What is return to work? An investigation into the quantification of return to work

To describe and demonstrate issues with return to work (RTW) outcome metrics in common use among clinical researchers and injury compensation organisations. We also aim to describe a framework on which to capture relevant RTW information including current employment status and data on participation and maintenance. Structured telephone interviews discussing participant health and vocational status were conducted following compensable transport-related injury. Participants who were working at the time of injury and took time off work because of their injuries (N = 414) were asked questions relating to their work participation and maintenance, including length of continuous employment, hours worked and duties performed before and after injury. A series of RTW metrics was developed and applied to survey data. Rates of RTW according to each metric were calculated. Eighty-four per cent of participants had achieved some employment since their injury, and 74% were working at the time of the survey. In contrast, only 58% of participants were working the same hours as prior to their injury and had been doing so for at least 3 months. These data show that different impressions of rehabilitative success can be obtained depending on the criterion used to define RTW suggesting that reliance on a single RTW index (e.g. 'are you currently working?') will not represent important characteristics of employment. A multi-layered approach to measuring RTW that includes data on reasons for not working, length of continuous employment, hours and duties performed after injury provides greater insight into the vocational status of injured individuals compared to single metrics or outcomes that fail to capture key detail on motives and participation. This information can assist clinicians to more accurately monitor the progress of rehabilitation following injury and compensation schemes to more effectively monitor their performance.