Jun 3, 2021 | Insights
How can MedRisk services help streamline treatment for neck injury patients? Manager of Clinical Services Suzanne Sadusky, PT, DPT, shares the important role her team plays in injured worker recovery.
This blog is part 3 of a 3-part series titled “Neck Injuries in Workers’ Comp: Managing Pain and Controlling Cost.”
Neck injury can be a complex treatment area for physical medicine clinicians. From headaches to nerve pain, the symptoms of neck injury can be wide-ranging, which can increase the cost of diagnosis and treatment if not managed appropriately.
MedRisk aims to simplify the pathway to recovery for injured workers, including those being treated for neck injury. We sat down with Suzanne Sadusky, PT, DPT, MedRisk’s Manager of Clinical Services, to discuss the journey of a neck injury referral and how MedRisk supports streamlined, cost-effective treatment every step of the way.
1. Pre-Treatment Services
As soon as a referral is made, MedRisk gets to work in matching the patient with an appropriate provider based on specialty, location, and availability – within an average of 4 hours. This helps patients be seen for an initial evaluation within 2.6 days of referral. First, the patient may consult with one of MedRisk’s on-staff physical therapists prior to treatment. During this dialogue, the PT can identify things that could impact recovery, such as prior surgeries, existing ailments, and psychosocial factors such as depression or anxiety. Notes from the consult are delivered to stakeholders in a comprehensive report, which allows these insights to be considered in developing an optimal treatment plan. In addition, the PT uses the consultation to educate the patient on the treatment process, set expectations for recovery and encourage patient participation and compliance.
“We try to alleviate any anxiety about starting therapy and answer their questions,” Sadusky said. “We are not the treating therapist and we are not the insurance carrier. We are a third party, which puts us in a unique position.”
2. Clinical Oversight
As the first company to introduce evidence-based guidelines for managed physical medicine, MedRisk is committed to keeping treatment guidelines up to date. The company’s proprietary guidelines, which are categorized by body part, are assigned to every case that opens at MedRisk, and they help set expectations for the number of visits and the amount of time that is expected for recovery. The guidelines were developed by and are maintained by MedRisk’s International Scientific Advisory Board (ISAB), an elite panel of world-renowned specialists in physical medicine and workers’ compensation who oversee all clinical aspects of MedRisk’s medical management programs. The group meets regularly to review current scientific literature and new treatment protocols and vet MedRisk’s guidelines, which are specific to physical therapy and workers’ compensation.
“The guidelines go a long way in keeping treatment on track. However, there will always be instances when patients do not progress as expected,” Sadusky said. In these cases, Sadusky’s team is called upon to do a clinical review. During this process, the team reviews the case documentation and reaches out to the treating therapist to discuss whether additional therapy is necessary. With these insights in hand, MedRisk is then able to provide recommendations to adjusters on how to optimize treatment moving forward.
3. Telerehabilitation
Telerehabilitation has become a more standard component of treatment throughout the pandemic, and according to Sadusky, the benefits will hold up well into the future.
“During COVID, it often wasn’t always safe or possible to be in the clinic, and it really showed how telerehab can support continuity of care,” she said. The option of receiving PT services from home can help patients avoid gaps in treatment, maintain steady progress, and control their symptoms in the expected timeframe. In the case of neck injury, patients may receive equipment, including TheraBands, an exercise ball, and weights, with instruction for self-management and advanced strength exercises through a virtual PT appointment. This allows patients to avoid common pitfalls that could have derailed in-person treatment, extended the duration of the claim, and potentially delayed return to work.
Conclusion
What presents as neck pain can often be more complex than meets the eye, as the injury can sometimes involve the shoulder or spine. When treating a clinically complex injury, it’s important that treatment plans are both patient-centered and streamlined. Through MedRisk’s managed physical medicine services – communication with patients and stakeholders, clinical oversight, and telerehabilitation – a more predictable and cost-effective path to recovery can be achieved.
About Suzanne Sadusky, PT, DPT
Suzanne is a licensed physical therapist. She has worked at MedRisk for over 6 years and is currently the Manager of MedRisk’s Clinical Services team. Her team is responsible for performing clinical reviews and providing documented recommendations based on use of appropriate clinical guidelines. Suzanne holds a Doctor of Physical Therapy degree from Boston University and a Bachelor’s in Health Studies degree also from Boston University. Prior to joining MedRisk, Suzanne worked in a variety of settings as a physical therapist. These include outpatient orthopedics and workers’ compensation, acute care, and acute inpatient rehabilitation, as well as independent living and skilled nursing facilities. She has also been involved in facilitating online learning through Boston University’s transitional DPT program.
May 5, 2021 | Insights
Can effective provider communication minimize time away from work for injured workers?
A recent article published in Medical Care looked at how healthcare provider (HCP) communication can facilitate the successful return to work (RTW) for injured workers.
There is a growing recognition among HCPs that injured worker treatment must go beyond biomechanical therapies in order to help the patient achieve optimal outcomes. Patient education and communication can be important components of minimizing time loss after injury. The authors analyzed linked survey and administrative claims data from workers’ compensation recipients to assess whether HCP communication could predict time off work and whether this impact could be hampered by a stressful HCP experience.
The report found that sharing a likely RTW date with patients reduced the odds of future time loss, regardless of the stress of their HCP experience. In addition, HCPs may be able to reduce the length of future time loss by reaching out to stakeholders in the return-to-work process and possibly through prevention discussions, but only in low-stress encounters.
MedRisk helps facilitate patient education by providing informational materials and scheduling a consultation with an on-staff PT for patients prior to treatment. Insights from these conversations, along with ongoing progress notes, are communicated to stakeholders to support the injured employee and help mitigate hurdles on the path to recovery.
To read the complete article, click here.
Lane, T. J., Lilley, R., Black, O., Sim, M. R., & Smith, P. M. (2019). Health care provider communication and the duration of time loss among injured workers. Medical care, 57(9), 718-722.
May 5, 2021 | Insights
What are the unique challenges faced by neck injury patients, and how can self-management strategies help them in the recovery process? Donald Murphy, DC, FRCC, weighs in.
This blog is part 2 of a 3-part series titled “Neck Injuries in Workers’ Comp: Managing Pain and Controlling Cost.”
When we think of musculoskeletal problems in workers’ comp, the first thing that comes to mind is low back pain. And with 37% of global low back pain cases believed to be work-related, this is rightfully a primary focus for the industry. But what many do not realize is that neck pain is a common issue faced not only by injured workers but the population at large. In fact, back pain and neck pain are the leading causes of years lived with disability in most countries and age groups.
We recently sat down with MedRisk International Scientific Advisory Board (ISAB) member Donald Murphy, DC, FRCC, to understand the unique challenges of treating neck pain, how therapy has evolved over the years, and strategies for effective return to work for neck injury patients.
Treatment Challenges
Getting injured on the job can be a traumatic experience. Whether it’s the effect of a fall, an accident or poor ergonomics, pain is perceived as something out of our control – and according to Dr. Murphy, this is particularly the case with neck pain.
“Neck pain is different from knee or wrist pain. The perception is that neck pain must be the result of a spine problem, and if it involves the spine, it must be a catastrophic situation,” he said.
There is a misconception that because the spine is a complex system it must be delicate and vulnerable. In actuality, the spine is one of the most protected parts of the entire body, shielded by thick ligaments and muscles. Neck pain can involve the spine, but whether a nerve root, disc, or joint is to blame, according to Dr. Murphy, educating the patient about the nature of their injury is the first step in deescalating the urge to catastrophize. The next step is getting the patient involved in their own recovery. While some passive modalities, such as manual therapy, may be a useful component of the treatment plan, he says a more active approach to treatment is essential.
The rise of telerehabilitation during the pandemic helped promote self-management strategies among injured workers. While in-person therapy is sometimes necessary and often preferred, delivering therapy virtually inherently involves instructing patients on how to help themselves. A physical therapist can demonstrate a particular neck stretch over the screen to help the patient increase mobility.
“It’s important to help the patient take an active role in their own rehabilitation. I may need to use my hands to help the situation, but the patient needs to feel empowered. I don’t want a machine to be the hero in this story. I don’t even want to be the hero in this story. I want it to be the patient,” Dr. Murphy said.
Returning to Work
It’s clear that empowering the patient is an important component of neck pain treatment, but Dr. Murphy emphasizes that this philosophy must be carried through the patient’s return to work and beyond. The likelihood of chronic pain following neck injury is often dependent on the nature of the injury; however, whether the initial cause was whiplash or ergonomics, he says it’s important to set expectations around the long-term pain experience.
“A lot of patients have a fear around returning to work. They think they shouldn’t go back until they feel 100% like they did pre-injury, or they believe going back to the same environment could lead them to hurting themselves again,” Dr. Murphy said.
He suggests talking through this fear and positioning returning to work as a natural next step in the therapy process. Getting back to normal activity, even if it triggers some level of pain, can help the process resolve as quickly and completely as possible, whereas avoiding activity can actually delay recovery. By providing patients with long-term self-management strategies and exercises that can be performed at home or on the job, they will feel better equipped to manage hurdles along the way.
“Plant that seed early,” Dr. Murphy said. “Set the expectation that the patient may feel some pain when they get back to work, but that resuming normal activity is the goal. Help them gain confidence in their ability to get their life back and provide the necessary self-management strategies to do so. With this, their pain experience often transforms.”
About Donald Murphy, DC, FRCC
In addition to serving on MedRisk’s ISAB since December 2008, Dr. Murphy is Clinical Assistant Professor at the Warren Alpert Medical School of Brown University. He is also Adjunct Assistant Professor in the Physical Therapy Department at the University of Pittsburgh, where he co-leads the Primary Spine Practitioner certificate course. He has also helped implement and direct high value spine pathways in several states through Spine Care Partners.
He has been on the Expert Panel for several spine care guidelines, including those of the American College of Environmental and Occupational Medicine, American College of Physicians and the American Pain Society. Dr. Murphy has published dozens of papers in the peer-reviewed spine literature as well as three books on back and neck pain.
Apr 12, 2021 | Insights
How can PTs empower patients to self-manage their condition, even after their initial treatment has ended?
In a recent article published in the Journal of Orthopaedic and Sports Physical Therapy, Hutting et al contend that self-management strategies are integral to managing chronic musculoskeletal disorders and discuss how physical therapists (PTs) can provide self-management support throughout the course of treatment.
What types of self-management strategies are most effective when treating low back pain and other persistent musculoskeletal disorders? In their discussion, the authors recommend an individualized, holistic approach to self-management that addresses biomechanical, psychosocial and individual characteristics. Research has shown that while passive self-management approaches (e.g., hot packs) increase the likelihood of pain behavior and disability, active strategies (e.g., exercise) can decrease the probability of these experiences.
The authors recommend that PTs integrate self-management strategies into treatment by: (1) working with the patient to identify any barriers or goals they may have, (2) identifying strategies to reduce or avoid symptom exacerbation through problem solving, and (3) discussing ways to measure the effectiveness of self-management with the patient.
MedRisk supports an active, person-centered approach to treatment, beginning with a consultation prior to treatment. During the consultations, an on-staff PT is able to educate patients on the importance of physical therapy, describe what to expect and address any initial barriers to recovery.
To read the complete article, click here.
Hutting, N., Johnston, V., Staal, J. B., & Heerkens, Y. F. (2019). Promoting the use of self-management strategies for people with persistent musculoskeletal disorders: the role of physical therapists. journal of orthopaedic & sports physical therapy, 49(4), 212-215.
Mar 31, 2021 | Insights
Recent study finds high levels of satisfaction with telehealth among outpatient therapy patients.
In a recent article published in the American Journal of Physical Medicine & Rehabilitation, Tenforde et al reviewed findings from a survey of 211 study participants who received a telehealth visit for lower limb injuries, pediatric neurology, or primary impairments in sports during the COVID-19 pandemic.
Intended to gather “measures of experience with a therapist” including physical therapists (PTs), occupational therapists (OTs), and speech language pathologists (SLPs), the 16-item survey covered seven focus areas: addressing concerns and questions, therapist communication, treatment plan development, treatment plan execution, convenience, overall satisfaction and perceived value of a future telehealth visit.
More than half of the visits examined (53%) were with a PT, and the overall findings showed that over 90% of participants selected “excellent” or “good” when rating having their concerns addressed, communication with their therapist, treatment plan development and execution, convenience and overall satisfaction. About 87 of respondents replied with “excellent” or “good” when asked about the perceived value of having a future telehealth visit.
As a provider of telerehab services since 2017, MedRisk supports the authors’ commentary that high patient satisfaction scores across age, gender and condition point to the value telerehabilitation can provide, such as reduced travel time and convenience, beyond the public health emergency.
To read the complete article, click here.
Tenforde, Adam S. MD; Borgstrom, Haylee MD, MS; Polich, Ginger MD; Steere, Hannah MD; Davis, Irene S. PhD, PT; Cotton, Kester PT; O’Donnell, Mary MS, OTR/L; Silver, Julie K. MD Outpatient Physical, Occupational, and Speech Therapy Synchronous Telemedicine, American Journal of Physical Medicine & Rehabilitation: November 2020 – Volume 99 – Issue 11 – p 977-981 doi: 10.1097/PHM.0000000000001571
