Early Symptom Evaluation for Musculoskeletal Complaints: How This Tool Is Improving Patient Outcomes and Reducing Claims Costs
It’s common for an employee to dismiss a little wrist or back pain here and there. A light ache, many people think, will go away on its own. They may try to push through it and continue to attend to their regular duties at their job. Maybe they treat it with a little ice or an over-the-counter pain reliever.
These little aches and pains don’t always go away on their own; sometimes, they’re the beginning of a more serious musculoskeletal injury.
“There is an opportunity to help someone before they have full-blown tendonitis, a full-blown strain, a bad sprain, you can help people when they’re just sore, when they’re just fatigued, when they’re maybe just dealing with a minor complaint,” said Chris Studebaker, PT, DPT, senior director of onsite preventive services for Concentra.
Musculoskeletal disorders (MSDs) are one of the most common workers’ compensation injuries. Encompassing everything from lower back pain to carpal tunnel syndrome, these soft-tissue injuries account for close to 30% of all workers’ comp claims costs, OSHA reports.
Most people — many health care professionals included — recommend taking a wait-and-see approach to MSDs. A doctor might recommend an injured worker go home, rest their sore shoulder and wait to see if it gets better on its own, for instance. It’s only when the injury escalates that workers seek more aggressive treatment. By then, the injury might require surgery, or the doctor may have to prescribe prescription-strength medications or even opioids for the worker to manage the pain. After that, the worker may need physical therapy (PT) to help them regain their strength. Can you feel the claims costs spiraling?
“In the traditional workers’ comp process, let’s say you had somebody who had relatively minor elbow soreness. They may not get any care. They might choose to just not report it for two weeks or three weeks,” Studebaker said. “Most people don’t access a physical therapist until things get bad enough that it can’t be ignored anymore.”
Rather than waiting for an MSD to escalate before starting treatment, what would happen if the industry started using on-site rehabilitation services to help workers heal from these conditions earlier?
The Advantages of On-site Access to Care and Early Symptom Evaluation
That’s exactly what employers with on-site rehabilitation clinics are doing. In these settings, physical therapists (PTs), athletic trainers (ATs) and occupational health therapists (OTs) meet with workers who have relatively mild musculoskeletal disorders and recommend simple stretching and strengthening exercises to help them recover.
“This model switches that priority around and has rehab professionals as the entry point when things are really at a much more minor level of complaint,” Studebaker said. “You’re getting in front of it, you’re providing a more conservative level of care, and you’re doing so up front, before things have gotten so far down the road that they’ve really developed into a more debilitating injury.”
By seeing workers early and helping them address their complaints, on-site clinicians prevent a wide swath of injuries from becoming so severe that the patient requires surgery. A 2015 study of lower back pain patients found that early PT prevented many patients from needing further treatments later on (like lumbar injections, surgeries or opioids), and it reduced costs associated with the injury by 60%. With an on-site clinician, workers aren’t just resting — losing muscle strength in the process — while they wait to heal. They’re playing an active role in recovery.
“An injured worker could lose their ability to do the lifting, pushing, pulling as they wait to heal,” Studebaker said. “By having an active treatment plan, you’re having the worker doing things to stay conditioned for the job. This approach can help the worker to do better in the long-term.”
Some conditions will still need more serious treatments. When surgery or other more advanced care is required, on-site therapists can still help improve patient outcomes and reduce costs by helping doctors and nurses understand the work environment where an injured worker will be returning. On-site PTs, OTs and ATs have extensive knowledge of the businesses they work for. They can recommend light-duty positions and offer additional support during the return-to-work process.
“A doctor in a local outpatient health clinic is not going to have a super detailed understanding of the pushing, pulling, lifting and carrying required of the job, but those on-site ATs or PTs do. They become very, very knowledgeable of the physical demands of the job,” Studebaker said.
“Once things escalate, this rehab professional can be the eyes and the ears for that community doctor or nurse practitioner and give them additional information about job duties, helping them to make decisions about return to work, maybe helping to put physician restrictions into play in the work environment in the best, most conducive way for recovery.”
Fostering a Culture of Safety
The advantages of on-site early symptom evaluation for large employers with a high number of MSD claims each year are clear: Therapy and rehabilitation services can control the progression of injuries and reduce the number of days an employee has to miss work. Researchers have found that employees who received early rehabilitation care for an MSD missed just over 59 days of work for an injury. The group who didn’t receive early interventions missed more than 126 days.
In the best cases, on-site clinics with therapists or athletic trainers on staff will offer preventative services — like morning stretching exercises, ergonomic assessments or new worker safety education programs — in addition to early treatments. These programs ensure that a worker’s body is in proper condition for the tasks they need to complete, averting future accidents. If employers commit to these programs and educate their workers about the benefits, they can create a culture of safety where employees feel cared for by their company.
“These programs cannot be successful without buy-in from all aspects of the company,” Studebaker said. “At each site, the managers, supervisors and certainly the safety personnel have to understand not only the process of a program like this but also how to work with their workers to encourage utilization of the program.”
One key to changing company culture: educating workers on the value of early symptom evaluation. Some workers, when facing a mild injury, might avoid reporting it out of fear of troubling their manager or disrupting their team. Better to push through the pain, they might think. They “don’t want to cause a problem,” Studebaker says, so they don’t seek care right away. Our goal is to influence a change in behavior.
“They don’t want to be seen as complaining, or they don’t want to make extra work for people,” he explained. “We really emphasize that you’re not doing anything to burden anybody else. We want you to let us know if that shoulder’s starting to bother you; we want to know if that elbow’s a little sore.”
A Reliable Partner
Concentra’s on-site and outpatient care providers deliver crucial therapy and rehabilitation services to employers. Its programs can help prevent injuries, intervene following and injury and before it progresses to a more serious state, and help support doctors and other providers in caring for advanced injuries and developing return-to-work plans.
What’s easier than attending PT at the workplace? Employer partners and their safety teams can feel confident that their on-site programs will be built to meet their specific needs and the physical demands their workers face. On-site PTs, OTs and ATs walk the floor of the businesses they work with, acquainting themselves with the requirements of a particular position and assessing the physical capabilities of an employer-partner’s workforce.
“They are embedded in the work environment,” Studebaker said. “Much of that time is spent teaching pre-shift exercise programs and working with new employees in new employee orientation.”
On-site care programs provide employers with actionable insights that they can use to change company policy in ways that promote safe lifting practices and improve ergonomics. “These guys can bring a lot of value by quantifying recommended limits for things like pushing, pulling, lifting and carrying, and by helping provide the ideal dimensions of the work environment to the safety and engineering teams who might actually create the changes to improve the workplace,” Studebaker said.
These programs show workers that their employer cares about their health and safety. When workers feel like their employer is investing in their health, they’re less likely to turn to litigation. Claims outcomes, too, are improved because workers receive early care that is suited to their needs.
“The sooner you can get care for a worker who might be in the process of developing a more serious injury, the less likely they are to adapt to these complaints with reduced stamina or reduced mobility,” Studebaker said, “and they’re less likely to lose the conditioning that allows them to complete the essential functions of their job.”
To learn more, visit: https://www.concentra.com/onsite-clinics/
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Concentra. The editorial staff of Risk & Insurance had no role in its preparation.