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Return to Work After Injury: A Review of Evidence Regarding Expectations and Injury Perceptions, and their Influence on Outcome


Introduction Work disability after injury is a complex problem, and there remains a lack of clarity about what factors are most influential on whether or not someone will experience difficulty returning to work. Increasingly, expectations and injury perceptions are being explored as potential factors in work disability, because of their role in influencing behaviours. Methods This paper reviewed the literature regarding how expectations (regarding injury recovery and return to work) and injury perceptions relate to return to work outcome. A wide range of electronic journal databases were searched, and identified articles were critically appraised to assess quality and relevance. Results were then synthesised and discussed in relation to the evidence available regarding the role of expectations and injury perceptions in return to work, and implications for practice and further research. Results Findings showed that evidence regarding to how both expectations and injury perceptions contribute to return to work outcome is limited. Some suggestions for application to practice are made. Methodological issues and key points to consider for future research are discussed. Conclusions While in general little is known about how much expectations and injury perceptions influence return to work outcome, it is clear that the issue requires further investigation. Key limits to current knowledge result from inadequate methods of measuring expectation/s, lack of clear definitions of ‘return to work outcome’ and differences in timeframes and populations. Never-the-less, there is promising evidence to suggest that, in particular, pain catastrophizing research is warranted due to its correlation with outcome and amenability to change.

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Appreciation is extended to Amanda E. Young for her comments on an early draft of this paper.

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Correspondence to Joanna Fadyl.



Table 5 Summary table—measurement of expectation
Table 6 Summary table—Outcome variable measurement

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Fadyl, J., McPherson, K. Return to Work After Injury: A Review of Evidence Regarding Expectations and Injury Perceptions, and their Influence on Outcome. J Occup Rehabil 18, 362–374 (2008).

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  • Expectation
  • Injury perception
  • Return to work
  • Pain catastrophizing
  • Fear-avoidance