At the 2016 National Workers’ Compensation & Disability Conference, Marcos Iglesias from The Hartford and Robert Hall from Helios discussed the impact of disability and tools for improving outcomes for injured workers.
Ways injured workers are impacted by disability include:
- Loss of income – Not only during the course of the claim, but potential loss of income in the future.
- Passivity – Not taking an active role in your own rehabilitation. Waiting for others to tell you want to do.
- Loss of self-efficacy – Loss of initiative to do things for yourself.
- Isolation – Work provides a great deal of our social contacts. Taking away work leads to isolation of the injured worker.
- Depression – Not necessarily clinical depression, but certainly a feeling of being down.
- Family relationships – The divorce rate is higher for people disabled from work.
- Overall wellness – Studies show that those who are disabled are in significantly worse overall health than the general population. One study showed that the mortality rate for disabled individuals was double the general publication.
Barriers impacting return to work or function include:
- Past injuries and claims – People with a history of claims tend to have delayed recovery.
- Attorney involvement – There is a significant correlation between claim litigation and delayed recovery.
- Administrative delays – Delays in claim investigation or treatment authorization can delay recovery.
- Age – Older workers often experience delayed recovery.
- Gender – Women have a higher risk of delayed recovery.
- Co-morbid conditions, including obesity, depression, insomnia, high blood pressure, COPD, arthritis, substance abuse and diabetes.
- Duration of disability – The longer a person is off work, the less likely that person is to ever return to work. They develop a disability mindset and become comfortable in this role. If someone is off work a year, there is less than a 10% chance they will ever return to work.
- Adverse childhood experiences – Adverse childhood experiences can have a life-long impact on a person’s resiliency and ability to bounce back from adversity. This is something that is very difficult to identify and treat.
- Psychological risk factors – A person’s expectations about the successes of their treatment and recovery have an impact on their actual recovery. This is somewhat of a self-fufilling prophecy.
It is very important to identify claims with these potential barriers as early as possible so that appropriate resources can be devoted to the case.
Integrated tools and measures that facilitate return to work/function include:
- Text mining medical records looking for key words indicating the presence of risk factors for delayed recovery. The more risk factors identified, the more at risk that claim is for adverse recovery.
- Making sure you are asking the injured worker what their expectations are for return to work. This question provides tremendous insights into their expectations of success.
- Communication with the injured worker and all stakeholders must be consistent and positive. Use simple language, address fears and reassure the injured work.
- The treatment plan must be developed early and modified as needed. It should be patient-centered and guideline-based with an allowance for exceptions.
- Goals must be meaningful, measurable, attainable and have realistic timeframes.
- Focus on function, not pain. What can the person do, not what can’t they do. Encourage physical activity even if it hurts as this will improve with time and keep them from deconditioning.
- Education of all parties in terms of the expectation for the claim. This includes educating the medical provider on the availability of modified duty so that they are focused on timely return to work.
- Shared decision making.
Summarize non-pharmacological treatment alternatives:
- Anti-inflammatory drugs can improve function, but opioids and muscle relaxants do not. Any pharmacological treatment should be focused on improving function.
- Physical medicine modalities such as chiropractic care and physical therapy can provide pain relief and increase function. But this treatment needs to be monitored to make sure there is a treatment plan with the goal of improving function.
- Electro medical devices such as a TENS unit or spinal cord stimulator can provide pain relief. There should be a corresponding decrease in opioid use when using these alternatives. The doctor should not be just piling on different modalities.
- Acupuncture can be useful for certain conditions, but not for others. Again, the focus is this treatment being an alternative to opioids.
- Injections can provide some relief, but these treatments are not curative. This includes trigger point, epidural steroid, and others. They simply mask pain in the short term. Such treatment should be used in conjunction with restorative treatment programs.
- Fear avoidance, belief training and cognitive behavioral therapy can assist injured workers in understanding how to manage their pain and the importance of activity in pain relief.