RETURN-TO-WORK DECISIONS IN REHABILITATION: HOW TO GET WORKERS, CLINICIANS AND STAKEHOLDERS ON THE SAME PAGE?

Purpose:

   To date, shared decision making (SDM) has not yet been adapted to work rehabilitation. We sought to design a SDM program in the context of work rehabilitation and assess its acceptability by stakeholders.

Method:

  Using a sequential mixed method, we first designed a preliminary evidence-informed program for return-to-work decisions for workers suffering from pain due to musculoskeletal injuries. The preliminary program was peer-reviewed by expert health care professionals (occupational therapists and psychologists) using individual consultation (questionnaire). Based on this consultation, suggestions were made to improve the program which was then discussed during consensus group. After, improvements on the program were made and an adapted version was created. Using the same steps, we documented the feasibility and acceptability of the program with other stakeholders (workers, insurers, employers and union representatives). Descriptive analyses were performed to determine agreement scores and a content analysis of group discussions was accomplished.

Result:

   Out of 66 approached, a total of 15 experts and 39 stakeholders participated in group discussions. A consensus was reached among participants on the pertinence and feasibility of SDM in work disability prevention context. The final version of the program included one general longitudinal objective (the preservation of a working alliance and ensuring mutual comprehension among all stakeholders), and 11 specific objectives: establishing a working alliance, seven in the deliberation phase of the SDM process, and three in the implementation of the decision. Participants also reached consensus on 1 to 8 indicators per objective. Stakeholders suggested nuances in the operationalization of the program to optimize its acceptability. They suggested tool that was added to the program in order to better respect insurance policies and employers restrictions. 

Conclusion:

  We developed an SDM rehabilitation program intended for a return-to-work implementation plan. This program has been well accepted by all stakeholders. Results of this study support the feasibility of an SDM program in the context of work disability prevention. The next step is to test the program implementation.