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
Mar 5, 2021 | Insights
Injuries involving the neck are among the costliest workers’ comp claims. What are the causes, and what role does physical medicine play in recovery?
This blog is part 1 of a two-part series titled “Neck Injuries in Workers’ Comp: Managing Pain and Controlling Cost.”
As many businesses have shifted to working from home throughout the pandemic, the effect of long hours spent at a poorly designed workspace has been felt by many Americans. But poor ergonomics is just one of the many causes of neck pain among today’s workforce. In fact, injuries involving the neck are the third most costly lost-time workers’ compensation claim, behind injuries involving the head/central nervous system and multiple body parts, averaging $61,510 per claim, according to the National Council on Compensation Insurance (NCCI).
Why are neck injuries such an important focus for workers’ compensation? In this blog, we take a closer look at the nature of neck injury, methods of treatments, and the important role played by physical therapists and chiropractors in recovery.
What Causes Neck Pain?
While a claim may carry a diagnostic code for neck injury, there are often other body parts involved. Because the neck supports the weight of the head, it is particularly vulnerable to injury. Unsurprisingly, hours hunched over a computer, smartphone or book can lead to muscle strain and neck pain. However, even something as seemingly unrelated as grinding your teeth can cause neck pain and restrict motion. Additionally, if a herniated disk or bone spur is present on the vertebrae of your neck, it can put pressure on the nerves branching out from the spinal cord, leading to nerve compression and amplifying neck pain. Neck injury is also a common effect of whiplash injury in accidents such as rear-end auto collisions, which can cause the head to be jerked back and forth, straining the soft tissues of the neck. All of these triggers have the potential to have a more significant impact as we age, as neck joints wear down over time.
Diagnosing and Treating Neck Pain
In order to diagnose neck injury, a physical exam is used to assess neck function – that is, a patient’s ability to move their head forward, backward, and side-to-side – as well as symptoms such as tenderness, numbness, and muscle weakness. In some cases, imaging tests such as CT scans, x-rays or MRIs may be ordered to investigate the root cause of injury.
Once a diagnosis is made, neck injury treatment is often put in the hands of a physical therapist (PT). Among the many benefits of a more conservative approach to neck pain treatment is the reduced likelihood of opioid prescription. One study found that initially consulting with a non-pharmacological provider such as a PT can decrease opioid exposure in the year following diagnosis. PTs and chiropractors help injured workers manage neck pain and regain neck function by normalizing alignment, teaching exercises to correct muscle flexibility and strengthen deficits, and educating them on proper posture and self-care. Early on, heat, ice, and electrical stimulation may be applied along with traction, using weights and pulleys to stretch the neck – an approach often used to address nerve root irritation. In certain instances, treatment may go beyond conservative care measures to include injections of corticosteroids or numbing medications such as lidocaine to relieve neck pain; however, surgery is rarely needed.
Conclusion
As a common and costly problem among injured workers, neck injury has been a longtime focus for MedRisk. How has treatment in this area changed over the years, and where is it headed? In the remaining blog in this series, we will learn more about the nuances of neck pain treatment from MedRisk’s International Scientific Advisory Board member Dr. Donald Murphy, DC, FRCC, and explore the unique ways a managed physical medicine program can support recovery from neck injury.
Mar 5, 2021 | Insights
Early Access to Physical Therapy and Specialty Care Management for American Workers with Musculoskeletal Injuries Study Underscores the Value of Care Management
The multiple benefits of early physical therapy have been documented in recent studies, but this article published in the Journal of Occupational and Environmental Medicine also recognizes the vital role of the care manager – the adjuster, case manager and other claims representative. Phillips et. al analyzed the workers’ comp claims of employees of a large, integrated healthcare system located in the Midwest for the study.
Researchers conducted a retrospective chart review of claims from 2009 that were not managed. These injured workers also received no early access to PT. Their outcomes were compared to those of workers whose claims from 2012 and 2013 were managed through a care pathway, included early access to PT and a high level of communication with all stakeholders. A third cohort was comprised of 2012 claims that were not managed through this path.
The managed path involved an initial visit with a physician and physical medicine provider (PT or occupational therapist) at the same time. If the patient met eligibility criteria, this was immediately followed by a PT evaluation that included an exam, patient education, treatment, home exercise program, referrals, and recommendations for work restrictions, written at the highest levels that would not hinder healing.
The program included seven pre-authorized physical medicine visits. Patients were observed performing core physical job demands during visits, and providers updated written work restrictions accordingly.
The PT or OT met with the physician and study coordinator who served as the care manager every week. They discussed the patient’s progress and any changes to the plan of care.
The care coordinator:
- Was the injured worker’s point of contact
- Communicated with all the providers, making sure everyone had information needed to make care decisions in a timely manner
- Managed all electronic health records
- Provided work restriction updates to Disability Department each week
Results
The managed claims lasting longer than 90 days had lower indemnity costs, fewer therapy visits, and lower total costs of claims than the ones that did not go through the care pathway. Researchers believed the rapid and regular work restriction updates accelerated return to work as did offering to let injured workers voluntarily test their abilities to meet the physical job demands at each session.
Because the study was conducted in a healthcare facility with its own employees and providers, not every employer or payer can control implementation of all the strategies. Yet there are takeaways to explore:
- Heightened communication with all stakeholders
- Pre-authorizing a number of visits
- Patient consultation with a physical therapist prior to treatment
- Identifying and overcoming barriers to early PT
As always, MedRisk stands ready to facilitate early and well-managed PT with our rapid response to referral guarantees, smooth scheduling, PT consultations, and patient education materials. We also have the EDI to quickly transmit electronic health records so our network providers are up to speed on the case before the patient arrives. We have the technology and the resources to help you make early, well-managed PT a reality.
