Generating workplace accommodations: lessons learned from the integrated case management study.

Modified duty and other accommodations by employers have been shown to be helpful in managing workplace disability associated with injuries and illnesses. Benefits of accommodation have been attributed to both reduced physical and psychosocial exposures. Although many employers have adopted proactive return to work policies that emphasize temporary work modifications, standardized methods for specifying appropriate accommodations have been elusive. On the basis of the experiences and results of a randomized controlled study of case management services for work-related upper extremity disorders, we describe issues pertaining to the application of self-report measures of function and exposure assessment for generating accommodations. Challenges of this approach are 1) including specific work tasks on measures of physical function; 2) improving concordance between ergonomic exposure categories and methods of accommodation; and 3) providing a structured process for negotiating employee and employer preferences. To improve the effectiveness and efficiency of accommodation efforts, new tools for assessing function and ergonomic exposures in the workplace should be developed to specify accommodations more directly.