Key to workers compensation = early and active intervention

By Aaron McErlaine, Exercise Physiologist & Hadyn Sleeman, Physiotherapist

In Western Australia, there continues to be an increase in the use of active therapies such as exercise physiology for managing workers compensation claims. This falls in line with the overwhelming evidence for use of exercise therapy as a primary treatment for a multitude of health conditions, both physical and psychological. Early referral of compensable patients to a trusted network of good quality allied health professionals with experience in the scheme will maximise the chances of a positive clinical outcome for patients.

Injured workers have symptoms, restrictions and functional deficits which directly affect their quality of life. Just like anyone that sustains an injury, they have goals that include reduced symptoms and a return to meaningful employment. A patient’s return to health and work should be viewed as a continuum, not as isolated silos of intervention.

The evidence strongly suggests that the following approach gives the best chance of a successful return to pre-injury function, and quality of life – injury seen by a GP for assessment and medical management, then acute symptomatic treatment overlapping with early active-based therapies, progressing to gym-based and jobspecific strength and conditioning. All health professionals involved in a claim are to provide comprehensive and coordinated care, requiring regular, open and clear communication to all other parties involved in the treatment of the patient. This creates a truly patient-centred approach, an approach which addresses the physical, emotional, psychological, and social needs of the patient. The known positive outcomes of a truly collaborative approach are comprehensive and effective care to patients; improved patient satisfaction and outcomes; reduced burden and time on the GP; and reduced overall length and cost of the workers compensation claim.

Active therapy benefits

Exercise physiology is one of the primary allied health options available early in a workers compensation claim for GPs and specialists. The benefit of early intervention with exercise physiology is it will empower the patient to have a self-management mindset with regards to their treatment.

Passive therapies may offer the patient temporary symptomatic relief, but there is minimal functional or long-term benefit after the initial two-to-six week acute phase of a musculoskeletal injury has passed.

Early reliance on passive therapies can also result in the patient being reluctant and apprehensive to move on to active therapies with the feeling that ‘exercise’ may

Key messages

Have a multi-disciplinary team that works well together to get the best outcome for the patient

Refer early for exercise physiology as an active treatment within a workers compensation claim increase pain and discomfort as opposed to the more relaxed and dependant nature of passive therapies such as massage and dry needling.

Establish an allied health team that specialises in workers compensation.

The reality is that exercise-based therapies will help in the following ways: individualised specific programs that improve functional capacity and promote a quicker return to work and activities of daily living, faster recovery, pain relief, reduced risk of reinjury through improved strength and education, and improved mental health associated with exercise and routine

As a GP, what should you expect from your accredited exercise physiologist for your workers compensation patients?

• Regular and easy to understand functional capacity updates to make filling in medical certificates easy. Spending less time on paperwork will provide you with more time to focus on patient care and developing the best strategy for your patient.

• Attendance at medical case conferences to provide real-time feedback on patient progress as well as an opportunity to address any barriers to recovery including any biopsychosocial flags.

• Individualised, job-specific and evidence-based exercise programming should be provided to get optimal outcomes in the quickest time frames. Completing work specific conditioning provides you and the patient with confidence in progressing their return to work.

• A deep understanding of the WA workers compensation system and the roles of different stakeholders that work within the system including insurers and vocational rehabilitation consultants. Specialists within workers compensation can speed up the treatment approval process with insurers and provide guidance on any questions you may have about a claim.

• Fully mobile to reduce any barriers that patients may have with travelling to a clinic, particularly if their current capacity may inhibit their ability to travel.

• All the tools should be provided to your patient to empower them to take control of their rehabilitation and self-manage their condition. This should include their individualised program on an app, a printout or other resource that provides visual support and clear guidance on how to complete their program, both supervised and independently. Access should also be set up to a gym or pool facility close to home to promote self-management.

– References available on request

Author competing interests – nil

By Mr Peter Ammon Foot Ankle & Knee Surgery

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