Patients seen within the Workers’ Compensation system can add additional challenges for healthcare providers. Although nothing surpasses clinical experience when navigating this patient population, following a systematic approach can alleviate some of the frustrations while improving the experience for therapists and patients alike. This can ultimately allow for consistent, high-quality outcomes.
When working with an injured worker, physical therapists, along with all stakeholders overseeing the claim, should consider the following points to ensure success:
It is crucial to effectively screen all injured workers on the initial evaluation and throughout care for medical considerations that may impact treatment progression. Understanding that nutrition, sleep hygiene, education levels, and comorbidities (diabetes, anemia, inflammatory conditions) can all impact healing. It is therefore crucial for therapists to assess these factors and communicate relevant findings to all stakeholders if identified.
Furthermore, should a patient present for treatment, and the therapist establish that care may not be appropriate (based on safety considerations or medical complexity), discussion with stakeholders is needed to determine if treatment is to be rendered of if referral out may be necessary.
Similarly, consideration of a patient’s psychosocial status is imperative. In fact, there is such a preponderance of evidence regarding an injured worker’s psychosocial state as significantly impacting return-to-work trajectory that a recent publication by the Journal of Orthopaedic and Sports Physical Therapy outlined that therapists should be screening every injured worker using appropriate, validated psychosocial testing (Fear Avoidance belief Questionnaire, Work and Health Questionnaire, etc.).
These questionnaires serve to measure a patient’s baseline perception of their condition and can illuminate patients who may progress slowly or have an increased risk of delayed return-to-work. Understanding how the patient perceives their pain and disability can allow for appropriate communication/education about their physical condition, and facilitate discussions with relevant stakeholders regarding impediments to progress and overall prognosis.
As with any patient, a solid objective examination is essential to a good outcome. In Workers’ Compensation cases, the examination is important to establish if the patient’s subjective complaints are consistent with the objective findings. Additionally, a therapists’ ability to reproduce a patient’s primary symptom during the exam helps to illuminate structures that are involved, and guide treatment decisions.
Finally, by identifying the source of the patient’s symptoms, and intervening with manual therapy, exercise, and other modalities to reduce symptoms during treatment, the injured worker can develop a confidence that therapy is a useful intervention. This can improve compliance with treatment and performance of a Home Exercise Program (HEP), both elements that facilitate timely resolution of a work-related injury.
Many of these patients already present with high levels of fear and anxiety over their injury. This can be further compounded by imaging studies, many of which can show positive findings for structures unrelated to the patient’s actual injury. Some of these changes seen on imaging are simply the natural response to aging and not associated with their current injury/symptoms.
Communication with the injured worker to place context around their imaging findings can be particularly useful at calming an injured workers’ worries. Therapists should remain positive in their interactions with injured workers, and highlight the body’s natural ability to heal and return to function.
As a patient’s symptoms become more chronic, pain is not necessarily the result of damaged tissue. Patients should be educated that pain itself is a conscious experience aimed at protecting the tissues involved, but does not mean that tissue is being damaged or is incapable of healing.
Once again, injured workers need encouragement, education, and coaching on the normal healing process. Some injured workers simply have unrealistic expectations for their rehabilitation, believing that they’ll be back to their prior level of function within 6 weeks post-operatively. Others believe that therapy should progress without any discomfort. As a therapist, it’s our responsibility to ensure that injured workers are educated on what to expect and that ultimately, functional recovery is highly probable.
Continue to reinforce that some pain/soreness can be expected, but does not indicate tissue damage. Long gone are the days of bed rest, heat, and medication for an injury. Evidence supports that getting a patient active and engaged in functional tasks as soon as possible supports the healing process and gets the patient back to work more quickly.
This is where physical therapy can be effective at reducing symptoms and improving function. Therapists’ unique skillset and education allow for optimal loading of healing tissue and allow for faster recovery with fewer lingering deficits or compensatory movements.
Many patients feel like they lack any control over their Workers’ Comp case. Involving them as much as possible, while still moving the case towards return to work and claim closure, will engage the patient in their care and develop trust between them and their therapist. Development of this “Therapeutic Alliance,” where therapists and their patients agree on goals and interventions, while building trust and working towards a common goal, has been shown in the literature to facilitate return-to-work for injured workers. This Therapeutic Alliance will also help to ensure compliance with their HEP, reinforcing that exercise/movement will allow for a return to ALL aspects of their life.
It’s important to highlight that this patient population can be particularly vulnerable. Staying with the same provider is important, and Physical Therapists should communicate with physicians, employers, case managers, and others to ensure that the patient is being communicated to consistently. Nothing disrupts a WC case more, and seeds doubts related to the competency of their healthcare team, than when a patient hears one thing from one provider and something totally different from another.
In summary, a Workers’ Comp claim is going to have the most successful outcome when there is quality care, consistent messaging, education, appropriate communication, and emphasis on movement and return to function. Upstream Rehabilitation strives to deliver all of these components to all of our Workers’ Compensation patients. We do this through our commitment to professional development, both in our orthopedic evaluation skills and the training we provide to our therapists in how to communicate with all stakeholders in a Workers’ Compensation claim.