Rehab Rx: Return to Work
“Injured workers are a rewarding group to take care of, but a challenging group,” said Robert Hall, corporate medical director, Helios.
He and Dr. Marcos Iglesias, vice president and medical director, The Hartford, outlined the barriers to returning injured workers to full functionality and how to overcome them at a Wednesday morning session at the National Workers’ Compensation and Disability Conference, titled “Medical Director’s Perspective: Restoring Function and Returning to Work.”
Comorbid conditions – both physical and psychosocial – present the greatest obstacle.
They not only set people up for injury but also delay recovery. If an injured worker has a physical condition like obesity, diabetes or older age, recovery time usually doubles, Iglesias said.
If that condition is coupled with a psychosocial factor like catastrophic thinking or perceived injustice, the recovery time quadruples. Add in a mental health issue like depression or anxiety, and that time increases by a factor of eight.
Psychosocial risk factors are increasingly gaining awareness from the workers’ comp provider and payer community.
“Self-predictions about return to work are often self-fulfilling prophecies,” Iglesias said. He said that claims managers can identify patients as high or low risk by asking them when they believe they can return to work.
“Any answer beyond 10 to 14 days means they are at high risk for delayed recovery,” he said.
The best way to manage comorbid conditions and speed up return to work is through open and frequent communication between patient, provider, payer and employer, Hall said.
Physicians should use simple language to address patients’ fears and provide reassurance, and payers should follow up with doctors to verify that their treatment plan follows evidence-based guidelines.
Non-pharmacological treatments like exercise and socialization should also pay a big role. As Hall said, “Opioids alone don’t bring about recovery.”
Because time away from work only increases the likelihood of developing depression and exacerbating existing comorbids, returning to work should also be considered part of the rehab process, Iglesias said, and not just the end goal.