Marcos A. Iglesias, MD, MMM, FAAFP, FACOEM, Vice President and National Medical Director, The Hartford, lead a discussion on practical tools and techniques to help minimize employee’s disability and delayed recovery during a session at the WCI’s 2017 Workers’ Compensation Educational Conference.
Delayed recovery is the deviation from the happy path. Work means identity to most people. There are economic, physical, social and emotional factors that go along with getting back to the workplace. Work actually increasing our resilience and our coping mechanisms with our injury. When the injured worker is not working there are many factors that affect their mental and physical state such as depression, substance abuse and many other. Worklessness is detrimental to a person. One study compared worklessness to a person who smokes 10 packs of cigarettes a day. They have the same negative affect to your health. Time is of the essence when trying to get an injured worker back to work. There needs to be an urgency to get the worker back to work sooner.
We are always looking for what is triggering the pain in the back, pain in the foot, pain in the hand. When there is pain we think we must find a source. Always looking for that source or trigger. What about phantom pains? This model sees the boys as a machine like your car. There must be a fix for something that is wrong. We our bodies are not like that. We have to look at the body thru three lenses: biological, psychological and social. This is called the biopsychosocial model. Think behavioral and this is less threatening.
Disability factors are the risk factors for disability are the same regardless of the nature of the condition. Biological risk factors for delayed recover include age, gender, comorbid conditions, compensation, legal, health provider, home situation and work factors.
What are yellow flags regarding psychosocial risk factors for delayed recovery? These are risk factors or delayed recovery flags that can show an inclination to a delayed recovery.
- Fear – money, losing job, recovery time, blame, fear of injury again, fear of retaliation
- Catastrophic thinking – projects the worst case scenario
- Recovery expectation – an individual’s expectation or perception of their time off for injury is pretty similar to the actual time of their recovery
- Perceived injustice – subconscious motivator, blaming someone or something for the injury
- Poor coping skills – normal schedule is no longer happening and this throw all other things off such as sleeping pattern and eating patterns, schedule is important to get back to work sooner and consistency is key
Psychosocial interventions include identify risk factors early on, address them, minimize sick role, focus on rapid return to work, reinforce adaptive responses, cognitive behavioral therapy, and functional restoration programs. The more of these barriers you can identify early on, the better chance there is of counteracting against the delayed recovery.