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Does gradually returning to work improve time to sustainable work after a work-acquired musculoskeletal disorder in British Columbia, Canada? A matched cohort effectiveness study
  1. Esther T Maas,
  2. Mieke Koehoorn,
  3. Christopher B McLeod
  1. School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Esther T Maas, School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada; esther.maas{at}


Objective This study investigates if gradual return to work (GRTW) is associated with full sustainable return to work (RTW) for seriously injured workers with a musculoskeletal disorder (MSD), in British Columbia, Canada.

Methods This is an effectiveness study using a retrospective cohort study design. Accepted workers’ compensation lost-time claims were extracted for workers with an MSD who were on full work disability for at least 30 days, between 2010 and 2015 (n=37 356). Coarsened exact matching yielded a final matched cohort of 12 494 workers who experienced GRTW at any point 30 days post-injury and 12 494 workers without any GRTW. The association between GRTW and sustainable RTW through to end of 12 months was estimated with multivariable quantile regression.

Results Workers who were provided with GRTW experienced more time-loss days until sustainable RTW between the 2nd and 5th months after the first time-loss day (<50th quantile of time loss), but less time-loss days until sustainable RTW between the 6th and 12th months of work disability (70th quantile of time loss), with the largest effect for women, workers with soft-tissue injuries and workers in the manufacturing or trades sector (all in the 60th and 70th percentile, after 6–7 months of time loss).

Conclusions For seriously injured workers with at least 30 days of disability due to a work-acquired MSD, the effect of GRTW becomes apparent at longer disability durations (more than 6 months), with larger beneficial effects for women, workers with soft-tissue injuries and for trade and manufacturing sectors.

  • epidemiology
  • sick leave
  • musculoskeletal system
  • occupational health

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  • Contributors All authors were involved in the conceptualisation of the project. ETM and CBM were involved in the analyses. ETM drafted the manuscript. All authors edited the manuscript.

  • Funding This study is funded by a Canadian Institutes of Health Research postdoctoral fellowship (MRE-152431).

  • Disclaimer All inferences, opinions and conclusions drawn in this dissertation are those of the author, and do not reflect the opinions or policies of the Data Stewards.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. The BC Freedom of Informant and Protection of Privacy Act [RSBC 1996] CHAPTER 165 (the legislation that authorises us to use the data for our study) does not authorise this data be access or view outside of Canada. Under our obligations under this legislation and under an information sharing agreement with WorksafeBC to use the data, we are prohibited from sharing the data outside of Canada and outside our research team. If other researchers wanted access to the data, they would need to negotiate access directly with the data provider, WorkSafeBC.The data for this project can only be accessed in Canada and making an application through to WorkSafeBC and by entering into an Research Agreement with WorkSafeBC.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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