As physiotherapists, we play a vital role in helping injured workers recover and return to work. Recent evidence highlights the significant impact of psychosocial factors on recovery outcomes, offering us tools to streamline our work and achieve better results.

By implementing routine screening for psychosocial barriers and knowing how to effectively use these results, we can transform our approach to workers compensation cases.

Failing to address psychosocial factors leads to prolonged recovery times, increased risk of chronic pain, higher healthcare costs and poorer return-to-work outcomes.

Patients may become stuck in a cycle of passive treatments, investigations, increased rates of opioid use, unnecessary medical procedures and poorer quality of life.

It pays to care

The initiative It Pays to Care, launched by the Australasian Faculty of Occupational and Environmental Medicine, advocates for evidence-informed practices in work injury management.

This campaign builds on the success of the Health Benefits of Good Work® initiative (here), focusing on addressing psychosocial factors that affect recovery and return to work.

The claims industry has shown strong engagement with this approach and has recognised its potential to improve outcomes for injured workers, reduce costs and enhance the efficiency of workers compensation systems across Australia.

Elevating your practice

Embracing effective management of psychosocial barriers benefits patients and can also significantly enhance your professional experience as a physiotherapist.

By implementing these evidence-based strategies, you can:

• reduce frustration by proactively identifying and addressing barriers before they escalate
   
• improve patient engagement and compliance, leading to more satisfying treatment outcomes
   
• enhance your professional reputation as a holistic, forward-thinking practitioner
   
• develop stronger relationships with other stakeholders in the workers compensation process
   
• experience greater job satisfaction by seeing more patients return to work successfully.

As physiotherapist Fleur Balmain notes, ‘Since getting my team to consistently use the Örebro we have seen a marked improvement in patient outcomes and a reduction in my own stress levels.

'Complex cases that used to leave our team feeling stuck now have clear pathways forward.’

Early intervention strategies

Early, high-quality care is critical in workers compensation cases.

As physiotherapists, we are among the first healthcare professionals to assess and treat injured workers.

This puts us in a unique position to influence the trajectory of care and identify potential barriers to recovery early on.

Psychosocial factors play a pivotal role in work injury outcomes, accounting for up to 85 per cent of unnecessary work disability.

These factors, including coping challenges, workplace barriers and anxiety, often go unnoticed unless we actively look for them.

Research has demonstrated the significant impact of psychosocial factors on recovery and return to work.

Workers exposed to high levels of psychosocial risk have over three times as many days off work as those with low risk.

For every one-point increase on the Örebro Musculoskeletal Pain Screening Questionnaire Short Form (OMPSQ-SF) (out of 100), the chance of return to work is reduced by four per cent.

And as the number of psychosocial risk factors increases, so does the cumulative probability that a worker will not recover.

These psychosocial barriers are modifiable if we recognise them early and manage them proactively.

Addressing such barriers has been associated with substantially quicker recovery and notable improvements in work engagement.

Psychosocial screening tools

To effectively identify and address psychosocial barriers, physiotherapists can use validated screening tools.

Understanding the differences between and advantages of these tools can help you determine when and how to implement them effectively.

OMPSQ-SF

The OMPSQ-SF has been extensively studied and is considered the gold standard for early psychosocial screening in musculoskeletal injuries.

It’s particularly useful in the early stages post-injury when the dominant barriers are often workplace issues, passive coping tendencies or low self-efficacy.

Key benefits of the OMPSQ-SF include that it is quick to administer (10 items), it is validated for use in various musculoskeletal conditions, it provides a clear risk score to guide intervention and it can be repeated to track progress.

Early post-injury, the OMPSQ-SF can help identify issues such as workplace concerns, passive coping strategies, low self- efficacy and pain-related anxiety.

People with scores over 50/100 are considered to be at elevated risk of prolonged work disability.

However, the overall score by itself is insufficient to identify the particular barriers affecting the person.

Exploring and clarifying the response to each question is critical to accurately identifying the specific barriers for that person.

A free online version of the OMPSQ-SF that enables simple and straightforward administration has been developed by Axis.

Known as the Orebro Plus, this version allows ease of application, automatic scoring and tracking of data (one-off or repeated applications).

The questionnaire can be forwarded to a patient by SMS.

An extra question was added (which is not calculated in the overall score), addressing support in the workplace.

This is particularly relevant to workplace risk factors and can act as a ‘conversation starter’.

Tampa Scale of Kinesiophobia

The Tampa Scale of Kinesiophobia (TSK) may be particularly useful for patients who are some months post-injury and slow to recover.

It measures fear of movement and (re)injury, which can be a significant barrier to recovery in many musculoskeletal conditions.

Key benefits of the TSK include that it focuses specifically on fear of movement, it is useful for identifying barriers in later stages of recovery and it can guide specific interventions related to movement and pain education.

A high score on the TSK might prompt you to focus more on pain education and graded exposure to feared movements, while a high score on the OMPSQ-SF might indicate a need for broader psychosocial interventions.

Conversation toolkit

When discussing psychosocial barriers with patients, there are a number of advantages to having done independent screening.

For example:

• The screening can be done as a routine component of completing initial paperwork and be available for the first consultation.
   
• Completing the questionnaire independently removes any bias.
   
• You can use the completed results to relay back to the patient. For example, ‘I note that you have indicated concerns about the workplace.’

You may wish to introduce the questions with something like ‘As part of your assessment, I’d like to ask you some questions about how you’re coping with your injury.

'Our thoughts, concerns and what is going on in our lives can all impact recovery, so understanding these factors helps us provide the best care’.

You can also ask the following questions to address specific barriers.

Low self-efficacy—‘On a scale of zero to 10, how confident do you feel about managing your condition? What do you think might help increase your confidence?’
Passive coping—‘What strategies have you been using to manage your symptoms at home? I’d like to work with you to develop some active approaches that can complement our treatment here.’
Workplace stress—‘How has your injury affected your relationship with your colleagues or supervisor? Are there any workplace issues you’re concerned about?’
Fear of movement—‘I’ve noticed you seem hesitant to move in certain ways. Can you tell me more about what you’re experiencing when you try these movements?’
Catastrophising—‘I hear you’re worried about your long-term abilities. Let’s talk about what most concerns you and how we can address those concerns.’

The key is to listen actively, validate the patient’s experiences and frame psychosocial factors as normal, modifiable aspects of the recovery process.

Conclusion

Understanding and addressing psychosocial factors is crucial for improving outcomes in workers compensation cases.

By implementing routine screening and early intervention strategies, we can identify potential barriers to recovery and tailor our treatment approaches accordingly.

This not only benefits our patients but also enhances our own professional satisfaction and effectiveness.

The next part of the series will explore effective communication techniques and how to tailor treatment approaches based on identified psychosocial factors.

>>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 (occupational health and quality manager, Axis), Thomas Adler, Fleur Balmain, Wade Byrnes, Craig Elliott, David Elvish, Marcus Mancer and Des O’Shaughnessy.