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Health provider > Key principles of injury management

Screening for risks of long term disability

Simple and formal risk screening should be undertaken to identify workers at risk of:

  • long-term disability
  • development of chronic conditions or persistent pain
  • failure to return to work.

Simple and formal risk screening can identify these risks early.

Simple screening

Simple screening can involve the use of clinical judgement, informal questioning or brief questionnaires. Screening for the following factors can assist during the initial consultation phase.

  • High levels of self-reported pain at onset of injury [1]
  • High levels of self-reported disability at onset of injury [2]
  • The presence of psychosocial factors (yellow flags) [3], such as fear avoidance, catastrophising and psychological distress.

Examples of simple screening questions:

  • When do you think you will be able to return to work?
  • Do you feel physically capable of returning to your usual work activities?
  • Do you think your injury would become worse if you returned to your usual work activities?
  • Do you think that your injury would interfere with your usual work activities?

Asking the injured worker "When do you expect to return to work?" is a useful simple screening question to predict return to work [4]. A negative response indicates the likelihood of a poor return to work outcome [5].

Formal screening

Formal screening includes the use of standardised outcome measures and screening instruments. Formal assessment of psychosocial and occupational risk factors should occur, regardless of the site of the soft tissue injury, where:

  • simple screening indicates a need
  • there is failure to improve in function within expected recovery timeframes
  • there is absence from work for more than 3 to 6 weeks.

The vast majority of injured workers return to work within expected recovery timeframes, therefore the number who require formal screening is limited [6].

Examples of interventions for identified risks

Biological
Risk factor Intervention
Medical/pathological
  • Surgical opinion and treatment if indicated
Failure of treatment
  • Consider ceasing ineffective treatment
  • Formal reassessment of biopsychosocial risk factors
  • Consider transition to work-related activity and incorporate a cognitive behavioural approach
  • Second opinion if warranted
Psychological
Risk factor Intervention
Unhelpful beliefs about pain and injury
  • Education and information
  • Work-related activity and incorporate a cognitive behavioural approach
  • Psychology: Brief intervention
Catastrophising or fear avoidance
Stress
Anxiety, depression, stress
  • Consider psychology referral for further assessment or intervention
Social
Risk factor Intervention
Unhelpful beliefs about compensation system
  • Educate worker about their role in the recovery process (eg, compliance with an offer of suitable duties to return to work)
Occupational
Risk factor Intervention
Reluctance to return to work
  • Treating medical practitioner to certify capacity
  • Discuss capacity with injured worker
  • Certify alternative or modified duties in collaboration with employer and rehabilitation provider.
Failure to return to work
  • Workplace assessment
  • Functional capacity assessment
  • Certify alternative/modified duties identified by employer rehabilitation consultant
  • Contribute to return to work plan
No suitable duties offered/available
  • Employer and rehabilitation provider explore options for suitable duties

Click here for information about simple and formal outcome measures and screening tools.

Click here for information about the assessment of red and yellow flags.

References

  1. Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 2007 Feb;30(1):77-94.
  2. Hansen A, Edlund C, Branholm IB. Significant resources needed for return to work after sick leave. Work 2005;25(3):231-40.
  3. Accident Compensation Corporation. New Zealand Acute Low Back Pain Guide. Wellington 2004.
  4. Hansen A, Edlund C, Henningsson M. Factors relevant to a return to work: a multivariate approach. Work 2006;26(2):179-90.
  5. Heijbel B, Josephson M, Jensen I, Stark S, Vingard E. Return to work expectation predicts work in chronic musculoskeletal and behavioral health disorders: prospective study with clinical implications. J Occup Rehabil 2006 Jun;16(2):173-84.
  6. WorkCover NSW. Advice sheet 3: Review and transition process (WC05367). Gosford 2008.

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