Musculoskeletal (MSK) conditions form the majority of workers’ compensation costs in Australia. For most businesses that have manual job roles, musculoskeletal conditions such as shoulder and back strains are common place, and will form the majority of their statutory costs. Work related MSK injuries hurt business culture, operational capacity and impacts the bottom line.
To reduce the financial and operational impacts of MSK injury, it is important that workers receive best practice care. But what is best practice care for MSK pain and injury?
The British Journal of Sports Medicine has recently published a paper outlining eleven consistent recommendations from high quality clinical practice guidelines for the management of MSK pain.
The 11 consistent recommendations were:
1.Care should be patient centred.
2. Screen patients to identify those with a higher likelihood of serious pathology/red flag conditions.
3. Assess psychosocial factors.
4. Radiological imaging is discouraged unless: i. Serious pathology is suspected. ii. There has been an unsatisfactory response to conservative care or unexplained progression of signs and symptoms. iii. It is likely to change management.
5. Undertake a physical examination, which could include neurological screening tests, assessment of mobility and/or muscle strength.
6. Patient progress should be evaluated including the use of outcome measures.
7. Provide patients with education/information about their condition and management options.
8. Provide management addressing physical activity and/or exercise.
9. Apply manual therapy only as an adjunct to other evidence based treatments.
10. Unless specifically indicated (e.g. red flag condition), offer evidence-informed non-surgical care prior to surgery.
11. Facilitate continuation or resumption of work.
Some of these are pretty straight forward. However in a workplace setting, there are some that need to be examined in more detail. The question is: Is your business managing workplace musculoskeletal injuries according to best practice care?
Care should be patient centred.
This sounds obvious, however, in the Workers’ Compensation environment this can be hard to achieve as there are a range of competing interests. The Dr. and Physio get paid more the longer the patient requires treatment. The workplace has its own KPIs in regards to LTIs, statutory costs and Workers’ Compensation premiums, and the insurer makes decisions often based on their own policies and targets. So, is the care of a worker’s injury really ‘patient centred’?
Screen patients to identify those with a higher likelihood of serious pathology (red flags).
This is an important one. Any experienced health professional is well trained to screen for red flag conditions. Screening is typically in the form of subjective questions of the patient, together with a physical assessment, if required. For a workplace, the challenge is often having a suitably trained health professional as part of your team to do this screen with confidence. Employ Health uses our Rapid Response Physio service when an onsite provider is unavailable to perform this vital triage.
It is equally important that simple MSK strains and sprains are not treated like serious 'red flag' conditions as it is to ensure 'red flag' conditions are not missed.
Assess psychosocial factors.
While screening for psychosocial factors is important in the general setting, it is considerably more important is the Workers’ Compensation setting. Psychosocial factors, or ‘yellow flags’, as they are often referred to, are things such as poor recovery expectations, fear avoidance behaviours, catastrophising and worry, poor coping strategies and distress. Perhaps, better described as the workers' beliefs about their condition, their behaviours, their expectations of recovery, and return to function. Screening for, and addressing psychosocial factors can make a tremendous difference to recovery in the workplace setting.
Psychosocial hazards (often referred to as ‘blue flags’) are also important to consider in the workplace setting. Organisational hazards, such as high workloads, poor support and leadership and low job control, as well as workplace relationship hazards such as a poor supervisor relationship, interpersonal conflict and low recognition are factors that contribute to workplace MSK risk. These can also be barriers to recovery for workplace injury. Screening, and addressing these barriers is vital.
Radiological imaging is discouraged unless: i. Serious pathology is suspected. ii. There has been an unsatisfactory response to conservative care or unexplained progression of signs and symptoms. iii. It is likely to change management.
I have written about this previously and would encourage you to read HERE. Unnecessary scanning is harmful - FULL STOP. If you are associated with a clinic that champions the fact that they can get people scans quicker, cancel that relationship immediately.
Unless specifically indicated (e.g. red flag condition), offer evidence-informed non-surgical care prior to surgery.
Sadly, in the Workers’ Compensation setting, we see surgery take place prior to a period of conservative management, even when such conservative management is warranted. We see this far too often. The most up to date contemporary evidence should be used when evaluating which patients are good candidates for surgery.
Facilitate continuation or resumption of work.
This is a no brainer in the workplace setting. Work is great for recovery, and having a supportive injury management process is vital. Supervisors should receive training around their role in this, a consultative process for meaningful suitable duties should be adopted, and barriers to recovery should be identified and promptly addressed.
In summary, there are number of things your business can do to ensure best practice when managing work related MSK pain and injury:
- Focus on the worker first and foremost. If your worker feels cared for, supported, and you make decisions based on their best interest first, you are on the right path. Provide training to your leaders and supervisors, as they are a key part of this.
- Have health partners that understand your business and work as part of your team. Ensure they specialise in your setting and follow a biopsychosocial injury management model of care.
- Make sure your medical providers follow a contemporary evidence based approach to care. If scans, such as MRIs and ultrasound, for minor MSK complaints is common, change providers.
- Don’t hesitate to seek advice about what best practice really is for any given MSK condition.
If you'd like more information reach out to the Employ Health team and we'll be happy to discuss where you are on your journey and your best options, moving forward.
https://employhealth.com.au/contact-us/
