Do return to work interventions for workers with disabilities and health conditions achieve employment outcomes and are they cost effective? A systematic narrative review
| Published date | 01 October 2018 |
| Date | 01 October 2018 |
| DOI | https://doi.org/10.1108/ER-01-2017-0023 |
| Pages | 999-1014 |
| Author | Pauline Dibben,Geoffrey Wood,Rachel O’Hara |
| Subject Matter | HR & organizational behaviour,Industrial/labour relations,Employment law |
Do return to work interventions
for workers with disabilities and
health conditions achieve
employment outcomes and are
they cost effective? A systematic
narrative review
Pauline Dibben
University of Sheffield, Sheffield, UK
Geoffrey Wood
University of Essex, Essex, UK, and
Rachel O’Hara
University of Sheffield, Sheffield, UK
Abstract
Purpose –The purpose of this paper is to evaluate existing evidence on whether return to work
interventions achieve employment outcomes and are cost effective in order to better inform those needing
accommodations at work, as well as their line managers and trade union representatives, occupational health
specialists and HR managers.
Design/methodology/approach –The paper uses a systematic narrative review to evaluate the evidence
on the employment outcomes and cost effectiveness of return to work initiatives.
Findings –Evidence on interventions for musculoskeletal conditions such as lower back pain indicates that
certain forms of intervention such as vocational rehabilitation and workplace-based rehabilitation facilitate
outcomes such as employment, reduced sick leave and effective return to work. However, there is very little
evidence on whether these interventions are cost effective. More generally there are glaring gaps in evidence
on cardio-respiratory (heart and breathing) and mental health conditions with regard to both employment
outcomes and the cost of interventions.
Research limitations/implications –This systematic review has critical and timely implications for both
knowledge development and practice. While highlighting methodological limitations in the existing research
base, it also presents avenues for further research on return work strategies and the factors inhibiting and
facilitating their adoption and effective operation.
Originality/value –Although there is much existent literature on the return to work process, far less
attention has been paid to the employment outcomes and cost effectiveness of interventions. This paper
highlights the interventions for musculoskeletal conditions such as lower back conditions that may resultin
positive employment outcomes, with implications for practice. However, it also highlights gaps in evidence on
the employment outcomes and cost effectiveness of interventions for cardio-respiratory (heart andbreathing)
and mental health conditions.
Keywords Cost effectiveness, Disability, Employment outcomes, Return to work interventions
Paper type Literature review
Introduction
This study reviews existing evidence on the effectiveness of return to work initiatives
aimed at the disabled and those with long-standing/chronic health conditions. Disabled
workers form a particularly vulnerable category of the labour market, with respect to pay Employee Relations
Vol. 40 No. 6, 2018
pp. 999-1014
© Emerald PublishingLimited
0142-5455
DOI 10.1108/ER-01-2017-0023
Received 31 January 2017
Revised 16 February 2018
Accepted 16 February 2018
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/0142-5455.htm
This review was commissioned and funded by the Department for Work and Pensions. The conclusions are
the authors’interpretations and do not necessarily reflect the views of any government department.
999
Return to work
interventions
and broader subjective measures regarding their treatment at work (Fevre et al., 2013).
This vulnerability has been recognised as an international development problem as well
as a national problem by countries such as Britain which are aiming to increase the
employment levels and work situation of disabled workers (Gov.UK, 2017). However,
achieving these outcomes requires workplaces to be able and willing to accommodate the
requirements of disabled workers, and have the capacity to ensure that they reach their
fullest potential. Moreover, long-term success is contingent on sustained employment of
disabled workers and the effectiveness of rehabilitative return to work policies and
practices. The latter form the scope of this review. More specifically, the two key research
questions are:
RQ1. What is the available evidence on effective interventions in terms of employment
outcomes and cost effectiveness?
Additionally:
RQ2. Are there gaps in evidence with regard to the effectiveness of interventions for
certain conditions?
It should be noted that the rehabilitation and accommodation of workers with disabilities or
chronic health conditions is a contested domain. Central to work and employment are
struggles over resources and control; the latter have encompassed contestations regarding
skill, reward and working time (see, e.g., Thompson and van den Broek, 2010). There has
also been an intensification of the struggle over another front: illness, sick leave, disability
and the relative capability to perform specific types of work (see, e.g., Taylor et al., 2010).
Return to work accommodations following sick leave require active engagement from a
range of actors within the workplace and the allocation of appropriate resources
( James et al., 2006). The resources put into return to work interventions may be diverted
from other well-being initiatives, and therefore justification of their costs is important.
Within the literature, various potentially vulnerable groups of workers have received
attention, with some authors highlighting the need to protect the rights of groups such as
immigrants or women or older workers (Lain and Loretto, 2016). However, with the
exception of a limited number of studies of long-term absence (e.g. Cunningham et al., 2004,
2006; Taylor et al., 2010), disabled workers and those with long-term health conditions have
received relatively little attention in the employment relations literature, with most attention
being paid to them within the medical and social policy fields (Berthoud, 2008;
van Amelsvoort et al., 2014). Meanwhile, the return to work literature often lacks a clear
focus on musculoskeletal conditions and mental health (Cullen et al., 2017; Follmer and
Jones, 2018). Yet, disabled workers and those with health conditions are arguably some of
the most vulnerable in the workforce in terms of income and employment security, facing
disadvantage due to factors directly related to disability, and indirect factors such as
education and age, resulting in poor employment prospects (Berthoud, 2008, p. 132;
Schur et al., 2009). Those with mental health conditions can face a particular disadvantage
(Berthoud, 2008), due to a lack of knowledge about their condition, stigma and prejudice
(Erickson et al., 2013).
At the same time, workers who take sickness absence are often subject to disciplinary
action (see, e.g., Taylor et al., 2010). Yet, positive action within the workplace can yield
dividends: effective return to work practices can be of mutual benefit for both the worker
and the organisation (Collins and Cartright, 2012). Such action is required for those who
currently have a disability or health conditions, and is pertinent for an ageing workforce,
given increased longevity and changes to the statutory pension age which may mean an
increasing population of older workers who need to have accommodation for ongoing health
conditions (Lain and Loretto, 2016).
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