'Worklessness' has profound negative effects on the injuried individual and their family. People who are unemployed suffer from poorer general health and they are more likely to participate in risk-taking behaviours such as alcohol and drug abuse, sexual promiscuity and smoking.

Unemployment also leads to wider social inequalities, and economic stress can impact on families with implications played out over decades. Importantly, regaining work may reverse these adverse health effects, and re-entry into work leads to an improvement in health.

There are several principles that health-care professionals need to take into account when assessing an individual's fitness for work.

It is important to consider not only if the person is likely to be able to perform their duties effectively, without harm to themselves, but also if the patient's return to work may lead to risk to others.

Individuals do not need to be symptom free to work. Many medical conditions, and virtually all minor health problems, have minimal implications for work and should not prevent employment.

The majority of people who are off work due to MSDs return to work within 4 weeks without vocational rehab advice or intervention. The priority at this stage is to support and encourage restoration of function and to avoid exacerbating disability, as there is evidence that occupational outcomes for most people with MSDs are improved by early return to some work.

Once an individual has been off work with an MSD for 4 weeks, an intervention to assist return to work is more likely to be required. By 26 weeks of absence, incapacity is likely to have become entrenched and rehabilitation becomes much more difficult. Therefore, the period of 4-26 weeks is often referred to as the ‘window of opportunity’ for effective return-to-work management.

Medical fitness should be assessed in relation to the particular demands of the work, such as hours; shiftwork; exposure to physical, chemical, biological and psychosocial hazards; work relationships; physical work environment; and requirement to travel.

An in-depth knowledge of the workplace and the duties of the job invaluable when assessing a employees fitness for work. Another reason this process should be done by the workplace injury management co-ordinator or injury management provider.  OH service. If such a person is not available majority descisions regards fitness to work are therefore undertaken by general practitioners (GPs) or hospital-based health professionals. These individuals often have limited knowledge of an employees workplace and roles.

Assessment of work capability is complex, and despite its importance, there is very limited scientific evidence to base RTW decisions on in part as there is no standard or valid methodology for assessing suitability for RTW used over all professions.

Outcomes from fitness for work assessments may range from ‘fit’ to ‘unfit’, with intermediate categories such as ‘fit subject to work modifications’, ‘fit with restrictions’ or ‘conditionally fit (temporarily, permanently)’. Workplace modifications to improve or adjust working conditions should always be considered.

Adjustments to work may be temporary or permanent, and they may take many forms. They may include shorter working hours, different shift patterns, avoidance of manual handling or transferring someone from a physical to a sedentary post.

For example, an employee with arthritis may benefit from starting work slightly later in the morning to allow time for the medication to take effect and early morning stiffness to reduce.

It is important to consider how individuals travel to work. Employers may be able to provide workers with a parking space to facilitate their access to work. Individuals who use public transport may temporarily or permanently benefit from travelling before or after the rush hour, so as to ensure that they get a seat.

Patients should be forewarned that they are likely to experience disproportionate fatigue on return to work. This symptom is likely to be more prominent in individuals with inflammatory MSDs. This can be mitigated in some cases by simple strategies such as returning to work on alternate days for the first week; returning in the middle rather than the beginning of the working week; and, if possible, working shortened hours, gradually increasing to usual working hours over a period of a few weeks.