Biopsychosocial Approach to Improving Health Outcomes in Managing Injured Persons

4. Introduction

5. International & National Recognition • To improve health outcomes when managing injured persons; we need to adopt a biopsychosocial / ‘whole person’ approach. • The whole person approach is accepted and supported by: • World Health Organisation (WHO) • Heads of Workers Compensation Authorities (HWCA) and Heads of Compulsory Third Party (HCTP). • TIO and NT WorkSafe • Federal government agencies including Comcare and DVA • Insurers within the life insurance framework

6. Medical Model to Whole Person Model: Paradigm Shift

7. Traditional Medical Model

8. The Biopsychosocial Model“Whole Person” Individual-centred model considers the whole person, their health problem and their social context: • Biological—refers to the physical or mental health condition. • Psychological—recognises that personal/psychological factors also influence functioning. • Social—recognises the importance of the social context, pressures and constraints on functioning.

9. Evidence Based Approach What Does the Research Say?

10. Research-Based Comparison

11. Industry Research: Realising the Health Benefits of Work • It’s therapeutic • Promotes recovery and rehabilitation • Better health outcomes • Minimises the harmful physical, mental and social effects • Reduces the risk of long-term incapacity • Promotes full participation in society, independence and human rights • Reduces poverty

12. Did You Know? The longer someone is off work, the less likely they become ever to return. If the person is off work for: • 20 days the chance of ever getting back to work is 70% • 45 days the chance of ever getting back to work is 50%; and • 70 days the chance of ever getting back to work is 35%.* *2011 The Royal Australasian College of Physicians, Australian & New Zealand Consensus Statement on the Health Benefits of Work: Position Statement: Realising the Health Benefits of Work

13. Using a Functional Approach & Best Practice Framework to Maximise Capacity

14. Functional Evidence-based Framework Principles: • Measure and demonstrate the effectiveness of treatment • Adopt a biopsychosocial approach • Empower the injured person to manage their injury • Goal setting to maximise function, participation and RTW • Evidence-based intervention / treatment

15. Principle 1:Measure and demonstrate the effectiveness of treatment Why measure? • Information on health status • Track and monitor progress or any changes in status • Continue, change or cease treatment, • Target treatment and improve treatment outcomes.

16. Principle 1: Measure and demonstrate the effectiveness of treatment • What to Measure? • Outcome measures must be related to the functional goals of therapy and relevantto the person’s injury. • Customised Outcomes - Practical Examples: • A change in work status (RTW program) • A change in participation at home (ADL functional upgrading program)

17. Principle: 2Adopting a biopsychosocial approach • Factors affecting function and participation at home, work and in the community. • Early identification and management of risk factors helps to address issues that can impact on an optimal outcome. • Identifying risk factors using the Flags Model • Early identification of risk factors (biological, psychological and social domains) - important during the assessment phase as it informs and guides treatment.

18. Principle: 2Adopting a Biopsychosocial approach The Flags Model * * Based on Main, CJ, Sullivan, MJL and Watson, PJ 2008, Pain Management: practical applications of the biopsychosocial perspective in clinical and occupational settings, Churchill Livingstone, Edinburgh, New York.

19. Principle 3: Empower the injured person to manage their injury Empowering the injured person to manage their injury is key: • Education • Setting expectations • Self-management • Promoting independence • Healthcare professionals

20. Principle 3: Empower the injured person to manage their injury Education and Setting Expectations Injured person is empowered when they: • Set expectations • Know respective roles • Know nature of their injury, expected recovery timeframes and prognosis • Actively participate in activities at home, work and the community • Know risks of prolonged inactivity • Know risks and benefits of the treatment proposed • Have collaborative treatment goals • Learn to manage their condition as independently as possible

21. Principle 3: Empower the injured person to manage their injury Influencing Beliefs: • Fear avoidance • Catastrophysing • Lack of acceptance • Blaming others Practical Strategies: Education and motivational interviewing

22. Principle 3: Empower the injured person to manage their injury Active strategies that support self-management and independence: • Collaborative goal setting • Activity scheduling • Pacing strategies • Functional upgrading programs • Exercise program

23. Principle 4: Functional goal setting to maximise function, participation and RTWSetting GoalsFunctional and SMARTRegularly assessed SpecificMeasurableAchievableRelevantTimedCurrent Evidence – where the injured person has a role in selecting treatment, better health outcomes are achieved.

24. Principle 4: Functional goal setting to maximise function, participation and RTW Poor Goals Good Goals To return to work in two days on modified duties To be able to drive between home and work within three weeks. Independently manage preparing breakfast three mornings per week within four months. To be able to concentrate on reading for 30 minutes four days per week within one month. • To return to work • To improve driving confidence • To improve activities of daily living • To reduce depression

25. Principle 5: Evidence-based intervention / treatment • Research evidence to inform decision making • Referencing MD guidelines in relation to expected recovery and treatment timeframes • Systematic reviews • Trials • Evidence-based treatments

26. Case Study: How do we integrate this functional approach into effective case management?

27. Case Study: A Functional Approach Case Profile • John – 41 year old landcare worker • Cervical disc injury • Referred for physiotherapy • Graded RTW attempted but reports pain when attempting to upgrade closer to PIDs • Employer unable to provide modified duties on a permanent basis • Social: an active touch football coach

28. Case Study: A Functional ApproachCase Information

29. Case Study: A Functional Approach

30. Case Study: A Functional Approach Principle 1: Measure and demonstrate the effectiveness of interventions

31. Case Study: A Functional Approach Principle 2: Adopt a biopsychosocial approach • Interventions designed to consider the individual, injury & circumstances • Use of screening tools: e.g. DASS, OMPQ, VAS • Use of targeted questions for assessment

32. Case Study: A Functional Approach Principle 2: Adopt a biopsychosocial approach (Cont.)

33. Case Study: A Functional Approach Principle 3: Empower the injured person to manage their injury • Teaching independence • Use of positive encouragement to develop self-efficacy • Collaborative goal setting • Activity scheduling • Pacing strategies • Functional upgrading program

34. Case Study: A Functional Approach Principle 3: Empower the injured person to manage their injury

35. Case Study: A Functional Approach Principle 4: Goal setting to maximise function, participation and RTW

36. Case Study: A Functional Approach Principle 5: Evidence-based intervention / treatment

37. Case Study: A Functional Approach Outcome

38. Stakeholder Collaboration

39. Stakeholder Collaboration • Collaborative Approach by: • Treatment providers • Claims managers • Rehabilitation providers • Shared Goals: • Early intervention and tailored programs • Use of a functional approach to case management • Work on the premise that ‘work is good for you’ • Return to pre-injury / pre-accident activities (including work) • Active engagement of injured person and working towards a common goal • Progress review and management of risk factors • Evidence-based decisions.

41. THANK YOU Rehab Management [Aust] Pty Ltd www.rehabmanagement.com.au Ph: 1300 762 989 referrals@rehabmanagement.com.au