Cornerstones of Disability Prevention and Management Effective Date: May 1, 2011 Contributors Evidence-based Practice Disability Panel Chair: Garson M. Caruso, MD, MPH, CIME, FAADEP, FACOEM Evidence-based Practice Disability Panel Members: Robert J. Barth, PhD Jennifer Christian, MD, MPH Michael Goertz, MD, MPH Gideon Letz, MD, MPH Michael S. Weiss, MD, MPH, FACOEM, FAAPMR, FAANEM Co-Author, Psychological Factors Section: Pamela A. Warren, PhD Panel Consultants: Jeffrey P. Kahn, MD James B. Talmage, MD, FACOEM Methodology Committee Consultant: Jeffrey S. Harris, MD, MPH, FACOEM Specialty Society and Society Representative Listing: ACOEM acknowledges the following organizations and their representatives who served as reviewers of the Cornerstones of Disability Prevention and Management chapter. Their contributions are greatly appreciated. By listing the following individuals or organizations, it does not infer that these individuals or organizations support or endorse the final Cornerstones of Disability Prevention and Management chapter developed by ACOEM. The American Occupational Therapy Association Vicki Kaskutas, OTD, MHS, OT/L American Physical Therapy Association Deirdre Daley, PT, DPT Copyright ©2020 Reed Group, Ltd. Page | 1 Table of Contents Introduction and Overview ............................................................................................................................................................... 3 Work Disability Prevention and Management .............................................................................................................................. 3 Summary of Recommendations ........................................................................................................................................................ 4 General Recommendations .......................................................................................................................................................... 4 Specific Recommendations ........................................................................................................................................................... 5 Principles, Terms, and Definitions ..................................................................................................................................................... 6 Seven Dimensions of the Health-Disability Relationship .............................................................................................................. 6 Serious Medical Conditions and Common Health And Life Problems ........................................................................................... 7 Other Principles and Terminology ................................................................................................................................................ 8 General Considerations in Work Disability Prevention and Management ...................................................................................... 10 The Biopsychosocial Approach ................................................................................................................................................... 10 The Biomedical Model ................................................................................................................................................................ 10 A Conceptual Framework for Work Disability Prevention and Management ............................................................................. 11 Multi-Stakeholder Collaboration ................................................................................................................................................ 14 Iatrogenicity ................................................................................................................................................................................ 15 Focus on Pain Relief vs. Functional Restoration ......................................................................................................................... 17 The SPICE Model ......................................................................................................................................................................... 19 Transitional Work and Activity Prescription: Go to Work/Stay at Work/Return to Work .......................................................... 19 Evidence-Based Medicine and Evidence-Based Management.................................................................................................... 23 Physician Compensation for Work Disability Prevention and Management Activities ............................................................... 26 Primary and Secondary Prevention............................................................................................................................................. 27 Attitudes, Beliefs, and Expectations: a Fundamental Theme ..................................................................................................... 27 Specific Considerations and Potential Interventions in Work Disability Prevention and Management .......................................... 29 Medical Management Factors .................................................................................................................................................... 29 Introduction ................................................................................................................................................................................ 30 Other Factors Considered ........................................................................................................................................................... 30 Inappropriate Initial Management .............................................................................................................................................. 30 Physician Training and Orientation Factors ................................................................................................................................ 31 Personal Factors .......................................................................................................................................................................... 40 Psychological Factors .................................................................................................................................................................. 43 Potential Levels of Management of Psychological Factors ......................................................................................................... 47 Individual and Systemic Reluctance to Address Behavioral Health Issues .................................................................................. 51 Societal and Cultural Factors ...................................................................................................................................................... 52 Systemic Factors ......................................................................................................................................................................... 54 Workplace Factors ...................................................................................................................................................................... 59 Disability Risk Prediction ............................................................................................................................................................. 63 Case Management and Coordination ......................................................................................................................................... 66 References....................................................................................................................................................................................... 69 Copyright ©2020 Reed Group, Ltd. Page | 2 Introduction and Overview Work Disability Prevention and Management Evidence has been steadily accumulating that “worklessness” for any reason is associated with substantially increased morbidity and mortality, as well as other negative psychological, social, and economic effects on the affected person, their family, and the community. The years of productivity lost (YPL) among Washington State workers receiving time loss payments for injuries in 1986 has been estimated to be 14,624 to 28,027 (3.8 to 7.3 million workdays).(1) A recent study documented severe impacts from occupational illness or injury, noting the following(2): ▪ Two-thirds of respondents lost their health insurance after being diagnosed with a work-related illness or injury (most for more than 1 year), ▪ Striking financial burdens, with respondents reporting that they were encumbered with both costs directly related to the medical care of their condition, and with coping with ongoing general expenses on a reduced income (many reporting depleting savings, borrowing money, taking out retirement funds, and declaring bankruptcy), and ▪ Issues of depression, anxiety, and loss of identity and self-worth. Unnecessary lack of work in an employment-age person wastes human and financial resources, creating net economic dependents out of former economic contributors. The disparity between outcomes in well versus poorly managed health- related employment disruptions reveals not only how much work disability (particularly as a result of common everyday health problems) is avoidable, but also exposes its destructive consequences. Physicians,