Monash University
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The outcome of a return to work programme for injured workers with musculoskeletal disorders

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posted on 2017-02-17, 04:02 authored by Murad, Mohd suleiman
The studies contained in this thesis investigate the impact of a return to work (RTW) programme that has been conducted by Malaysian Social Security Organisation (SOCSO). Important findings on underlying issues of occupational performance and participation, health status, and emotional wellbeing of injured workers is presented using two frameworks, the Model of Human Occupation (MOHO) and International Classification of Functioning and Disabilities (ICF), and also the different phases of RTW programme (off-work, re-entry, maintenance and advancement phases). To examine the issues, these four phases were used to explore injured workers abilities and capacities. The injured workers also were interviewed about their experiences and expectations regarding the supports that they had obtained from the stakeholders whilst involved with SOCSO’s RTW programme. The thesis is organised into the following chapters. The background of the research and appraisal of the underpinning theoretical frameworks are explained in Chapter 1. A literature review of studies regarding musculoskeletal disorders and RTW outcomes, types of interventions and instruments that have been used to study RTW are critiqued in Chapter 2. Five publications (two published and three under consideration) comprise Chapters 3 to 7. These are individual studies addressing five key research questions that arose from literature review, theoretical model and the process of RTW. A variety of methodologies have been employed to answer the research questions, including test and re-test reliability, validity analysis, cross-sectional surveys, parametric and non-parametric tests, correlation test and qualitative study (thematic analysis). In the first study (chapter 3), we found that Malaysian language Occupation Self Assessment version 2.2 (OSAv2.2) was reliable and valid to be used to assess biospsychological factors in the Malaysian RTW programme. The Malaysian OSAv2.2 showed high overall internal consistency, with a Cronbach’s alpha coefficient of 0.91. In addition, test-retest reliability (Intra-class correlation (ICC)) for all 21 items ranged from 0.41 to 0.84. In terms of convergent validity, the physical functioning subscale of the Health Surveillance Survey (SF-36v2) had a moderate and significant relationship to the OSAv2.2 competence scale (rho= 0.552, p=0.001). In the second study (chapter 4), we found that occupational competence (mean=53.09, SD=10.38) in our sample (n=35) was found to be significantly lower than the reference population (mean=57.19, SD= 7.47, p=0.025) but there were no differences in our results based on gender, job status, or whether the person was still receiving medical treatment. Significant associations were found with most activity limitations measured by the SF-36v2, with the strongest of these occurring with the item “bending, kneeling or stooping” (rho=0.64) and “carrying groceries” (rho=0.53) (p<0.05). All participants rated the impact of their health problems on social activities as moderate to extreme. In the third study (chapter 5), we found that all of the injured workers (n=102) exhibited below-average health (as measured by SF-36v2) when compared to the internationally-established normative population (mean=50.00, SD=10.00), with their physical health component summary (mean= 37.77, SD=7.69) rated lower than their mental health (mean= 38.98, SD= 11.11). Across the different groups, significant differences were found in 5 of 8 SF-36 v2 domains including role-physical, vitality, bodily pain, general health, and mental health (p<0.05). The maintenance group had significant differences when compared to either the off-work or re-entry groups. However, non-significant differences emerged when comparing between off-work and re-entry groups. In the fourth study (chapter 6), injured workers (n=78) exhibited significantly lower occupational competence (OC) (mean= 50.45 SD= 11.86) (as measured by OSAv2.2) in comparison with an international group with various disabilities (mean=57.19, SD= 7.47, p<0.001). In contrast, there was a significantly higher negative emotional state (NES) (mean=21.30, SD=15.99) (as measured by Depression Anxiety Stress Scale (DASS-21)) when compared with Malaysia’s general population (mean=16.50, SD=9.10, p=0.011). Significant differences in OC and NES were also found between workers in the three RTW phases (p<0.031). In particular, OC and NES in the off-work and re-entry phases were significantly lower (OC) and higher (NES) than in the maintenance phase. Furthermore, there was a moderate, negative correlation between OC and NES in the off-work and re-entry phase groups. This indicated that low levels of perceived OC were associated with higher levels of NES. In the fifth study (chapter 7), injured workers (n=21) described personal experiences and expectations of support they obtained when they were in the SOCSO’s RTW programme. While participants experienced several positive supports in their RTW, they also suggested that the compensation provider, case managers, employers and health professionals provide further resources and services. These ranged from more flexibility in RTW programmes, provision of clear information and communication about requirements for injured workers to the employer and more moral and psychological support. All provide support for the need for consideration of the injured workers health status, emotional wellbeing and occupational functioning across the off-work, re-entry, maintenance and advancement phases of the RTW programme. The final chapter (Chapter 8) provides a discussion of the significant findings in relation to the health, emotional wellbeing and occupational functioning statuses of the participants involved in this thesis. It summarises the themes that emerged from their experiences and expectations of support whilst they were in the SOCSO’s RTW programme. It also includes the limitations of the study and directions for future research. This thesis has demonstrated that, because the occupational performance and participation of injured workers with musculoskeletal disorders is impacted, return to work programmes need to address these issues, especially when workers are in the off-work and re-entry phases. In particular, health status and emotional wellbeing need to be addressed because, as shown in this body of work, these are associated with occupational performance and participation. RTW programmes must not only look at actual numbers of people who are returning to work, but also the underlying issues related to workers’ interests, roles, routines, and performance or skills in daily living/work. Furthermore, the findings recommend the establishment of RTW guidelines for employers, employees and health providers. These must be produced and implemented at a national level, as per the practice in other developed countries. These studies provide an evidence base to consider injured workers’ occupational performance and participation in the process of RTW, since these are associated with overall health and mental status. The findings also provide a basis for the development of occupationally-based interventions to support RTW conducted by SOCSO especially in the early off-work and re-entry phases. The emergent themes in terms of expectations from the injured themselves of different stakeholders can be reflected on to improve the management of SOCSO’s national RTW programme


Principal supervisor

Louise Farnworth

Year of Award


Department, School or Centre

Occupational Therapy

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Doctor of Philosophy

Degree Type



Faculty of Medicine Nursing and Health Sciences

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