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Objective: The study's aim was to gain insights into factors influencing sustainable return to work following total knee arthroplasty (TKA). Design: A descriptive multiple-case design was used. A case was defined as a worker's following TKA work disability situation. Settings: The cases came from public hospitals in urban and semi-urban areas in Quebec (Canada) and involved mostly non-work-related TKAs. Subjects: Workers had to be between 6 and 12 months post-TKA, have physical/manual jobs and currently employed. Their rehabilitation professionals and workplace representatives (employer and/or union) were also recruited, based on the work disability paradigm. Main measures: Semi-structured interviews, questionnaires on pain, physical work demands (workers only), and observation of the work activities of those workers back at work were used. Cases were compared and categorized for worker-perceived levels of difficulty in returning to or staying at work: little or no difficulty (n = 8); some difficulty (n = 5); not back at work due to excessive difficulty with their knee (n = 4). Results: A total of 17 cases were constituted. In only one case, the worker benefitted from an interdisciplinary work rehabilitation approach. Results highlight the interplay among these factors: (1) the workers' perceptions of their residual symptoms and ability to manage them, (2) the interaction between work adjustments and tools offered by the employers and the workers' own strategies, and (3) perceptions of the workers' physical capacities. Conclusion: Workers' who face high levels of work demands/difficulties and who have limited access to work adjustments and tools should be referred for work rehabilitation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite the importance of the legislative and insurance systems in the return to work process after an occupational injury, the perspective of the insurer on what influences return to work has rarely been documented. OBJECTIVE: To understand the barriers or facilitators for return to work, from the perspective of the insurer. METHODS: A comprehensive qualitative approach was used. Semi-directed interviews were done with nineteen (19) insurers (claims adjudicator and rehabilitation case manager) from a Canadian workers' compensation board. A thematic analysis was done using QDA Minor Software. RESULTS: Fourteen themes (e.g. family reaction, quality of work relationship) were classified into four categories representing the main stakeholders: worker with disability, workplace, healthcare system and compensation system. Emotional, cognitive, and adaptive reactions from the worker and his family were identified. We observed that good work relations and support practices, lack of access to medical resources, focus on the employee's ability, and complexity and consequences of the compensation process are the main barriers and facilitators from the insurers' perspective. Many of the perceived elements are coherent with the compensation system's administrative and legal context. CONCLUSIONS: The results enable us to better understand the insurers' perspective regarding what influences return to work. It reinforces the necessity to consider the administrative and legal context to better understand the insurers' perspective. [ABSTRACT FROM AUTHOR]