Preventing delayed recovery by adopting a biopsychosocial approach
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1 Preventing delayed recovery by adopting a biopsychosocial approach IFDM 2018 October 15, 2018 Vancouver, BC Marcos Iglesias MD, MMM, FAAFP, FACOEM
2 OBJECTIVES 01. Review the importance of addressing disability from a biopsychosocial perspective 02. Describe a flag system to identify medical, psychosocial, psychiatric, work and system barriers to functional recovery 03. Learn the tools that are available to minimize delayed recovery
3 Expected recovery Delayed recovery
4 DELAYED RECOVERY
5 IWs WHO RTW BY QUARTERS AFTER DOI 100% 90% z Washington State Department of Labor and Industries conducted a study of all the state s compensable claims from 2011 to 2012 and tracked them for two years post-injury, finding that the probability of returning to work after one year was 32% if not returned in the previous quarter, and after two years fell to just 4.9%. [WDLI, 2013] 80% 70% 60% 50% 40% 30% 20% 10% 0% IAIABC Disability Management and Return to Work Committee, 2016
6 NEEDLESS DISABILITY 60% 80% to of lost work days attributed to medical conditions in the United States involved time off from work that was not really required by the condition itself. Jurisic M, et al. The Personal Physician s Role in Helping Patients with Medical Conditions Stay at Work or Return to Work. JOEM. 2017
7 WORKLESSNESS 2-3 X 2-3 X 6 X 120% WARNING Not working may be harmful to your health
8 BIOMEDICAL MODEL Biochemistry Anatomy Physiology Pathology Diagnostics Therapeutics Pharmacology
9 The body as a machine
10 The good physician treats the disease; the great physician treats the patient who has the disease. Sir William Osler
11 Bio BIOPSYCHOSOCIAL APPROACH Social Function Psycho
12 Risk factors for disability are the same regardless of the nature of the condition
13 FLAG SYSTEM
14 Red flags BIOLOGICAL RISK FACTORS Age Gender Comorbid conditions Obesity Diabetes COPD Smoking Opioids
15 Black Flags SYSTEM RISK FACTORS NOMOIATROGENESIS Compensation Administrative delays Iatrogenesis
16 Blue Flags CONTEXTUAL OBSTACLES Job Dissatisfaction Unsupportive work environment Workplace climate Work overload and pressure Belief that work may cause injury
17 Blue Flags CONTEXTUAL OBSTACLES Heavy manual job Long commute distance
18 Yellow Flags PSYCHOSOCIAL BARRIERS Fear Recovery expectation Catastrophic thinking Perceived injustice Maladaptive coping Absence of positive adaptive behaviors
19 Yellow Flags PSYCHOSOCIAL BARRIERS Low social support Dysfunctional family situation ACE
20 Progression to chronic low back pain was more closely dependent on demographic, psychosocial and occupational factors than on medical characteristics. Valat et al, 1997
21 Psychosocial risk factors play a dominant role in developing chronic low back pain disability. Spine, 1995
22 PSYCHOSOCIAL BARRIER PSYCHOLOGICAL SYMPTOM PSYCHIATRIC DISORDER
23 PSYCHIATRIC ILLNESS Orange Flags Depression MDD Anxiety Anxiety disorders Poor coping Adjustment disorder Unpleasant experience Traumatic experience Maladaptive behavior Personality disorder Absence of positive adaptive behaviors Job avoidance PTSD
24 DATA TEXT SCREENING TOOLS FORMAL ASSESSMENT GUT FEEL
25 SCREENING TOOLS: GENERAL Orebro STarT Back Disability Risk Questionnaire (Shaw) Acute Low Back Pain Screening Questionnaire
26 SCREENING TOOLS: SPECIFIC FACTORS Pain catastrophizing Perceived injustice PCS IEQ Fear avoidance TSK, FABQ
27 SCREENING TOOLS: SPECIFIC FACTORS Depression PHQ-9; PHQ-2; BDI Anxiety GAD-7; Beck Anxiety Inventory Alcohol and substance abuse CAGE; AUDIT
28 Interventions Rapid return to work Activity Motivational interviewing Health/RTW coaches Cognitive behavioral therapy
29 THANKS!
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