Return to work practices for musculoskeletal and mental health conditions


Like many others, I always feel that it’s a bit of a struggle returning to work after the Christmas and New Year holiday period. And as I started to prepare my Vocational Rehabilitation module teaching materials for the year 3 Physiotherapy students at Glasgow Caledonian University, I got thinking about what the best practices would be for practitioners supporting someone returning to work, not after a nice holiday, but following a musculoskeletal or mental health problem.

It was then that I came across a literature review by Durand et al (2014) that seemed to address this very topic.

This review was part of a broader study in which the authors were interested in putting in place an evidence based work absence management and return to work (RTW) programme to reduce work absenteeism. The overall aim of the review was to establish best practice in work absence management and RTW.


Managing work absence and supporting people as they return to work is complicated further when there are complex health issues to consider.


The reviewers conducted searches of systematic reviews in the following databases: CINAHL, MEDLINE, PsycInfo, Scopus and ABI/INFORM Complete, using a range of keywords covering terms related to absenteeism, job retention, RTW management, work disability and vocational rehabilitation. Searches were limited to publications published in English or French in the period from 2000 to 2011. Searches were also conducted of guidelines and reports.

Recommendations regarding work-absence management and return-to-work practices were extracted and summarised into a conceptual framework.

This was not a systematic review, but a literature review of a range of reliable publication types.


A total of 17 documents were analysed, which included 9 guidelines and 8 systematic reviews. In addition to these documents, the authors identified and included eight other relevant papers, four research reports, and eight book chapters. Following analysis of the included documents the reviewers identified and summarised a number of common practices.

Return to work best practice

The best RTW practices from all the included documents are listed below, which are described in detail in the review:

  1. The importance of having a worker support approach.
  2. Clearly described roles and responsibilities of all relevant stakeholders.
  3. A six-step process for work-absence management and return to work:
    1. Time off and recovery period;
    2. Initial contact with the worker;
    3. Evaluation of the worker and his/ her job tasks;
    4. Development of a return to work plan with accommodations;
    5. Work resumption;
    6. Follow-up of the return to work process.
All stakeholders should be involved using a worker support approach

The review concluded that all stakeholders should be involved using a worker support approach.


The authors concluded:

… each stakeholder involved in work-absence management has a particular role to play. The policy developed by the organisation helps clarify these roles and promote the common objective of adopting a worker support approach among stakeholders. To facilitate an absent employee’s return to work, all stakeholders’ actions must form a cohesive whole throughout the process, while taking into account several essential steps that foster the success of the process.

The Musculoskeletal Elf’s view

The Musculoskeletal Elf

This review, although not a full systematic review, provides a very useful summary of best practice for either students of, or practitioners involved in vocational rehabilitation.

The reviewers have constructed a very useful table that summarises their recommended six step RTW process, incorporating the roles of involved stakeholders.

The recommendations would have to be contextualised by practitioners with respect to their own country’s and organisation’s policy and practice setting(s).

What do you think?

Q. What are your views of the six step return to work process? Would you suggest any refinements?

  1. Time off and recovery period;
  2. Initial contact with the worker;
  3. Evaluation of the worker and his/ her job tasks;
  4. Development of a return-to-work plan with accommodations;
  5. Work resumption;
  6. Follow-up of the return to work process.

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Durand MJ, Corbière M, Coutu MF, Reinharz D, Albert V  2014 A review of best work-absence management and return-to-work practices for workers with musculoskeletal or common mental disorders.Work. 48(4):579-89. [PubMed]

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