Donald E. Shrey

Workplace Disability Management: International Trends and Perspectives

The social and economic costs of injury and disability in the workplace has had an adverse impact on employers and societies throughout the world. International trends in worksite disability management policies and practices, as surveyed by the International Labor Organization, are explored. The impact of formal training for Disability Management Coordinators is discussed, as relates to reductions in unnecessary lost time and workplace disability costs. A disability management audit system is summarized, as a strategic planning process for developing return-to-work programs for workers with disabilities.

Accelerating the return to work (RTW) chances of coronary heart disease (CHD) patients: part 1 - development and validation of a training programme

Purpose : Conventional phase II cardiac rehabilitation (CR) programmes have not resulted in an improvement in returning coronary heart disease (CHD) patients to work in over 35 years. This 4 year field-initiated research, sponsored by the National Institute on Disability and Rehabilitation Research, compares conventional CR programmes with a low-intensity CR programme that simulates elements of work (job-simulated CR programme) in terms of return to work (RTW) and physiological conditioning. The effect of training on physical capabilities of patients participating in the job-simulated CR programme was also of equal interest. Method : Thirty patients (15 bypass and 15 angioplasty; 15 males and 15 females) participated in a conventional CR programme (control group). The job-simulated CR programme included 15 male and 2 female bypass and angioplasty patients (experimental group). Patients in the control group underwent regular aerobic exercise training (treadmill and bicycle). Experimental group patients participated in a series of low-intensity exercises such as progressive time exercises, flexibility exercises, and dexterity exercises. Results : All patients participating in the low-intensity job-simulated CR programme returned to the same job they held at the onset of myocardial infarction (MI). In contrast, only 60% of the control group patients returned to work; at least one-third of these did not go back to the same job they held at the onset of MI. Patients in both groups achieved the same level of physiological conditioning. The physical functional capabilities of the experimental group patients improved significantly throughout training. Conclusion : The results of this field-study lead to the conclusion that a low-intensity phase II cardiac rehabilitation programme that simulates elements of work may be far superior to conventional endurance exercise-based cardiac rehabilitation programmes in terms of returning patients to work. Such a programme also strengthens patients, improving their physical capabilities, without compromising their physiological conditioning.

Effective Worksite-Based Disability Management Programs

This chapter provides a comprehensive overview of effective worksite-based disability management programs. The basic principles of disability management are reviewed, emphasizing the direct involvement of the employer, the disabled worker, and other worksite representatives. The importance of “early intervention” as a key to effective disability management outcome is emphasized. The merits of the “therapeutic” worksite are discussed and contrasted with traditional clinical interventions and rehabilitation programs. Disability management is conceptualized at the clinical, organizational, and statutory levels. Each of these three levels is reviewed in terms of its relative importance to the injured worker, the employer, and the community.

Disability management and the cardiac rehabilitation patient: Job simulation and transitional work strategies

Medical advances and treatment interventions among patients with coronary heart diseases have not resulted in more timely return to work outcomes among cardiac rehabilitation programs. This article reviews vocational rehabilitation outcomes among persons with coronary heart disease, and the importance of employer-based disability management concepts. Job simulation, transitional work strategies, and ergonomic job site modifications, when integrated within the cardiac rehabilitation protocol, may yield promising results. The article discusses an experimental research project at the University of Cincinnati Medical Center that addresses worker-work environment interaction, encourages direct employer involvement, and promotes employer accommodation under the Americans with Disabilities Act.

Cardiac rehabilitation : potential for ergonomic interventions with special reference to return to work and the Americans with Disabilities Act

This paper briefly reviews the contemporary cardiac rehabilitation process and highlights its limitations. It argues that, in order to improve return-to-work chances, cardiac rehabilitation should focus on simulating actual work conditions. The role of ergonomics in the cardiac rehabilitation process is also outlined. Finally, the current impediments to early return to work are identified and corrective actions are suggested.