Journal of Occupational Rehabilitation, Vol. 15, No.

4, December 2005 (

C 2005)

DOI: 10.1007/s10926-005-8034-z

A Developmental Conceptualization of Return to Work

Amanda E. Young,1,5 Richard T. Roessler,2 Radoslaw Wasiak,1
Kathryn M. McPherson,3 Mireille N. M. van Poppel,4 and J. R. Anema4

Introduction: Although return to work (RTW) is a phenomenon that has been researched for
many years, our ability to understand and improve outcomes is still limited. As an avenue
for advancing the field, this paper presents an alternative way of thinking about RTW.
Method: The conceptualization was constructed based on a review of the literature and
the comments of RTW and workers’ compensation researchers. Results: RTW is presented
as an evolving process, comprising four key phases: i.e., “off work,” “work re-entry,”
“retention,” and “advancement.” In addition, multiple phase-specific outcomes that may
be used to evaluate RTW success are advanced. Conclusion: Broadening thinking about
RTW to take into consideration the complexities of its developmental nature holds promise
for understanding and improving RTW, as it not only clarifies the importance of incremental
milestones, but also facilitates intervention choice and evaluation.
KEY WORDS: RTW; outcomes; stakeholders; assessment; work disability.

INTRODUCTION

The need to further the understanding of return to work (RTW) following work
disability is evidenced by several important realizations: first, rising health care costs re-
ported by business and industry worldwide (1–3) underscore the significant economic
impact of illness and injury; second, employment rates of people with disabilities remain
at unacceptably low levels, with a recent US poll (4) indicating a 43% employment dif-
ferential when comparisons were made between a random sample of adults with disability
(35% employed) and a random sample of the general adult population (78% employed);

1 Center for Disability Research, Liberty Mutual Research Institute for Safety, 71 Frankland Rd, Hopkinton,
Massachusetts.
2 Department of Rehabilitation, Human Resources, and Communication Disorders, College of Education and
Health Professions, University of Arkansas, Fayetteville, Arkansas.
3 Centre for Physical Rehabilitation Research, Division of Rehabilitation and Occupation Studies, Auckland
University of Technology, Auckland, New Zealand.
4 Department of Public and Occupational Health, VU University Medical Center, Institute for Research in Extra-
mural Medicine, Amsterdam, The Netherlands.
5 Correspondence should be directed to Amanda E. Young, PhD, Center for Disability Research, Liberty
Mutual Research Institute for Safety, 71 Frankland Rd, Hopkinton, MA, 01748, USA; e-mail: amandae.
[email protected].

557
1053-0487/05/1200-0557/0

C 2005 Springer Science+Business Media, Inc.
558 Young et al.

third, a detailed understanding of the long-term outcomes of people affected by work dis-
ability has not yet been achieved (5–7); and fourth, because RTW can be a long and resource
consuming process, intermediary information is often needed to determine if the individual
is on the path to success and likely to achieve a good outcome (8).
Although RTW following work disability has been a focus of clinical practice and
academic research for many years, the extent to which we are able to predict, understand
and facilitate good outcomes is still limited (9). A partial explanation for this may be that, to
date, much of the research addressing RTW has focused on characteristics of work disability
(e.g., time off or performance deficits), rather than the actions associated with successful
work resumption. Further, the sustainability, quality and appropriateness of outcomes has
not been comprehensively addressed.
The majority of early RTW research assumed a high level of medical determinism
and a linear progression of events. Work status was viewed as being dependent upon the
nature and severity of a clinical condition, and the ability to return to employment was
viewed as directly related to the trajectory of recovery. Studies tended to characterize dis-
ability as having an acute onset with associated work loss and either prompt or delayed
resolution of both symptoms and disability. In some cases, workers have been character-
ized by clinical and disability stage (10). As the field advanced, it was realized that the
situation is usually much more complex, with varying patterns of appearance and resolu-
tion of symptoms, occurring loosely associated with patterns of work disability (11,12).
The importance of environment and accommodations in modifying these relationships was
recognized and research demonstrated the independence of clinical course and work status
in musculoskeletal, cardiac, and other disorders (11,13). Indeed, thinking has moved so far
away from medical determination, such that early resolution of medical concerns with a
subsequent focus on treating work disability as a separate and non-medical issue is now an
accepted strategy for achieving better RTW outcomes (14–16).
Along with recognizing the non-medical components of work disability, recent stud-
ies have found support for the notion that RTW is an evolving process (17,18) that is
influenced by different factors at different times (19); however, a developmental approach
has infrequently been taken in RTW research. While several longitudinal studies of work-
related musculoskeletal conditions have attempted to capture a wide range of outcomes,
researchers have tended to distinguish only between those working and those out of work
at follow-up (20–22). As such, it is difficult to differentiate between those who are still
transitioning to stable employment and those who have achieved vocational stability. In
addition, many of the subtleties of the RTW process, such as a return to graduated duties,
are missed (23). Although mental-health and psychiatric-rehabilitation research has moved
towards a staged approach (24), a comprehensive conceptualization of the developmental
nature of RTW has not been advanced.
In this paper, RTW is discussed as a developmental and dynamic process involving
multiple phases and encompassing a range of actions and related outcomes that are of
varying interest to stakeholder groups. Based on this line of thinking, a new conceptual
approach for defining and assessing RTW is advanced. The approach argues for the impor-
tance of assessing outcomes appropriate to not only the event of resuming employment, but
also to events prior to and following work resumption. The approach is explored in terms
of its ability to address stakeholder’s questions, and its implications for RTW research are
discussed.
Developmental Conceptualization of Return to Work 559

THE PROPOSED CONCEPTUALIZATION

The proposed conceptualization represents a broad view of RTW, beginning with out-
comes of importance while the worker is off work and extending to include outcomes rele-
vant to work re-entry, maintenance and advancement. When developing the conceptualiza-
tion, we, RTW researchers from Europe, North America and Australasia with backgrounds
in health and rehabilitation psychology, economics, vocational rehabilitation, occupational
medicine, and epidemiology, drew on the language and ideology contained within the
World Health Organization’s International Classification of Functioning, Disability and
Health (ICF) (25). We adopted this approach as we felt doing so would facilitate a broader
understanding of meaning that would ideally result in the improved comprehension and
comparability of RTW research.
As a first step towards achieving our aims, it is necessary to establish a shared
understanding of key terms:

• Work Disability: Work disability is the result of a condition that causes a worker
to miss at least one day of work and includes time off work as well as any ongoing
work limitations. Conditions resulting in work disability may be either traumatic
or non-traumatic in etiology; thus, this discussion is applicable to individuals with
acute injuries and/or chronic conditions such as arthritis or diabetes.
• RTW: While the term RTW is commonly used, the extent to which it has a shared
meaning is surprisingly small. An explanation for this may be that while RTW can
be an outcome (e.g., the event of resuming work), it is also a process beginning
with the initial steps of functional recovery and concluding with achieving full
vocational potential. In this paper, when RTW is used without a qualifier (i.e.,
stakeholder, process, outcome, goal, etc.), it refers to RTW as a phenomenon
encompassing both the process and associated outcomes.
• RTW Stakeholder: For the purpose of this paper, a RTW stakeholder is a person,
organization or agency that stands to gain or lose based on the results of the
RTW process. Consistent with our earlier work (8), five stakeholder groupings
are referred to: workers, employers, health-care providers, payers and society (for
further discussion of these groups, their motivations, interests, and concerns please
see our other paper contained within this issue).
• RTW Goal: For the purpose of this exercise, a RTW goal is viewed as a mutually
acceptable RTW target. In the majority of cases the RTW goal will be a safe,
sustainable and timely return to the pre-injury employer at pre-injury levels of
productivity and wages; however, in other cases, an alternative RTW goal may be
set. RTW goals are not assumed static; indeed the RTW process may include goal
review and change based on information that becomes available during the RTW
process.
• RTW Process: This term refers to the process workers go through in order to
reach, or attempt to reach, their final RTW goal. The RTW process is thought of as
encompassing a series of events, transitions and phases and includes interactions
with other individuals and the environment. The process begins at the onset of
work disability and concludes when a satisfactory long-term outcome has been
achieved.
560 Young et al.

• RTW Outcome: This term describes a measurable characteristic of the workers’

RTW status or experience. Outcomes can occur throughout the process and include
such variables as employment status, productivity, job satisfaction, promotion and
satisfaction with disability management activities.

Along with applying the ideology contained within International Classification of

Functioning (ICF), the proposed conceptualization draws on competent role performance
and career development theory. Competent role performance theory (26), when applied
to RTW, would suggest that workers pass through a series of phases when returning to
work including: experiencing and coping with injury or chronic illness, being off work,
reentering work, retaining the job, and advancing in the position. These role performance
phases are compatible with the stages of normative vocational development (i.e., establish-
ment, maintenance, advancement, and retirement) depicted in career development theories
(27,28).
Drawing on these role performance and career models, we developed a dynamic view
of RTW in which a work-disabling condition precipitates a cycle that places the worker in
an off-work phase during which at least partial physical recovery is needed before work re-
entry can be attempted. Once the individual has initiated work re-entry, there is a period of
adjustment and determination with regards to the worker’s ability to maintain employment
and perform satisfactorily. Once work has been re-established, issues of work retention
(or maintenance) and advancement arise. Reflecting this line of thought, the argument is
made that RTW consists of four key phases: off work, work re-entry, maintenance and
advancement. A description of each of these phases follows, and a representation of the
developmental nature of RTW is contained within Fig. 1.
Phase 1—Off Work: This phase begins the first day the worker is off work due to
his/her condition. At no time during this phase is the worker back at work, either in his
or her pre-injury or alternative capacity; however, it should be noted that the worker may
not be work disabled for this entire phase as there may be other reasons why work re-entry
is delayed (e.g., retraining or the lack of a suitable position) or not pursued (e.g., early
retirement). The off work phase concludes when a suitable RTW option is available and
the worker is about to attempt work re-entry.
Phase 2—Re-Entry: During this phase the worker recommences work at either his or
her pre-injury workplace or at some alternative worksite and stakeholders go through the
process of determining if and how work can be undertaken in a way that is satisfactory to
all parties. During this phase, performance will likely be monitored and the RTW goal may
be reassessed. This phase incorporates adapting to the work role and concludes when the
worker begins working at goal RTW status.
Phase 3—Maintenance: During this phase, the worker strives to maintain goal status
and may consider his or her desires for advancement. This phase ends when the worker
decides to pursue advancement.
Phase 4—Advancement: During this phase the worker seeks advancement, may qualify
for higher-level job tasks and responsibilities and ideally attains promotion. The individual
may seek employment options external to his/her initial post-injury employer, and may
even return to being “off work” (i.e., Phase 1) in order to gain qualifications needed for
advancement.
Following promotion, the worker may cycle through the maintenance and advancement
phases and finally end in the “off work” phase (i.e., retirement). Although the phases have
Developmental Conceptualization of Return to Work 561

Fig. 1. The developmental nature of RTW.

been described sequentially, workers may move between phases in a non-linear fashion
(designated by the dashed lines in Fig. 1). As an example, an unsuccessful attempt to
resume working may result in the person returning to the off-work phase. As such, the
proposed conceptualization is applicable to the analysis of recurrent work disability.

MEASURING RTW

One of the most important implications of this way of thinking about RTW is that
it allows for the understanding that as the worker progresses through the RTW process,
outcomes of interest change. Early on, the focus is likely to be on the individual’s ability
562 Young et al.

to recommence working, and outcomes pertaining to functional abilities and employment

seeking behaviors are likely to be of greatest concern. In addition, outcomes related to
the individual’s motivation to recommence work are likely to be of particular importance.
During the re-entry phase, questions arise about the process of reintegration: whether the
disabling condition is exacerbated by work activities, whether the employer can accommo-
date the needs of the worker, and how the worker’s return to the workplace is influencing
organizational climate. Success in the re-entry phase depends very much upon establishing
a good match between worker capabilities and job requirements (29). If such a match is
not established, the employee may be unable to progress to later RTW phases. Outcomes
likely to be important during work re-entry include job performance, disability recurrence,
and coworker and supervisor interactions.
In the maintenance phase, the sustainability of the position becomes of prime im-
portance. Career theorists have described the maintenance phase as a time when the key
questions relate to how the worker interacts and performs within the workplace. Dix and
Savickas (30) and Super, Savickas and Super (31) have argued that retention of employment
requires adapting “to the organizational culture and achieving a satisfactory level of po-
sition performance,” relating “effectively to co-workers and maintaining productive work
habits,” and moving “toward the next promotion within the current organization and plan-
ning future career moves” (30, p. 94). Critical outcomes during the retention phase relate
to workers’ capacity to settle into the job, with examples including their ability to perform
duties satisfactorily, their psychosocial reintegration into the workplace, their capacity to
achieve goal productivity levels over the long term, and their demonstrated potential for
advancement.
In the advancement phase, achieving career potential and long-term success come to the
fore. Research has identified five categories of challenges within the advancement phase,
specifically 1) keeping up with new developments, technology, advances, and changes;
2) clarifying future directions and goals and planning accordingly; 3) making the effort
to hold on to one’s current position; 4) setting and attaining continuing education goals;
and 5) shifting focus on the job by developing new ideas, expanding responsibilities,
and/or assuming administrative or management tasks (32). Employers and employees are
likely to be the primary stakeholders in the advancement phase, as they attempt to work
out mutually beneficial long-term employment relationships; however, society also has
an interest in individuals achieving their vocational potential. Outcomes pertinent to the
advancement phase include improvements in the worker’s responsibility and remuneration
levels, completion of continuing education and career development programs, and presence
of short and long-term career goals.
The end of each RTW phase marks the achievement of important RTW outcomes:
the ability to attempt work re-entry, ability to perform satisfactorily, ability to maintain
employment and ability to advance in one’s career. As such, completion of each phase
can be seen as a milestone upon which to judge a worker’s progress towards achieving
the mutually agreed upon RTW goal. If the worker has achieved the RTW goal and
there is satisfaction on the part of all stakeholders, further action is not required and the
RTW may be considered complete. However, if there is dissatisfaction on the part of any
stakeholder, strategies can be put in place to address the mismatch. If the worker has not
achieved his or her goal, an assessment may be made of his or her current actions and
prior achievements, and determination may be made with regards to the satisfactoriness
Developmental Conceptualization of Return to Work 563

of the individual’s progression. Again, if the individual’s progress is deemed satisfactory,

additional intervention may not be required; however, if progress appears stalled, barriers
can be identified and measures can be taken to facilitate goal achievement.
While in this paper RTW is described as a comprehensive and potentially lengthy
process, it should be noted that it is not expected that all stakeholders will be equally
interested in the outcomes associated with each RTW phase. For example, while workers
may have concerns about advancement issues, health care providers may have little interest
in outcomes relevant during this phase. Similarly, within phases, outcomes of interest are
likely to differ depending on stakeholder perspective. It is also not suggested that any one
party is responsible for the underwriting of interventions across all phases of the process;
rather, the purpose of this line of thinking is to highlight that maximum return from RTW
efforts requires attention to and assessment of employment maintenance and advancement
outcomes.

APPLYING THE CONCEPTUALIZATION

An analysis of stakeholders’ RTW motivations, interests and concerns (8) suggests

several conclusions. First, there is general agreement that a safe, sustainable and timely
return to productivity is desirable. In addition, while individual variation occurs, most
stakeholders are interested in knowing the answers to the following questions: What is the
worker’s potential for RTW goal attainment? Is the worker progressing towards achieving
the RTW goal? What might be done to improve the chances of success? Is attaining the RTW
goal likely to be of net benefit? Was/is the RTW process being managed appropriately?
Building upon a) the proposed developmental conceptualization, b) the World Health
Organization’s (WHO) classification of activities and participation (25) and c) knowledge
regarding what stakeholders want to know about a worker’s RTW (8), we constructed a
taxonomy of actions and associated outcomes for each of the four phases of RTW (see Fig. 2)
and suggest that this may be used to address stakeholders’ RTW questions. By applying
a multi-phase view of RTW, stakeholders’ questions can be addressed at any phase of the
RTW process through the assessment of the key actions and associated outcomes.
The RTW actions listed in the taxonomy were developed based on the ICF’s domains
of activities and participation, which includes reference to work, but does not go into detail
nor specifically address RTW. Continuing with the ICF framework, it is suggested that
the various RTW actions can be qualified by performance and capacity; with performance
describing what the individual does in his or her current context, and capacity describing
the individual’s ability to execute a task or action (25). Performance may be understood
as a person’s “lived experience” within his or her actual contexts, including all aspects of
the physical, social and attitudinal world, whereas capacity aims to indicate the highest
probable level of functioning that a person may gain.
How the taxonomy may be used to guide research investigating stakeholders’ questions
about workers’ potential for and extent of goal attainment, and questions regarding the
satisfactoriness of the worker’s RTW progression, will now be discussed. Potential for
RTW goal attainment is synonymous with the worker’s ability to perform certain actions
and achieve certain outcomes. A list of such actions and outcomes is presented in Fig. 2,
with an illustration being that the individual would need to perform the action of searching
564 Young et al.

Fig. 2. Key RTW actions and associated outcomes.

for suitable work and achieve the outcome of having a suitable work option identified. If
the worker is unable to carry out the actions and achieve the milestone outcomes, his or her
potential for successfully resuming work is arguably small. To answer questions regarding
goal attainment, one must first determine the specific RTW goal. The worker’s employment
status, workplace, hours, duties, productivity, and remuneration (see Fig. 2) are compared
to the goal. If the worker is working at goal status, the safety, timeliness, and sustainability
of that status may then be assessed.
Developmental Conceptualization of Return to Work 565

Whether a worker is on the path to goal attainment can be evaluated through a review of
his/her RTW actions and related outcomes. If the individual is in the process of completing
an action, he or she may be considered to be on the path to goal achievement. One would
measure the satisfactoriness of progress based on timeliness of milestone achievements and
the likely net benefit of the return. For example, in the work re-entry phase, if the worker’s
past job proves to be a poor match (action—determine job suitability), a determination
needs to be made regarding whether or not duties can be changed (outcome—conclude that
job has potential to be suitable or not). If the job cannot be modified, then the worker would
need to move to the next set of actions and outcomes (i.e., seek alternative work).
The proposed way of thinking about RTW can also assist in addressing stakeholders’
questions regarding interventions needed to improve the probability of goal attainment,
the likely net benefit of the worker achieving his or her RTW potential, and adherence to
policies and procedures. A discussion of how this might be achieved follows.
By working sequentially through phase-specific actions and outcomes, one can identify
roadblocks to achieving the RTW goal. The WHO (25) concepts of capacity (i.e., ability to
execute an action in a standardized environment) and performance (i.e., ability to execute
an action in the individual’s life situation) may be applied to determine if the individual is
limited by personal or environmental characteristics, or a combination of both. Measuring
what can be done to facilitate goal attainment can be accomplished by a comparison of
an individual’s RTW action capacities and performance. If capacities are greater than
performance, then it may be said that some aspect of the individual’s context, including
the way he or she is interacting with it, is limiting his or her success. Identifying the
specific contextual factors limiting success may be guided by the WHO’s classification of
environmental and personal factors thought to influence disability outcomes (25).
Although resources are commonly considered in monetary terms, they may be more
broadly conceived as all the assets (including time, money, reputation, public image, life
satisfaction, health, etc.) that stakeholders gain from, or expend on RTW. In some cases,
significant resource expenditure will be required before a return is achieved. While expen-
diture on work resumption is likely to be high in the early phases of RTW and return on
investment may be low, in the case of a successful RTW, this trend will likely reverse as
the worker moves into more advanced phases. In some cases it may take some time before
the benefits of RTW outweigh the costs; however, by taking a far-sighted approach the
justification of resource expenditure in the short-term may be more easily achieved.
Throughout the RTW process stakeholders have obligations and procedures for RTW
management. For example, a number of stakeholders have responsibility to either offer
or monitor legally mandated services in the off work and work re-entry phases. In the
retention and advancement phases, adherence to policies addressing accommodations and
career development for employees is important. Taking a phased approach to assessment
has the potential to identify where guideline adherence might be lacking and result in
opportunities to mitigate problems before they escalate.

IMPLICATIONS FOR RTW RESEARCH

The proposed conceptualization has a number of implications for RTW research.

One of the most important is that it may enable discoveries beyond those that can be
achieved with the use of less comprehensive models. As has been found in other areas of
rehabilitation research, broadening the scope has lead to significant advancements including
566 Young et al.

the realization that a disease/pathology cure does not always indicate the best outcome for
the individual (33). Further, a wider perspective highlighted negative outcomes that were
unrecognized when medical “cure” was viewed as the primary treatment goal (e.g., low
quality of life in medically successful dialysis) (34). Similarly, it has been said that brain
injury research was limited for many years by the use of imprecise injury severity criteria
(i.e., mild, moderate, and severe) without a clear understanding of what those categories
constituted (35,36). Such realizations have contributed to efforts to facilitate a broader
approach, including the introduction of ICIDH and now the ICF, extending the range of
outcomes evaluated beyond pathology and impairment. Arguably, this has resulted in many
advances in the understanding of health, disability and the factors impacting upon them;
indeed, the ICFDH has been called one of the greatest advances in rehabilitation in recent
years (37).
The proposed way of thinking about RTW also has implications for the interpretation
of past research and raises questions regarding the satisfactoriness of observed outcomes.
As has been discussed, for some persons, being out of work, either in the long or short
term, may be an acceptable outcome; however, this has not been commonly reflected in
RTW research. Similarly, a return to a position that is less than the stakeholder’s goal may
not be a truly positive outcome. The proposed way of thinking also highlights the potential
applicability of other areas of research to the investigation of RTW; in particular, the career
development and quality of life literature may prove insightful.
The purpose of presenting the proposed conceptualization was to advance a framework
for the conduct of RTW research and suggest additional RTW outcome measures. While it is
hoped that what is proposed will facilitate the understanding of RTW, it is not recommended
that the conceptualization be viewed as a complete model of RTW, as further research and
development is required before it could be regarded as such. In particular, research is
needed to determine whether the conceptualization is consistent with the nature of RTW,
and studies are needed to confirm the exact nature of each of the phases and the types
of RTW outcomes implicit within each phase. Other important and related questions for
further research could include: Does conceptualization provide a useful framework for
existing RTW outcome measures? Does it facilitate discussion of the differences as well
as the similarities in outcomes sought by different stakeholders at different points in time?
How does the framework’s use affect the planning and success of disability management
interventions? The applicability of this approach to those who are affected by conditions that
do not result in lost time is unclear; however, it would seem that many of the issues would
be similar. While normative career-development theory has been applied, and it would
seem that the process of career development is quite similar to people not experiencing
work disability, the extent to which work disability results in a different pattern of career
progression and/or achievement is something that requires further investigation.
A further research task would be to elaborate the phases of RTW in terms of outcomes
of importance to stakeholder groups. To achieve this, researchers could draw on the existing
research literature and gather input from expert groups. In gathering these stakeholder data,
it would be important to determine the priority of each outcome from the perspective of
different stakeholders as it is reasonable to believe that stakeholders may differ in their
opinions regarding both the existence and priority of specific RTW outcomes across the
phases. An example of different views of outcomes (existence and priority) comes from
recent client-centered research in injury/illness rehabilitation in which employers’ goals for
Developmental Conceptualization of Return to Work 567

a safe, sustainable and timely return to productivity may conflict with workers’ goals for a
sense of assurance that RTW efforts would not result in recurrence of the work disability
or in significant barriers to other life goals (38). The extent to which this conflict occurs,
and the impact it has on outcome, is a topic worthy of further research.
Although the ICF’s concepts of activity, participation, capacity, performance and con-
text were called upon when discussing how the taxonomy may be used to assess RTW, it
is likely that additional insight can be gained from the application of the ICF framework.
In particular, the concepts of activity limitations (i.e., the difficulties an individual expe-
riences in executing activities relative to a generally accepted population standard) and
participation restrictions (i.e., the difficulties experienced in context relative to a generally
accepted population standard) may be useful when assessing the timeliness and satisfac-
toriness of outcomes. For this reason, researchers planning to use or adapt the proposed
conceptualization are encouraged to also consult the ICF.

CONCLUSION

RTW is a complicated and evolving process that can be viewed from a variety of
perspectives. In this article a conceptualization of RTW has been offered that is more
comprehensive than has traditionally been used in RTW research. What is presented can be
viewed as a step towards the elaboration of a taxonomy of RTW outcomes that represents
both a broader way of thinking about RTW and an integration of additional outcome
measures. Our hope is that what is proposed stimulates research that reflects RTW’s complex
and developmental nature, as it is felt that taking this approach has the potential to result in
better outcomes for all.

REFERENCES

1. Chandler D. Constructing return to work programs: Building for better returns. In: Workers’ Compensation:
Containing costs and managing outcomes—A PERI Symposium 2003. Fairfax, VA: Public Entity Risk
Institute, 2003.
2. Creen M. Best practices for disability management. J Ontario Occup Health Nurses Assoc 2002; Winter:
4–7.
3. Williams C, Reno V, Burton JF, Jr. Workers’ compensation: Benefits, coverage, and costs, 2001. Washington,
DC: National Academy of Social Insurance, 2003.
4. Humphrey T. 2004 N.O.D./Harris survey. New York: Harris Interactive Inc. 2004.
5. Biddle J. Estimation and analysis of long-term wage losses and wage replacement rates of Washington state
workers compensation claimants. Olympia: Department of Labor and Industry, 1998.
6. Boden LI, Galizzi M. Economic Consequences of workplace injuries and illnesses: Lost earnings and benefit
adequacy. Am J Ind Med 1999; 36: 487–503.
7. Reville R, Boden L, Biddle J. Comparing Compensation Adequacy: Workers’ Compensation Permanent
Disability Benefits in Five States. Santa Monica: RAND, 2005.
8. 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 Rehabil 2005; 15: 557–
568.
9. Pransky G, Gatchel R, Linton S, Loisel P. Improving return-to-work research. J Occup Rehabil 2005; 15:
453–457.
10. Krause N, Dasinger LK, Deegan LJ, Rudolph L, Brand RJ. Psychosocial job factors and return-to-work after
compensated low back injury: A disability phase-specific analysis. Am J Ind Med 2001; 40: 374–392.
11. Vingard E, Mortimer M, Wiktorin C, Pernold RPTG, Fredriksson K, Nemeth G, et al. Seeking care for low
back pain in the general population: A two-year follow-up study—Results from the MUSIC-Norrtalje Study.
Spine 2002; 27: 2159–2165.
568 Young et al.

12. Lame IE, Peters ML, Vlaeyen JW, Kleef M, Patijn J. Quality of life in chronic pain is more associated with
beliefs about pain, than with pain intensity. Eur J Pain 2005; 9: 15–24.
13. Chernen L, Friedman S, Goldberg N, Feit A, Kwan T, Stein R. Cardiac disease and nonorganic chest pain:
Factors leading to disability. Cardiology 1995; 86: 15–21.
14. Indahl A, Haldorsen EH, Holm S, Reikeras O, Ursin H. Five-year follow-up study of a controlled clinical
trial using light mobilization and an informative approach to low back pain. Spine 1998; 23: 2625–2630.
15. Mueser KT, Torrey WC, Lynde D, Singer P, Drake RE. Implementing evidence-based practices for people
with severe mental illness. Behav Modif 2003; 27: 387–411.
16. Loisel P, Abenhaim L, Durand P, Esdaile J, Suissa S, Gosselin L, et al. A population-based, randomized
clinical trial on back pain management. Spine 1997; 22: 2911–2918.
17. 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 Rehabil 2002; 12:
233–256.
18. Krause N, Ragland DR. Occupational disability due to low back pain: A new interdisciplinary classification
based on a phase model of disability. Spine 1994; 19: 1011–1020.
19. Durand MJ, Loisel P, Hong QN, Charpentier N. Helping clinicians in work disability prevention: The work
disability diagnosis interview. J Occup Rehabil 2002; 12: 191–204.
20. Rudolph L, Dervin K, Cheadle A, Maizlish N, Wickizer T. What do injured workers think about their medical
care and outcomes after work injury? J Occup Environ Med 2002; 44: 425–434.
21. Keogh JP, Nuwayhid I, Gordon JL, Gucer PW. 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.
22. Pransky G, Benjamin K, Hill-Fotouhi C, Fletcher KE, Himmelstein J, Katz JN. Work-related outcomes in
occupational low back pain: A multidimensional analysis. Spine 2002; 27: 864–870.
23. Wasiak R, Pransky G, Verma S, Webster B. Recurrence of low back pain: Definition-sensitivity analysis using
administrative data. Spine 2003; 28: 2283–2291.
24. Becker DR, Smith J, Tanzman B, Drake RE, Tremblay T. Fidelity of supported employment programs and
employment outcomes. Psychiatr Serv 2001; 52: 834–836.
25. World Health Organization. International Classification of Functioning, Disability and Health.
In: http://www3.who.int/icf/icftemplate.cfm?myurl=introduction.html%20&mytitle=Introduction. Geneva:
WHO, 2002.
26. Keough J, Fisher T. Occupational-psychosocial perceptions influencing return to work and functional perfor-
mance of injured workers. Work 2001; 16: 101–110.
27. Savickas M. The theory and practice of career construction. In: Brown S, Lent R, eds. Career development
and counseling: Putting theory and research to work. New York: Wiley, 2005, pp. 42–70.
28. Savickas M. Career construction. A developmental theory of vocational behavior. In: Brown D, Associates,
eds. Career choice and development (4th ed). San Francisco: Jossey Bass, 2002.
29. Buys N, Renne J. Developing relationships between vocational rehabilitation agencies and employers. Rehabil
Couns Bull 2001; 44: 95–103.
30. Dix J, Savickas M. Establishing a career: Developmental tasks and coping responses. J Vocat Behav 1995;
47.
31. Super D, Savickas M, Super C. The life-span, life-space approach to careers. In: Brown D, Brooks L,
Associates, eds. Career choice & development (3rd ed). San Francisco: Jossey-Bass, 1996, pp. 121–187.
32. Williams C, Savickas M. Developmental tasks of career maintenance. J Vocat Behav 1990; 36: 166–175.
33. Higginson IJ, Carr AJ. Measuring quality of life: Using quality of life measures in the clinical setting. BMJ
2001; 322: 1297–1300.
34. Armstrong D, Ogden J, Lilford R, Wessely S. Quality of life as an innovative health technology. Heslington,
York: Economic and Social Research Council, 2005.
35. Almli CR, Finger S, eds. Early brain damage. New York: Academic Press, 1984.
36. Wade D. Measurement in neurological rehabilitation. New York: Oxford University Press, 1992.
37. Wade D, Halligan P. New wine in old bottles: The WHO ICF as an explanatory model of human behaviour.
Clin Rehabil 2003; 17: 349–354.
38. Levack W, McPherson K, McNaughton H. Success in the workplace following traumatic brain injury: Are
we evaluating what is most important? Disabil Rehabil 2004; 26: 290–298.