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PHTY3280 > L14: Ax Planning RTW > Flashcards

L14: Ax Planning RTW Flashcards

1
Q

What are 9 principles of return to work for a Workers Compensation claimant?

A
  1. Goal of Rehabilitation is ALWAYS RTW (in CTP, it is return to preinjury function/status)
  2. Early intervention
  3. Workplace best place for rehabilitation
  4. Rest – associated with de-conditioning and social disconnect
  5. Keep HBOGW front of mind
  6. Communication with key stakeholders essential
  7. Focus on what person CAN do not what they CAN’T do
  8. Psychosocial factors important in RTW outcome and transition from acute –chronic phase (Krause et al 2001)
  9. Provision of modified or alternate duties improves speed and sustainability of RTW
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2
Q

What are 7 workplace interventions have demonstrated scientific evidence?

A
  1. Contact between health care provider and workplace
  2. Early contact with worker by workplace
  3. Presence of a RTW coordinator
  4. Offers of work accommodation eg light duties; graded work exposure; work trial; supported employment
  5. Worker’s offered modified work, RTW twice as often as those who do not ie doubles chances of success
  6. Ergonomic work site visits
  7. Supervisors are trained in work disability prevention and included in RTW planning
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3
Q

What is the hierarchy of return to work?

A
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4
Q

What are the 3 likelihood of RTW after injury?

A

Educate patients about these stats

If off work:

  • 20 days, the chance of ever getting back to work is 70%;
  • 45 days, the chance of ever getting back to work is 50%;
  • 70 days, the chance of ever getting back to work is 35%
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5
Q

What are the 3 steps involved in RTW?

A
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6
Q

What are 3 characteristics of “1. Understand prognosis, functional limitations” as steps in planning a RTW?

A
  1. Review medical reports, certificates, treatment plans
  2. Expected recovery timeframes, time since injury. Is recovery proceeding as expected or is it ‘delayed’?
  3. What if any barriers are there for RTW?
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7
Q

What are 4 characteristics of “2. Understand job ie the inherent physical demands” as steps in planning a RTW?

A
  1. Ask the worker what they do at work, and/or
  2. Use a self-report tool eg Job Requirements and Physical Demand Scale and/or
  3. Attend the workplace to view the work and do a task analysis is time permits and funding available (South Australian Physios are paid by Workers Compensation Insurer to attend the workplace) and/or
  4. Obtain job description, job dictionary, or task analysis from employer – hours, shifts, days, number of workers, tools, weights
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8
Q

What are worker self report of physical job demands?

A
  • What does your job involve? – how much of your day is spent sitting, standing, etc
  • Consider which body parts may be affected by the demands? Eg stooping may exacerbate LBP

Try to go to work place (if possible)

  • To tailor treatment/management specifically to the patient
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9
Q

What is the Job Requirements and Physical Demands scale?

A
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10
Q

Which duties may be suitable for a warehouse worker with back pain?

A
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11
Q

What are 6 characteristics of “3. Match job tasks with worker (eg.warehouse worker)” as steps ?

A
  1. Injured cartilage in right knee
  2. Off work for 2 months
  3. Had surgery 6 weeks ago
  4. Normal duties lifting outgoing stock into trucks on loading bay
  5. To start graduated RTW
  6. Possible restrictions from Dr could be:
    1. No lifting
    2. No prolonged standing
    3. No squatting
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12
Q

What task satisfies all tasks?

A

ALL criteria satisfied:

B (while alternate between sitting on chair and standing)

D (mechanical sweepers)

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13
Q

What are 5 features of “making recommendations for work or developing a ‘suitable duties’ plan”?

A

Suitable duties should:

  1. consider the worker’s capacity for work and matched to tasks available in workplace
  2. Are meaningful and contribute to production (eg photocopying for 4 hours is not meaningful and not contribute to production)
  3. be upgraded regularly
  4. Be within the restrictions of medical certificate
  5. Consider the workers age, education, skills and work experience
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14
Q

What are 3 types of suitable duties for RTW?

A
  1. Pre-injury duties with some modifications eg altered hours, days, shifts to reduce load, number and duration of breaks, order of job tasks, extra help, rotate heavy/sedentary work
  2. Modified duties – components of some of the pre-injury duties that have been included or removed to match the injured worker’s capacity
  3. Alternative duties – duties that are different from the pre-injury duties but allow the injured worker to stay at work or return to work.
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15
Q

What are pre-injury duties that are a type of suitable duties for RTW?

A

Pre-injury duties with some modifications eg altered hours, days, shifts to reduce load, number and duration of breaks, order of job tasks, extra help, rotate heavy/sedentary work

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16
Q

What are modified duties that are a type of suitable duties for RTW?

A

components of some of the pre-injury duties that have been included or removed to match the injured worker’s capacity

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17
Q

What are alternative duties that are a type of suitable duties for RTW?

A

duties that are different from the pre-injury duties but allow the injured worker to stay at work or return to work.

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18
Q

What are 4 possible modifications as a suitable duty for RTW?

A
  1. New equipment
  2. Workstation(s) and layouts
  3. Individual’s work methods
  4. Work flows/ work rates
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19
Q

What if they can’t RTW usual job or employer?

A
  1. Medical Deployment
    • Offer jobs that are consistent with skills (Eg. strokes or brain injuries)
  2. Host employment
    • Unable to go back to normal employment (eg. trial period as a new career)
  3. Off work until end of claim – Disability Services, Centrelink. Will need to have a ‘job capacity assessment’ which is similar to a ‘functional capacity assessment’
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20
Q

Should a person disclosure an injury or disability?

A

NO - If the disability or injury not acquired at work, there is no legal obligation to disclose a disability to your employer, unless it is likely to affect your performance or ability to meet the inherent requirements of the job.

However, you will need to tell your employer if your disability or injury is likely to affect your ability to work safely and ensure the safety of co-workers.

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21
Q

What are the experiences of injured workers?

A
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22
Q

What are 6 concerns of workers?

A
  1. managing pain and impact on performance at work and colleagues at work;
  2. fear of re-injury should they return too soon;
  3. limited knowledge of rights and organizational policies on sickness absence, work modifications or workers’ compensations entitlements;
  4. repercussions from disclosing their condition/pain in the workplace of everyone knowing;
  5. feelings of reduced worth as an employee;
  6. a lack of flexibility in job tasks
23
Q

What are red, orange and yellow flags of workers?

A
24
Q

What are 4 characteristics of injured workers?

A
  1. Demographic – older age, female gender, not married, lower education level, comorbidities associated with reduced likelihood of RTW
  2. Lower rates of return-to-work in females ? related to greater physical, stress and time demands related to domestic and home duties
  3. Positive association between marriage and improved RTW outcomes ?due to social support through marriage
  4. Likelihood of RTW increases with every additional year of education
25
Q

What are 4 individual psychosocial factors of workers?

A
  1. Attitudes and Beliefs
  2. Expectations for Recovery
  3. Behaviour – fear avoidance, coping
  4. Emotional Response eg distress
26
Q

What are 4 attitudes and beliefs for workers?

A
  1. Motivation to work predictive of work status
  2. Beliefs about severity of health condition significant predictor of RTW outcomes
  3. Pain viewed as harmful may lead to fear-avoidant behaviour and ‘pain catastrophizing’
  4. Exaggerated negative orientation towards noxious stimuli and pain experience
  • “this pain is so bad that something must be seriously wrong”

Assess with Pain Catastrophizing Scale

27
Q

What are 4 poor expectations for RTW? How can it be assessed?

A
  1. Realistic assessment?
  2. Self-fulfilling prophecy?
  3. May vary during Rehab process
  4. Predictive of work participation & RTW outcomes

Assess with

  1. 10-item RTW self efficacy scale, or
  2. one Question: “On a scale of 0 to 10 (not confident at all to extremely confident), “How confident are you that you will be at work in one month?
28
Q

What are 2 fear avoidant behaviours for workers?

A
  • Behaviours associated with abnormal pain beliefs – eg withdrawing from social functions, rest used as a pain control strategy
  • Reliance on substances for pain control – alcohol, smoking, pain medication
  • “I don’t play with the kids anymore, don’t walk the dog, don’t go to book club due to the pain”
  • “ As soon as I feel pain, I stop what I am doing and take pain killers” (passive pain coping strategy)
29
Q

What are 3 characteristics of fears of re-injury for workers? How is it assessed?

A

“If I return to that machine / job, I’m worried I will hurt myself again”

  1. Often related to specific tasks / machines
  2. LBP recurrence 50% in one year
  3. Desire to be 100% before RTW

Assess with

  1. 17 item TAMPA scale of kinesophobia
  2. Fear Avoidance and Beliefs 2 subscales
30
Q

What are coping strategies, locus of control? How can it be assessed?

A
31
Q

What are 2 types of coping strategies of prolonged work disability?

A
  1. Passive: something is done to or given to the patient who, in turn, plays a passive role eg avoidance or escape manoeuvres by the person in pain ‘conventional medical’ e.g. prescription analgesics, physiotherapy, TENS; and ‘passive behavioural’ e.g. rest, heat treatments, cold packs, using alcohol, having a hot bath.
  2. Active: activity initiated by the person in pain to deal with pain, but only if not characterised by avoidance or escape eg ‘behavioural’ e.g. exercising, working, and using correct postures and ‘cognitive’ e.g. use of prayer, relaxation, meditation, mental distraction
32
Q

What is a passive coping strategy of prolonged work disability?

A

Passive: something is done to or given to the patient who, in turn, plays a passive role eg avoidance or escape manoeuvres by the person in pain ‘conventional medical’ e.g. prescription analgesics, physiotherapy, TENS; and ‘passive behavioural’ e.g. rest, heat treatments, cold packs, using alcohol, having a hot bath.

33
Q

What is an active coping strategy of prolonged work disability?

A

Active: activity initiated by the person in pain to deal with pain, but only if not characterised by avoidance or escape eg ‘behavioural’ e.g. exercising, working, and using correct postures and ‘cognitive’ e.g. use of prayer, relaxation, meditation, mental distraction

34
Q

What are 3 characteristics/effects of emotions of workers? How can this be assessed?

A
  1. Presence of psychological distress likely to increase risk of disability
  2. Elevated anxiety, insomnia, depression predicts chronicity in patient with LBP
  3. May pre-exist current injury or result from prolonged pain and disability – ‘Secondary psychological injury’

Assess with: Disability Anxiety Stress Scale, K6, GHQ

35
Q

Is family a barrier or facilitator in injured workers?

A
  1. Family and social support
  2. Overly caring partner
  • “my mum has moved in to care and cook for me because my shoulder is too painful”
  • “my wife is sick of me complaining about my pain – my injury is placing a lot of extra work and pressure on her”
36
Q

What are 6 individual characteristics likely to facilitate RTW?

A
  1. Greater self-esteem,
  2. Positive work role models,
  3. Optimism
  4. Positive coping styles
  5. Work-orientated goal setting and motivation
  6. Positive work attitude and internal locus of control contribute to job seeking
37
Q

What are 4 injury related factors likely (but not necessarily) delay RTW?

A
  1. Severity of symptoms, pain intensity
  2. Presence of clinical signs eg neurological, reduced SLR, pain radiation
  3. Multiple co-morbidities
  4. Previous history of problem

Note – it is possible to work with pain eg headache

38
Q

What are 6 unhelpful activities and responses of Health Care Professional (HCP)?

A
  1. Diagnosis – how it is presented affects patients beliefs
  2. Patients chasing a diagnosis (‘I must have a scan’) or finding a HCP who can ‘fix me’
  3. The HCP commenting on seriousness of diagnosis “this is the worst case I have seen”
  4. Conflicting diagnoses from various HCPs creates confusion and distrust
  5. HCPs making referrals for multiple investigations to ‘find a cause’ just to appease the patient
  6. Advice to withdraw from job
39
Q

How important are workplace factors?

A

General conclusion of several systematic reviews:

“while attending to the physical and medical aspects of the work-disabled employee is important, much of the variability in RTW outcomes is accounted for by what takes place at the workplace”

40
Q

What are 3 characteristics of job dissatisfaction? How can it be assessed (2)?

A
  1. Boring, monotonous
  2. Unrewarding, undesirable
  3. Dissatisfied workers have worse RTW rates as more likely to have time lost claims and more spells of joblessness
  • “I hate my job”,
  • “my boss is putting pressure on me to RTW ASAP”

Assess with:

  1. On a scale of 1-10, “How much do you enjoy your present job?”
  2. Modified Work APGAR
41
Q

What are 3 characteristics of high job stress? How can it be assessed?

A
  • “I have too much work to do”
  • “My job is very stressful”
  1. Competitive work setting
  2. Time pressures
  3. No decision latitude

Assessment usually undertaken by employer or psychologist or Ergonomist

42
Q

What are 4 characteristics of inability to modify work? How can it be assessed?

A

“There are no light duties”

  1. Confining job task or location
  2. No modified duty options
  3. No flexibility or leeway
  4. Public safety concerns

Assessed with 25-item Job Leeway Scale (outcome measures)

43
Q

What are 5 characteristics of lack of workplace support? How can it be assessed?

A

“My supervisor is not interested in me”

  1. New or precarious employment
  2. Isolated work setting or hours
  3. Interpersonal conflicts
  4. Employer showing no interest or not making contact
  5. Social support at work associated with better RTW rates

Assess with:

Work APGAR or Psychosocial Aspects of Work questionnaire (outcome measures document)

44
Q

What are 2 characteristics of heavy physical demands?

A
  1. Bending, lifting, pushing, pulling
  2. Self-report is best predictor of long-term disability
45
Q

What are 8 questions to identify work-related barriers?

A
  1. How is your employer responding to your problem or what has your employer done to help?
  2. When do you think you will return to work?
    • Self-efficacy
  3. Is there any control/flexibility in your job? Are there any alternate duties you can do?
  4. Do you have tight deadlines?
  5. Is your employer supportive of graduated RTW
  6. How has your employer reacted to your injury
  7. Can you talk to your boss about the problems you are having?
  8. Is your job physically demanding, repetitive, heavy loads – what are the critical job and/or physical demands or Borg Scale
46
Q

What are 9 workplace features that support RTW?

A
  1. A strong safety culture where management ‘walk the talk’
  2. Effective leadership
  3. Culture of trust
  4. A ‘no blame’ response to injury
  5. Positive feedback channels
  6. Flexible appropriate alternative work duties
  7. Time delivery of rehabilitation services
  8. Supervisors trained in work disability prevention and included in RTW planning
  9. Employer makes an early and considerate contact with injured worker
47
Q

What is Compensation / Legal / Industrial Context?

A
48
Q

What is perceived injustice (for compensation)?

A

attribution of blame to others eg “it was the company’s fault that I was hurt” so compensation ‘owed’

49
Q

What is procedural justice (for compensation)?

A

a process perceived to be fair if an individual feels able to express views and feelings and able to have influence on the process

  • Insurer is listening to them (they are being heard)
50
Q

What are 2 characteristics of compensation?

A
  1. Delays in accessing income support and treatment cost, disputes over eligibility; Complex processes and language
  2. Involvement of a solicitor slows compensation process
51
Q

What are 2 factors of compensation stress?

A
  1. Secondary Gain
  2. Secondary victimisation

(from perceived injustice)

52
Q

Those involved in compensation have worse recovery than those who do not. WHY? (compensation stress)

A
  1. Secondary Gain - being involved in claims settlement creates an unconscious financial incentive for victims not to get better as long as the settlement lasts;
  2. Secondary victimisation - the compensation process is a stressful experience: victims suffer from renewed distress caused by the claims settlement process e.g. numerous assessments, repeated confrontation with the traumatic history, delayed funds, and financial risks, and the often adversarial relationship between client and the insurance agency
53
Q

What are 3 screening methods for psychosocial risk factors?

A
  1. Uni-dimensional scales eg
    1. Yellow flags: pain catastrophizing, TAMPA, Expectations for Recovery;
    2. Blue Flags: Readiness to RTW scale; Selfefficacy for RTW; Work APGAR; Psychosocial aspects of work Q
  2. Multi-dimensional scales to quantify risk of chronicity based on a threshold
  3. Interviewing – targeting questioning; stepped care approach
54
Q

What are 5 Multi-dimensional scales preferred – less onerous on HCP and worker?

A
  1. Örebro Musculoskeletal Pain Questionnaire – most commonly used and recommended with evidence to support use (10 and 25-item)
  2. STarTBack Screening Tool (9-items)
  3. Obstacles to Return-to-Work Questionnaire (55-item)
  4. Psychosocial Risk for Occupational Disability Instrument (122-items PRODI) – correctly predicted RTW in 80% of cases with LBP
  5. PRICE – Pain Recovery Inventory of Concerns & Expectations (46-items)

PHTY3280 (17 decks)

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