Institute for Work and Health, 481 University Ave, Suite 800, Toronto, ON, M5G 2E9, Canada.
Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
Soc Psychiatry Psychiatr Epidemiol. 2020 Aug;55(8):1041-1051. doi: 10.1007/s00127-020-01839-3. Epub 2020 Feb 12.
To examine differences in the return to work (RTW) process for workers' compensation claimants with psychological injuries compared to those with musculoskeletal (MSK) injuries.
We collected data from 869 workers' compensation claimants in Victoria, Australia, at three time points over a 12-month period (21% with psychological injury claims). RTW was assessed through self-report. Potential mediators were identified at the personal, health-care provider, workplace and system levels. The relationships between injury type, mediating factors and RTW were assessed using path analysis, with adjustment for confounders through inverse probability weighting.
We observed better RTW outcomes for claimants with MSK injuries (compared to those with psychological injuries) at T1 and T2, but not at T3. We also observed differences between psychological injuries and MSK injuries and all but two of the mediating factors examined. These differences, in particular related to supervisor response to injury, consultative RTW planning and offers of accommodation, as well as differences in mental health symptoms, explained approximately two-thirds of differences in RTW between injury types at T1. Differences in RTW at T2 were explained by mediating factors, and differences in RTW at T1.
Claimants with work-related psychological injuries experience a variety of challenges in RTW compared to those with MSK injuries. While treating and preventing further exacerbation of psychological symptoms should remain an important part of the rehabilitation process, other modifiable factors, in particular supervisor response to injury and consultative RTW planning and modified duties, should be prioritised to reduce inequalities in RTW across injury types.
研究与患有肌肉骨骼（MSK）损伤的工人赔偿索赔者相比，患有心理损伤的工人赔偿索赔者在重返工作（RTW）过程中的差异。
我们在 12 个月的时间内从澳大利亚维多利亚州的 869 名工人赔偿索赔者那里收集了数据（21%的索赔者有心理损伤）。通过自我报告评估 RTW。在个人、医疗保健提供者、工作场所和系统层面确定潜在的中介因素。使用路径分析评估损伤类型、中介因素与 RTW 之间的关系，并通过逆概率加权对混杂因素进行调整。
我们观察到，在 T1 和 T2 时，患有 MSK 损伤的索赔者（与患有心理损伤的索赔者相比）的 RTW 结果更好，但在 T3 时并非如此。我们还观察到了心理损伤和 MSK 损伤以及除了两个中介因素之间的差异。这些差异，特别是与主管对伤害的反应、协商性 RTW 计划和提供住宿以及心理健康症状的差异有关，解释了 T1 时两种损伤类型之间 RTW 差异的大约三分之二。T2 时 RTW 的差异由中介因素和 T1 时 RTW 的差异来解释。
与患有 MSK 损伤的索赔者相比，患有与工作相关的心理损伤的索赔者在 RTW 方面面临各种挑战。虽然治疗和预防心理症状进一步恶化仍应成为康复过程的重要组成部分，但其他可改变的因素，特别是主管对伤害的反应、协商性 RTW 计划和修改后的职责，应优先考虑，以减少不同损伤类型之间 RTW 的不平等。
