Attachment 3. Suggested actions for physiotherapists Early intervention 4-12 post injury Chronic phase rethink and reassess – Within 3 weeks post-injury Detailed review and modify treatment Consider multidisciplinary approach Use brief screeners2 like Orebro in addition to a Re-administer Orebro and review clinical assessment and Identify and treat persistent pain issues clinical assessment to gain insight into the worker’s: consider the specific risks and test with: Re-administer Orebro and consider pain Function Pain Catastrophising Scale self-efficacy questionnaire Global prediction of RTW Pain Self Efficacy Q’re (coping with pain) Discuss with GP possible referral to pain Fear/avoidance behaviour, prominent K10 for distress assessments psychologist/multidisciplinary team for detailed distress and fears of re-injury risk assessment Risk Undertake active treatment and monitor Reassess progress against goals and patient’s Review clinical treatment and assess progress understanding of their condition outcomes against goals set Listen, reassure, foster self-management, Review treatment and consider referral to a Assess and manage impact of deactivation extend activity levels to be despite specialist musculoskeletal physiotherapist ‘active Ask about sleep difficulties and discuss with pain’ Liaise with GP re: GP if clearly present Educate pain e.g. pain/harm Function, suitable duties; using mobile case Communicate/coordinate with each party Early contact with GP re any concerns, manager, RTW consultant or coordinator if and other clinicians involved recommendations workplace issues raised by patient Suggest referral to pain psychologist if behaviour response or screening indicates risk factors for pain behaviour Clinical Now consider Contact GP regarding any concerns raised in the Now consider Review pain management and education assessment: Pain management techniques using: to: Pain education Prominent distress and or anxiety identified Address inaccurate beliefs about the Physical exercise regime Focus on function and advise on suitable injury and modify management Coaching/motivational techniques including pain education duties clinical Re-activation strategy Focus on re-activation (identify any Liaise with (a) return to work coordinator and/or (b) barriers and manage). mobile case manager if workplace problems management identified e.g. suitable duties, relationships Additional
Attachment 3. Suggested actions for physiotherapists Early intervention Within 3 weeks post-injury 4-12 post injury Detailed review and modify treatment Chronic phase – rethink and reassess Consider multidisciplinary approach Risk assessments Use brief screeners2 like Orebro in addition to a clinical assessment to gain insight into the worker’s: Function Global prediction of RTW Fear/avoidance behaviour, prominent distress and fears of re-injury Re-administer Orebro and review clinical assessment and consider the specific risks and test with: Pain Catastrophising Scale Pain Self Efficacy Q’re (coping with pain) K10 for distress Identify and treat persistent pain issues Re-administer Orebro and consider pain self-efficacy questionnaire Discuss with GP possible referral to pain psychologist/multidisciplinary team for detailed risk assessment Clinical response Undertake active treatment and monitor progress Listen, reassure, foster self-management, extend activity levels to be ‘active despite pain’ Educate pain e.g. pain/harm Early contact with GP re any concerns, recommendations Reassess progress against goals and patient’s understanding of their condition Review treatment and consider referral to a specialist musculoskeletal physiotherapist Liaise with GP re: Function, suitable duties; using mobile case manager, RTW consultant or coordinator if workplace issues raised by patient Suggest referral to pain psychologist if behaviour or screening indicates risk factors for pain behaviour Review clinical treatment and assess outcomes against goals set Assess and manage impact of deactivation Ask about sleep difficulties and discuss with GP if clearly present Communicate/coordinate with each party and other clinicians involved Additional clinical management Contact GP regarding any concerns raised in the assessment: Prominent distress and or anxiety identified Focus on function and advise on suitable duties Liaise with (a) return to work coordinator and/or (b) mobile case manager if workplace problems identified e.g. suitable duties, relationships Now consider Pain management techniques using: Pain education Physical exercise regime Coaching/motivational techniques Re-activation strategy Now consider Review pain management and education to: Address inaccurate beliefs about the injury and modify management including pain education Focus on re-activation (identify any barriers and manage).
Outcomes-of-early-psychosocial-screening.docx