In the 1980’s, when rehabilitation was legislated as an injured worker entitlement, Rehabilitation Providers, Doctors, Insurers and Employers respected each other’s expertise and collaborated to achieve desired health and work outcomes.  

Rapid growth in the Vocational Rehabilitation industry produced providers of varying levels of capacity, with professional inexperience outnumbering professional excellence. Costly and declining outcomes contributed to industry frustration and legislative change resulting in the proverbial ‘throwing the baby out with the bathwater.’

There are Providers who now achieve significantly better outcomes than their competitors. They have invested in resources and training to efficiently deliver strong results.

However, under current scheme processes they are marginalised by an industry that has focused on cost shifting, entitlement reduction and service control, rather than work disability reduction. Whereas evidence shows that the latter is the best way to reduce the costs of injury.

Most Rehabilitation Providers employ health professionals. A key benefit of having health professionals in the workplace is the reduction in gulf between health care recommendations and the employer’s commercial realities. In this setting a worker’s responses to injury can be normalised rather than medicalised, and the approach is biopsychosocial rather than biomedical.

Pain is the most common reason given by workers for their work disability.  When health and rehabilitation professionals are appropriately trained to facilitate pain management education outcomes are improved. However this role is commonly assigned only to treatment providers operating in a clinical environment outside the workplace.

The consequence of this approach is loss of opportunity for worker health behaviours to be influenced in their usual workplace environment. Yet the learning of new behaviours is most effective when a person is motivated by relevance, by seeing directly how this information or new skill will make a real and immediate difference to their home and working life.

Over the past 10 years researchers have shown that neuroplasticity is relevant to pain management strategies. Lasting improvement in function can be achieved through appropriate care, including reduced pain, disability and distress.

A key principle of neuroplasticity is ‘use it or lose it’. This applies equally to helpful and unhelpful actions and thoughts. Hence the critical requirement for targeted education for injured workers to “lose” unhelpful behaviours and develop and “use” helpful skills.

Under current scheme processes “self-help skill development” and “biopsychosocial rehabilitation” are often paid lip service; they are promoted but not measured. Biomedical treatment is expected to deliver work capacity and Rehabilitation Providers are acknowledged as the Return to Work Specialist but not as the Workplace Health Specialist. 

Rehabilitation Providers employ a wide range of health professionals; this is both their strength and their weakness. It is their strength because it gives them a multi-disciplinary team and their weakness because they do not have a common professional body to manage professional development and accreditation.

Over the past 30 years, the capacity of Rehabilitation Providers to provide health care services has in general atrophied through disuse. This has been market driven. Process-obsessed micro management of provider services has discounted professional expertise and denied professional innovation in outcome achievement. As a consequence there has been stagnation in scheme outcomes.

Rehabilitation Providers who are achieving strong outcomes for their clients have invested in the necessary training and resources to achieve this result. They measure the worker’s attitudes, beliefs and expectations, before and after coaching. The initial report generated from this assessment secures the worker’s understanding of the impact of these important factors, that they are amenable to change and that this will result in less pain and disability. 

Reports from these assessments are also provided to employer, insurer and treatment providers ensuring all parties understand the domains of psychosocial influence on the worker’s recovery.

This level of service delivery, barrier metrics and accountability should be expected and requested by all referrers to Rehabilitation Providers. A premium should be paid to Rehabilitation Providers who can prove capacity to deliver these services as this will return quicker and more durable outcomes and savings in all claim expenses, including claim administration as these professionals do not need micro managing.

Such a structured biopsychosocial approach within Workplace Rehabilitation is equally effective for workers dealing with a physical or psychological injury.  In all cases, work has contributed to the injury or illness and therefore is the most relevant context for learning health behaviour change.

Fortunately for the worker, individualised self-help skills not only improve coping, they bring about structural and functional change resulting in reduced pain, disability and distress and work capacity that continues to grow. 

A broad uptake of this approach would constitute a paradigm shift in the management of personal injury.  Work disability reduction would finally be able to influence the unacceptably high personal and financial costs of compensable injury.
 

'Rather than aiming for control of the health condition, successful outcomes are dependent on learning processes toward self-management, confidence building and independence'. Professor Sir Mansel Aylward CB