According to Dr. Douglas Benner, employers need to learn a new term: functional restoration. “It’s returning employees to the function level they had before they were injured,” he says.
Some employees experienced childhood incidents – such as abuse, alcoholism or drug abuse – which make it more difficult, physically and emotionally, to recover from a work-related injury. There also are other factors, such as pain tolerance and general attitude, which can impact recovery time. The employee’s attitude about the workplace, the employer and coworkers and supervisors also can impact his or her ability to recover from an injury.
“You need to determine how people handle illness and injury. Some people make big things out of little things,” says Benner, who is the medical business product development officer for EK Health in San Jose, Calif.
For example, two employees trip and fall in the workplace. One employee shakes it off, takes an over-the-counter pain reliever the next day when he feels a little stiff and doesn’t even bother to report the injury. The second employee immediately reports the fall and goes to the hospital for x-rays because he’s worried that he might have re-injured a knee that was damaged in a high school football game. The x-rays are inconclusive, but the employee complains of pain and starts taking the prescription pain reliever Vicodin. He tells his boss he is in too much pain to return to work and he worries that his knee will never feel 100 percent again.
A wise employer will have a nurse practitioner or workers’ compensation claims manager ask the injured employee one simple question, says Benner: “Do you think you are going to recover from this injury?’”
The answer to that question speaks volumes about the recovery path that employee will take, says Benner. If the employee says “no” or “probably not,” then intervention needs to start immediately, with a support system created for that employee. “By the time you’re talking to them about their addiction to opiate painkillers, it’s too late,” says Benner.
He suggests employers look at the STarT Back tool, which
was created to group patients suffering from back pain into three categories of risk of poor outcome (persistent disabling symptoms) - low, medium and high-risk. By categorizing patients into these three groups, physicians and physical therapists are able to target interventions to help improve outcome.
The high-risk group often has psychological obstacles to recovery, which requires a comprehensive package of care, including psychological counseling and medical care. Medium-risk patients have physical obstacles to recovery, which require “face-to-face conservative treatment,” including physical therapy and medical treatment. Injured employees who have a low risk of developing a chronic problem require medical advice, reassurance that they will be well soon and, perhaps, medication.
Many of the questions on the survey, such as “In general, I cannot enjoy all the things I used to enjoy,” could apply to any type of workplace injury. Benner suggests adapting the more-specific questions found in the tool to fit the workplace. For example, rather than have the employee agree or disagree with the statement “My back pain has spread down my leg(s) at some time in the last 2 weeks,” have them respond to the statement “My injury has caused other body parts to hurt.”
The tool can be used by physicians, nurses and physical therapists to help claims managers and others determine how much intervention is necessary to return an employee to work. Some high-risk employees, especially those who genuinely fearful of re-injury or who have a history of depression might need to see a psychologist to help them develop a more positive outlook. Others who fall into the medium-risk category might need to see an occupational or physical therapist to help them establish a activity plan to help cope with the negative outlook often associated with injuries that limit normal activities.
Benner recently participated in a panel discussion about early intervention functional restoration, which identifies injured workers at risk for delayed recovery or return to work, and targets them for accelerated treatment, an approach that dramatically reduces lost work days. This injury prevention and safety program helps employees with poor coping skills return to work.
“There needs to be a collaborative approach between the physical therapist, the nurse practitioner or the claims manager and the physician,” says Benner. “They need to show the employee that he has experienced measured improvement every week and essentially, coach the employees like a trainer would. Reassure them they’re doing well and they will recover.”