Peer group discussion: Recovery at Work

Published: 4^th March, 2025

The following questions can be used as discussion points for peer groups or self-reflection.

It is strongly recommended that the following article is read before considering the questions:

• Recovery at Work: reframing the conversation, bpac^nz, Oct, 2024

The recovery trajectory for patients following an injury can vary significantly. Depending on the nature of the injury and other factors, there may be minimal disruption on a patient’s daily life, including their ability to engage in work. However, in some cases, injuries can have a more significant impact on functional capacity, and consideration must be given towards work capacity and associated decisions around medical certification.

A prompt return to, and recovery at, work should be prioritised for most patients with non-complex injuries to improve physical rehabilitation, mental health and to maintain social/vocational connections. Clinicians have an important role within the Recovery at Work model by performing initial injury consultations, evaluating work capacity, setting shared expectations and making decisions around medical certification. In keeping with the principles of rational medicine use, if time off work is required following injury, it should be “prescribed” at an appropriate dose, frequency and duration. Just as prescribing too much medicine can lead to harm, prescribing too much time off work can detrimentally affect a patient’s vocational outcomes, without providing any added benefit to their physical recovery.

The ACC definitions for medical certifications are as follows:

“Fit for selected work” should usually be the first consideration for most injured patients who are not “Fully fit” for work. However, if time fully off work is required to support initial recovery, a pragmatic approach is that most patients with non-complex musculoskeletal injuries should not be signed off work for more than a few days to one-week post-injury before attempting a transition to “Fit for selected work” or “Fully fit”.

When completing medical certification, a key point for clinicians is to focus on the physical and cognitive capacity of the patient after an injury, and to identify the functions they can perform (not just what they cannot do); deciding whether suitable work tasks exist to meet these functional parameters is the responsibility of the patient and their employer (not the clinician), with assistance from ACC if required. ACC can provide a range of additional support(s) for patients following injury if they do not have straightforward vocational or personal circumstances. Types of assistance include more comprehensive return to work support, compensation for lost earnings, travel costs, childcare, personal care, equipment provision and home modifications and additional treatments, e.g. surgery.

Regular follow up is essential to facilitate a successful return to work. This presents an opportunity to monitor physical progress, reinforce positive recovery expectations, enquire if workplace accommodations are being implemented and to adjust the treatment plan accordingly. In general, more regular consultations are often necessary initially, with the frequency gradually reduced as improvements become apparent.

Questions for discussion

1. What is your perspective on balancing the need for rest following injury versus getting people back to work promptly?
2. How do you usually approach conversations with patients about returning to work after an injury, particularly in those who seem hesitant to engage with the process or who think they should only return to work once they are fully healed? What are some other key barriers you have encountered?
3. Were you aware of the limited criteria in which a patient should be designated as “Fully unfit” for work? Does this align with your past clinical decision-making when signing a patient off from work (beyond any initial brief recovery period)? Are you likely to make any changes to how you decide whether a patient is “Fully unfit”?
4. What is your approach when establishing a return to work plan for patients certified as being “Fit for selected work” and how do you explain this medical certification to the patient? What do you do if the patient says their employer doesn’t want them to come to work or is unwilling to make accommodations to support a recovery at work? What is one of the more difficult return to work situations you have dealt with, and what did you learn from it?
5. Do you feel that you know enough about the additional support services available via ACC and how to co-ordinate access to these? In particular, have you had patients engage with a dedicated vocational rehabilitation service (e.g. Stay at work services), and how did this shape their experience? Are there any additional resources or supports that you think would assist this process? How confident are you in discussing with patients how ACC-mediated financial compensation works?
6. What criteria or functional goals do you use to assess the success of recovery plans over time, and how do you decide when a patient is “Fully fit” for work? What is your approach when things don’t go as planned, and patients feel they have returned to work too soon or have aggravated their injury?