Figure 7 . People are remaining in the workforce for longer . |
Figure 9 . Pregnancy at work . |
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and no other upper limb or musculo- |
including peripheral neuropathy . Also |
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skeletal issues . She describes herself |
consider job-specific factors such as |
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as having a “ high pain tolerance ”. |
the hours ( long shifts , shift work ), loca- |
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Following a discussion between |
tion ( remote , travel , proximity to med- |
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Jessica , her GP and her supervi- |
ical attention ), ambient temperature |
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sor , Jessica starts a gradual return to |
( for example , outdoor or underground |
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work . She starts with labelling and |
work ), safety equipment ( such as |
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assists with some administrative |
boots ) and access to hydration . |
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tasks before gradually increasing her |
The use of insulin , or other |
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time on the production line . |
hypoglycaemic medications , may |
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The communication between the |
require closer monitoring in a safe- |
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employer and Jessica allows her to |
ty-critical role , such as driving , |
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return to work safely and sustain- |
because the need for tight control |
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ably . Note that not all employers |
must be weighed against the risk of |
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will accommodate a gradual return |
hypoglycaemia . |
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to work . |
Charles ’ adherence to his medi- |
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Case study two
Charles , 19 , was diagnosed with
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cal treatment is unclear at this stage ; he has had repeated episodes of incapacity from hypoglycaemia , and there |
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type 1 diabetes in childhood . He is |
are a number of safety risks working |
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on insulin and his condition was well |
with electricity . The remote location , |
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Figure 8 . Medicinal cannabis . |
managed throughout his childhood . In his mid to late teens , he started to drink alcohol heavily , use recreational |
lack of immediate access to urgent medical care , and working outside in the heat all confer an additional risk . |
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marijuana and ice , and did not engage |
In addition to his diabetes , Charles |
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spectrum , dismissing a patient ’ s |
the money ”. Jessica works on a pro- |
overuse of individual joints . Most of |
with his diabetes management . |
has alcohol and other drug issues and |
experience of pain and simply stating |
duction line in a factory that manu- |
the roles involve repetitive fine fin- |
He developed symptoms of anx- |
psychiatric conditions for which his |
that it is entirely their choice whether |
factures sensors . She states that it is |
ger movements and wrist flexion , and |
iety and depression and started to |
treatment and prognosis are unclear . |
they wish to work with pain is sim- |
“ pretty easy work and I don ’ t need to |
some require tight gripping move- |
self-harm by overdosing on insu- |
These are also likely to impact on his |
ilarly unlikely to result in a durable |
lift anything heavy ”. |
ments . There is limited rest time . Jes- |
lin . He had several hypoglycaemic |
capacity to perform his role and his |
return to work in the short term and |
Her surgery was two weeks earlier |
sica needs to keep up with the speed |
episodes in his final year of high |
safety at work . |
may drive the patient away . |
and there were no complications . The |
of the line , and any delay will slow |
school and was treated in hospital |
Based on the information provided , |
In the authors ’ view , a more |
wound is healing well , and Jessica is |
down the other workers . |
on three occasions . He has a con- |
the GP is concerned that Charles is not |
nuanced approach is needed in these |
happy with her symptomatic recovery . |
Jessica is ready to return to some |
ditional driving licence for private |
medically fit for this role at this time . |
challenging cases . It is often neces- |
Although it is common , and a rel- |
work , but not yet fit for all her usual |
vehicles but was denied a commer- |
There may be other roles that are not |
sary to further engage and spend more |
atively minor procedure , the number |
tasks . She will need to ease back into |
cial licence ( for truck driving ) by his |
safety-critical or in remote areas for |
time with the patient discussing con- |
of days required off work after carpal |
the repetitive wrist movements as her |
endocrinologist after his most recent |
which he may be better suited . |
cepts such as the distinctions between |
tunnel release varies widely . A system- |
recovery progresses , and although |
hypoglycaemic event . 8 |
If permitted by the employer , |
hurt and harm , the importance of |
atic review revealed a range between |
her wound is healing well , she may |
When Charles is offered an elec- |
the involvement of an occupational |
maintaining physical activity in |
four and 168 days , with a median 21 |
need additional time before she does |
trician apprenticeship on a remote |
physician is recommended , and liai- |
accordance with their treatment plans |
days for non-manual work and 39 days |
repetitive tight gripping tasks . |
mine in Western Australia , he moves |
son between the GP , employer and |
and the health benefits of maintaining |
for manual work . 25 |
Prognostic factors for quicker |
to Perth . Here he presents to a new |
occupational physician will help |
employment . This may necessitate a |
The GP reviews Jessica ’ s hand |
return to work include worker expec- |
GP for a health check before starting |
optimise Charles ’ health and oppor- |
short period of restrictions while the |
function and notes that she is doing |
tation , no work disability prior to the |
the new job . |
tunities for employment in areas that |
patient processes these recommenda- |
well , but still has some discomfort on |
surgery ( that is , that their role was |
When assessing patients with diabe- |
interest him . |
tions and education before being able to progress them back to more regular employment . |
flexion and extension of the wrist and some weakness in grip strength .
The GP seeks Jessica ’ s consent to
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unaffected by their carpal tunnel symptoms ) and lower pain anxiety . 26 Poor prognostic factors include |
tes for fitness for work , assess them on an individual basis because of the wide range of symptoms , complications , |
Case study three
Nitesh is a 60-year-old electrical engi-
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|
CASE STUDIES
Case study one
JESSICA , a 40-year-old factory worker ,
has recently had a carpal tunnel
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discuss her return with her employer and to get more details about her job , and Jessica agrees .
Her supervisor states that she works day shifts , five days per week ,
|
several job-related factors , including high job strain , poor coworker relationships , increased upper extremity functional limitations , more than one region of musculoskeletal pain and |
medications and job roles . Consider the medical aspects , including the risk of sudden incapacity caused by hypoglycaemia ; 27 other symptoms in an emergency , such as |
neer . He presents to his GP because he is concerned that he is making mistakes at work and is worried that he is going to be fired .
He describes recent short-term
|
release ( see figure 10 ). She presents to |
on a production line . She is trained to |
higher levels of pain anxiety . 26 |
confusion with hyperglycaemia ; the |
memory loss and an episode of confu- |
her GP asking for a clearance certifi- |
do one of several different roles on the |
Jessica is keen to return to work , |
need for urgent access to medica- |
sion where he could not find his office |
cate to return to work as she “ needs |
line , and staff are rotated to prevent |
has a supportive work environment |
tion ; and the relevant complications , |
at work . He has reviewed his recent |