Managing Employee Stress and Anxiety Following a Work-Related Injury
Ways to Improve Workers’ Compensation Outcomes
INTRODUCTION
For stakeholders in the workers’ compensation system, it is well known that patients receiving care for a work-related injury generally take longer to return to work and return to their preinjury levels of employment at an overall lower rate, when compared to other patient populations.¹ A common, inaccurate assumption is that secondary gain issues such as monetary awards are the primary driver for these poorer results. While this can be a factor in a minority of cases, there are many other factors that can contribute to poorer functional outcomes. These additional factors must be understood by all stakeholders, so that effective strategies can be implemented to improve outcomes.
In the paragraphs ahead, we’ll discuss how two often overlooked factors – stress and anxiety – contribute to employee health, and what employers and healthcare providers can do to prevent this mental strain from hindering a rehab process and delaying return-to-work.
STRESS AND THE BODY
When a person experiences prolonged mental stress or anxiety, a variety of systems are activated within the body. This includes our fight/flight system, and a series of other hormone response systems. The result is a body that heals slower, responds poorly to physical stress, and encourages the development of depression and despair.²
When it comes to rehabilitating an injured worker, the negative consequences listed above delay return-to-work, extend case duration, and contribute to poor long-term outcomes. So, what can be done by workers’ compensation stakeholders to reduce factors that contribute to injured workers’ anxiety?
FIRST LINE OF DEFENSE – EMPLOYER EMPATHY
Step one is to demonstrate empathy. Employers that prioritize their employees’ health and wellbeing, ultimately gain trust and confidence from them. This results in greater employee engagement and motivation, and has been shown to decrease overall costs associated with a workplace injury.³ Timeliness is also crucial. Engaging the injured worker early boosts resilience and trust, and has been shown to help improve recovery while also reducing costs.⁴
By demonstrating empathy and coordinating care early, employers learn about the unique concerns of each individual injured worker. Employers can address misconceptions, provide guidance on next steps, ensure the employee has a point of contact for questions, and set expectations as the injured worker moves through the workers’ compensation system.
For a moment, put yourself in the shoes of the injured worker. You’ve had an injury, you’re uncertain whom to contact, your pain is persisting, you’re unable to work, and you’re uncertain about the next steps. Sounds stressful doesn’t it? For many workers, a work-related injury and the associated process is completely foreign to them. The system and rules can be complex, and without a proper resource to manage the injured worker’s needs, stress and its negative consequences, will result.
Luckily, employers can intervene. By being involved and attentive to the needs of their employees, employers can develop a positive culture in the workplace. This been shown to be good for business (improved retention, productivity, and overall job satisfaction³). Making all workers feel like they are assets to the employer has a positive impact on outcomes, should an injury occur.⁵
SECOND LINE OF DEFENSE – PAYER EMPATY
This “employee first” approach is not only crucial for employers, but for insurance adjusters as well. If employers fail to find insurance carriers that share their values and prioritize employee health, negative outcomes can result regardless of the steps taken by the employer. In fact, evidence suggests that involvement in the workers’ compensation system contributes to poorer outcomes, and that the interactions between insurers and injured workers are often “pathogenic” and contribute to secondary complications rather than facilitating recovery.⁶ Think about that; involvement with the system designed to help the injured worker has resulted in the opposite.
So, what can be done? Payers, like employers, must learn to demonstrate empathy to all injured workers, and commit to communication early and frequently throughout the claims process. By doing so, payers can facilitate a positive environment for the injured worker to heal. This “positive claims experience” has been shown in the research to be strongly associated with earlier return to work after a work-related injury.⁷
FIRST LINE OF OFFENSE – HEALTHCARE PROVIDERS AND A BIOPYSCHOSOCIAL APPROACH
Regardless of how engaged and proactive an employer is in developing a safe working environment, accidents may still happen. How those injuries are managed contributes greatly to the outcome. As mentioned in the paragraphs above, empathy and engagement from the employer and payer are important. While empathy contributes to positive outcomes, it fails to address the actual injury.
This is where healthcare providers, and often physical therapists (PTs), become important for recovery. PTs, by nature of the time spent with the injured worker (often several hours/week during treatment), are in a prime position to educate, listen, coach, and manage the ups and downs of an injured worker as they progress through rehabilitation. In short, PTs are able to implement a biopsychosocial approach to care (a model of care that promotes that a medical injury is more than just biological factors, but also psychological and social).
Why is this important? Because by being actively involved and collaborating with the injured worker regularly, the physical therapist demonstrates empathy and provides a support system, thereby reducing stress. PTs can also provide education to the injured workers that can reduce their worries and anxieties. For example, the soreness that an injured worker may feel after therapy isn’t a new injury, but just part of the healing process. Therapists can also advise injured workers on stress-mitigating techniques (like meditation) to manage pain and improve function. While exercise, hands-on therapy, and other modalities are certainly implemented as part of the treatment program, PTs and their ability to emphasize a biopsychosocial approach to care serves the injured worker well by also treating the injured worker as a whole, not just their injury.
SUMMARY
Employers, payers, and healthcare providers can improve functional outcomes and facilitate faster return-to-work by being conscious of the role stress plays in delaying return-to-work. By demonstrating empathy, listening to the specific needs of the injured worker, and providing education and support, the injured worker can return to work at a faster rate and at a reduced cost.³,⁸ It’s a win-win.
REFERENCES
- Gruson KI, Huang K, Wanich T, Depalma AA. Workers' compensation and outcomes of upper extremity surgery. J Am Acad Orthop Surg. 2013; 21(2):67-77. doi: 10.5435/JAAOS-21-02-67
- Butler D, Moseley L. Explain Pain. 2nd ed, NOIgroup Publications; 2013
- Texas Mutual Workers’ Compensation Insurance. The secret to improving worker’s compensation outcomes and how to get started. Accessed April 27, 2022. https://www.texasmutual.com/blog/posts/2018/11/the-secret-to-improving-workers-compensation-outcomes-and-how-to-get-started
- Grant GM, O'Donnell ML, Spittal MJ, Creamer M, Studdert DM. Relationship between stressfulness of claiming for injury compensation and long-term recovery: a prospective cohort study. JAMA Psychiatry. 2014;71(4):446-453. doi:10.1001/jamapsychiatry.2013.4023
- Hallden J. The original intent of workers' compensation: a team approach. Work. 2014;48(3):435-439. doi:10.3233/WOR-141909
- Kilgour E, Kosny A, McKenzie D, Collie A. Interactions between injured workers and insurers in workers' compensation systems: a systematic review of qualitative research literature. J Occup Rehabil. 2015;25(1):160-181. doi:10.1007/s10926-014-9513-x
- Collie A, Sheehan L, Lane TJ, Gray S, Grant G. Injured worker experiences of insurance claim processes and return to work: a national, cross-sectional study. BMC Public Health. 2019;19(1):927. doi:10.1186/s12889-019-7251-x
- Netterstrøm B, Friebel L, Ladegaard Y. Effects of a multidisciplinary stress treatment programme on patient return to work rate and symptom reduction: results from a randomised, wait-list controlled trial. Psychother Psychosom. 2013;82(3):177-186. doi:10.1159/000346369
About Christopher P. Scoma PT, DPT, OCS, COMT, CEAS, CDNT - Director of Worker’s Compensation Quality and Education, Upstream Rehabilitation
Chris completed his undergraduate training and PT school at the University of Evansville in Indiana. He graduated in 2008 with a bachelors in Exercise Physiology and in 2010 with his Doctorate in Physical Therapy. He joined Results Physiotherapy in 2010, and has worked as a staff clinician, clinic director, Regional Occupational Health Coordinator, and Clinical Manager of Occupational Health, overseeing the occupational health clinical product for all 200+ Results Physiotherapy clinics. Most recently, with the purchase of Results Physiotherapy by Upstream Rehabilitation, Chris has stepped into the Director of Workers’ Compensation Quality and Education, providing clinical oversight and serving as the work comp educational resource for over 1,150 clinics across 28 states. Upstream Rehabilitation brands include Results Physiotherapy, Benchmark, Drayer, Elite, and SERC. He has furthered his clinical knowledge by pursuing and obtaining his Certified Orthopedic Manual Therapy certification (COMT), Certified Dry Needling Therapist certification (CDNT), Certified Ergonomic Assessment Specialist (CEAS) certification, and Board Certification through the American Board of Physical Therapy Specialties as an Orthopedic Clinical Specialist (OCS). Chris believes that early utilization of physical therapy is an integral part of facilitating return to work for the injured worker, and he has tailored internal and external educational content to highlight the evidence supporting this perspective.
R.E.W.A.R.D. PROGRAM: RETURN EMPLOYEES TO WORK AND REDUCE DISABILITIES
Did you know a post-injury checklist is included in the REWARD toolkit? Review the checklist REWARD Toolkit (tn.gov) and read the details of three important steps taken post-injury when implementing a REWARD Program.
MEET WITH LIKE-MINDED EMPLOYEES
The REWARD Employer Support Network is an ever-growing group of Tennessee employers who are interested in (or are already) running great return-to-work programs. Listen and join the discussion on October 26th at 9:30 CDT guided by guest speaker, Jason Parker, President and Senior Work Disability Consultant of Centrix Disability Management Services.
DISCLAIMER
Views expressed in the REWARD Report are solely those of the authors and may not reflect the official policy or position of the Tennessee Bureau of Workers’ Compensation, the Tennessee Court of Workers’ Compensation Claims, the Tennessee Workers’ Compensation Appeals Board, or any other public, private, or nonprofit organization. Information contained in the REWARD Report is for educational purposes only.