On the spot

on-site occupational physiotherapy service brings relief to sufferers of
musculoskeletal disorders and makes real savings for employers.  By Claire Trickey and James Bowden

In 1999, 8,500 new cases of work- related musculoskeletal disorders were
reported by occupational health professionals and rheumatologists under the
MOSS and OPRA surveillance systems1. Importantly, only a few specific
conditions can be reported under these systems, and only the fortunate workers
with access to occupational physicians would ever be assessed. Given these
enormously limiting factors, 8,500 new cases is a significant number of this
limited population, and an increase on the 7,666 new cases of 1998.

Perhaps a more realistic picture was painted by the 1995 SWI survey2. This
survey estimated that over one million people in Great Britain believed they
were suffering from a musculoskeletal disorder caused by work.

There is building evidence that treatment by chartered physiotherapists is
successful in dealing with a wide range of common musculoskeletal ailments
associated with work or leisure activities. Consequently, more and more people
are looking to physiotherapy to treat their musculoskeletal problems.

Between 1995 and 1999, the Chartered Society of Physiotherapy (CSP) recorded
growth of 34.7 per cent in the annual number of qualifying students, showing an
increased provision of physiotherapy to the general population3. The CSP has a
UK membership of 35,000 providing a significant service to be used by the

Growth of physiotherapy

The growth in the availability and uptake of physiotherapy is perhaps
unsurprising given the fact that musculoskeletal disorders are the most common
form of work-related ill health in Great Britain1. Worker absence due to these
conditions amounted to around 9 million days5 in 1995.

Given the cost to employers of musculoskeletal disorders (£523 to £556m
based on 1995/1996 estimates6) more and more organisations are looking to
provide in-house physiotherapy for their staff. But given the demands on budget
holders in today’s "streamlined" workplace, is on-site physiotherapy
a cost-effective investment?

There have been a limited number of cost-benefit analyses published that
look at on-site physiotherapy. Those that have been published have presented
conflicting views and different measures for success7,8. The following case
study outlines a compelling argument for the cost-effectiveness of on-site

Case study

A study was recently conducted in association with a large organisation that
wanted to try out an occupational physiotherapy service (OPS). Along with the
management of the OPS, OH consultancy COPE provided the client with all
clinical treatment, occupational physiotherapy assessment, rehabilitation
treatment and advice. In addition, physiotherapists carried out any ergonomic
workplace interventions required for the staff being treated.

The study centred on several of the organisation’s locations within a close
geographical area (referred to as the study group). These locations represent
approximately 7,000 employees.

The main drive of the study was to see whether there was a tangible and
significant reduction in days lost from work in the study group. The locations
selected for the study already had a sickness absence record well below the
overall average for the organisation, so they were not necessarily going to
yield the most obvious results. However, the aim was still to show that fast
and effective on-site treatment of musculoskeletal disorders would reduce lost
days and therefore accrue real savings for the client.

A control group was also selected, which had a slightly poorer sickness
absence record, but was demographically similar.

Benefits of the OPS

The study was conducted over the course of one year and savings calculations
were based solely on reductions in total sickness absence costs against budget.
The budget is calculated according to a location’s previous sickness absence

Any significant alterations to the management of sickness absence in addition
to the occupational physiotherapy service were consistent in both the study and
control groups.

While the control group’s sickness absence costs met budget expectations,
the study group demonstrated a significant saving, spending under their budget.
The cost of sickness absence within the organisation is calculated using a
generic formula, according to the number of working hours lost. Therefore this
cost saving represents more staff at work more of the time.

Alongside the direct savings, an interesting set of secondary effects was
also observed in conjunction with the OPS.

– Improved morale – official feedback systems outlined a significant
improvement in staff morale in locations with the OPS, when compared to
controls and when compared with the company as a whole

– Decrease in staff turnover – staff turnover was increasing across the
control and study locations, but was seen to increase more slowly where the
client had the OPS in place.

Relevant factors

Clearly this is a single study and there are a number of factors to consider
before applying this principle to any organisation. Some of the variable
factors might be:

– The cost of clinical provision in different organisations – the nature of
the work carried out by the study organisation meant that a
"moderate"9 number of employees could be serviced for every hour of
physiotherapy provided. In some heavier industries, where staff are exposed to
higher degrees of musculoskeletal risk, a smaller number of staff would be
serviced per physiotherapy hour. However, while the cost per employee is higher
in this instance, the savings too should be higher since the pre-intervention
prevalence of musculoskeletal disorders and the resulting sickness absence is
likely to be higher

– Cost per day lost to the organisation through sickness – the higher the
cost per sickness day, the greater the savings to an organisation for every day
not lost

– Cause of sickness absence – in the case study presented, pre-intervention sickness
absence was not divided into musculoskeletal and non-musculoskeletal, but was
taken as a whole. Obviously the greater the contribution to overall sickness
absence from musculoskeletal disorders, the greater the impact an OPS can have.
Having said that, some of the secondary factors associated with the OPS such as
increased morale may well lower sickness absence from non-musculoskeletal

– Existing sickness absence management programmes – organisational
approaches to sickness absence management vary in policy and procedure.
Positive and proactive approaches will foster stronger support and usage of an
OPS and increase the value of such a service. Such approaches establish health
criteria for jobs, carry out appropriate pre-employment screening and
assessment and give advice on sickness absence cases in timely fashion. This
then links back into a health and safety risk management system of which the
OPS becomes a vital part.

How are the cost savings achieved?

As outlined above, in broadest terms the cost savings come about because of
reduced sickness absence. But how does this service work to reduce days off on
sick leave?

– By treating the problem – the most obvious reduction in sickness absence
comes from treating the injury or condition and returning staff to work

– By treating the problem rapidly – our experience has shown that patients
treated more than 21 days from the onset of the problem are less likely to
recover completely (potentially missing more work later), and take longer to
return to work (being off for longer with this episode). So there is a two-fold
benefit from having a rapid, on-site response. Anecdotal evidence suggests that
waiting lists for NHS physiotherapy can be as long as six months. If staff are
off work during this waiting period, the chances of them ever returning to work
are greatly reduced7

– By amending the workplace – on-site physiotherapists with ergonomics
training can make recommendations to improve the work environment helping to
prevent reoccurrence

– By eliminating travel time away from work

– By decreasing turnover – a reduction in staff turnover means lowering the
outlay for recruitment, training and any interim agency cover

– By boosting morale – there is growing evidence to suggest that psychosocial
factors play a significant role in both musculoskeletal problems and other
causes of lost days. If increased morale is an indicator of a decrease in some
aspects of psychosocial stress, this could also be a factor in the success of
the OPS.

Concluding remarks

The case study presented outlines the cost effectiveness of an occupational
physiotherapy service. Its benefits are multifarious, but the fast, successful
treatment of musculoskeletal disorders is the platform for cost savings. Given
the position of musculoskeletal disorders at the top of the list of causes of
days lost to industry, the uptake of occupational physiotherapy services across
British industry is likely to increase.

Claire Trickey is senior ergonomist and James Bowden is director of occupational
physiotherapy at OH consultancy COPE


1. HSC (1999/2000) Health and Safety Statistics – A National Statistics
Publication. www.statistics.gov.uk

2. Jones JR, Hodgson JT, Clegg TA. (1998) Self-reported work-related illness
in 1995 HSE Books.

3. Physiotherapy Workforce Statistics (1995-2000) A report for the Chartered
Society of Physiotherapy.

4. www.csp.org.uk

5. Information Sheet 2/99/EMSU Economic Impact: Revised data from the
self-reported work-related illness survey in 1995 (SW195).

6. HSE (1996) The costs to Britain of workplace accidents and work-related
ill health in 1995/96. HSE Books.

7. Hochanadel CD, Conrad DE (1993) Evolution of on-site industrial physical
therapy program. Journal of Occupational Medicine, 35(10): 1011-1016.

8. Bonsall JL et al (1991) Effect of Physiotherapy on Sickness Absence in
Industry: A Comparative Study. Journal of the Society of Occupational Medicine,
41(4): 176-180.

9. COPE – in-house statistics. Provision of physiotherapy in various
industries. Not in the public domain.

Cost savings

How the cost savings were achieved

– By treating the problem and
treating it rapidly

– By amending the workplace

– By eliminating travel time away from work

– By decreasing staff turnover

– By boosting morale

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