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Education masterclass 15 November 2018
Education masterclass
15 November 2018
Welcome!
What will be covering today
(and of course some general housekeeping!)
WorkCover Queensland update
Matthew BannanExecutive Professional Services
15 November 2018
What’s our purpose?
Ben Roche
Operator & labourer
Real people,Real stories
WorkCover Queensland Ecosystem
Our role in this RTW journey
Injuredworker
WorkCover WorkCover
• Safety• Reporting• Communication• Support• Suitable duties
• Communication• Rehabilitation• Suitable duties
Employer Medical andAllied HealthProviders• Timely services• Communication• Rehabilitation• RTW focus
RTW
Customerstrategyprinciples
Our values
Towards 2022Our vision To be the best workers’ compensation insurer and make a positive difference to people’s lives
ExcellenceTo deliver outcomes that are highly valued by our customers
IntegrityTo always do the right thing
ResponsivenessTo provide an experience that meets the individual needs of our customers
RespectTo be considerate of the rights and dignity of everyone
We partner with and support our customers to keep Queenslanders working• Trusted partnerships underpin our focus on return to work outcomes• Tailored quality experiences for workers and employers• Creating value for business through innovative and sustainable outcomes• Influencing and investing in injury prevention
Our purpose
I had life goals
My family counts on
me
Having an injury
makes life confusing
I want a business partner
How much will this claim impact my premium
Help me find
suitable duties for my injured
worker
Engaged people better CX
Workers reporting positiveclaims experiences are 3x
more likely to achieve positive RTW outcomes than those with negative /
neutral experiences
Almost half of workers reporting positive claims experience had RTW within 30 days compared with 31% of
those with negative / neutral claims experience
3x 47%
Return to work
RTW outcomes
Workers reporting negative claims experiences were 2x more likely to
be not working at the time of interview than those with positive
experiences
2x Notworking
Versus 31%
Experience is related to return to work outcomes
Source: https://www.monash.edu/medicine/sphpm/units/iwhgroup/projects-and-partners/compare-project
Our progress
We are here
RESEARCH
DESIGN
TEST
Our partnership
Build understanding Identify the right care Support recovery
The approach
Gather information. Understand our customers.
Understand the best path.Identify the best ways to help.
Support at the right time.The best possible outcomes.
Our aim is to get the best outcome for everyone.
What do we know about the education and training industry?
Top 3 new claims by
body location
1. Back 2. Hands and fingers
3. Knee and upper leg
What do we know about the education and training industry?
Top 3 new claims by
nature
1. Musculoskeletal injuries and
diseases
2. Wounds, lacerations,
amputations and internal organ
diseases
3. Mental disorders
What do we know about the education and training industry?
Top 3 new claims by
mechanism1. Falls on same
level
2. Muscular stress while lifting,
carrying or putting objects down
3. Being assaulted by a person or persons
What do we know about the education and training industry?
Top 3 injuries by average
cost
1. Mental disorders 2. Shoulder/upper arm
3. Trunk/Back
What do we know about the education and training industry?
Top 3 new claims by age group
1. 51 to 60 years 2. 41 to 50 years 3. 31 to 40 years
Thank you
we care.
Part 1: Early intervention for work-related injuries.
What is it?Does it work?David Brentnall
Specialist Physiotherapist
AXIS Rehabilitation at Work
15 November 2018
What is early?
What is proper care?
Does it really matter?
Proper Care
MRI changes in a pain-free population
0%10%20%30%40%50%60%70%80%90%
0 20 40 60 80 100
Disc
bul
ge (%
)
Age (years)
Disc bulge in Asymptomatic population
0%5%
10%15%20%25%30%35%40%45%50%
0 20 40 60 80 100
Disc
pro
trus
ion
(%)
Age (years)
Disc protrusion in Asymptomatic population
Proper Care
Zigenfus, G.C., et al., Effectiveness of early physical therapy in the treatment of acute low back musculoskeletal disorders. J Occup Environ Med, 2000. 42(1): p. 35-9
Early Physiotherapy
>Compare 3867 Acute LBP:
• Early intervention: 48 hours• Middle: 2-7 days• Delayed intervention >8 days
>Early Physiotherapy =• Less lost time and short time on SD and • short claim duration / claims cost
Linton, S.J., A.L. Hellsing, and D. Anderson, A controlled study of the effects of an early intervention on acute musculoskeletal pain problems. Pain, 1993. 54(3): p.353-9.
Early Physiotherapy
>Compare LBP cases:• 72 hours vs 8 days+
>Early Physiotherapy =• Less lost time and • incidence of chronic pain from 15% down to 2%
Work Related Injuries
Injury Work Related or Non-Work Related?
See Doctor Geography (where is physio?)
Physio
Contemporary approach to early intervention.
1. Direct relationship with doctors and physio2. Less barriers : First thought is support.
Access for WR and NWR, price, within work hours, geography3. Biopsychosocial model 4. Support alternative duties– supervisors in a central role – assisted with Dr
and physio5. Goal settings/ managing expectations
Injury Work Related or Non-Work Related?
See Doctor Geography (where is physio?)
Early ProperCare
Early Intervention
Supervisor support
we care.
Part 2Risk factors and management for three common MSDs in ageing workers -tennis elbow, shoulder pain and knee pain.
David Brentnall
Specialist Musculoskeletal Physiotherapist
AXIS Rehabilitation at Work
October 2018
Population change, Age group – 1997 to 2017
Baby Boomers
% change
Proportion of claims by age group, 2000-01 to 2014-15
2 weeks longer RTW
Working age & non working age population annual growth rate comparison
Risk factors: Tennis elbow
>Use of heavy hand held tools, and >Combined forceful work, non-neutral posture of hands and arms, and
repetition. >Vibration was inconsistent>Psychosocial factors: Poor social support
Conservative Interventions
Weeks0
102030405060708090
100
Succ
ess
(%)
(Com
plet
ely
reco
vere
d)
Weeks
Wait and See policy
Bisset et al BMJ 2006
3 6 12 26 52
(9% recurrence rate)
Conservative Interventions
Weeks3 6 12 26 520
102030405060708090
100
Succ
ess
(%)
(Com
plet
ely
reco
vere
d)
Weeks
Bisset et al BMJ 2006
Corticosteroid Injection (72% recurrence rate & delayed healing)
Wait and See policy
(9% recurrence rate)
Conservative Interventions
Weeks
3 6 12 26 520102030405060708090
100
Succ
ess
(%)
(Com
plet
ely
reco
vere
d)
Physiotherapy(8% recurrence rate)
Corticosteroid Injection (72% recurrence rate & delayed healing)
Bisset et al BMJ 2006
Weeks
Conservative Interventions
Weeks3 6 12 26 520
102030405060708090
100
Succ
ess
(%)
(Com
plet
ely
reco
vere
d)
WeeksBisset et al BMJ 2006
Corticosteroid Injection (72% recurrence rate & delayed healing)
Wait and See policy
(9% recurrence rate)
Conservative Interventions
Treatment Short-Term Effects Long-Term EffectsAcupuncture Manual Therapy ?Exercise ?Orthotic Devices ?Shock Wave Therapy Deep Friction Massage Platelet rich plasmainjections
Cortisone Not recommended worse
Surgery
>This study failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB over placebo surgery for the management of chronic tennis elbow.
Cortisone is contraindicatedPhysiotherapy is effectiveNeuropathic medications (not opioids)Modifications supporting stay at work Psychosocial support – especially social & job control
>rotator cuff tendinopathy>supraspinatus tendinosis
>partial / full thickness tears>subacromial bursitis
>subcrominal impingement syndrome
>shoulder impingement syndrome >subacromial pain syndrome
>shoulder pain syndrome
Ultrasound findings in asymptomatic individuals
>51 men without symptoms aged 40-70 and US scans (25 right and 26 left)
>Findings:>- subacromial bursal thickening 78%>- AC joint degeneration 65%>- Supraspinatus tendoniosis 39%>- Partial thickness tear supraspinatus 22%
SHOULDER ‘ABNORMALITIES’ WERE FOUND IN 96% OF ASYMPTOMATIC PEOPLE!
Grish et al 2011
Rotator Cuff Tears in Asymptomatic Individuals
>An MRI study found a 34% rate of full-thickness tears in 96 asymptomatic volunteers.
Sher et al 1995
>When looking at patients over the age of 60 years, the prevalence increased to 54%.
Templehof et al 1999
MRI scans
>Sub acromial impingement (n=42)>Age matched asymptomatic control (n = 31)>Findings (pathology on MRI):>Impingement group:22/42 (55%)>Control group: 16/31 (52%)>RC pathology related to age>RC pathology does not correlate with symptoms
Frost et al 1999 J Shoulder Elbow Surg.
Imaging can’t tell us where the pain is coming from
>Biggest predictor of Rotator cuff tear?.........getting older>Serious implication: Many people will have shoulder surgery on
shoulder tissues not related to their symptoms
Physical load factors: Shoulder pain (meta analysis)
>heavy physical load (14 studies); >awkward postures, including twisted postures, >working with arms above shoulder level (13 studies); >repetitive movements (eight studies); >Sustained / prolonged work—such as typing or driving—(five
studies); >vibration (six studies)
Psychosocial factors: Shoulder pain (meta analysis)
>psychological demands at work (mental stress, job pressure, 14 studies);
>control at work (participation in job decision making, influence on work schedule, 11 studies);
>social support at work (from co-workers and supervisors, 12 studies); and
>job satisfaction or stimulus at work (work content, monotonous work, career prospects, 12 studies).
Cortisone for Rotator cuff related pain.
>Multiple injections no more benefit over single injection>No better effect than analgesic after 3 months>NNT = 5 and benefit mild>Not a quick fix – needs to be kept to a minimum>May accelerate tendon degeneration>“Their widespread use may be attributable to habit,
underappreciation of the placebo effect, incentive to satisfy rather than discuss a patient’s drive to physical intervention or for remuneration, rather than their utility”
Rotator Cuff Related Shoulder Pain
Subacromial Impingement Syndrome
Exercise is as effective as Surgery
……at 1,2,4, and 5 year follow-ups
…at a fraction of the cost of surgery
> Haahr et at 2005 1 year follow-up> Ketola et al 2009 2 year follow-up> Haahr & Andersen 2006 4 year
follow-up> Ketola et al 2013 5 year follow-up
Rotator Cuff Related Shoulder Pain
Rotator Cuff Partial Thickness Tears (<75%)
Exercise is as effective as Surgery……at a fraction of the cost of surgery
“These results suggest that at one-year follow-up, operative treatment is no better than conservative treatment with regard to non-traumatic supraspinatus tears, and that conservative treatment should be considered as the primary method of treatment for this condition.”
Rotator Cuff Related Shoulder Pain
(Atraumatic) Full Thickness Rotator Cuff Tears
Exercise significantly reduces the need for Surgery
……up to 75% at 2 year follow-up
No clear relationship of age and outcomePoor outcome from poor self efficacy, level of education
and comorbiditiesPhysiotherapy = primary treatment RC disorders
May require exercise for 3-9 monthsKeep injections to a minimum
Modifications and psychosocial support to stay at work Most people do not need surgery
Rotator Cuff Related Shoulder Pain
Full Thickness Rotator Cuff Tears Surgery46.4% arthroscopic repairs had re-teared at 2
year follow-up…….. but this did not affect outcome.
>The lifetime risk of symptomatic knee OA 45% (85)
>No significant differences by sex, race, and education,
>Obese participants had a significantly higher lifetime risk 61%
>Normal weight lifetime risk 30% >Overweight life time risk 47%>History of knee injury 57% >No history of knee injury 42%
Johnston County Osteoarthritis Project
Incidence of OA knee pain
>89% of over 50s had MRI finding consistent with OA but only 29% complained of pain.
Conservative InterventionsTreatment Short-Term Effects Long-Term EffectsAcupuncture Exercise
Surgery Not recommended Not recommended
Orthotic Devices ?Electrotherapy Oral opioids Not recommended Not recommended
Viscosupplementationinjection
Not recommended Not recommended
Intra-articular steroid ? Platelet-rich plasma (PRP) injection
CBT Weight loss
Surgery of degenerative knee arthritis
“We make a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease ……. further research is unlikely to alter this recommendation.”
Partial meniscectomy no significant difference to sham surgery
……progression to OA more rapid in persons who had meniscectomy and
3X more likely to go on to have a knee replacement
Painful OA: overweight, less strength, previous injury and depression
Physiotherapy/exercise = primary treatmentCBT and Weight loss helps
Modifications and psychosocial support to stay at work
Surgery: not recommended
Yes, there are two paths you can go by,But in the long run,There's still time to change the road you're on.
Worry
Injections
Surgery
Scans
Support at workReassurance
QualityPhysiotherapy
CONTRIBUTORS
> Nick Kendrick> Pain Management Co-ordinator> APA Sports Physiotherapist > APA Musculoskeletal Physiotherapist
> Associate Professor Leanne Bisset> Griffith University> Menzies Health Institute Queensland> APA Sports Physiotherapist
David BrentnallManaging Partner280 Adelaide St Brisbane QLD 4000P 07 3229 9441 E [email protected]
