In workers’ compensation, the path to recovery and return to work often hinges on effective rehabilitation. As a physical therapist with over 20 years of experience and 15 years specifically in workers’ comp, I’ve witnessed firsthand how quality physical therapy can transform outcomes for injured employees when delivered at the right time with the right approach.
Yet, the U.S. health care system faces a significant challenge in inconsistent care management and the use of physical medicine services. This reality is particularly problematic in workers’ comp, where delayed recovery means extended time away from work and increased claim costs.
Evidence-based physical therapy addresses this challenge by focusing on what research shows actually works. Rather than applying a one-size-fits-all approach, evidence-based care tailors treatment to the specific needs of each injured employee, guided by clinical research and best practices.
1. Physical Therapy as First-Line Treatment
For most musculoskeletal injuries sustained on the job, physical therapy represents an excellent opportunity for early intervention. Early access to physical therapy can help injured employees better manage pain, restore function, and develop strategies for returning to work safely. Research consistently shows that prompt initiation of appropriate physical therapy leads to better outcomes and reduced overall claim costs.
One study found each day of PT referral delay was associated with increased costs and disability duration, and for every day earlier that injured workers received PT, there was approximately a 3% decrease in total medical costs.
Another study in Spine found early PT (within 14 days of injury) for low back pain was associated with:
- 28% reduction in advanced imaging utilization
- 26% decrease in opioid prescription requirements
- 55% reduction in subsequent surgery rates
However, it’s important to recognize when standard physical therapy isn’t producing the expected results. In these cases, advanced clinical oversight employing evidence-based guidelines helps identify when alternative or complementary approaches may be needed.
2. Critical Role of Clinical Oversight
Advanced clinical oversight serves as a vital component in ensuring injured employees receive appropriate care. This approach uses evidence-based guidelines to identify red flags in treatment plans and facilitates peer-to-peer discussions between health care professionals. When physical therapists collaborate with physicians and case managers, they can develop treatment plans that optimize recovery.
Benefits of this collaborative approach include:
- Early identification of cases that aren’t progressing as expected
- Reduction in unnecessary treatments
- Focused rehabilitation strategies
- Better coordination across continuum of care
3. Additional Treatment Considerations to Address Psychosocial Factors
When injured individuals fail to recover as expected, there may be more than just physical issues causing the delay; underlying psychosocial components can also affect their progress. Psychologically based PT can help flag catastrophizing (anticipating the worst outcome when there’s little evidence to support it), fear-avoidance or malingering behaviors that may be impacting recovery.
In addition, functional capacity evaluations provide a quantitative assessment of functional abilities and test validity of effort. Virtual reality tools are also showing promise in helping patients manage chronic pain and change how they perceive and respond to it. These tools can be particularly valuable for injured employees who catastrophize their pain or struggle with traditional rehabilitation approaches.
4. Shift to Earlier Outpatient Care
A significant rehabilitation trend is the movement from inpatient to outpatient orthopedic surgeries, resulting in earlier initiation of PT. This shift presents both challenges and opportunities for physical therapists and injured employees alike.
Outpatient physical therapists now often see patients 24-48 hours after surgery, rather than the traditional 7-10 days following an acute care stay. This requires therapists to expand their expertise beyond range of motion and strength training to include aspects of medical management such as wound care.
While this shift demands more from physical therapists, it generally benefits patients. Research shows returning patients home sooner reduces risks of hospital-acquired complications and infections. The more comprehensive and aggressive rehabilitation protocols available in outpatient settings often lead to better outcomes than traditional inpatient approaches. Additionally, outpatient procedures can save over $8,000 compared to inpatient alternatives, representing significant cost savings for the workers’ comp system
The Path Forward
As we look to maximize the benefits of physical therapy in workers’ compensation, several priorities emerge. These include:
- Timely intervention: Ensuring injured employees access appropriate care as quickly as possible after injury
- Coordination of care: Facilitating communication between all stakeholders, including surgeons, physical therapists, and claims professionals
- Geographic coverage: Building strong networks that can accommodate the growing trend toward outpatient care
- Appropriate utilization: Using evidence-based guidelines to determine when treatment should continue and when it should change direction
By 2026, it’s predicted that more than 50% of joint replacements will be performed in outpatient settings, compared to just 10-15% in 2010. This dramatic shift underscores the importance of having well-prepared physical therapy networks with expertise in early medical management.
Quality physical therapy delivered at the right time with evidence-based approaches remains one of the most effective approaches to workers’ compensation rehabilitation. The focus must remain on what works best for each individual injured employee, using evidence to guide treatment decisions and being willing to adjust approaches when recovery doesn’t proceed as expected. By maintaining this patient-centered, evidence-based focus, we can continue to improve outcomes while managing costs effectively in workers’ comp.
Kim Radcliffe, DHA, MHA, PT, provides clinical and strategic direction as SVP, Product Management of Apricus Specialty Solutions at Enlyte.