Sedgwick
Physical therapy in workers’ comp: keeping a claim on track
After an occupational injury, specialists prioritize determining the best treatment route that will enable a quick and safe return to work. An increasing number of injured workers are receiving physical therapy (PT) to reach their recovery goals. But by the time a case falls off track, or requires intervention to make progress, PT can arguably do more harm than good. Managing — and, when necessary, redirecting — an injured worker’s treatment trajectory is key to promoting the best possible outcomes.
Physical therapy on the rise
A rehabilitative therapy, PT centers around targeted exercises meant to enhance bodily functions, improve mobility, alleviate pain and foster overall well-being. It can help those suffering from musculoskeletal disorders, chronic pain and movement disorders, as well as in treating short-term disabilities associated with on-the-job injuries. In workers’ compensation, physical therapy is often a critical step between injury and returning to work.
There is mounting evidence to suggest top-tier, focused PT treatment — combined with high levels of patient engagement — results in shorter disability durations, better patient mobility and lower claim costs. Early access to PT can also reduce opioid use among patients with musculoskeletal pain by serving as an alternative to short-term opioid use for acute pain episodes. These could be, in part, why we’re seeing an increase in prescribing rehab therapies, both in workers’ comp and in general.
An American Physical Therapy Association (APTA) independent study found that PT delivers significant clinical and economic outcomes, compared to alternative treatments, across multiple conditions. These include three common workers’ compensation injuries: carpal tunnel syndrome, low back pain, and lateral epicondylitis (also known as tennis elbow). When physical therapy was part of a treatment plan with these conditions, net savings across total medical costs were observed as a result of reductions in additional referrals, diagnostic imaging, and surgery rates.
Timing is everything
But access to PT services is not the end-all be-all, and how each case is handled will affect its outcome. Timing — both in case durations and how quickly following the injury PT begins — also influences treatment outcomes. Studies show early intervention using goal-oriented PT prevents long-term disability and chronic pain.
In one Workers’ Compensation Research Institute (WCRI) study, on average, the number of weeks of temporary disability per claim was 58% longer when PT was initiated more than 30 days post-injury. The percentage of cases with attorney involvement were significantly higher, too.
Conversely, when an injured worker gets PT for low back pain — the most common work-related musculoskeletal disorder — within 14 days of their injury, it’s been shown to significantly reduce the use and costs of medical services (e.g., MRIs, opioid prescriptions, pain management injections, surgery). In most cases, the earlier PT begins, the better the chance of returning to work without needing surgical intervention.
Keeping claims on track
A case only reaches its desired outcomes if it is guided by a driven, collaborative treatment plan. Treatments repeating for weeks on end, for example, would be a strong indication of insufficient progress. If, at six to eight weeks post-injury, there is little to no progression in range of motion, pain or function — or if the injured employee is more than 150% over the guideline-recommended number of visits — Sedgwick’s physical therapy experts will intervene. They will try to redirect the treatment’s trajectory and, in turn, the claims process.
How to most efficiently resolve symptoms will differ based on whether the injury is acute or chronic, and a range of other factors. In any case, each intervention should be tailored to better reach the injured worker’s treatment goals. It may mean providing education and closer direction to the injured worker. It may mean initiating clinician-level discussions and education on programming and possible options to implement. Keeping a claim on track through intervention speeds up employees’ healing and reduces long-term treatment costs.
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