RTW and the Injured Worker -- It's all in their head!

Research demonstrates why we should be concerned about what the injured worker believes to be true regarding the outcome of their recovery.  When an injured worker is told, and believes, that they are going to return to their pre-injury duties, it is more likely that it will happen.  This obviously has to do with how accurate the doctor’s prognosis is, but also with how the injured worker aligns their behaviors with what they believe to be true.

Social psychology can help explain some of this.  The social psychological theory of confirmation bias posits that as humans, we will likely seek out information that supports our beliefs, and we will reject information that contradicts them.  If you hold a particular political view, you're likely going to be drawn to people, publications, and sources that support your views.  You will naturally reject ideas or points that are dissonant with your beliefs.  I, for one, will likely not search for articles that do not support RTW.

Another example is smoking.  Everyone seems to agree that it is not good for your health, but why do some highly intelligent, self-aware individuals continue to smoke?  They justify it in various ways, or reject information in an attempt to ease the dissonance between their actions and what they know.

In a 2002 study of 1566 injured workers who were receiving temporary total disability benefits, researchers found that workers' expectations about their recovery had a statistically significant impact on the duration of their disability.¹

When controlling for other suspected factors that could influence the injured workers' RTW, it was found that injured workers who felt their recovery would be slow or reported higher levels of uncertainty about the length of their disability were consistently associated with longer disability durations.  Conversely, workers who reported more positive expectations returned to work sooner. 

When measuring injured workers' recovery expectations, researchers found that 4 variables were able to explain 15.5% of the variance in the duration of receiving benefits. To put it another way, when a physician determines that an injured worker will recovery in x number of weeks, there is typically some variation between the prognosis (x) and the actual duration of disability.  If x is 10 weeks, and the injured worker actually returns in 13 weeks, 15.5% (or 1.5 days) of the 3 week variance can be attributed to the injured worker’s expectations about their ability to RTW.

So why is this study important?

·    Medical providers play an integral part of managing an injured worker's expectations about their ability to RTW.

·    Employers who offer modified duty can increase injured workers' self-efficacy by allowing them to prove that they are capable of doing more than what they initially thought.

·    Employers and medical providers must set realistic recovery expectations early in the recovery process. 

1. Cole, D. C., Mondloch, M. V., & Hogg-Johnson, S. (2002). Listening to injured workers:  How recovery expectations predict outcomes -- a prospective study. Canadian Medical Association Journal 166(6).