Early intervention in rehabilitation and RTW

Prompt, proactive and practical strategies

The current RTW rate nationally is 81% (Safe Work Australia) and more than 10% of injured workers remain on extended leave or withdraw permanently from the workforce. How do we know when people are likely to become the almost 20% who fail to RTW? And if we can identify these at risk people, how do we help them?

Early intervention is considered to be the most impactful way of improving RTW outcomes. But what actually is early intervention? There is no formula and every injured or ill worker is unique. However there are a few practical and proactive initiatives that employers, insurers, treatment providers and workers themselves can apply for better outcomes in rehabilitation and RTW. 

 

Insurers and employers

  • Use the Orebro Musculoskeletal Pain Questionnaire[i] to identify those workers who are at risk of delayed recovery and/or failed RTW and refer to an occupational rehabilitation provider in such cases. The Orebro should be administered to people off work or struggling with RTW in the first 12 weeks following physical injury and it has been shown to have good predictive validity in identifying those at high risk of protracted recovery and failure to RTW. The original Orebro has 21 scored questions concerning attitudes and beliefs, behaviour in response to pain, affect, perception of work and activities of daily living. A cut-off score of 105 and below has been found to predict, with 95% accuracy, those who will recover well. A cut-off score of 130 and above correctly predicted 86% of those who failed to return to work.

  • Refer to an Occupational Rehab Provider when a high risk Orebro score is recorded. The timely appointment of a rehab provider (within the first 8 weeks) can improve RTW rates by 3% to 5% and can result in total claims costs savings of between 4% and 9%. (Impact of Workplace Rehabilitation Providers, Analysis of claims data, September 2021, Ernst & Young)
    https://higherlogicdownload.s3.amazonaws.com/ARPA/b0d4c978-5587-43dd-a1c4-b8d197670d08/UploadedImages/ROI_on_workplace_rehabilitation.pdf

  • Maintain early and regular supportive contact. Schedule the catch up in your diary. Take notes for your memory. A terrific guide from Safe Work Australia gives practical guidance on managing the relationship with an ill or injured worker.
    safeworkaustralia.gov.au/sites/default/files/2024-06/rtw_supervisor_guide_for_publication-updated-final-jun24-v2.pdf

  • Express genuine care. “What can I do to help?” Ask what details the worker is comfortable sharing with the team.  Encourage coworkers to stay in touch with the injured worker if they did so previously. Extend invitations to social activities even if they are not likely to attend. Social belonging is a strong reason for RTW.

  • Minimise blame. Act promptly to fix issues that may have contributed to the accident/injury. Share this information with the injured worker.

  • Apologies have a positive role in resolving disputes and providing a mechanism for achieving justice between people with differing perspectives. A sincere apology offered in a timely manner can reduce anger about what happened and begin the process of rebuilding trust. Apologies and expressions of regret provided to workers following a workplace injury are protected under the Workers’ Compensation and Rehabilitation Act 2003 (the Act) and excluded from being considered in determining liability for common law damages, where a notice of claim for damages is made on or after 30 October 2019.

  • Offer suitable duties. Consult with the worker about those duties. Ensure they are meaningful. Small employers can access supernumerary support from WCQ to keep people at work in ‘created duties’.

  • Build capabilities in middle managers to know about the RTW process.
    Back on Track’s RRTWC Course is a great way of building capacity.

Treatment Providers

  • Stay up to date with the Health Benefits of Good Work and principles of occupational rehabilitation. Share this information with the patient.

  • When you identify psychosocial risk factors either in the patient or in the workplace, recommend to the insurer or on the medical certificate that an occupational rehab provider be engaged.

  • Participate in case conference with stakeholders. Your time is billable to the insurer and it is equal in therapeutic value to your treatment recommendations.

  • Be careful with language and be aware of the potential for catastrophising beliefs.

  • Offer reassurance and encouragement to stay active as able, engage socially as able and to maintain contact with the workplace (unless unsafe).

  • Refer for physiotherapy. There are VERY few contraindications and physios are well aware of red flags.

  • Know the clinical guidelines for back pain management. (Lancet, 2018)
    https://backontrackqld.com.au/back-pain-what-really-works/

The injured or ill worker

  • Stay as active as able – walking, swimming, water walking, recumbent bike, dance, resistance exercise.

  • Get outdoors in nature.

  • Continue to socialise, including with coworkers.

  • Get involved in the planning for your own RTW.

  • Use the support available to you and ask for help. In addition to your injury treatment you can access support from a psychologist if you are feeling vulnerable. If you are experiencing a lack of support in returning to work you can ask for an occupational rehabilitation provider. Your GP is the best person to initiate various forms of help and support.

  • Learn about your condition from trusted sources such as hospital, university or government websites.

  • For learning about pain management consider the following low and no cost options:
    Explain Pain https://www.noigroup.com/product/explain-pain-second-edition/
    Curable app https://www.curablehealth.com/
    MindSpot https://www.mindspot.org.au/treatment/our-courses/pain-course/

Get in touch for more information on how Back on Track can assist you and your people. 

[i] Linton SJ, Boersma K.. Early identification of patients at risk of developing a persistent back problem: the predictive validity of the Orebro Musculoskeletal Pain Questionnaire. Clin J Pain 2003;19:80–6.