How Mental Health and Age Factor into Injured Workers’ PT Needs

Knowing how age and mental health affect an injured worker’s need for physical therapy can help employers develop plans for a recovery roadmap and its impact on their resources.
By: | March 31, 2023
And older factory worker operates a drill press

Thirty-nine percent of the American workforce is expected to be older than 55 in 2026, and one in five Americans suffers from a mental health condition that impacts their daily life at any given time.

Both statistics ought to draw the attention of employers who want to ensure their workforce stays safe, healthy and productive.

The aging workforce and mental health issues among workers, particularly those who have suffered an injury, are spotlighted in MedRisk’s Industry Trends Report 2023 Outlook, which examines the impact of age and mental health on the number of visits and duration of physical therapy in workers’ compensation claims.

“It’s widely accepted that the older you are, the longer the recovery process may take, but exactly how much longer?” said Brian Peers, vice president of clinical services and provider relations for MedRisk. “As the U.S. workforce continues to age, it’s crucial for the industry to understand how factors such as age and mental health can affect the length of recovery for patients.”

For its annual report, MedRisk, which is a provider of managed physical medicine services for the workers’ comp industry and related market sectors, did a deep dive into these issues affecting workers’ comp.

The company’s report relies on data amassed over decades and the analysis of millions of claims to determine, in this case, the impact of age and the presence of depression and anxiety on the length of physical therapy treatment and the number of visits.

“Every year, we look at all the data and put it in context and look at something novel that hasn’t been covered before,” said Peers.

Age and Physical Therapy

While older employees get injured less frequently, they often suffer more severe injuries and have longer recovery times, the report noted.

Injured employees aged 56 and older have 21% more physical therapy (PT) visits than those aged 18 to 55. The duration of PT visits also increases with age. Injured employees aged 56 and older have 31% longer duration in PT compared to those in the 18 to 55 age bracket.

The report also noted what types of injuries MedRisk sees most in PT claims.

Portrait of Brian Peers

Brian Peers, vice president, clinical services and provider relations, MedRisk

Five diagnosis codes represent 26% of all claims with PT involvement: low back pain, pain in the left shoulder, pain in the right shoulder, cervicalgia (neck pain) and pain in the right knee.

“MedRisk has seen little variation in the distribution of diagnosis codes with PT involvement over the years,” according to the report.

Peers said employers, particularly those that tend to have an older workforce, need to understand the impact of age and pay attention to these numbers.

“It’s a bigger factor in some industries that gravitate to an older workforce, such as trucking,” he said.

Knowing that older employees tend to require more PT visits should help employers plan better for a worker’s recovery and the impact that injuries may have on their resources.

“It should sharpen what their expectations are for how long a recovery will be,” he said. “It will help them better plan for expenses. As you are more sensitive to risk, you can also plan accordingly in risk prevention,” Peers said.

He said employers need to evaluate the types of injuries they see and ask themselves about what prevention measures they have in place, or need to establish, to better prevent injuries among older workers.

He suggested, for instance, that they look at creating more ergonomically safe work stations, installing walking desks to prevent the detrimental effects on physical health of being sedentary, or better accommodating the needs of older workers whose vision may be changing as they age.

The number of employers taking a proactive approach to preventing injuries in an older workforce is significant.

“It’s not pervasive,” he said. “The more proactive you are, the more successful interventions tend to be.”

Mental Health

The report also delves into the impact of mental health conditions on injured workers and finds that stress, depression and anxiety are common among injured employees and can delay a worker’s recovery and return-to-work, leading to an increase in medical costs.

It’s easy to see how a painful or debilitating injury could negatively impact a person’s mental health. They might, for instance, be afraid of reinjuring themselves.

The report finds that 50% or more of injured employees experience clinically related depressive symptoms at some point, especially in the first month after injury.

Mental health is not on the upswing overall, particularly since the beginning of the COVID-19 pandemic, which had a large impact on employees’ mental health. The study found a 25% increase in anxiety and depression worldwide as a result of the pandemic.

The state of a person’s mental health can greatly affect how long it takes to recover from an injury, according to Peers, who said, “We knew we would find that the length of treatment increases with age, but we also saw that depression has a similar impact on case duration.”

Claims reported with anxiety or depression had a 7% higher rate of utilization of PT services, the report found.


Another insight from the report states that conservative care initiatives, such as physical exercise rather than surgery, improve back and joint pain more effectively than surgeries do. Use of injections can lead to short-term pain relief but mask the problem rather than address it, according to the report.

MedRisk found that prior to the pandemic, rates of surgery were declining; one-quarter of all claims involving PT led to surgery in 2015, compared to 16% in 2022.

Peers said he hopes the report will help better guide decisions related to PT, surgery and mental health to best support workers.

State Laws

The report also covers legislative issues in selected states such as California, Maryland and Texas, and some greater issues such as telehealth compliance with HIPAA and state privacy laws. It noted the Wall Street Journal reported in 2023 that many state laws in the coming year would focus on consumer data privacy. &

Annemarie Mannion is a freelance writer. She can be reached at [email protected].

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