Return-to-Work Activities in a Chinese Cultural Context

  • Andy S. K. ChengEmail author
  • Patrick Loisel
  • Michael Feuerstein


Introduction Several studies have been conducted in the West showing that return to work (RTW) coordination is a key element to facilitate RTW of injured workers and to prevent work disabilities. However, no study has been carried out to investigate the scope of RTW activities in China. The purpose of this study was to explore the views of key RTW stakeholders on necessary activities for RTW coordination. Methods A cross-sectional survey was conducted in Guangdong province of China. A three-tiered approach including focus group discussions and panel reviews was used to collect RTW activities, analyze the content validity, and classify domains. Descriptive statistics and intra-class correlation (ICC) were used to describe the importance of RTW activities and the degree of agreement on the classification of different domains. A Kruskal–Wallis test with subsequent post-hoc analysis using multiple Mann–Whitney U tests was carried out to check for any differences in the domains of different RTW activities among RTW stakeholders. Results The domains of RTW activities in China were similar to those in the West and included workplace assessment and mediation, social problem solving, role and liability clarification, and medical advice. Good agreement (ICC: 0.729–0.844) on the classification of RTW activities into different domains was found. The domains of the RTW activities of healthcare providers differed from those of employers (P = 0.002) and injured workers (P = 0.001). However, there was no significant difference between employers and injured workers. Conclusions This study indicated that differences among stakeholders were observed in terms of areas of relative priority. There is a clear need for research and training in China to establish a nation-wide terminology for RTW coordination, facilitate cross-provincial studies and work toward a more integrated system addressing the diverse perspectives of stakeholders involved in the RTW process.


Return-to-work activities Domains of coordination RTW stakeholders Chinese cultural context 



The authors would like to thank all those who took part in this study, especially Mr. Yan-Wen Xu from the Guangdong Provincial Work Injury Rehabilitation Centre who was the project coordinator and helped arrange the focus groups discussions, the panel reviews, and other administrative work during the study. This work was supported by the Work Disability Prevention CIHR Strategic Training Program, through the Canadian Institutes of Health Research (CIHR) grant(s) FRN: 53909.


  1. 1.
    Wikipedia. World population. Retrieved from 2010.
  2. 2.
    Escobar P. Guangdong, the unstoppable “world’s factory”. Asia Times Online. Retrieved from 2010.
  3. 3.
    Chen G. The constitution of work injury insurance system and the development of work injury rehabilitation in China. Proceedings of 2009 international seminar on work injury rehabilitation: challenges of 21st century occupational rehabilitation. Guangzhou, China; 2009.Google Scholar
  4. 4.
    Tian XB, Zhou XZ. Social security in China. Beijing: China Intercontinental Press; 2006.Google Scholar
  5. 5.
    Li Z. Realistic option for the work injury rehabilitation system in China. Proceeding of national symposium on work injury rehabilitation. Guangzhou, China; 2005.Google Scholar
  6. 6.
    China Labour Bulletin. Compensation for work-related injury and occupational disease in China. Retrieved from; 2009.
  7. 7.
    Young AE, Wasiak R, Roessler RT, McPherson KM, Anema JR, van Poppel MNM. Return-to-work outcomes following work disability: stakeholder motivations, interests and concerns. J Occup Rehab. 2005;15(4):543–56.CrossRefGoogle Scholar
  8. 8.
    Loisel P, Buchbinder R, Hazard R, Keller R, Scheel I, van Tulder M, Webster B. Prevention of work disability due to musculoskeletal disorder: the challenge of implementing evidence. J Occup Rehab. 2005;15:507–24.CrossRefGoogle Scholar
  9. 9.
    Franche RL, Krause N. Readiness for return to work following injury or illness: conceptualizing the interpersonal impact of health care, workplace, and insurance factors. J Occup Rehab. 2002;12:233–56.CrossRefGoogle Scholar
  10. 10.
    Szymanski E, Parker G, Ryan C, Nerz M, Trevino-Espinoza B, Johnston-Rodriguez S. Work and disability: basic constructs. In: Szymanski E, Parker R, editors. Work and disability. Austin, TX: Pro-ed; 2003.Google Scholar
  11. 11.
    Shaw WS, Huang YH. Concerns and expectations about returning to work with low back pain: identifying themes from focus groups and semi-structured interviews. Disabil Rehabil. 2005;27(21):1269–81.PubMedCrossRefGoogle Scholar
  12. 12.
    Keogh JP, Nuwayhid I, Gordon JL, Gucer P. The impact of occupational injury on injured worker and family: outcomes of upper extremity cumulative trauma disorders in Maryland workers. Am J Ind Med. 2000;38:498–506.PubMedCrossRefGoogle Scholar
  13. 13.
    Franche RL, Baril R, Shaw W, Nicholas M, Loisel P. Workplace-based return-to-work interventions: optimizing the role of stakeholders in implementation and research. J Occup Rehab. 2005;15(4):525–42.CrossRefGoogle Scholar
  14. 14.
    Williams RM, Westmorland M. Perspectives on workplace disability management: a review of the literature. Work. 2002;19:87–93.PubMedGoogle Scholar
  15. 15.
    Kenny DT. Employers’ perspectives on the provision of suitable duties in occupational rehabilitation. J Occup Rehab. 1999;9(4):267–76.CrossRefGoogle Scholar
  16. 16.
    Fisher TF. Perception differences between groups of employees identifying the factors that influence a return to work after a work-related musculoskeletal injury. Work. 2003;21:211–20.PubMedGoogle Scholar
  17. 17.
    Larsson A, Gard G. How can the rehabilitation planning process at the workplace be improved? A qualitative study from employers’ perspective. J Occup Rehab. 2003;13:169–81.CrossRefGoogle Scholar
  18. 18.
    Pransky G, Katz JN, Benjamin K, Himmelstein J. Improving the physician role in evaluating work disability and managing disability: a survey of primary care practitioners. Disabil Rehabil. 2002;24:867–74.PubMedCrossRefGoogle Scholar
  19. 19.
    Barrett J, Kirk S. Running focus groups with elderly and disabled elderly participants. Appl Ergonomics. 2000;31:621–9.CrossRefGoogle Scholar
  20. 20.
    Kitzinger J. The methodology of focus group: the importance of interaction between research participants. Sociol Health Illn. 1994;16:103–21.CrossRefGoogle Scholar
  21. 21.
    Krueger RA. Quality control in focus group research. In: Morgan DL, editor. Successful focus groups: advancing the state of the art. California: Sage; 1993. p. 65–85.Google Scholar
  22. 22.
    Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 3rd ed. Thousand Oaks, CA: Sage; 2000.Google Scholar
  23. 23.
    Shaw W, Hong QN, Pransky G, Loisel P. A literature review describing the role of return-to-work coordinators in trial programs and interventions designed to prevent workplace disability. J Occup Rehab. 2008;18:2–15.CrossRefGoogle Scholar
  24. 24.
    Portney LG, Watkins MP. Foundations of clinical research: application to practice. Prentice-Hall, NJ; 2000, pp. 560–7.Google Scholar
  25. 25.
    Stice BD, Dik BJ. Depression among injured workers receiving vocational rehabilitation: contributions of work values, pain, and stress. J Occup Rehab. 2009;19:354–63.CrossRefGoogle Scholar
  26. 26.
    Morse TF, Dillon C, Warren N, Levenstein C, Warren A. The economic and social consequences of work-related musculoskeletal disorders: the Connecticut Upper-Extremity Surveillance Project (CUSP). Int J Occup Environ Health. 1998;4(4):209–16.PubMedGoogle Scholar
  27. 27.
    Asmundson GJ, Norton GR, Allerdings MD, Norton PJ, Larson DK. Posttraumatic stress disorder and work-related injury. J Anxiety Disord. 1998;12(1):57–69.PubMedCrossRefGoogle Scholar
  28. 28.
    Kirsh B, McKee P. The needs and experiences of injured workers: a participatory research study. Work. 2003;21:221–31.PubMedGoogle Scholar
  29. 29.
    Kessler RC. The effects of stressful life events on depression. Annu Rev Psychol. 1997;48:191–214.PubMedCrossRefGoogle Scholar
  30. 30.
    Seff MA, Gecas V, Ray MP. Injury and depression: the mediating effects of self-concept. Soc Perspect. 1992;35(4):573–91.Google Scholar
  31. 31.
    Dawis RV, Lofquist LH. A psychological theory of work adjustment. Minneapolis, MN: University of Minnesota Press; 1984.Google Scholar
  32. 32.
    Jin K, Lombardi DA, Countney TK, Sorock GS, Li M, Pan R, Wang X, Lin J, Liang Y, Perry M. Patterns of work-related traumatic hand injury among hospitalised workers in the People’s Republic of China. Inj Prev. 2010;16:42–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Gold JE, d’Errico A, Katz JN, Gore R, Punnett L. Specific and non-specific upper extremity musculoskeletal disorder syndromes in automobile manufacturing workers. Am J Ind Med. 2009;52:124–32.PubMedCrossRefGoogle Scholar
  34. 34.
    Pransky G, Wasiak R, Himmelstein J. Disability system: the physician’s role. Clin Occup Environ Med. 2001;1:829–42.CrossRefGoogle Scholar
  35. 35.
    Schultz IZ, Crook J, Fraser K, Joy PW. Models of diagnosis and rehabilitation in musculoskeletal pain-related occupational disability. J Occup Rehab. 2000;10(4):271–93.CrossRefGoogle Scholar
  36. 36.
    Stowell AW, McGeary DD. Musculoskeletal injury: a three-stage continuum form cause to disability to decision. In: Schultz IZ, Gatche RJ, editors. Handbook of complex occupational disability claims: early risk identification, intervention, and prevention. New York: Springer; 2005.Google Scholar
  37. 37.
    Kelly M, Field D. Comments on the rejection of biomedical model in sociological discourse. Med Sociol News. 1994;19(3):34–7.Google Scholar
  38. 38.
    Hunt D, Zuberbier OA, Kozlowski A, Berkowitz J, Schultz IZ, Milner RA, Crook JM, Turk DC. Are components of a comprehensive medical assessment predictive of work disability following an episode of occupational low back trouble? Spine. 2002;27(23):2715–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Cocchiarella L, Turk MA, Andersson G. Improving the evaluation of permanent impairment. J Am Med Assoc. 2000;283:532–3.CrossRefGoogle Scholar
  40. 40.
    Tate D, Pledger C. An integrative conceptual framework of disability. Am Psychol. 2003;58:289–95.PubMedCrossRefGoogle Scholar
  41. 41.
    Olkin R, Pledger C. Can disability studies and psychology join hands? A new model of disability. Am Psychol. 2003;58:296–304.PubMedCrossRefGoogle Scholar
  42. 42.
    Waddell G, Burton AK. Concepts of rehabilitation for the management of low back pain. Best Pract Res. 2005;19(4):655–70.CrossRefGoogle Scholar
  43. 43.
    Zhuo DH. Education and training of the professionals in work injury rehabilitation. Proceedings of 2009 international seminar on work injury rehabilitation: challenges of 21st century occupational rehabilitation. Guangzhou, China; 2009.Google Scholar
  44. 44.
    Green-Mckenzie J, Parkerson J, Bernacki E. Comparison of workers’ compensation costs for two cohorts of injured workers before and after the introduction of managed care. J Occup Environ Med. 1998;40:568–72.PubMedCrossRefGoogle Scholar
  45. 45.
    Bernacki EJ, Tsai SP. Ten years’ experience using workers’ compensation case management system to control workers’ compensation costs. J Occup Environ Med. 2003;45(5):508–19.PubMedCrossRefGoogle Scholar
  46. 46.
    Shrey D, Lacerte M. Principles and practices of disability management in industry. Winter Park, FL: GR Press; 1995.Google Scholar
  47. 47.
    Amick BI, Habeck R, Hunt A, Fossel A, Chapin A, Keller R, Katz J. Measuring the impact of organizational behaviors on work disability prevention and management. J Occup Rehab. 2000;10(1):21–38.CrossRefGoogle Scholar
  48. 48.
    Bruyère S, Shrey D. Disability management in industry: a joint labor-management process. Rehabil Couns Bull. 1991;34(3):227–42.Google Scholar
  49. 49.
    Feuerstein M. A multidisciplinary approach to the prevention, evaluation, and management of work disability. J Occup Rehab. 1991;1(1):5–12.CrossRefGoogle Scholar
  50. 50.
    Shaw WS, Feuerstein M. Generating workplace accommodations: lessons learned from the integrated case management study. J Occup Rehab. 2004;14(3):207–16.CrossRefGoogle Scholar
  51. 51.
    Gates LB. The role of the supervisor in successful adjustment to work with a disabling condition: issues for disability policy and practice. J Occup Rehab. 1993;3:179–90.CrossRefGoogle Scholar
  52. 52.
    Shaw WS, Robertson MM, Pransky G, McLellan RK. Employee perspectives on the role of supervisors to prevent workplace disability after injuries. J Occup Rehab. 2003;13:129–42.CrossRefGoogle Scholar
  53. 53.
    Strunin L, Boden LI. Paths of reentry: employment experiences of injured workers. Am J Ind Med. 2000;38:373–84.PubMedCrossRefGoogle Scholar
  54. 54.
    Zhang J. The role of trade unions under the corporatist model. Theory Pract Trade Unions. 2001;1:1–6.Google Scholar
  55. 55.
    Sun CL. Protecting workers’ rights or serving the party: the way forward for China’s trade unions. China Labour Bulletin, 2009.Google Scholar
  56. 56.
    Brunarski D, Shaw L, Doupe L. Moving toward virtual interdisciplinary teams and a multi-stakeholder approach in community-based return-to-work care. Work. 2008;30(3):329–36.PubMedGoogle Scholar
  57. 57.
    Friesen MN, Yassi A, Cooper J. Return-to-work: the importance of human interactions and organizational structures. Work. 2000;17(1):11–22.Google Scholar
  58. 58.
    Loisel P, José-Durand M, Baril R, Gervais J, Falardeau M. Interorganizational collaboration in occupational rehabilitation: perceptions of an interdisciplinary rehabilitation team. J Occup Rehab. 2005;15(4):581–90.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Andy S. K. Cheng
    • 1
    Email author
  • Patrick Loisel
    • 2
  • Michael Feuerstein
    • 3
  1. 1.Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHung Hom, KowloonHong Kong
  2. 2.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  3. 3.Departments of Medical and Clinical Psychology and Preventive Medicine and BiometricsUniformed Services University of the Health SciencesBethesdaUSA

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