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Health & Work MattersA Biopsychosocial Approach to Return

to work for MSDs

Overview

Copyright Heather Watson 2015 except where other sources referenced

• What is a Biopsychosocial (BPS) approach?

• Categories of identifying return to work (RTW) obstacles/

Identifying ‘flags’

• Stepped Care

• Stratified Care

• Active Case Management

• Musculoskeletal rehabilitation – levels of service, how this fits

with stepped and stratified care

Overview


Note:

You do not need to all be experts in BPS!

- But an understanding is helpful

Biopsychosocial Approach


BPS (2)


Identifies:

• Why some people with common health problems do not recover

as expected

• Why each case benefits from an individualised approach

• All of these dimensions should be considered in assessment,

rehabilitation and planning a RTW

Kendal&Burton

TSO (2009)

Identifying ‘Flags’


Categories of identifying return to work (RTW) obstacles (Flags,

Think Tank, 2009)

Yellow (Personal)

Blue (Workplace)

Black (Context)

Identifying ‘Flags’ (2)


Yellow (Personal)

• Thoughts

• Feelings

• Behaviours concerning their health condition - anxiety



Blue (Workplace)

Employee & employer perceptions about work & health

e.g. perceived physical demands may be ‘damaging’

Difficult to accommodate workplace support

Poor relationships between employee/employer/ colleagues



Black (Context)

• Outside control of the employee

• Inflexible company policies

• Financial issues around benefits

• Social/media influences

applying the

biopsychosocial model Kendal&Burton

TSO (2009)

Stepped Care


Ensure appropriate support is given at the right time

Minimise potential –ve

effects of over-complicating

cases

Efficient use of resources available

Stepped Care “just what’s needed when it’s

needed”

Kendal & Burton:TSO (2009)

www.tsoshop.co.uk/flags

Stratified Care


The process of deciding what service is required at what time

Not always appropriate / necessary to apply the steps sequentially

You do not need step 1 to be completed before you start another

step

Keele University STarT Back Tool

Stratified Care (2)


Low Back Pain – Risk Assessed

Low Risk Moderate Risk High Risk

Example: Keele University STarT Back Tool

(http://www.keele.ac.uk/sbst/matchedtreatments/)

http://www.keele.ac.uk/sbst/matchedtreatments/

Active Case Management


HSE Report (Hanson et al., 2006)

‘Goal orientated approach to keeping employees at work &

facilitating an early return to work’

Case manager- key point of contact

Active case management = Cost effective

↓ Time off work

↓ Lost productivity

↓ Healthcare Costs

Moderately effective

Often OH, but doesn’t necessarily need to be

Musculoskeletal Rehabilitation


HSE Report (Hanson et al., 2006)

Rehabilitation programs were effective in management of

subacute & chronic groups that were screened (flag-based tools)

as having high risk of a poor outcome

Strong Evidence:

↓ pain

↑ productive activity

↑ cost effectiveness

Strong evidence sub-acute group: ↓ long term problems & time

off work

MSK Rehabilitation (2)


Key Components of best practice (Hanson et al., 2006)

• Use a screening process

• Correct timing of the intervention (Stepped & Stratified Care)

• Individualised plan

• Case management – agreed plan

• Work focused :, cognitive-behavioural problem solving, activity

based in context of their work

• Evidence based clinical approaches

MSK Rehabilitation


Standard outpatient physiotherapy

• Commonly available in NHS & private providers

• Manage common MSDs

• May have own areas of expertise – but no specialist OH

knowledge

Vs

Specialist OH Physiotherapy

• Fitness for work assessment skills

• Fitness for work rehabilitation provision

• Ergonomics & workplace assessment skills

Bringing all the principles together


Example model of process in Fit for Work Service.

Step 1: Triage

Step 2: Physiotherapy

treatment service (OH

monitoring)

Step 3: Specialist

OH Physiotherapy

FFW Assessment

Step 4: OH Rehabilitation

programme

Case Study


‘Jim’

63 year old porter (10+ years)

2 recent episodes of low back pain - 10 days

- 4 weeks

Trauma early 20’s

Recent visit to pain clinic

Otherwise fit & well

Case Study (2)


Perceived he could do all of his work tasks (12 pages!)

BPS Screening Tool – indicated very high risk of further sickness

absence

Why?

Unhelpful beliefs about ‘damage’

Workplace morale, relationships

Motivation to stay at work

Case Study (3)


Physical Examination

Good range of movement Lx spine

Decent walking stamina

Safe lifting technique and capacity

Struggled with full shoulder flexion

Mild patella-femoral joint pain in his right knee

Case Study (4)


• Re-assurance of test results (compared to normative data)

• Simple, functional exercises relating to his work

• Pain Education: Basic physiology, Affect of BPS factors, pacing

strategies

– Discussed his examples where he was struggling & discussed

possible solutions

• 6 x 1 hour treatment sessions – above

• Report to management

Case Study (5)


Outcomes

• Discharged: BPS model tool identified low risk of sickness

absence

• Gave examples in last 2 sessions of better coping strategies at

work – task rotating, pacing himself, cooperative conversation

with his manager

• ↑ Mood

• ↑ QOL & physical activities

• ↓ Reliance on medication

Conclusions


• Key components of effective practice = successful outcome

e.g.s

↓ Sickness absence

↑ Work productivity, activities & work stability

• Doing nothing = likely remain high risk of further sickness absence

• Stepped & Stratified care pathways identify who needs what level

of support & when

Conclusions (2)


Complex cases: taking the time to understand Jim’s perceived

problems then providing specialist MSK rehab. & planning an

individual solutions = successful outcome

• You do not need to all be experts in BPS!

- But an understanding is helpful

Take home messages


To do list…

Check your support options:

? Case manager/ OH support

? Physio support – BPS work focused?

Use TSO for interviewing

Our services


Health & Work Matters services:

-Consultancy – review current service strategy , review current

service provision

-Education / training for managers and employees / conference

speaking

-FFW assessment for tough cases

Contact details…..


Website: http://healthworkmatters.com/

Twitter: @HWMatters

Email: [email protected]

Phone: 07494 177159 (Office)

Health & Work Matters

Thank you for watching


References


http://kendallburton.com/Flags/flagsindetail.html

Keele University Website: http://www.keele.ac.uk/sbst/

Waddell and Burton (2004). Concepts of Rehabilitation for the management of

common health problems. TSO. Available at :

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/208

968/hwwb-concepts-of-rehabilitation.pdf

Watson, H (2015). A Biopsychosocial Approach to Return to Work. Occupational

Health Journal, Pages 26-29

http://www.keele.ac.uk/sbst/

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/208968/hwwb-concepts-of-rehabilitation.pdf