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MSDs and health care professionals 44 5.3 Condition- specific interventions treatment of MSDs involving specialists, nurses, psychologists etc. is recognised. A survey by the Rheumatoid Arthritis Friendship Association found that the establishment of better links between different physicians and institutions was the number one improvement that patients wish to make to their medical care (Japan Rheumatoid Arthritis Friendship Association, 2010). The committee also recommended the production of comprehensive set of guidelines for clinicians to assist with early diagnosis and effective treatment of chronic pain, including pain caused by MSDs (MHLW Chronic Pain Investigative Committee, 2010). Whilst it is widely acknowledged that early intervention is an essential part of addressing the onset of MSDs and work-related absence caused by these conditions, there is still some way to go before people with MSDs are given the best possible support to remain in work or return to work. Specific barriers which remain to be overcome include: • Failure to disclose health conditions in time to receive the most efficient treatment;, • Certain employers’ lack of capacity to deal with sickness; • Insufficient employee awareness about MSD conditions and their management; and • Inconsistency of messages regarding the effectiveness of various workplace interventions or return-to-work programmes. For those with specific musculoskeletal conditions, speedy referral to an appropriate specialist for diagnosis and treatment is generally vital. Those with MSDs may experience numerous problems associated with long-term care, including long waits, failure to undertake a multidisciplinary approach, poor advice on pain management, and a lack of clear pathways for an integrated treatment. Notwithstanding this, there are a number of condition-specific interventions which have been shown to be effective in improving job retention and return to work. 5.3.1 Non-specific MSDs The primary focus of this report has been to examine the interventions and other factors which affect job retention, labour market participation and job quality among those with MSDs. As we have seen, there is evidence that physical impairment can represent a barrier to each of these aspects, but that many people – even those with serious and chronic incapacity – can and do lead full and fulfilling working lives. Since back pain and the majority of work-related upper limb disorders are not diseases to be cured, and there is very limited evidence that prevention is possible, it has been argued that the focus of treatment should be on returning to the highest or desired level of activity and participation, and the prevention of chronic complaints and recurrences (Burton, 2005; Bekkering et al., 2003) rather than on eradicating the cause of the problem or restoring the patient’s state of health to that before the onset of the condition. Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market
MSDs and health care professionals Whilst treatment to ease or relieve the symptoms of non-specific MSDs will always be a priority, medical intervention is not necessarily the only, or the best route to full recovery or sustainable management of the condition for the patients with non-specific MSDs. In fact, for non-specific conditions, an individual’s recovery and chances of returning to work can be adversely affected by ‘over-medicalising’ their condition. The limitations imposed by sick notes, statutory sick leave and formalised return to work programmes may serve to reinforce the ‘illness’ of the patient and can tie employers’ hands. Based on evidence that psychosocial factors are a determinant of chronicity and disability in those with back pain, there is a strong argument for reconceptualising this condition and its treatment, which has important lessons for other types of non-specific musculoskeletal pain (Burton, 2005). Waddell and Burton (2006b) summarise the challenge neatly in their work on vocational rehabilitation. They point out that, whilst many non-specific MSDs do not have clearly defined clinical features and have a high prevalence among the working age population, most episodes are resolved naturally, and most people with these conditions remain at work or return to work very quickly. According to Waddell and Burton, a focus on incapacity alone can be unhelpful: ‘..the question is not what makes some people develop long-term incapacity, but why do some people with common health problems not recover as expected? It is now widely accepted that biopsychosocial factors contribute to the development and maintenance of chronic pain and disability. Crucially, they may also act as obstacles to recovery and return to work. The logic of rehabilitation then shifts from dealing with residual impairment to addressing the biopsychosocial obstacles that delay or prevent expected recovery.’ (Waddell and Burton, 2006b, p.7) (bold in original text) The biopsychosocial model is an explanatory framework that recognises the importance of psychological and social factors in determining how those with MSDs cope with their conditions. It is now widely accepted that ergonomic, psychological and occupational-psychosocial factors all contribute to the development of non-specific MSDs, such as WRULDs. In some cases the patient risks entering a self-reinforcing cycle of incapacity, delayed recovery and even depression if their dominant response to pain is to ‘catastrophise’ it. Of course there may be many factors which affect an individual’s disposition to ‘catastrophise’, including personality, previous medical history, levels of family support or job satisfaction (Sullivan and D’Eon, 1990). According to the biopsychosocial model of disease, an effective treatment for non-specific MSDs has to address all the causes rather than concentrate on the affected body part. In particular, it is crucial to identify and tackle the psychological syndromes associated with MSDs, such as anxiety or depression. Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market 45
Page 1: Fit For Work? Musculoskeletal Disor
Page 4 and 5: Contents 4 1. Executive summary 6 2
Page 6 and 7: 1. Executive summary 6 The ‘Fit f
Page 8 and 9: Executive summary 8 the data that i
Page 10 and 11: 2. Introduction 10 2.1 The global b
Page 12 and 13: Introduction 12 2.3 International c
Page 14 and 15: Introduction 14 2.5 Structure of th
Page 16 and 17: Work and MSDs in Japan 16 Figure 3.
Page 18 and 19: Work and MSDs in Japan 18 3.2 Defin
Page 20 and 21: Work and MSDs in Japan 20 3.3 The i
Page 22 and 23: Work and MSDs in Japan 22 average t
Page 24 and 25: Work and MSDs in Japan 24 RA affect
Page 26 and 27: Work and MSDs in Japan 26 3.3.4 Spo
Page 28 and 29: Work and MSDs in Japan 28 3.4 Summa
Page 30 and 31: MSDs and government 30 4.2 MSDs: Po
Page 32 and 33: MSDs and government 32 of good heal
Page 34 and 35: MSDs and government 34 Figure 4.1.
Page 36 and 37: MSDs and government 36 deliver bett
Page 38 and 39: 5. MSDs and health care professiona
Page 40 and 41: MSDs and health care professionals
Page 50 and 51: 6. MSDs and employers 50 6.1 Costs
Page 52 and 53: MSDs and employers 52 6.2 The role
Page 54 and 55: MSDs and employers 54 Occupational
Page 56 and 57: MSDs and employers 56 The most freq
Page 58 and 59: MSDs and employers 58 levels of pai
Page 60 and 61: MSDs and employers 60 • Modified
Page 62 and 63: MSDs and employers 62 Box 2. Case s
Page 64 and 65: MSDs and employers 64 lower the mor
Page 66 and 67: 7. MSDs and individuals 66 7.1 Impa
Page 68 and 69: MSDs and individuals 68 Figure 7.1.
Page 70 and 71: MSDs and individuals 70 7.2 MSDs: I
Page 72 and 73: MSDs and individuals 72 and other h
Page 74 and 75: MSDs and individuals 74 Figure 7.4.
Page 76 and 77: MSDs and individuals 76 Cont. Kaize
Page 78 and 79: MSDs and individuals 78 reported wo
Page 80 and 81: Conclusions and recommendations 80
Page 82 and 83: References 82 American Chamber of C
Page 84 and 85: References 84 Dagfinrud, H., Mengsh
Page 86 and 87: References 86 Hori, Y., Hoshino, J.
Page 88 and 89: References 88 Matsudaira, K., Hara,
Page 90 and 91: References 90 Rudwaleit, M., Gooch,
Page 92 and 93: References 92 Young, A., Dixey, J.,
Page 94 and 95:
Appendix 2: Fit Note Sample 94 Sour
Page 96 and 97:
Appendix 3: Benchmarking grid 96 So
Page 98 and 99:
Appendix 3: Benchmarking grid 98 So
Page 100 and 101:
Appendix 3: Benchmarking grid 100 O
Page 102 and 103:
Appendix 3: Benchmarking grid Refer
Page 104:
We provide: Research Advisory Consu
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