Return-to-Work Expectations and Workplace Supports in New Zealand: Injured Workers' Perspectives
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Background. Work disability owing to musculoskeletal injury constitutes an extensive and expanding health problem globally. The vast majority of costs attributed to work disability are currently associated with long-term work disability. Furthermore, the risk of developing long-term work disability compounds with increased time off work. Recent research into work disability prevention has started to investigate the predictive ability of return-to-work expectations and workplace supports as risk factors of long-term work disability. However, at this stage, the mechanisms by which they influence work disability are poorly understood. Aims. Study one investigated existing evidence of the effects of return-to-work expectations and workplace supports on return-to-work outcomes in workers with acute musculoskeletal injuries. Study two sought to better understand how return-to-work expectations and workplace supports may be better addressed through analysing the perspectives of acutely injured workers undergoing vocational rehabilitation. Methods. A systematic literature search was carried out and the retrieved literature underwent critical appraisal and synthesis to address the aim of study one. In study two, semi- structured interviews were conducted with five acutely injured participants who were currently undergoing vocational rehabilitation in Northland, New Zealand. Thematic analysis was used to analyse and interpret the data. Results. The results of study one confirmed that that both return-to-work-expectations and workplace supports affect return-to-work outcomes. Furthermore, the outlining of several research gaps in the topic area from the synthesis of the literature led to the development of focussed questions that were then used to inform study two. Five themes were generated from the data in study two. “Worker health or company wealth?” discussed how the different priorities that companies exhibit in their decision-making and workplace culture can affect the provision of workplace supports. “Trust underpins workplace supports” reported on differing forms of trust within the workplace environment and also had an influence on the provision of workplace supports. “Workplace supports move my goal” highlighted that workplace supports were found to influence return-to-work expectations. The influential roles medical and insurance providers played in relation to the participants’ return-to-expectations was presented within “is standard care sub-standard?”. “What about the worker?” discussed how participants’ contrasting “worker” identities and perspectives of pain had an influence on return-to-work expectations. Discussion. The findings of study one identified gaps in the research which had not yet been analysed in depth. Study two addressed these identified gaps. The effects of systemic factors and trust were found to have a bearing on the provision of workplace supports. The role of workplace supports in influencing return-to-work expectations was also illustrated. Furthermore, medical and insurance providers were shown to influence return-to-work expectations. Finally, some of the individual characteristics of the participants were shown to influence return-to-work expectations. Conclusion. This thesis contributes to the growing body of knowledge in this research area by providing original insights into how return-to-work expectations and workplace supports can be better addressed. These findings have implications for injured workers, employers, vocational rehabilitation providers, workers’ compensation systems and society. Further research investigating work disability prevention strategies will be necessary if the global problem work disability has created is to be brought under control.