Seizing the Healing Benefits of Life After Injury
By Lori Berdahl
Injuries disrupt normal life routines. Research demonstrates that time away from regular life activity derails injury recovery. Vicious cycle? Indeed.
Studies have repeatedly shown that staying involved in any amount of work activity during recovery shortens recovery time and results in better medical outcomes. While pointing out the benefits of early return to work, research has also identified many ways in which prolonged time away from work is actually harmful. This has led medical groups such as the American Medical Association and the American Occupational Medical Association’s Committee of Practice to issue statements in support of early return to work after injury. The American Academy of Orthopedic Surgeons’ position on early return to work states that it is in the best interest of patients, helps workers regain function, prevents de-conditioning, avoids negative psychological behavior patterns, avoids financial perils, and maintains quality of life for the injured worker.
The American College of Occupational and Environmental Medicine’s (ACOEM) report on “Preventing Needless Work Disability by Helping People Stay Employed,” estimates that as many as 75% of days off work after injury are not actually medically necessary. Many are instead due to delays in treatment when specialty referrals are made, assumptions on the part of the provider that no modified duty work is available, or lack of communication between the provider, employer, and patient. Even if a specialty referral is advised, temporary functional restrictions for home and work should be issued by the initial provider because contact with the specialist may be delayed. It is also beneficial to provide functional restrictions even if the patient indicates that no modified duty work is available with their employer. In many cases, the patient is simply not aware of what is available throughout their entire organization. Information about physical job requirements can be requested from the employer if needed, including a videotape or physical demand job description. Communication can help to overcome return to work barriers and eliminate unnecessary and harmful time away from work.
The ACOEM report recommends that medical providers adopt a Disability Prevention Model. This means that rehabilitation and return to one’s normal roles should begin and be planned at the patient’s very first visit. Even restrictions limiting the patient to sedentary tasks or “no use” of the affected body part can be beneficial to help maintain overall physical endurance, contact with co-workers, focus on recovery, and psychological health. The patient should be encouraged to take responsibility for their recovery by staying physically active in safe and conservative ways. Patient fears or apprehension can be reduced by explaining that some measure of discomfort is normal when resuming activities after an injury. A therapist could be enlisted to instruct a patient on safe techniques to protect themselves from re-injury or exacerbation of symptoms at work and home. An ergonomics study of the job could be recommended to decrease injury risk factors and exposures.
Setting the expectation for a positive outcome and laying out plans for functional performance to increase incrementally throughout recovery encourages a function focus instead of a disability focus. One 2015 study measured expectations for recovery and found that patients with positive expectations were five times as likely to be recovered at the one year follow-up than those with negative recovery expectations. Negative expectations is a predictor of work-disability. Just the encounter and communication between patient and provider can provide healing, as much as treatment itself.
Medical providers at all levels play a key role in preventing long term work disability and boosting positive expectations for recovery. Early return to work can be leveraged to prevent loss of endurance, reduce fear and avoidance, increase worker confidence, limit disruption to the patient’s normal life roles and routines, enhance recovery, and improve medical outcomes.
Lori Berdahl is an occupational therapist and holds the Certified Ergonomic Evaluation Specialist designation. She is an Ergonomics and Loss Control Specialist with RAS.