OPTIMAL RETURN TO WORK:
THE NEXT ITERATION
Ms Jessica Fullarton
Comcare Australia
KEY WORDS: Return to Work, Personal Wellbeing, Function Capacity, Work Environment, Job
Satisfaction, Support
BACKGROUND
Workers’ compensation schemes around the world have used a range of measures to assess Return
to Work (RTW) following a workplace injury/illness. The vast majority of these measures, however,
do not provide insights into the subjective experiences of injured workers.
Comcare shared some of the initial work on a new measure called ‘Optimal RTW’ at the 2012
Australasian Compensation Health Research Forum. The measure aims to provide insights into the
quality of an injured/ill worker’s RTW from their perspective.
In May 2013, the measure was expanded to capture a fourth construct: support.
AIM OF THE RESEARCH
The aim of this research is twofold: First, to better understand how four separate, yet related
theoretical constructs of RTW (work environment, personal wellbeing, functional capacity, and
support) can be combined to provide better insights into the quality of an injured/ill worker’s RTW
from their perspective; and second is to positively influence an individual’s recovery and return to
work by:
 providing better insights into the factors which influence the success of an injured/ill worker’s
RTW
 improving our understanding about the recovery and RTW pathway of injured/ill workers, and
 identifying opportunities for the Comcare scheme, including employers, to better support the
recovery and RTW of injured/ill workers.
METHODOLOGY
PARTICIPANTS: Data was collected from a total of 791 workers with accepted workers’
compensation claims from both premium paying (n=436) and self-insured (n=355) organisations
within the Comcare Scheme.
QUESTIONNAIRE: The Comcare Injured Worker Survey collects information from injured/ill workers.
Respondents took an average of 25 minutes to complete the survey with an overall response rate of
79%. The questionnaire collects information on the attitudes, perceptions and experiences of
injured/ill workers.
The Optimal RTW scale is comprised of 18 items that are rated on a 5-point Likert scale, from
strongly agree through to strongly disagree. The items were grouped according to the four
theoretical constructs: personal wellbeing, functional capacity, work environment and support.
PROCEDURE: An independent research company conducted the survey in May 2013 using Computer
Assisted Telephone Interviewing (CATI). Engaging an independent research company ensured
confidentiality and anonymity for participants.
SAMPLING: A probability proportional to size design was used with a minimum critical sample size of
30. The sampling framework considered the two sectors of the scheme (premium paying and selfinsured) and five cohorts with varying incapacity payment durations. A representative sample was
obtained.
ANALYSIS: SPSS was used to explore the theoretical model and factor structure as well as test the
reliability of the new Optimal RTW scale.
RESULTS
The Optimal RTW scale was revised in early 2013 to incorporate an additional factor of support. The
four factors now included in the Optimal RTW Scale are believed to be a critical influence in the
success and longevity of an individual’s RTW. These factors are associated with:
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work environment - the way in which an individual interacts and feels about their
workplace, including their relationship with their manager
personal wellbeing - how an individual perceives themselves, including their level of selfesteem, self-concept, and locus of control
functional capacity - the way in which an individual perceives their injury and their capacity
to do their job, and
support - an individual’s perception of the support available/accessible to them.
Figure 1. Four factor model of Optimal RTW.
Principal components analysis with an oblique rotation was conducted. Figure 2 (right) illustrates the
structure recommended by the analysis.
The total variance explained by the original three factor model was 60%. The total variance
explained by the inclusion of the fourth factor and all 18 items was 62%, which indicates the model
was strengthened with the inclusion of the support items. Of the 18 items, one did not meet our
criteria for saturation on one factor (>0.40) and non-saturation on other factors (<0.40). The final
analysis therefore excluded this item (“Given your recovery, your skills and abilities are used
appropriately”) which was loading above 0.4 on two of the factors (0.485 and 0.412). Previous
analysis had supported including this item, however, it had the lowest loading of the 15 items
analysed last year (0.418).
The final four factor model suggested that two of the factors should be renamed from Personal
Wellbeing to Job Satisfaction and from Functional Capacity to Work Conditions. The total variance
explained by the final four factor model, with 17 items, is 63%.
Figure 2. Variance contribution and item loading following factor analysis.
The internal consistency across the 17 items included in the structure displayed in Figure 2 is high
(α=0.90).
CONCLUSIONS
Our primary objective was to develop a scale to provide better insights into the quality of an
injured/ill worker’s RTW from their perspective. The introduction of support items and the
continued development of the Optimal RTW scale has provided Comcare with confidence that the
scale will provide both us and employers with greater insights into the perceptions of injured/ill
workers about the quality of their RTW.
The analysis showed support for:
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including 17 of the 18 items
the presence of four discrete factors (work environment, job satisfaction, work conditions
and support)
a model explaining a significant amount of the variance (63%)
an increase in the variance explained by the three factor model which excluded support
(↑3%).
A key outcome of the analysis undertaken has been the reaffirming and reemphasis of the
importance of the workplace and the role of work in helping someone to return to and remain at
work.
RESEARCH INTO ACTION
The original three factor Optimal RTW scale was included in the inaugural Australasian RTW Survey
in May 2013. This will enable analysis across other jurisdictions with the potential for including the
support factor items in future waves.
The next step for the Optimal RTW concept is to work with employers to test the usefulness of the
tool within an organisational setting to ensure an injured/ill workers return to work is optimal,
sustainable and achievable from both the individual and the organisation’s perspective.
CONTACT DETAILS
Ms Jessica Fullarton
Senior Research Consultant
Comcare (Melbourne Office)
[email protected]
Comcare Research Team
GPO Box 9905
Canberra ACT 2601