship should be a priority for rehabilitation providers and insurance carriers.

Factors influencing the duration of work-related disability: a population-based study of Washington State workers' compensation

OBJECTIVES

The purpose of this study was to examine factors predictive of duration of work-related disability.

METHODS

Multivariate survival analysis techniques were used to conduct a population-based, retrospective cohort study on a random sample of 28,473 workers' compensation claims from Washington State filed for injuries occurring in 1987 to 1989. The principal outcome measure was length of time for which compensation for lost wages was paid, used as a surrogate for duration of temporary total disability.

RESULTS

The findings suggest that, even after adjusting for severity of injury, older age, female gender, and a diagnosis of carpal tunnel syndrome or back/neck sprain significantly predict longer duration of disability. Other predictors that were stable and significant, but involved lower magnitudes of effect included divorced marital status, firm size of fewer than 50 employees, higher country unemployment rates, and construction and agricultural work.

CONCLUSIONS

Greater disability prevention efforts targeting these higher risk subgroups could have significant economic and public health effects. The greatest impact may be on claimants who remain disabled at 6 months after an injury that did not require hospitalization.

Return to work of road accident victims claiming compensation for personal injury

Road accidents resulting in personal injury are an increasing cost to society. This study is based on 609 accident victims (of whom 521 survived injury) who were in employment when injured and whose claims for personal injury were settled for 5000 pounds or more by one insurance company over 2 years. It examines survivors' residual disablement, return to work and involvement with rehabilitation services. Data on a representative sample of 101 cases are analysed in more detail to identify possible 'predictors' of return to work. Both univariate and stepwise logistic regression analysis suggest that return to work is less associated with clinical variables, on which much medical advice on return to work is based, than with such other variables as time off work, absence of psychological problems and younger age. Very low rates of referral to rehabilitation may indicate that a rehabilitative approach to cost containment is underutilized in comparison with the traditional emphasis on preventive measures and enhanced medical treatment. More effective rehabilitation, however, may require new approaches to clinical case management, especially in orthopaedic departments where most personal injury claimants are treated.

Vocational Rehabilitation Index assessment of rehabilitation medicine service patients

Only a minority of working-age patients referred to rehabilitation medicine services return to work, but could more be helped? A first step is identifying those potentially able to do so. This paper describes the retrospective application of the Vocational Rehabilitation Index (VRI) to 223 patients of working age and with various diagnoses referred to one rehabilitation medicine service. The VRI discriminates between patients who return to work and those who do not, as well as between groups with apparently differing degrees of need for vocational rehabilitation assistance. It also has good face validity. Results suggest that it is feasible to apply the VRI in rehabilitation medicine settings and that further prospective evaluation and practical applications should be undertaken.