Case Management Focus: The Impact of Perception and Non-Physical Factors on Return-to-Work Outcomes

Sarasota, FL (WorkersCompensation.com) -- Case Managers are liaisons between the injured worker, the health care team, and the employer. WorkersCompensation.com caught up with Jen Henry, DPT, MPH, Clinical Consultant at Bardavon Health Innovations to address how non-physical factors can impact outcomes for the injured worker and how case managers can advocate for their patients by working closely with physical and occupational therapists.

How do psychosocial variables impact outcomes for the injured worker?

Research has shown that a patient’s self-reported psychological distress is a predictor of poor outcomes for a variety of injuries. Rehabilitation tends to focus entirely on what a patient can do physically, like load tolerance, range of motion, endurance. We spent most of our time measuring and treating functional impairments and pain—which makes sense historically, given our training and scope of practice.

However, it is equally important to measure and understand a patient’s psychosocial variables (fear, anxiety, depression, financial strain, social isolation, etc). These psychosocial factors could play a significant role in their ability to heal and their understanding of what they are capable of functionally.

Psychology trumps physiology every time! Failure to address these variables early in a case is not only inadequate care for the patient, but it can also result in increased visits, longer case duration, and increased costs to the employer.

How are targeted assessments of emotional factors integrated into rehab for injured workers?

Right now, for most therapists, the integration is limited. Many systems are disjointed and do not communicate self-reported psychosocial and emotional outcomes to providers in a useful or comparative way. Many outcome measures do not help identify reasons a patient may not be improving.

To best utilize measures of non-physical factors, the information must be gathered early in the case. It should also be regularly compared to not only their initial values but also analyzed against the physical and functional data that is already collected at each visit.

Bardavon is working to support clinicians with a guidance system that helps them identify non-physical factors and discuss them with patients. That will involve helping clinicians develop the most appropriate plan of care, invite necessary care team members to assist (including case managers and mental health professionals), and determine true maximum medical improvements that consider the physical and non-physical factors impacting the patient’s injury.  

How can case managers work with therapists to advocate for the injured worker when psychological issues are identified?

They can take notice when a patient’s physical numbers seem to be improving, but their self-reported function or perception of limiters is not. When a progress note is trending in the right direction, but the patient is not showing similar functional gains, improved pain, or upgraded job duties, the likelihood of a non-physical barrier is high.

Optimizing the powerful teamwork between nurse case managers and therapists requires both groups to identify mental health or non-physical issues early in care. Therapy providers should be using their physical data and patient-reported outcomes to determine when adding a case manager to a case is beneficial. On the other hand, when therapy providers are communicating this info to the care team verbally or in their written documentation, they may need the case manager partnership to support or engage in moving the injured worker’s case along by adding other services – especially since case managers have wonderful community connections to help serve patients.

Lastly, having case managers help the therapist have difficult conversations with the patient around a possible emotional, familial, or financial hardship would provide excellent, comprehensive services to the patient.

References:

Nickolai Bogduk, MD, PhD, Dsc. Editor’s Choice: On Depression and Cervical Epidural Steroid Injections Pain Medicine, Volume 19 Issue 12, 1 December 2019, Page 2333

Gatchel RJ. Psychological factors that can influence the self-assessment of function. J Occup Rehabil. 2004; 14(3): 197-206.

Emanuel Brunner, Wim Dankaerts, André Meichtry, Kieran O’Sullivan, Michel Probst. Physical Therapists’ Ability to Identify Psychological Factors and Their Self-Reported Competence to Manage Chronic Low Back Pain, Physical Therapy, Volume 98, Issue 6, June 2018, Pages 471–479.

Do you have question for Anne? You can reach her at allewellyn48@gmail.com To reach Jen Henry, feel free to email her at jhenry@bardavon.com

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