Rousmaniere: Pransky’s Gift

06.14.2017


By Peter Rousmaniere

Liberty Mutual closed its Center for Disability Research, along with the rest of the Liberty Mutual Research Institute for Safety, on June 6, due to corporate cost-cutting. So ends 63 years of insurer-sponsored research.   

Glenn Pransky, MD, has led disability research there, arriving in 1999. His achievements, with those of his team, are unmatched in the workers’ compensation community for vision, persistence, and output.

His role in workers’ compensation can be likened to that of a great poet in our age — unread by most, yet immensely influential. He and his research staff produced more than 100 scientific papers on return-to-work research.

Pransky’s work has the marks of a successful life in our field. One is his early career restlessness, marked by curiosity and a high capacity to learn. Another is how he identified key problems to address. He and his team benefited from changes in the culture of workers' compensation, which 25 years ago had elements of resisting inquiry. His personal energy found an outlet in systematic changes underway, or those changes about to begin.

Over the years, I came to expect relentless curiosity, honesty and generosity from him.  He has said, “The average physician who treats work-related problems has had less than four hours of education in her entire career on work-related conditions, and no training on handling return-to-work issues. Few have ever toured a factory, read an article about ergonomics, or have an interest in reducing worksite risks.”

He once told me, "Our studies and those of others strongly suggest that the relationship between pain level and work status is often a weak one. I am doubtful of the implication that the removal of pain is a needed step before becoming productive."

In his first exposure to occupational medicine in 1975, when he treated shipyard workers in Baltimore, he saw that the medical community was not meeting the needs of injured workers and their employers. A mentor of his from Canada taught him the importance of taking time with injured workers, their supervisors, and others to fully understand the causes of the injury and ways to achieve the best outcomes.

In the late 1990s, he interviewed immigrants from El Salvador, many of them unauthorized, working within eyesight of the Pentagon. The published study of this fieldwork reported that only 31% received any job safety training and 55% had no workers' compensation coverage.

Also at about that time, he investigated under-reporting of work-related disorders in the workplace. The published article noted that, “Although less than 5% of workers had officially reported a work-related injury or illness during the past year, over 85% experienced work-related symptoms, 50% had persistent work-related problems, and 30% reported either lost time from work or work restrictions because of their ailment. Workers described several reasons for not reporting their injuries, including fear of reprisal, a belief that pain was an ordinary consequence of work activity or ageing, lack of management responsiveness after prior reports, and a desire not to lose their usual job.”

While most people in workers’ compensation do not pay attention to the long-term effect of injury, he and his team did. They surveyed injured New Hampshire workers about injury and job leaving, at 55 years or younger. They reported that, “Eleven percent planned to retire earlier due to their work injury, and their outcomes were significantly worse. Pre-injury dissatisfaction with the job and with medical care, and poor physical and mental health status were related to intent to retire early.”

Another study tore into conventional wisdom that older workers respond worse from injury. He and his co-authors found that, “despite more severe injuries in older workers, most outcomes were similar in both age groups… Age was unrelated or inversely related to poor outcomes. Older workers appear to fare better than younger workers after a work injury; their relative advantage may be primarily due to longer workplace attachment and the healthy worker effect.”

Prediction of delayed recovery attracted the attention of Pransky’s team from early on.  One of the initial studies on prediction, which he co-authored with William Shaw and Tom Winters, used a screening questionnaire on 1,509 workers with job-related back pain. They found that persistent pain, functional limitation, or impaired work status was predicted by six factors: injury type, work absence preceding medical evaluation, job tenure, prior back surgery, worries about re-injury, expectation for early return-to-work, and stress.

Pransky’s team may be the only group of researchers in the United States who took a deep interest in case management. “Does it work?” They asked. They did a rare study of early reporting, employee-centered case management, and removal of barriers to return to work. They reported, “The model of claims management investigated was effective in reducing the number of days of compensation, total claim costs, total medical costs and the amount paid in weekly benefits.” 

Pransky’s and his team’s influence will persist, reaching many thousands of practitioners who do not know Pransky’s name.

ABOUT THE AUTHOR

Peter RousmanierePeter Rousmaniere is widely known throughout the workers’ compensation industry, both for his writing and consulting experience. Based in the picture perfect New England town of Woodstock, VT, he is a regular on the conference circuit, and is deeply in tune with trends and developments within the industry. His passion is writing and presenting on issues largely related to immigration, and he maintains a blog on the subject at www.workingimmigrants.com.

 

 

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