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

  • M. K. NicholasEmail author
  • D. S. J. Costa
  • S. J. Linton
  • C. J. Main
  • W. S. Shaw
  • G. Pearce
  • M. Gleeson
  • R. Z. Pinto
  • F. M. Blyth
  • J. H. McAuley
  • R. J. E. M. Smeets
  • A. McGarity


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.


Screening 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.

Ethical Approval

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.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019
corrected publication 2019

Authors and Affiliations

  • M. K. Nicholas
    • 1
    Email author
  • D. S. J. Costa
    • 1
  • S. J. Linton
    • 2
  • C. J. Main
    • 3
  • W. S. Shaw
    • 4
  • G. Pearce
    • 1
  • M. Gleeson
    • 1
  • R. Z. Pinto
    • 1
  • F. M. Blyth
    • 5
  • J. H. McAuley
    • 6
  • R. J. E. M. Smeets
    • 7
    • 8
  • A. McGarity
    • 9
  1. 1.Sydney Medical School – NorthernUniversity of Sydney & Royal North Shore HospitalSt LeonardsAustralia
  2. 2.Center for Health And Medical Psychology, Department of Law, Psychology, and Social WorkÖrebro UniversityÖrebroSweden
  3. 3.Arthritis Care UK Primary Care CentreKeele UniversityKeeleUK
  4. 4.University of Massachusetts Medical SchoolWorcesterUSA
  5. 5.School of Public Health, Concord Clinical SchoolUniversity of SydneySydneyAustralia
  6. 6.Neuroscience Research Australia and School of Medical SciencesUniversity of NSWSydneyAustralia
  7. 7.Department of Rehabilitation Medicine, CaphriMaastricht UniversityMaastrichtThe Netherlands
  8. 8.CIR RevalidatieEindhovenThe Netherlands
  9. 9.Injury Management Health & Safety BranchNSW Fire and SafetySydneyAustralia

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