Journal of Occupational Rehabilitation

, Volume 20, Issue 3, pp 367–377 | Cite as

Do Clinicians Working Within the Same Context Make Consistent Return-to-Work Recommendations?

  • Yoko Ikezawa
  • Michele C. Battié
  • Jeremy Beach
  • Douglas GrossEmail author


Introduction Healthcare providers play important roles in the process of making return-to-work (RTW) recommendations, which have important consequences for injured workers and their employers. We studied the inter-rater reliability of RTW determinations between clinicians in a specific workers’ compensation setting. Methods Three case scenarios were given to clinicians working at one rehabilitation facility to examine consistency between clinicians in RTW recommendations. Additionally, we examined what information clinicians relied on to make decisions. Analysis included percentage agreement and other descriptive statistics. Results Thirty-six clinicians (13 physiotherapists, 10 occupational therapists, 8 exercise therapists, and 5 physicians) responded to the questionnaire. Subjects showed a high percentage agreement regarding RTW readiness on fracture and dislocation scenarios (97.2 and 94.4%, respectively), while agreement on a back pain scenario was modest (55.6%). In all cases, more than 50% of clinicians relied on biomedical information, such as physical examination. Conclusions Clinicians demonstrated a high level of agreement (>94%) when making RTW recommendations for injuries with clear pathology. However, a lower level of agreement (56%) was observed for back pain where the etiology of pain and disability is often more complex. Clinicians most commonly recommended RTW with restrictions, underlining the importance of workplace accommodations and modified duties in facilitating resumption of work.


Return-to-work recommendations Work disability prevention Reliability Workers’ compensation Musculoskeletal 



This research was financially supported by a grant from the Workers’ Compensation Board of Alberta. This research was conducted in partial fulfillment of Masters’ degree requirements for the lead author. Dr. Battié is supported by the Canada Research Chairs Program.


  1. 1.
    Talmage JB, Melhorn JM. A physician’s guide to return to work. Chicago, Ill: AMA Press; 2005.Google Scholar
  2. 2.
    Rainville J, Carlson N, Polatin P, Gatchel RJ, Indahl A. Exploration of physicians’ recommendations for activities in chronic low back pain. Spine. 2000;25(17):2210–20.CrossRefPubMedGoogle Scholar
  3. 3.
    Chibnall JT, Dabney A, Tait RC. Internist judgments of chronic low back pain. Pain Med. 2000;1(3):231–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Houben RM, Vlaeyen JW, Peters M, Ostelo RW, Wolters PM, Stomp-van den Berg SG. Health care providers’ attitudes and beliefs towards common low back pain: factor structure and psychometric properties of the HC-PAIRS. Clin J Pain. 2004;20(1):37–44.CrossRefPubMedGoogle Scholar
  5. 5.
    Houben RMA, Ostelo RWJG, Vlaeyen JWS, Wolters PMJC, Peters M, Stomp-van Den Berg SGM. Health care providers’ orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity. Eur J Pain. 2005;9(2 SPEC. ISS.):173–83.CrossRefPubMedGoogle Scholar
  6. 6.
    Englund L, Tibblin G, Svärdsudd K. Variations in sick-listing practice among male and female physicians of different specialties based on case vignettes. Scand J Prim Health Care. 2000;18(1):48–52.CrossRefPubMedGoogle Scholar
  7. 7.
    Rist PM, Freas DW, Maislin G, Stineman MG. Recovery from disablement: What functional abilities do rehabilitation professionals value the most? Arch Phys Med Rehabil. 2008;89(8):1600–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005;85:257–68.PubMedGoogle Scholar
  9. 9.
    Feinstein AR, Cicchetti DV. High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol. 1990;43(6):543–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Young AE, Roessler RT, Wasiak R, McPherson KM, Poppel MN, Anema JR. A developmental conceptualization of return to work. J Occup Rehabil. 2005;15(4):557–68.CrossRefPubMedGoogle Scholar
  11. 11.
    Waddell G. The back pain revolution. Edinburgh and New York: Churchill Livingstone; 1998.Google Scholar
  12. 12.
    Waddell G. Preventing incapacity in people with musculoskeletal disorders. Br Med Bull. 2006;77–78:55–69.CrossRefPubMedGoogle Scholar
  13. 13.
    Smart K, Doody C. The clinical reasoning of pain by experienced musculoskeletal physiotherapists. Man Ther. 2007;12(1):40–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Loisel P, Buchbinder R, Hazard R, Keller R, Scheel I, van Tulder M, et al. Prevention of work disability due to musculoskeletal disorders: the challenge of implementing evidence. J Occup Rehabil. 2005;15(4):507–24.CrossRefPubMedGoogle Scholar
  15. 15.
    Matheson LN, Isernhagen SJ, Hart DL. Relationships among lifting ability, grip force, and return to work. Phys Ther. 2002;82(3):249–56.PubMedGoogle Scholar
  16. 16.
    Oesch PR, Kool JP, Bachmann S, Devereux J. The influence of a Functional Capacity Evaluation on fitness for work certificates in patients with non-specific chronic low back pain. Work. 2006;26(3):259–71.PubMedGoogle Scholar
  17. 17.
    Gross DP, Battié M. Functional capacity evaluation performance does not predict sustained return to work in claimants with chronic back pain. J Occup Rehabil. 2005;15(3):285–94.CrossRefPubMedGoogle Scholar
  18. 18.
    Sheehan KM. E-mail survey response rates: a review. J Comput Mediat Commun. 2001;6(2). Accessed 5 Jan 2010.

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Yoko Ikezawa
    • 1
  • Michele C. Battié
    • 1
  • Jeremy Beach
    • 2
  • Douglas Gross
    • 1
    Email author
  1. 1.Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada

Personalised recommendations