Workplace factors play a major role in recovery from work-related injuries. In fact, research shows that workplace barriers—such as unsupportive supervisors, a lack of suitable duties or inadequate return-to-work support—are among the most prevalent and impactful psychosocial barriers to recovery. 

The quality of workplace relationships and the level of organisational support can often make or break a successful return to work. 

Understanding the workplace environment is crucial for effective rehabilitation and successful return to work. 

As physiotherapists, we can play a pivotal role in bridging the gap between clinical treatment and practical application in the work environment. 

Patient support 

Here are some practical tools to help you seamlessly integrate a biopsychosocial approach into your practice, taking psychosocial factors into account in the physiotherapy care of workers compensation patients. 

Two-minute psychosocial check-in 

Implement a two-minute psychosocial check-in at the start of each session. 

Ask the patient: 

• ‘How have you been managing since our last session?’
• ‘Have you encountered any challenges or concerns?’
• ‘On a scale of zero to 10, how confident do you feel about your progress?’ 

This brief check-in can help identify any new or ongoing psychosocial issues and set the tone for the session. 

Goal achievement diary 

Provide patients with a simple goal achievement diary. This could be a small notebook or a digital app where patients can: 

• set small, achievable daily or weekly goals
• record their progress and any challenges
• note any positive experiences or improvements. 

Reviewing this diary together at the start of each session can boost patient motivation and provide valuable insights into their psychosocial state. 

Workplace communication template 

Use a standardised template when communicating with employers or return to work coordinators. 

This should include: 

• a brief explanation of the patient’s condition in layperson’s terms
• current functional capabilities and limitations
• suggested workplace modifications or accommodations
• a proposed timeline for return to work or increased duties
• space for employer feedback or questions. 

This template can help standardise and improve communication between physiotherapists and workplaces, ensuring that all relevant information is conveyed clearly and professionally. 

A stronger professional impact 

Understanding your patient’s specific work situation is necessary for effective treatment and successful return to work. 

Key areas to focus on are: 

• job demands—gain a thorough understanding of the physical and cognitive demands of the patient’s job
• confidence in work tasks—assess the patient’s confidence in performing their full or partial role
• workplace adjustments—explore what reasonable adjustments could be made to facilitate return to work
• support mechanisms—inquire about support systems at work, such as supportive colleagues or supervisors. 

By demonstrating your understanding of the workplace context, you position yourself as a valuable resource in the return-to-work process. 

This can lead to more productive collaborations with employers and case managers, ultimately benefiting the worker.

Collaboration with return to work coordinators 

Effective communication with return to work coordinators and employers is important for successful outcomes. 

Here are some strategies to enhance this collaboration: 

• regular updates—keep return to work coordinators informed about the patient’s progress and any changes in work capacity
• clear communication—provide clear, jargon-free explanations of the patient’s condition and how it affects their work capacity
• proactive problem-solving—offer suggestions for workplace modifications or graduated return-to-work plans
• education—help employers understand the benefits of supporting early return to work and the importance of addressing psychosocial factors
• mediation—act as a bridge between the patient and the employer, helping to resolve any misunderstandings or conflicts. 

Building strong relationships with return to work coordinators and employers can significantly improve the likelihood of successful return-to-work outcomes. 

Workplace visits 

If appropriate in your jurisdiction, workplace visits can be an invaluable tool. 

They allow you to: 

• observe job demands firsthand—this gives you a more accurate understanding of the physical requirements of the job
• identify potential hazards—you can spot ergonomic issues or other workplace factors that may be contributing to the injury or hindering recovery
• suggest practical modifications—your firsthand knowledge allows you to recommend more accurate and practical workplace modifications
• build rapport—visiting the workplace demonstrates your commitment and can help build trust with both the patient and the employer
• enhance your professional knowledge—each workplace visit broadens your understanding of different work environments, making you a more effective practitioner overall. 

When conducting a workplace visit: 

• prepare in advance by reviewing the patient’s job description and current limitations
• observe the worker performing their tasks if possible
• take notes and photos (with permission) for future reference
• discuss your observations and recommendations with the worker and supervisor
• follow up with a written report detailing your findings and recommendations. 

Case study 

Sarah, a 37-year-old single mother of two, presented to the clinic with a lower back injury sustained while working as a warehouse picker. 

During her initial assessment, the physiotherapist used the Örebro Musculoskeletal Pain Screening Questionnaire (Short Form) (OMPQ-SF) to screen for psychosocial risk factors. 

Sarah’s OMPQSF score was 59 out of 100, indicating an elevated risk of delayed recovery and prolonged work disability. 

This score prompted the physiotherapist to further discuss psychosocial factors with Sarah, revealing several potential barriers to recovery: 

• financial stress due to concerns about lost income
• childcare responsibilities interfering with treatment adherence
• fear of job loss, leading to her pushing beyond physical limits
• workplace pressure from performance targets
• sleep disruption due to pain
• strained relationships with co-workers due to her reduced work capacity. 

Recognising these factors, the physiotherapist implemented the following strategies. 

Education 

The physiotherapist provided Sarah with clear information about her condition, her expected recovery time and the importance of pacing activities. This helped address her fears about job security and reduced her tendency to push beyond her limits. 

Workplace liaison 

With Sarah’s permission, the physiotherapist communicated with her supervisor about appropriate light duties and the need to temporarily adjust performance targets during her recovery. 

They also discussed strategies to improve workplace relationships and support. 

Flexible scheduling 

Therapy sessions were arranged to fit around Sarah’s childcare responsibilities, including some home-based exercises she could do with her children. 

Holistic approach 

Sleep hygiene techniques and stress management strategies were incorporated into her treatment plan. 

Goal setting 

Together, Sarah and the physiotherapist set realistic, functional goals that aligned with her work and home life, helping her to see progress and maintain motivation. 

Multidisciplinary care 

Sarah was referred to a psychologist for additional support in managing anxiety and developing coping strategies. 

Because these psychosocial factors were addressed alongside physical treatment, Sarah’s recovery progressed steadily. 

After eight weeks, she returned to full duties with improved pain management skills and a better work–life balance. 

Her workplace implemented some of the suggested ergonomic changes and initiated team-building activities, benefiting all employees and improving workplace relationships. 

A follow-up OMPQ-SF assessment at 12 weeks showed that Sarah’s score had decreased to 38, indicating a low risk of ongoing work disability and a successful integration of biopsychosocial care principles. 

Conclusion 

As we’ve explored throughout this series, adopting a biopsychosocial approach in workers compensation cases can significantly improve outcomes for patients and enhance our effectiveness as physiotherapists. 

By understanding psychosocial factors, communicating effectively, tailoring our treatments and integrating workplace knowledge, we can provide more comprehensive and effective care. 

Remember: 

• regularly screen for psychosocial factors using tools like the OMPQ-SF
• communicate openly and empathetically with patients about psychosocial barriers
• tailor your treatment approaches to address both physical and psychosocial aspects of recovery
• collaborate closely with return to work coordinators, employers and other healthcare providers
• consider workplace visits to gain firsthand knowledge of job demands and potential modifications
• implement practical tools like the two-minute check-in, goal achievement diary and workplace communication template to enhance your practice. 

By embracing these principles, we can transform our approach to work injury cases, leading to better outcomes for our patients, more satisfying professional experiences for ourselves and more efficient use of resources within the workers compensation system. 

It truly does pay to care—not just for our patients but for the broader workers compensation system and the community as a whole. 

Dr Mary Wyatt is an occupational physician practising in Victoria. Significant contributions were made to this article by members of the physiotherapy advisory group It Pays to Care: Rosemary Grant, Thomas Adler, Fleur Balmain, Wade Byrnes, Craig Elliott, David Elvish, Marcus Mancer and Des O’Shaughnessy.