Week 1 Lecture Flashcards
What is the importance of work?
- source of income
- personal identity
- social support
- contributes to overall health and wellbeing
- life structure and purpose
Discuss the different perspective and responsibility of the following stakeholders during work disability
- health care system
- worker
- union
- RTW coordinator
- manager
health care system
- are you healthy or unhealthy (Sick Role Theory and Biomedical Model);
- role: fit to RTW or not? completing functional abilities assessment form
- tends to err on the side of resting to recover vs staying active to recover
Disability management definition
systematic, goal oriented process of actively minimizing the impact of disability on an individual’s capacity to participate
competitively in the work environment; and maximizing the health of employees to prevent disability or further deterioration when disability exist
Describe the traditional RTW process and some limitations
At worksafe:
Injured or ill worker generally takes a period of absence, then does a referral intake, rehab plan is developed, services are provided, plan is undertaken and monitoring occurs, person returns straight to work
- reactive: waiting for worker to see a physician, waiting for WSB to make a claim decision, referrals, physician to clear worker, WSB does RTW planning, waiting for doctor to fully clear worker for RTW
- barriers: workplaces may have lack of policies, procedures, or guidance on RTW practices –> accommodations may not match the workers need. accommodations may be expensive for smaller firms. worker may have familial obligations making it difficult for them to attend appointments or follow GRTW plans w/o childcare support
Describe the process from work injury to full return to work
- first aid assesses injury right away
- manager and supervisor of worker is notified
- if minor injury, care treatment and follow up can be done by first aid attendant (first aid records must be kept)
- if person is able to stay at work, worker is monitored and can be assigned lighter duties
By law, if they require medical aid beyond first aid, workers must get a return to work package from the employer
includes: letter to worker, letter to physician, return to work planning form.
Employer must contact worksafebc to report the claim
Employer must provide transportation to medical aid if needed (taxi, ambulance costs)
Referral intake forms
- Employee fills out F6
- Manager fills out F7
- GP fills out F8, and occupational fitness assessment
WorkSafe determines if its compensable through WCB. if non-compensable, employee can explore using the workplace’s insurance provider
If compensable: wage loss, healthcare benefits, permanent disability and death benefits
How does WCB determine whether an injury is compensable
- Injury must arise out of, in the course of, or aggravated by work
- Claim manager adjudicates based on received forms.
Utilizes compensation practice directives as needed (activity-related soft tissue disorder claims and Compensable Consequences - Psychological Conditions)
Back injuries must be acute to be compensated
What does Schedule 1 say about activity related soft tissue disorders
What about other ARSTD that don’t fit in this definition?
Diseases listed in schedule 1 are presumed in individual cases to be work-related if the worker is working in a recognized industry or having worked as part of a process associated with the disease.
- Knee Bursitis,
- Shoulder bursitis,
- Hand-wrist tendinopathy,
- Shoulder tendinopathy, and
- Hand-arm vibration syndrome.
For other ARSTDs, WorkSafeBC does not presume these are due to employment. There must be evidence showing it is at least as likely as not that employment factors contributed to causing or aggravating symptoms.
Tendinopathies (includes Epicondylopathy and Stenosing Tenosynovitis)
Bursitis (other than those in schedule 1)
Hypothenar Hammer Syndrome
Cubital Tunnel Syndrome
Carpal Tunnel Syndrome
Plantar Fasciitis
Radial Tunnel Syndrome
Thoracic Outlet Syndrome
Disablement from Vibration
ASTD risk factors considered:
- cold temperature
- cognitive demands
- dose
- duration
- force
- frequency
- grip type
- posture
- repetition
- static load
other considerations (personal): age, weight, gender, previous injury/condition, smoking, non-work activities, claim history
Differentiate between
- client services representatives
- entitlement officers
- case managers
- Client Service Representatives - entitle routine
claims - Entitlement Officers - entitle non-routine
claims for acceptability and wage loss - Case Managers - entitle WRMDs, head
injuries, traumatic stress and psychological
What are the different types of WSB claims?
- No time loss claims: return without missing additional days other than injury day
- Time loss claims: RTW in <3 weeks. Handled by client service representative if less than 3 weeks RTW support services. Referred to entitlement officer to adjudicate if longer
- time loss case management: ASTDS, catastrophic
injury, severe brain injury or psychological injury and
claims more than 4-6 weeks (long-term/permanent disability) or difficulties
Describe the hierarchy of RTW solutions
- Return to own job, same employer
- return to other job, same employer
- return to similar job, other employer
- return to different job, other employer (vocational rehabilitation)
- training for self employment
RTW tasks/ suitable duities
- temporary
- meaningful and productive
- Allow the injured worker to return to the job site for
partial days, gradually working up to full-time hours
What are accomodations and their purpose?
- Providing adaptive technologies or equipment
- Ensuring accessibility to physically disabled
workers - Altering job duties including schedules
- Providing part-time as an alternative to full-
time work - Permit certain degree of absenteeism related
to disability
Describe the following model, discussing components and utility: biomedical model
health is the absence of signs and symptoms of disease. injured/ill individuals are in a passive patient role and excused from normal societal obligations
Physician drives the program, performing assessments,
The biomedical model’s consideration of an injured/ill person as a passive patient does not support gradual return to work practices, as it fully excuses these individuals from any work obligations. This can be problematic for individuals with chronic or long-term illnesses or injuries, as with the model, they may never return to work and it could result in issues such as identity loss, social isolation, and financial difficulties. On a societal or organizational level, a large amount of workers off work can cause labour shortages and affect productivity. Furthermore, for individuals with acute illnesses, their return to work may not be as expedited or successful than if they had followed gradual return to work plans.
Describe the following model, discussing components and utility: social model
How does it differ from the biomedical model?
Presents disability as not caused by illness or injury but due to societal organization. Barriers to participation are exclusively a result of the social environment and solutions demand collective effort of society. Societal ideology, culture, education, and social organization of work can shape how we all perceive disability.
Presents disability as not caused by illness or injury but due to societal organization. Barriers to participation are exclusively a result of the social environment and solutions demand collective effort of society. Societal ideology, culture, education, and social organization of work can shape how we all perceive disability.
Describe the following model, discussing components and utility: job fit/matching
- process for GRTW
- analyze the job using a physical demands analysis
limitations: PDAs are often out dated and don’t describe the realities of the work (work as imagined vs work as realized). PDAs often miss psychosocial issues - if disabled worker has plateaued in recover, evaluate the worker with an FCE, then match their ability to their job
Describe the following model, discussing components and utility: medically managed care models
Healthcare team performs assessment, creates care plan, plans rehab, provides leave estimation
- physician acts as the gatekeeper for RTW
Most GPs are not having discussion with their patients about the benefits of working while recovering
GP who do raise benefits of GRTW often back down when their patients express resistance, stress or a lack of readiness or willingness to RTW.
- Physician has no training in ergonomics
- Focus on rest and no work (Biomedical Model/Sick Role Theory)
- Doesn’t know about the patient’s job - how can they say if they’re ready for work?
Describe the following model, discussing components and utility: biopsychosocial model of injury
compare it to the biomedical model
Health and illness is a product of a combination of factors including individual biology (genetic predisposition, chemical imbalances), behavioural factors (lifestyle, stress, health beliefs), and social conditions (cultural influences, family relationships, social support)
Biomedical model focuses on just the signs and symptoms of illness
Holistic approach to understand patients
Addresses needs of each patient
Describe the following model, discussing components and utility: ecological case management
- Focuses on all stakeholders in case management.
Does not explain mechanisms but purpose is to guide stakeholders to consider all factors related to RTW
conceptual model
4 main categories: workplace system, health care system, personal system, legislative and insurance system
Middle things are considered the most important - but could they all be equally important and require consideration?
Does not show communication and interaction between elements
Describe the following model, discussing components and utility: New Zealand Model
Developed for Low back pain
Distinguishes/classifies barriers in RTW
- Red Flags – physical factors like nerve root pain, infection, fracture
- Yellow flags – psychosocial factors - increases individuals risk for prolonged pain and disability. Avoidance of normal activity, catastrophizing, distress, poor pain tolerance
- Orange Flags – mental health issues (major personality disorders, addiction to drugs/alcohol, major depression)
- Blue flags – employees perception of workplace: low expectation of RTW, belief that work is harmful, perceiving work as rushed, boring, unsatisfactory, unsupportive, unrealistic performance expectations, low reward - high demand)
- Black flags – actual features of work (System or contextual factors including relevant people, systems, and policies that can affect disability): compensation problems, unhelpful policies and procedures used by company, disagreement with key players, job involves shift work or working unsociable hours
Distinguish between a conceptual and operational model
Conceptual model: describes mechanisms and variables of a problem with directional and reciprocal influences
Operational model: describes optimum functioning of an intervention, decision making approach, or management structure
Describe the following model, discussing components and utility: Sherbrooke Model
The Sherbrooke Model is operational. It represents a multifaceted intervention to prevent low back disability.
Involves an integrated case management team
Combination of a clinical rehabilitation intervention
and occupational intervention that included an
ergonomic component
RTW 2.4 times quicker than standard care
Describe the following model, discussing components and utility: Previcap
PREVICAP (prevention of work handicap) model
* Person-environment interaction motel. operational
* Interactions are directed toward worker, workplace, and the interaction between the two
Components:
disability diagnosis step: precise causes for disability are determined (physical, psychosocial, occupational, and administrative)
Progressive return to work rehabilitation phase involving HCP team that can address various causes of disability
Interdisciplinary health care practitioner team: doctor skilled in MSIs and rehabilitation, occupational therapist, kinesiologist, ergonomist, team coordinator (case manager)
Identified two main concepts in medical management:
1. Need for coordination between worker & workplace intervention
2. Intervention delivered at secondary level of care
Describe the following model, discussing components and utility: International Classification of Functioning (ICF)
Conceptual model developed by the world health organization for communication purposes between healthcare professionals. Communicates work related factors leading to problems with functioning and health
Causality is shown in multiple directions.
Psychosocial factors (physical, social, attitudinal environments)
Describes the workplace (micro, meso, macro determinants) and work environment factors
Presents physical hazards as well (vibration, air quality, radiation, biological and chemical agents, ergonomics)
Limitations
- Does not consider others roles influencing work participation
- Does not identify a mechanism for factors interaction
- does not identify relationships between factors as positive or negative
