Worker Recovery and Return to Work

Posted on by Steve Wurzelbacher, PhD

Work-related disability is associated with many negative health and social outcomes including reduced quality of life, job loss, reduced lifetime income, injuries among family caregivers, and premature death. For example, a recent NIOSH-funded study found that workers who suffer serious injuries requiring days away from work are more likely to die sooner than workers with injuries requiring only medical treatment.

Other studies have shown that the chances of returning to work drop dramatically the longer the worker remains away from work. While more serious diagnoses are associated with longer periods off work, minor diagnoses can also lead to disability if the recovery and return-to-work processes are not properly managed.

We are interested in learning from you about resources related to worker recovery and helping them return-to-work. To start the discussion, we have listed some resources below and we welcome your suggestions, as well as input on the following questions.

  • What evidence-based resources exist?
  • How can best practices be shared?
  • What specific research is needed?


Worker Recovery Resources:

Division of Federal Employees’ Compensation (DFEC) POWER Initiative: The Protecting Our Workers and Ensuring Reemployment (POWER) Initiative collected and analyzed data on the causes and consequences of frequent or severe injury and illness among Federal employees, and identified effective safety and health management programs. This includes resources on achieving successful return-to-work of injured employees:

Washington State Department of Labor and Industries Centers of Occupational Health and Education (COHEs): These Washington State centers work with medical providers, employers, and injured workers in a community-based program. COHEs improve injured worker outcomes and reduce disability by training providers and coordinating cases.

Office of Disability Employment Policy (ODEP) Stay-at-Work / Return-to-Work: The Office of Disability Employment Policy (ODEP) is a non-regulatory federal agency that promotes policies and coordinates with employers and all levels of government to increase workplace success for people with disabilities. Since 2013, ODEP has utilized a Community of Practice and policy work groups led by subject matter experts to guide their SAW/RTW work. Through this collaboration, ODEP continues to explore effective practices to inform policy recommendations targeting federal and state agencies, as well as the private sector. For example, one policy working group is focused on adapting the Washington State WC COHE program.

International Association of Industrial Accident Boards and Commissions (IAIABC): IAIABC is a not-for-profit trade association representing government agencies charged with the administration of workers’ compensation systems throughout the United States, Canada, and other nations and territories.

The American College of Occupational and Environmental Medicine (ACOEM): ACOEM represents more than 4,500 physicians and other health care professionals specializing in the field of occupational and environmental medicine.

  • ACOEM Coding Initiative Guidance Statement: ACOEM supports changing the rules for documentation of care in workers’ compensation cases in order to provide reimbursement and other incentives for delivering care that adheres to best practices.

The Institute for Work & Health (IWH): The IWH is an independent, not-for-profit organization whose mission is to conduct and share research that protects and improves the health of working people.

  • Return-to-Work: The IWH conducts research on return-to-work as practiced by workplaces, workers’ compensation boards, insurance companies and rehabilitation providers. Return-to-work includes disability management and prevention, vocational rehabilitation, and work reintegration.
  • Clinical Treatment: The IWH conducts research on evidence-based practice for health care in treating back pain, neck pain, chronic pain, upper extremity disorders, and other soft-tissue injuries. This includes studies on health-care delivery and policy.
  • Compensation-Benefits (Canadian Provinces): The IWH has examined trends in workers’ compensation claims and benefits, their adequacy and equity, and their effects on workers.
  • Measuring Health-Function: The IWH conducts research to measure worker health, function, and disability; predict the course and pattern of recovering from disability; and determine the prevalence of certain health conditions among workers.

Steve Wurzelbacher, PhD, is the Director of the NIOSH Center for Workers’ Compensation Studies (CWCS)


Posted on by Steve Wurzelbacher, PhD

10 comments on “Worker Recovery and Return to Work”

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    Worker Recovery and Return to Work

    What evidence-based resources exist?

    We looked at this question very carefully particularly for a return to work (RTW) recommendations for the lower back pain patients in the primary care settings. We did not see a readily available recommendations/algorithm for the primary care providers who are not trained as occupational medicine physicians. Most of them struggle with the recommendation as they do not have a clear understanding of what does the RTW process entails. There been some challenges in making sure the recommendations are evidence-based so that working patients can safely return back to work. A lack of understanding of the individual’s workplace can intrinsically translate into how to recommend objectively the evidence-based recommendations pertaining to RTW process.

    How can best practices be shared?

    The best way to formulate and share the RTW recommendations/best practices is to incorporate it within the ecosystem that the providers are familiar with i.e. Electronic Health Records (EHRs). They are much more likely to use the recommendations/algorithms if it is readily available at the time of the encounter with the injured worker and it needs to be smart enough to morph with the diverse work setting for the provider to recommend RTW recommendations objectively.

    What specific research is needed?

    The idea of providing an evidence-based effective tool that can be seamlessly integrated into the primary care clinical ecosystem without overwhelming the clinical workflow and with the capabilities of adapting to the diverse patient’s workplaces setting requires a skill set and know-how in the area of Occupational Medicine and Clinical Informatics.

    Such research will really look at not only creating effective tools for RTW but essentially improves on medical related outcomes for work-related injuries.

    This is a great list of resources! I’d like to add another one from ACOEM, which recently published an update to its guidance document for treating physicians: The Personal Physician’s Role in Helping Patients With Medical Conditions Stay at Work or Return to Work.

    Also, ACOEM collaborated with IAIABC to publish this guidance document: A Guide to High-Value Physician Services in Workers’ Compensation – How to find the best available care for your injured workers

    Finally, I recommend readers check out the services and publications of the Job Accommodations Network, which provides free advice to employers and workers needing help with work accommodations:

    I read in a guide on the small business publication Fit Small Business that while a majority of states require you to purchase workers compensation insurance the moment as you hire your first employee. Texas is apparently the exception, with there being no requirement to buy coverage. Is there a plan this become a national requirement?


    Really a nice and informative blog. A new type of concept is sharing through this blog. Thanks for publishing this.

    We are dealing with massive restrictions as to staying home based on the Covid-19 threat.
    Will weeks at home be hard for workers to overcome? It will be interesting to see if the “forced” time at home is easier to overcome and return to work than is time at home because of an illness.

    I am a rookie researcher that has developed an effective treatment regimen to return spine injured workers back to work with significant efficacy. We are in the process of setting up a custom data base of assement tools to collect the best data that a workers comp expert would want to see collected for this special population of patients. We have collected SF-36 from the start as well as VAS. Are there any best practice assessment tools that you would recommend we collect to make our data more meaningful for the work comp clinician as well as the employer?

    Looking for evidence based, reliable, sound, and credible research that shows injured workers can recover faster when they return to work sooner. Please link articles if found.

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Page last reviewed: August 11, 2020
Page last updated: August 11, 2020