Mixed messages around disability management

2 studies look at employee satisfaction levels, benefits of return-to-work co-ordination

Commonly provided by insurers and employers, disability management programs are designed to promote recovery among employees who are unable to work due to an injury or illness.

There is considerable variation among such programs although they often include the completion of standardized forms and case managers who co-ordinate rehabilitation efforts and the return to work (RTW).

Recently, the Evidence-Based Insurance Medicine Research Group — clinical researchers and scientists from the Netherlands, Canada and Switzerland with an interest in optimizing disability management — looked at the impact of case management in two different studies.

The first found a majority of employees returning to work from short-term disability, and their supervisors, reported a high level of satisfaction with case management. The second found there was a small benefit to return-to-work co-ordination.

Returning to work after short-term disability

In a survey of 389 employees returning to work from short-term disability and their supervisors at a private Canadian insurance company, the majority (79 per cent) expressed positive attitudes towards their disability management experience.

In answering a questionnaire that specifically asked about their experience with, and attitudes towards, the disability management process, seven items related to case management were cited as most positive:

• “My case manager clearly explained her role and responsibilities.”

• “My case manager accurately explained information about the disability management process.”

• “My case manager clearly explained what was expected of me in the RTW process.”

• “My case manager responded to my questions or concerns in a prompt manner.”

• “My case manager was polite and respectful to me.”

• “I felt comfortable in my interactions with my case manager.”

• “My case manager made sure I received clinical assessments and care promptly.”

However, more than 25 per cent of employees disagreed that their case manager contributed directly to their recovery or that their case manager was effective in removing barriers to their recovery, found Attitudes Towards Disability Management: A Survey of Employees Returning to Work and Their Supervisors.

Fifty-six per cent of the employees provided written comments, often commenting on the importance of their case manager in the disability management process:

“I was so worried about missing so much work when I got sick but my case manager and supervisor made me feel like the most important thing was just getting better and returning to work when I was able. They never rushed me and made me feel very comfortable about everything,” wrote one.

“When I told my doctor how my employer was handling my absence, she said she was glad they were so understanding and that I was very fortunate, because not all employers handle absence in such a timely and respectful manner. Overall, any stress I had about missing work was alleviated and I looked forward to returning to work.”

Areas that may benefit from attention include ensuring continued support by case managers during the RTW process, when needed, and carrying out commitments to modify unhelpful work situations, when appropriate.

Return-to-work co-ordination

An important component of case management is RTW co-ordination. To explore the effectiveness of RTW co-ordination, the Evidence-Based Insurance Medicine Research Group reviewed the published literature for all trials that:

 • enrolled workers receiving sick leave or disability benefits for at least four weeks

 • randomly assigned them to RTW co-ordination or to usual practice

 • reported the effect on RTW and self-reported outcomes on functioning and quality of life.

In the end, the group looked at nine trials from seven countries that enrolled claimants with musculoskeletal complaints (seven trials), mental disorders (one trial) or a combination of both (one trial).

The interventions encompassed a wide range of individualized RTW co-ordination approaches, found The Effect of Return to Work Coordination for Employees Receiving Wage Replacement Benefits: A Meta-Analysis of Randomised Controlled Trials.

In combining and re-analyzing the results of the nine individual trials in a meta-analysis, the group found “moderate quality evidence supporting a small benefit of RTW co-ordination.”

Compared to practice as usual, an average of five more per every 100 claimants receiving RTW co-ordination returned to work. And the total days of sickness absence decreased by an average of 36 workdays per year (ranging from 17 to 56 days).

If maintained over the long term, many would consider these benefits to be important, said the group.

RTW co-ordination was also associated with small improvements in self-reported outcomes, found the study.

In calculating the proportion of claimants who significantly improved by the smallest difference that claimants are likely to notice, RTW co-ordination increased the proportion of participants who improved noticeably in overall function by nine per cent, physical function by eight per cent, pain by eight per cent, mental function by six per cent and social function by four per cent.

Jason Busse, Stefan Schandelmaier and Regina Kunz are members of the Evidence-Based Insurance Medicine Research Group, a scientific collaboration of researchers from the Netherlands, Canada and Switzerland. Busse is an assistant professor in the departments of Anesthesia and Clinical Epidemiology and Biostatistics at McMaster University in Hamilton. He can be contacted at (905) 525-9140 ext. 2173 or [email protected].

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