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A Prospective Study of the Effectiveness of Early Intervention with High-risk Back-injured Workers—A Pilot Study

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Abstract

Introduction It was postulated that workers, at the sub-acute stage after injury, respond differently to clinical and occupational interventions offered in a workers’ compensation environment. Individual worker risk of disability, it was further believed, would influence the effectiveness of early intervention. The objective of the current pilot study was to evaluate return to work (RTW) outcomes following proactive, combined clinical, occupational and case management-based interdisciplinary early intervention, provided in a workers’ compensation environment 4–10 weeks of onset of back pain, to workers with medium and high risk for disability. Methods The project was a controlled study comparing conventional workers’ compensation case management with integrated, interdisciplinary and multimodal early intervention (hereinafter referred to as “EI”). At baseline, risk status was determined by a validated Risk for Disability Questionnaire by Carragee et al. (Spine 5(1):24–35, 2005). Seventeen workers at high risk of protracted disability and 20 workers at moderate risk of disability received conventional case management, and 17 workers assessed at high risk of protracted disability and 18 workers at moderate risk of disability received the Early Intervention. Results At 3 months post back pain onset, no statistically significant differences were identified in RTW outcomes between conventional case management and the Early Intervention. However, by 6 months post back pain onset, workers at high risk of work disability who received the Early Intervention were significantly more likely to RTW than high risk workers who received conventional case management. In contrast, moderate risk workers continued to exhibit no statistically significant differences in RTW outcomes. Conclusion Multimodal Early Intervention in the workers’ compensation case management context is likely effective for workers with sub-acute back pain who are at high risk of occupational disability. The comprehensive Early Intervention is, however, likely redundant for workers who are not at high risk for disability and should not be applied indiscriminately. Further studies are required to determine longer-term Early Intervention outcomes, and to replicate the findings using a randomized control design. Also, with a larger sample size, it will be possible to determine predictors of occupational outcomes.

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Acknowledgements

The authors would like to thank the WorkSafeBC Research Secretariat for their grant support. The authors would also like to thank the following people for their assistance in the preparation of this paper: Alison Stewart, Research Coordinator and Researcher, Pilot EI Study, University of British Columbia; Zoe Paris, Pilot EI Researcher, University of British Columbia; and Wendy Meloche, Research Coordinator, Pilot EI Study. In addition, the authors are grateful to Dr. Mark Jensen from the University of Washington for the training of case management team members at WorkSafeBC in motivational interviewing.

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Authors and Affiliations

  1. Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Room 297, 2125 Main Mall, Vancouver, BC, Canada, V6T 1Z4

    I. Z. Schultz

  2. Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    J. Crook

  3. Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    J. Berkowitz

  4. Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    R. Milner

  5. Psychology Services, Workers’ Compensation Board of British Columbia/WorkSafeBC, Richmond, BC, Canada

    G. R. Meloche

  6. Worker and Employer Services, Workers’ Compensation Board of British Columbia/WorkSafeBC, Richmond, BC, Canada

    M. L. Lewis

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  1. I. Z. Schultz
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  4. R. Milner
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Correspondence to I. Z. Schultz.

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The views expressed herein do not necessarily represent the view of the Workers’ Compensation Board of British Columbia/WorkSafeBC.

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Schultz, I.Z., Crook, J., Berkowitz, J. et al. A Prospective Study of the Effectiveness of Early Intervention with High-risk Back-injured Workers—A Pilot Study. J Occup Rehabil 18, 140–151 (2008). https://doi.org/10.1007/s10926-008-9130-7

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