Efforts to influence physician recommendations

Interventions have attempted to improve the quality of physician recommendations about work resumption after injury, with varying degrees of success.

Medical educational efforts

Efforts to improve physicians’ education about the impact of activity recommendations on disability have been sparse, and the results are unimpressive. Lie (2003) reported on an educational effort in Norway to decrease the length of sick leaves by augmenting the knowledge base of GPs. Participating physicians received education about common musculoskeletal disorders and financial compensation for spending extra time with patients with extended sick leaves. Unfortunately, no impact on sick listing practices or disability outcomes were noted.

Perhaps it is not the direct knowledge about musculoskeletal disorders that is most important, but instead the pain attitudes and beliefs of the practitioners that are most critical in disability recommendations. If so, efforts to directly alter these may be of some benefit. This issue has also received limited study. Latimer et al. (2004) reported on an educational project designed to change the attitudes and beliefs about pain and function of physical therapy students. Results indicated that substantial changes in favour of endorsing function occurred following the teaching module and these changes were maintained 1 year out.

From another perspective, training for physicians should focus on skills that directly address the findings that it is psychosocial and not medical issues that are the primary determinants of disability. This implies developing an ability to elicit and address the factors that may inhibit successful return to work and knowledge of how to effectively address these factors (L. Shaw et al. 2002). Related skills such as prognostic screening and selective referral to resources based on the specific barriers to return to work, may also be directly related to producing evidence-based return-to-work recommendations, inasmuch as these interventions are necessary to insure a high likelihood of compliance and success (W.S. Shaw et al. 2001; Haldorsen et al. 2002).

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