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| Solutions: Fit for Work Fit for Work aims to provide solutions to complex cases. What is a complex case? In terms of rehabilitation, a complex case could be one involving multiple injuries, such as following a motor vehicle accident, or one involving a rare or serious medical condition ("How do you help someone with Wegener’s granulomatosis back to work?"). More often, though, complex cases are those in which factors other than the physical condition are acting as barriers to return to work, and delaying recovery. This is best illustrated with a real case (details changed to protect anonymity); Irene is a 52 year old woman who works in a supermarket warehouse, and has done for 15 years. In December 2007 she slipped down steps at home, and fractured her right ankle. She required surgery to plate the fracture, but her orthopaedic surgeon was pleased with the surgical outcome and discharged her 6 weeks later, with an expectation of return to work in 4 weeks. Irene was in some discomfort, and found that if she rested, the pain was less. She believed that if she got pain when she walked, that it was making the injury worse. She started to do less and less walking and activities about the home. Her husband was very supportive, and started to do everything for her. Weeks went by, and she continued to get medical certificates from her GP. Her ACC case manager asked why she was not improving. Her manager phoned from work to ask why she had not returned to work. Irene started to feel under pressure, and felt that everyone was getting at her and didn't understand the pain she was in. Her union became involved, and very quickly the only communication with her manager was through her union rep. She became reluctant to go out, in case her work colleagues saw her and thought she was shirking work. She was easily upset and weepy. Her husband seemed to be losing patience with her... She was seen and assessed by an occupational medicine specialist, who realised that her recovery had become stalled by a number of factors unrelated to her original injury, and that there were now a number of barriers which needed to be overcome. Time was spent explaining to Irene that actually she did need to start doing more - that the fracture was well healed and although walking was uncomfortable, that continuing to take weight on her feet and do more walking would strengthen it and reduce the pain. It was also explained that in response to her circumstances that she was probably a little depressed and that she really needed some psychological support to help her to overcome these feelings and develop coping strategies. On liaison with her GP, ACC case manager, manager and union, a rehabilitation programme was devised and implemented. This involved sessions of physiotherapy, cognitive behavioural therapy (CBT) with a psychologist and a graduated return to work programme under the supervision of an occupational therapist (OT). With support, Irene returned to work on limited hours and duties. She was welcomed back by her work colleagues, who had missed her, and she progressed to her normal job over the next few weeks. |
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