FfW Bulgarian report (English language) - Fit for Work Europe

4.3
Conditionspecific
interventions
Interventions
It seems that the reasons behind the burden of disability on the Bulgarian society are twofold.
First, unhealthy lifestyle factors, lack of timely treatment of illness and prevention of
disability determine the large number of working age people who become disabled and rely
on the welfare benefits. On the other hand, the rigid system of disability assessment, focused
on incapacity, as well as lack of opportunities to seek employment while not 100 per cent fit,
discourages many people from remaining active at the labour market.
A focus on rehabilitation services will increase social inclusion of disabled people, as well as
maintain pool of skilled workers participating in the labour market (NSSI, 2010). Yet, disabled
employees in Bulgaria rarely have access to individual support on the job that would take into
consideration their personal needs. It is important that people with limited abilities are better
integrated into society and the labour market in particular. Developing a system of disability
assessment that evaluates the ability of individuals to work not just their affected capability, has
to become a priority both at the state and organisational level.
For those with specific musculoskeletal conditions, speedy referral to the appropriate
specialist for investigation and treatment is usually vital. Those with MSDs can 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 integrated
pathways. 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.
4.3.1 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 eradicating the cause of the
problem or returning to normal function.
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 recovery or helping
those with non-specific MSDs to manage their condition. In fact, for non-specific conditions,
an individual’s recovery and chances of returning to work can be adversely affected by ‘over-
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