Implementation of Early Intervention Protocol in Australia for ‘High Risk’ Injured Workers is Associated with Fewer Lost Work Days Over 2 Years Than Usual (Stepped) Care
Purpose To evaluate whether a protocol for early intervention addressing the psychosocial risk factors for delayed return to work in workers with soft tissue injuries would achieve better long-term outcomes than usual (stepped) care. Methods The study used a controlled, non-randomised prospective design to compare two case management approaches. For the intervention condition, workers screened within 1–3 weeks of injury as being at high risk of delayed returned to work by the Örebro Musculoskeletal Pain Screening Questionnaire—short version (ÖMPSQ-SF) were offered psychological assessment and a comprehensive protocol to address the identified obstacles for return to work. Similarly identified injured workers in the control condition were managed under usual (stepped) care arrangements. Results At 2-year follow-up, the mean lost work days for the Intervention group was less than half that of the usual care group, their claim costs were 30% lower, as was the growth trajectory of their costs after 11 months. Conclusions The findings supported the hypothesis that brief psychological risk factor screening, combined with a protocol for active collaboration between key stakeholders to address identified psychological and workplace factors for delayed return to work, can achieve better return on investment than usual (stepped) care.
KeywordsScreening Psychosocial factors Workers’ compensation Work injury Early intervention
This study was supported by a Grant from the NSW Ministry of Health, EML Insurance, and SI-CORP (now icare). We would like to specifically acknowledge the contributions to the study by Karen Munk, Tamara Sprod, Rachel Elmes, Claims managers and staff at EML; Robert Lloyd, Susan Rafty, and Steven Hunt at icare; Michele Murphy and John Roach from NSWHealth, and the CEO’s, General Managers, and RTW coordinators at each participating hospital, as well as the Occupational Physicians and Dr Rob Borland, University of Sydney, who provided independent advice. We also thank the injured workers who voluntarily participated, and the helpful feedback on earlier drafts of this manuscript from Glen Pransky, Ian Cameron, Chris Maher, Alex Collie, and Amanda Williams.
This study was supported by a Grant from the NSW Ministry of Health, EML Insurance, and SI-CORP (now icare). The Grant funding supported only the work performed by the two project managers (Michael Gleeson, and Raphael Z Pinto).
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by the Sydney Local Health District Human Research Ethics Committee at Concord Hospital (17/06/2013), and the Human Research Ethics Committees of each participating hospital. The study was registered prospectively with the Australian and New Zealand Clinical Trials Registry (# ACTRN12613000847718). The system regulator, WorkCover(NSW), also gave its written approval for the protocol employed in the study.
- 2.Social Research Centre. Return to work survey, 2017/18 headline measures report. Canberra: Safe Work Australia; 2018.Google Scholar
- 3.Johnson D, Fry T. Factors affecting return to work after injury: a study for the Victorian WorkCover Authority. Melbourne Institute of Applied Economic and Social Research Melbourne, 2002.Google Scholar
- 7.Mallen CD, Peat G, Thomas E, et al. Prognostic factors for musculoskeletal pain in primary care: a systematic review. Br J Gen Pract. 2007;57:655–661.Google Scholar
- 8.Main CJ, Phillips CJ, Watson PJ. Secondary prevention in health care and occupational settings in musculoskeletal conditions focusing on low back pain. In: Schultz IZ, Gatchel RJ, editors. Handbook of complex occupational disability claims: early risk identification, intervention and prevention. New York: Springer; 2005. p. 387–404.Google Scholar
- 11.Sullivan MJL, Feuerstein M, Gatchel R, Linton SJ, Pransky G. Integrating psychosocial and behavioral interventions to achieve optimal rehabilitation outcomes. J Occup Rehabil. 2005;15:457–489.Google Scholar
- 15.Cullen KL, Irvin E, Collie A, Clay F, Gensby U, Jennings PA, et al. Effectiveness of workplace interventions in return-to-work for musculoskeletal, pain-related and mental health conditions: an update of the evidence and messages for practitioners. J Occup Rehabil. 2018;28:1–15.CrossRefGoogle Scholar
- 18.Pearce G, McGarity A, Nicholas MK, Linton SJ, Peat J. Better outcomes in worker’s compensation through very early selective intervention. Paper presented at: 2008 Combined Conference of the Australasian Faculty of Rehabilitation Medicine and the Australasian Faculty of Occupational and Environmental Medicine; Adelaide, Australia; May, 2008.Google Scholar
- 19.WorkCover NSW. Improving outcomes: Integrated, active management of workers with soft tissue injury (2008). Work Cover website: www.workcover.nsw.gov.au.
- 20.Balderson BHK, Von Korff M. The stepped care approach to chronic back pain. In: Linton SJ, editor. New avenues for the prevention of chronic musculoskeletal pain and disability, vol. 1. Amsterdam: Elsevier; 2002. p. 237–243.Google Scholar
- 25.Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med. 1994;23(2):129–138.Google Scholar
- 28.Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. Pain. 2015;156:1003–1007.Google Scholar
- 32.Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, et al. Framework for design and evaluation of complex interventions to improve health. Br Med J. 2000;321:684–686.Google Scholar
- 33.Medical Research Council (2009). Developing and evaluating complex interventions: new guidance. www.mrc.ac.uk/complexinterventionsguidance.
- 36.Main CJ, Sullivan MJL, Watson PJ, Greasley K. Pain and work: organizational perspectives. In: Main C, Sullivan MJL, Watson P, editors. Pain management: practical applications of the biopsychosocial perspective in clinical and occupational settings. 2nd ed. Edinburgh: Churchill Livingstone; 2008. p. 391–669.Google Scholar
- 37.Harbeck RV, Leahy MJ, Hunt HA, Fong C, Welch EM. Employer factors related to workers’ compensation claims and disability management. Rehabil Counsel Bull. 1991;34:210–226.Google Scholar
- 38.Social Research Centre. The cost of work-related injury and illness for australian employers, workers and the community: 2012–13. Canberra: Safe Work Australia; 2015.Google Scholar