The Center for Disability Research at Liberty Mutual’s Research Institute for Safety is now a decade old, a product of the company’s realization that while a safe and sustained return-to-work program was critical for workers who had been injured, there was a relative lack of research in this area in the United States. Although prior studies had suggested that prolonged disability was most often caused by medical or psychological reasons, research by the CDR has led to a different view: that returning to work after an injury is a process of adapting to a new situation, for both worker and workplace. To that end, CDR scientists research factors associated with work absence, re-injury, and post-injury job retention, as well as the impact of case management, clinical treatments, and employer response and accommodation. These findings help physicians, case managers, and employers understand the disability process; improve the outcome of those returning to work after injury; and make quality of life better for workers.
Recently, the CDR has made a number of advancements and has begun studies on pain-self management, as well as the role of return-to-work coordinators. Glenn Pransky, Director of the Center for Disability Research, gave us a run-down.
Can you explain a bit about what Liberty Mutual’s research on returning to work with a disability has revealed in the last decade? What’s the overall philosophy now versus ten years ago?
Our research has led us to a view that differs from prior studies of prolonged disability, which focused on formal work accommodations [such as making workplaces accessible with ramps, modifying equipment, modifying work schedules, etc.]. We now understand the critical importance of initial supervisor responses to a worker who reports a work injury, the role of effective and appropriate treatment and provider communication with the workplace, and a subsequent work re-integration process that involves worker, supervisor, and others. And we have a better understanding about how inappropriate medical treatment and accommodations can actually be harmful.
What have some of the most interesting revelations been in the past year at the CDR?
We’ve found a few interesting things: Many people with significant low back pain that affects their ability to do their job have developed effective strategies to manage their condition at work and avoid lost time. This has helped us research pain management.
Another thing that has been shown to be critical in successfully reintegrating into a work environment are return-to-work coordinators, who are facilitating the process in some of the most challenging and complex cases. What we’re finding, though, is that their most important contributions have little to do with workers compensation knowledge, medical information, or formal case management training—they are primarily related to listening, communication, negotiation, gaining trust, and the ability to stay focused on the ultimate goal of returning to work.
I’ve read about regional differences in how disability and return-to-work are handled in the U.S. Can you tell me more about that?
One of the most notable differences is the geographic distribution of early use of narcotics for pain relief. It’s much more prevalent in the Southeast than in the Northeast, for example. And what we’re finding is that early use of narcotics can lead to poor results in low back pain, which is one of the most common reasons for work disability. Most guidelines suggest that narcotics are an acceptable option of managing severe acute pain, but only for a limited period of time, and only in certain cases. We conducted a data-based study of early narcotics prescribing among workers in a selected compensation population [more than 21,000 workers] and found that the early use led to excessive time loss, unnecessary surgery, and long-term dependence on narcotics.
We hosted the major international conference on lower back pain and primary care research last year. One interesting point that we learned is that early intervention in the workplace through nonmedical experts has great promise in preventing disability.
What might a typical day include in one of CDR’s labs at the Institute?
Our labs might involve a subject with a history of lower back pain coming in for an exercise training session as part of a study to see if we can prevent recurrent pain. Simultaneously, our IVR [interactive voice response] system is quietly collecting data from another subject in the same study, reporting on how he’s doing 6 months after completing the training. Another computer collects a web-based survey response from a subject from Texas, enrolled in our study of early risk prediction, and then collects data for a study of research priorities in low back pain, from a researcher in Italy.
How do you collaborate with the other centers?
As an example, leading edge studies in Europe suggest that self-management for lower back pain is a viable strategy. We’re in the process of talking to workers and finding out what their issues are. Marv’s group [the Center for Behavioral Sciences] has expertise in running studies, which we’ll tap into. And Ted’s group [the Center for Injury Epidemiology] will tell us where the disabilities are concentrated.