Education Industry masterclass - WorkSafe Queensland · tennis elbow, shoulder pain and knee pain....

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 david.brentnall@axisrehab.com.au