Planning a Successful Return to Work: A Guide for Occupational Health Professionals

As occupational health (OH) professionals, supporting employees’ return to work (RTW) after illness or injury is crucial to promoting recovery, productivity, and workplace well-being. While many practitioners focus on fitness for work assessments, integrating vocational rehabilitation (VR) strategies—often led by occupational therapists (OTs)—can elevate the impact of RTW planning.

This guide outlines evidence-based RTW strategies, with a practical case study and tools to enhance your practice.

Why Does RTW Planning Matter?

Research highlights that early, structured, and individualised RTW plans result in faster recoveries and better outcomes. Poorly managed processes can lead to prolonged absence, disengagement, and higher employer costs. A proactive, collaborative approach, supported by VR principles, ensures a smoother transition for employees and employers.

Evidence-Based RTW Strategies

1. Early and Open Communication

• Why: Reduces uncertainty, builds trust, and addresses barriers early.
• How: Initiate dialogue with the employee, employer, and healthcare providers as soon as a need for RTW planning arises.

2. Workplace Assessments

• Why: A comprehensive understanding of job demands ensures sustainable solutions.
• How: Enlist VR specialists to analyse the physical, cognitive, and psychosocial elements of the role and workplace. Assessments can be face to face or remote.

3. Tailored RTW Plans

• Why: One-size-fits-all approaches are rarely effective and rarely provide a return on investment for employers.
• How: Design individualised plans, including phased returns, workplace modifications, job role modifications/ phased re-introduction to elements of the job role and support structures.

4. Psycho-Social Support

• Why: Addressing fears, stigma, or workplace relationships can be critical to success.
• How: Include strategies to build confidence, such as gradual task exposure and supportive communication channels. Consider education for colleagues and managers to understand the employee’s condition.

5. Regular Monitoring and Adjustment

• Why: Flexibility is key as recovery may not follow a linear path.
• How: Schedule regular reviews to assess progress and update the plan accordingly. Establish an agreed strategies and management plan of the employee’s health condition at work.

Case Study: Complex Return-to-Work for a Warehouse Manager Post-Multiple Orthopaedic Injuries

Background

Sam, a 48-year-old warehouse manager, sustained multiple orthopaedic injuries, including a fractured femur and wrist, following a motorbike accident. After surgical fixation and rehabilitation, Sam experienced residual physical impairments, including reduced strength, coordination, and pain in both injured areas. Additionally, Sam reported anxiety about returning to work, particularly regarding heavy lifting and undertaking physical tasks in a fast-paced environment.

Occupational Therapist (OT) Involvement

1. Comprehensive Workplace Assessment

An OT conducted an in-depth analysis of Sam’s job demands, identifying tasks requiring significant physical strength and precision, and the potential psychosocial challenges Sam might face while resuming managerial duties.

2. Functional Capacity Evaluation (FCE)

The OT undertook a targeted face to face FCE due to the complexity of injuries and tasks. This evaluation assessed Sam’s current physical capabilities (e.g., lifting, standing endurance, grip strength) and compared them with the job demands. The FCE also considered cognitive and psychosocial factors, offering insights into Sam’s anxiety and confidence levels.

3. Graded Vocational Rehabilitation Plan

The OT developed a phased RTW plan:

• Weeks 1–2: Administrative tasks (e.g., scheduling, inventory management) with ergonomic adjustments to workstation setup.
• Weeks 3–4: Gradual reintegration into supervisory roles with limited physical involvement.
• Weeks 5–8: Progressive exposure to physical tasks like light lifting and demonstrations, supported by a colleague for heavier tasks. Regular check-ins ensured adjustments based on Sam’s feedback.

4. Holistic Support

The OT addressed psychosocial barriers by providing coping strategies for anxiety and coordinating with a clinical psychologist for ongoing support. The OT also worked with the employer to foster a supportive environment, including training colleagues on task-sharing during Sam’s transition.

Outcome

Sam successfully returned to a modified version of his role within eight weeks. The collaborative plan enhanced Sam’s confidence and physical capacity while minimising risks of re-injury. Employer feedback highlighted the OT’s role in balancing productivity with employee well-being, making the RTW process smooth and sustainable.

Practical Tools for RTW Planning

1. RTW Planning Checklist

• Initial assessment completed?
• Job demands analysed?
• Employee concerns addressed?
• Employer concerns addressed?
• RTW plan collaboratively agreed upon?
• Adjustments and resources in place?
• Follow-up schedule confirmed?

2. FCE Referral Template

• Purpose: To ensure FCE referrals capture relevant details.
• Contents: Employee job description, key tasks, physical demands, and barriers to RTW.

3. Graded RTW Plan Template

• Structured table outlining week-by-week goals, hours, tasks, and adjustments.
• Include sections for review notes and plan revisions.

Conclusion

By integrating VR principles into RTW planning, OH professionals can deliver evidence-based, holistic support that benefits employees and employers alike. A collaborative approach, enriched by specialist input from OTs, enhances the sustainability of outcomes.

References

1. Waddell G, Burton AK. Vocational rehabilitation: what works, for whom, and when? London: Department for Work and Pensions; 2008.
2. Black C, Frost D. Health at work – an independent review of sickness absence. London: Department for Work and Pensions; 2011.
3. Cullen KL, Irvin E, Collie A, et al. Effectiveness of workplace interventions in return-to-work for musculoskeletal, mental health, and chronic health conditions: a systematic review. J Occup Rehabil. 2018;28(1):1-15.
4. Pomaki G, Franche RL, Khushrushahi N, et al. Best practices for return-to-work interventions for workers with mental health conditions. J Occup Environ Med. 2012;54(8):119-27.
5. van Vilsteren M, van Oostrom SH, de Vet HCW, et al. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database Syst Rev. 2015;10:CD006955.
6. Royal College of Occupational Therapists. The role of occupational therapy in vocational rehabilitation. London: RCOT; 2019.
7. Chartered Institute of Ergonomics and Human Factors. Ergonomic principles in the workplace. Leicester: CIEHF; 2020.
8. NICE. Workplace health: long-term sickness absence and capability to work (NG146). London: NICE; 2019.
9. MacEachen E, Clarke J, Franche RL, et al. Workplace-based return-to-work interventions: a systematic review of the qualitative literature. J Occup Rehabil. 2006;16(3):439-57.
10. Society of Occupational Medicine. Guidance on returning to the workplace after COVID-19. London: SOM; 2021.
11. Chambers M, Smith E, Gallacher J, et al. Early stroke specialist vocational rehabilitation: results from the RETAKE trial. PLoS One. 2024;19(5):e0311101.
12. Foster J, Keating J, Shepherd D, et al. Development of a vocational rehabilitation intervention to support return-to-work and well-being following major trauma: a person-based approach. BMJ Open. 2024;14(10):e085724.
13. Kus S, Streibelt M, de Boer WE, et al. Predictors of return-to-work outcomes following severe orthopaedic injuries: a biopsychosocial analysis. BMC Musculoskeletal Disord. 2023;24(1):139.