Introduction
As exercise physiologists (EPs), we play a vital role in helping injured workers recover and return to work. Growing evidence shows that psychosocial factors significantly impact recovery outcomes. This provides us with tools and scientifically based hope to streamline our work and achieve better results. By routinely screening for psychosocial barriers / challenges and knowing how to effectively apply the findings, we can transform our approach to workers' compensation cases.
Overlooking psychosocial factors leads to prolonged recovery times, an increased risk of chronic pain, higher healthcare costs, and poorer return-to-work outcomes. People may become trapped in a cycle of ineffective passive treatments, excessive investigations, increased opioid use, unnecessary medical procedures, and a reduced quality of life.
This article, the first in a 3-part series, explores the critical role of psychosocial screening in workers' compensation cases and how to effectively utilise the results. We will discuss why screening is essential, how to implement it in your practice, and what to do with the information gathered. Our goal is to equip EPs with practical strategies to identify psychosocial challenges early and use this knowledge to enhance treatment outcomes and streamline their work.
Context
The It Pays to Care initiative, launched by the Australasian Faculty of Occupational and Environmental Medicine, advocates for evidence-informed practices in work injury management. This campaign builds on the success of the 'Health Benefits of Good Work' initiative, focusing on addressing psychosocial factors that impact recovery and return to work. The claims industry has shown strong engagement with this approach and has recognised its potential to improve outcomes for injured workers, reduce costs and enhance the efficiency of workers' compensation systems across Australia.
Elevating your practice: Benefits for Exercise Physiologists
Embracing effective management of psychosocial challenges benefits people and can also significantly enhance your professional experience as an EP. By implementing these evidence-based strategies, you can:
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Reduce frustration by proactively identifying and addressing challenges before they escalate
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Improve patient engagement and compliance by providing scientifically based hope leading to more satisfying treatment outcomes
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Enhance your professional reputation as a holistic, forward-thinking practitioner
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Develop stronger relationships with other stakeholders in the workers' compensation process
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Experience greater job satisfaction by seeing more patients return to work successfully
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As exercise physiologist Alice Hyslop notes ‘Providing exercise physiology care that encompasses the psychosocial components of a worker's rehabilitation gives me a sense of achievement as it allows me to deliver the best clinical care to my patients.’
Spot the signs: Early intervention strategies
Early, high-quality care is crucial in workers' compensation cases. As Exercise Physiologists (EPs), we are among the healthcare professionals responsible for assessing and treating injured workers. This positions us uniquely to influence the trajectory of care and identify potential challenges to recovery early in the process.
The importance of early intervention cannot be overstated:
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Delays in EP referrals can significantly impact outcomes
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Psychosocial barriers become more challenging to address over time
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Early screening and intervention can prevent chronic pain development
Psychosocial factors play a pivotal role in work injury outcomes, accounting for up to 85% of prolonged work disability. These factors, which include aspects like coping challenges, workplace barriers or anxiety often go neglected unless we actively look for them.
Research has demonstrated the significant impact of psychosocial factors on recovery and return to work:
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Workers exposed to high levels of psychosocial risk have over three times as many days off work as those with low risk
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For every 1-point increase on the Örebro Musculoskeletal Pain Questionnaire Short Form (ÖMPQ-SF) (out of 100), the chance of return to work is reduced by 4%
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As the number of psychosocial risk factors increases, so does the cumulative probability that a worker will not recover
Importantly, these psychosocial influences are modifiable if we recognise them early and manage them proactively. Addressing these influences has been associated with substantially quicker recovery and notable improvements in work engagement.
The importance of psychosocial screening tools
To effectively identify and address psychosocial challenges, EPs can use several validated screening tools. Understanding the differences and advantages of these tools can help you determine when and how to implement them effectively. Of the available tools the ÖMPQ-SF is considered the gold standard.
ÖMPQ-SF: The current gold standard
The ÖMPQ-SF has been extensively studied and is considered the gold standard for early psychosocial screening in musculoskeletal injuries. It's particularly useful in the early stages post-injury when the dominant challenges are often workplace issues or passive coping tendencies or low self-efficacy.
Key benefits of the ÖMPQ-SF include that it:
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Is quick to administer (10 items)
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Is validated for use in various musculoskeletal conditions
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Provides a clear risk score to guide intervention
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Can be repeated to track progress
Early post-injury, the ÖMPQ-SF can help identify issues such as:
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Workplace concerns
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Passive coping strategies
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Low self-efficacy
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Pain-related anxiety
Scores over 50/100 are considered to be at elevated risk of prolonged work disability. The overall score by itself is insufficient to identify the particular challenges impacting the person. Exploring and clarifying the response to each question is crucial to accurately identifying the specific challenges for that person.
Additional Screening Tools
DASS (Depression, Anxiety & Stress Scale)
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Provides specific scores across three key psychological parameters
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Helps pinpoint particular areas of psychosocial concern
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Useful for tracking progress in these specific domains
PROMIS (Patient-Reported Outcomes Measurement Information System)
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Comprehensive assessment of patient-reported health outcomes
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Validated tool that can complement other screening measures
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Particularly useful for tracking progress over time
Timing and Frequency of Assessments
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Initial screening should be conducted as early as possible
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Reassessments typically performed at 4–6-week intervals
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Note: Frequent reassessments may condition responses
Conversation toolkit: Discussing psychosocial factors
These are some of the advantages of independent screening:
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The screening can be done as a routine component of completing initial paperwork and be available for the first consultation
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Completing the questionnaire independently removes bias
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One can use the completed results to relay back to the patient. For example, 'I note you have indicated concerns about the workplace'
With a preference for a conversational approach to identifying challenges, you may wish to introduce the questions with: 'As part of your assessment, I'd like to ask you some questions about how you're coping with your injury. Our thoughts, concerns and what is going on in our lives can all impact recovery, so understanding these factors helps us provide the best care'.
You can also ask these questions to address specific challenges:
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Low self-efficacy: 'On a scale of 0-10, how confident do you feel about managing your condition? What do you think might help increase your confidence?'
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Passive coping: 'What strategies have you been using to manage your symptoms at home? I'd like to work with you to develop some active approaches that can complement our treatment here'.
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Workplace stress: 'How has your injury affected your relationship with your colleagues or supervisor? Are there any workplace issues you're concerned about?'
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Fear of movement: 'I've noticed you seem hesitant to move in certain ways. Can you tell me more about what you're experiencing when you try these movements?'
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Worrying more easily: 'I hear you're worried about your long-term abilities. Let's talk about what you're most concerned about and how we can address those concerns'.
The key is to listen actively, validate the person's experiences and frame psychosocial factors as normal, modifiable aspects of the recovery process.
Physical Testing and its role in Identifying Psychosocial factors
- Functional Capacity Evaluations: EPs can also complement psychosocial screening with task-specific assessments, such as functional capacity evaluations (FCEs). These tools not only assess physical capabilities but observations made during the testing procedure can also identify psychological barriers like fear of re-injury during job-specific tasks.
- Graded Exercise Programs: In addition to functional testing protocols, EPs can use graded exercise programs to systematically reintroduce clients to movement. This approach is particularly beneficial for addressing fear avoidance, can improve functional confidence in workers and will also allow the EP to make observations regarding the client’s coping mechanisms and fears around re-injury.
Conclusion
Understanding and addressing psychosocial factors is crucial for improving outcomes in workers' compensation cases. By implementing routine screening and early intervention strategies we can identify potential challenges to recovery and tailor our treatment approaches accordingly. This not only benefits our patients but also enhances our own professional satisfaction and effectiveness.
In the next article in this series, we'll explore effective communication techniques and how to tailor treatment approaches based on identified psychosocial factors.