How did the first guidelines for physical therapy in workers’ comp come to be and how have they evolved over the years? Dr. Phil McClure discusses the core responsibilities of MedRisk’s International Scientific Advisory Board (ISAB).
Today, MedRisk is the largest specialty managed care organization dedicated to the physical rehabilitation of injured workers. But before it could grow its national network of physical medicine clinicians and develop its well-oiled patient advocacy program, it needed a strong, science-based foundation to build upon. Among the organization’s early “bricklayers” was Phil McClure, PT, PhD, FAPTA, professor and chair of Physical Therapy at Arcadia University in Pennsylvania, and vice president of MedRisk’s International Scientific Advisory Board (ISAB).
When McClure was recruited by Roger Nelson, PT, PhD, FAPTA, then-head of ISAB, in the 1990s, the group’s initial goal was a lofty one: to create the first-ever guidelines for physical medicine in workers’ compensation.
“Nowadays, every professional organization has guidelines and rules about creating them. But guidelines for our industry did not exist back then, so we were starting from scratch,” McClure said.
MedRisk’s clinical objectives for guidelines were to ensure appropriate treatment, eliminate unnecessary delays and medical costs, enhance communication among all parties, and promote better outcomes through changes in provider behavior. With no precedent to work from, the group began by discussing the fundamentals. How detailed should the guidelines be? How would they be structured? Initially, the board took a more prescriptive approach, advising certain treatments for certain diagnoses; however, they eventually concluded that a more flexible framework would benefit clinicians and patients alike.
“In many injury areas, the medical diagnosis doesn’t necessarily capture the degree of disability,” McClure said. “For example, if you lined up 100 people with rotator cuff tears, the amount of disability would vary a lot. Just because a patient has the label doesn’t mean it encompasses the entire problem.”
The current guidelines allow for individualized, patient-centric treatment and provide specific procedure-based guidance for cases that are flagged for review due to delayed recovery. They incorporate evidence-based recommendations on which procedures have been shown to be effective in helping injured workers regain function from a particular injury.
Many of the ISAB board members conduct research within their own specialties in physical medicine and monitor trends in their fields as they update and maintain guidelines for MedRisk. What began as a concerted effort by a half-dozen experts in the field has now become a rigorous review process by 13 board members, including several physical therapists, physicians, a chiropractor, and a clinical psychologist, as well as industry thought leaders with active research agendas and extensive publications.
These varying perspectives provide a well-rounded approach to new areas of concentration, which over the years have included creating guidelines for the treatment of concussion and updating recommendations on treating hand and wrist injuries. A current priority is to explore new methodologies for documenting patient outcomes – also a focus of McClure’s own research on shoulder injuries.
The workers’ compensation industry largely looks to data points like treatment duration, cost, and functional measures like strength and range of motion to measure patient outcomes. However, patient-recorded outcome measures (PROMs), which are derived from surveys completed by the patient, can provide additional insights into the value of treatment.
“PROMs just add to our understanding of the patient experience,” McClure said. “When we stop to ask them, ‘How much difficulty do you have putting on your shirt, tying shoes, running or climbing steps?’ this helps us see how treatment impacted their life and how they are doing now that it is complete.”
Another area of attention for the board has been telerehabilitation. As utilization rates have risen throughout the pandemic, the board continues to monitor new evidence that emerges on the applications and efficacy of virtual PT.
Similarly, ISAB has had to find ways to perform its work from a distance throughout the pandemic; however, the group’s commitment to its founding mission remains as strong as ever.