Overcoming Obstacles: Reducing Barriers and Improving Outcomes in Challenging Workers’ Compensation Cases

Robyn Lewis, P.T., CEAS, Regional Director of WorkStrategies, Select Medical

Many times, a person who experiences an injury while playing sports has a faster recovery time compared to an employee who is injured on the job. There are significant discrepancies in recovery time and functional outcomes among injured workers who appear to have similar severity of injuries. This can be frustrating to the stakeholders involved. These challenging cases substantiate the findings that 15-20% of employees with chronic worker disability account for 70% of the total costs.

Recent research has theorized a major difference in recovery paths of similar biomedical injuries are due to psychosocial factors. Studies have shown that if we can identify these psychosocial risk factors early and address them using evidence-based, psychologically-informed treatment strategies, the path to recovery is changed resulting in improved outcomes and decrease overall claim costs. Select Medical has allocated resources to provide tools and training for our clinicians to identify these factors. We develop treatment plans using a biopsychosocial approach that can help to shift the trajectory of potentially delayed recovery.

Early identification: We use the OREBRO musculoskeletal questionnaire at the initial visit to determine risk stratification for injured workers. This alerts clinicians to those patients who may be at high risk for impaired recovery due to psychosocial factors. This information helps formulate the most appropriate plan of care. Stakeholders, such as claims managers and the employer, may also find this information valuable for claim administration and return to work planning.

Personalized treatment approaches: Developing a strong therapeutic alliance, providing frequent communication and using evidence-based cognitive behavioral techniques can help reduce the impact of the psychosocial risk factors. Below are some examples of the most common psychosocial risk factors and the evidence-based approaches that can help to reduce the risks.

Select Medical’s data of risk stratification using the Orebro is approaching one million applications of the tool. Evaluation of this data demonstrates that although about 40% of individuals covered under workers’ compensation in Select Medical outpatient centers present high risk for impaired recovery, individuals can move to lower risk levels. In fact, those who start high risk and move to lower risk categories make the greatest self-perceived functional improvements on validated self-reported outcome surveys. The following example represents 5,789 workers who started high risk in a sample of 14,844 workers with non-surgical back pain. Workers who transitioned from high risk to a lower risk category through the course of care had subsequently greater self-perceived functional gains as measured by the modified Oswestry Disability Index (ODI). In fact, workers who transitioned from high to low risk by discharge had more than a ten-fold improvement than their counterparts who remained high risk.

Many of the strategies being taught to Select Medical’s clinicians are also applicable to other stakeholders in managing work-related cases, including the employer, adjustor, case manager and physician. Employer representatives can keep the injured worker connected to the job environment through transitional duty work or regular contact with supervisors and human resources. Claims professionals can form a therapeutic alliance through listening to the injured employee’s concerns and sending messages that their job is to guide the injured worker through the recovery process, making sure the resources needed to recover are available. Communication between treating providers is needed as not to give conflicting information which can erode trust in the providers and derail recovery. If we all take a personalized approach and attempt to understand the whole person, we can make a significant impact in helping the injured employees develop strategies to recover and return to work.

Complimentary Webinar:
Join us on August 11 at 2:00 p.m. eastern for a one hour complimentary webinar on Overcoming Obstacles of Compliance in Rehabilitation approved for Florida adjuster, CCM, CRC and nurse CEU credits. Register today: