Vol. 1, Issue 2, Part A (2025)

Background: Workers in physically demanding occupations such as construction, manufacturing, logistics, agriculture and hands-on healthcare face high rates of work-related musculoskeletal injury and prolonged work disability. Although vocational rehabilitation (VR) is recognized as a key strategy for improving return-to-work (RTW) outcomes, the optimal configuration of worker-directed and workplace-directed components for such jobs remains unclear.

Objectives: To evaluate the impact of multi-component, workplace-based VR on time to sustained RTW and work disability recurrence compared with limited VR and usual clinic-based care among workers in physically demanding occupations, and to identify prognostic factors associated with sustained RTW.

Methods: In this prospective multi-centre cohort study, 360 injured workers (18-60 years) employed in physically demanding jobs and on sickness absence ≥14 days for work-related musculoskeletal or orthopaedic injuries were followed for 12 months after VR initiation. Participants were classified into three exposure groups:

1. Multi-component, workplace-based VR (early employer contact, graded RTW, participatory ergonomic job redesign, work hardening, formal job accommodations),
2. Limited VR (basic advice/plan without structured workplace changes), and
3. Usual clinic-based care. Primary outcomes were time to first RTW and time to sustained RTW (≥4 consecutive weeks without recurrent absence). Survival analysis and Cox regression were used to compare groups and examine predictors.

Results: Median time to sustained RTW was shortest with multi-component VR (65 days; interquartile range [IQR] 48-88) versus limited VR (90 days; IQR 66-126) and usual care (120 days; IQR 82-168). At 12 months, sustained RTW was achieved by 82.0% of multi-component VR, 60.0% of limited VR and 48.9% of usual care participants, with lower recurrence of work disability in the multi-component group. Adjusted hazard ratios for sustained RTW showed significant benefits for multi-component VR (1.78, 95% CI 1.34-2.36) and limited VR (1.32, 95% CI 1.01-1.72) versus usual care. High physical workload and pessimistic RTW expectations were associated with delayed RTW, while strong supervisor support predicted faster RTW.

Conclusion: Multi-component, workplace-based VR substantially improves the speed and sustainability of RTW and reduces recurrent work disability among workers in physically demanding occupations. Integrating early employer contact, graded RTW, participatory ergonomics, work hardening and formal job accommodations, alongside attention to psychosocial and organizational factors, should be prioritized as standard practice in VR pathways for high-demand sectors.