WSIB MSK Program of Care Webinar

Transcription

1 WSIB MSK Program of Care Webinar July 17, 2014 Presented by:

2 Participants Anthony Tibbles (OCA) Bob Haig (OCA) Jennifer Holstein (OPA) Christie Brenchley (OSOT) Debbie Wilcox (RMTAO) Jill Haig (RMTAO) Frank Gielen (WSIB)

3 Learning Outcomes This webinar will provide you with an introduction to the new MSK Program of Care developed by the WSIB and the professional associations to apply evidence-based interventions for workers with MSK injuries At the end of this webinar, you will understand the components of the POC and how to use it in your care of injured workers

4 Programs of Care Evidence-based health care delivery plans that describe treatment shown to be effective for work-related injuries and illnesses Programs to date were designed for common musculoskeletal injuries and some important work-related conditions: Low Back Upper Extremities Injuries Shoulder Lower Extremities Injuries Noise Induced hearing Loss Mild Traumatic Brain Injuries

5 Programs of Care Until now programs have been developed for specific musculoskeletal diagnoses Now, a goal of the WSIB is to apply evidence-based treatment to a wider range of musculoskeletal injuries Application of evidence to the treatment of workers with musculoskeletal injuries should result in improved outcomes for workers, health providers and employers

6 Programs of Care The Musculoskeletal POC is an evidence-based health care delivery plan for a worker with an injury: This Program of Care will address the needs of workers with injuries not currently addressed by the Low Back or Shoulder POC To a muscle, tendon, ligament, fascia, intraarticular structure or any combination of these structures, causing mild to moderate tissue damage (Grade I or II) but does not include complete tears or ruptures (Grade III) which may require surgical repair.

7 The Evidence Studies or guidelines published The reviewed literature and recommended interventions are based on: since 2005 Working aged subjects Comparative studies Systematic reviews, guidelines, and individual research studies

8 Objectives Provide comprehensive assessment, working diagnosis and treatment plan that focuses on early reactivation and restoration of function Facilitate early, safe and sustained return to work Timely identification of workers who are not benefitting Use of Patient-Specific Functional Scale Communication with: Workers; other treating health professionals: and, WSIB as appropriate Achieve satisfaction with quality of care for all stakeholders

9 Target population Workers with: Acute soft-tissue injuries including strains and sprains, up to 8 weeks from injury or recurrence MSK injury not currently addressed by the Shoulder or ALBI POC No clinical evidence of Red Flags Another injury that does not preclude the worker from participating in this POC Still at work or off work, but not hospitalized

10 Providers of the MSK POC Regulated health professionals Within scope of practice and competency Referrals for treatment are required with the following exceptions: Chiropractor Nurse Practitioner Physician Physiotherapist

11 Assessment of Flags & Barriers to Recovery/ Return to Work Red signs of a serious medical condition, which may include significant neurological deficits, signs of infection, tumour or systemic condition. Reason to exclude from POC and refer Yellow normal but unhelpful psychological reactions to injury. Not a cause to exclude or discharge unless they become a significant barrier and include: belief that pain or hurt equals harm; preference for passive treatment; fear/avoidance of activities Blue social and environmental factors that may delay recovery that stem from the work environment Black legislative, or policy or procedure-related issues

12 Assessment of Flags & Barriers to Recovery/ Return to Work Orange psychological reactions to injury that stem from psychopathology The 3-step Clinical Screening Tool was developed to assist health care professionals in determining when a referral may be appropriate for non-physical symptoms. It uses a combination of observation of patient and responses of the injured worker to specific questions High scores may need to be referred for appropriate assessment

13 Outcome Measurement Patient-Specific Functional Scale (PSFS) Self-reported Patient-specific Designed to assess functional changes primarily in patients presenting with MSK disorders Not region or injury-specific Highly relevant to worker population Not dependent upon literacy skills

14 Outcome Measurement The worker is asked to identify 3 to 5 functional activities 2 of which need to be work-related, that are difficult as a result of the MSK injury. The worker rates the ability to perform on a scale from 0 (unable) to 10 (ability before injury) The maximum PSFS score is 10 (total score divided by number of tasks) and the minimum score is 0 The Minimum Clinically Important Difference is 3 points The PSFS is to be administered at admission into the POC and at discharge. Score is recorded on Initial Assessment and on the Care and Outcomes Summary reports

15 Evidence-based Interventions Interventions should be used in the most effective combination. Frequency and duration will be based on clinical judgement, clinical findings, and functional needs of the worker. The program is up to 8 weeks in duration. A minimum of 6 visits is required. Education Activity Modification Exercise Manipulation/Mobilization Massage Electro/thermal modalities Immobilization through Bracing

16 Education Education provides context to enable worker to understand the condition and expected treatment outcomes. Should include the following: Explanation of injury in terms understandable to the worker Positive re-assurance about prognosis Review of the treatment and recovery plan Discussion about the importance of early activation and remaining at work or return to work Self-management strategies Engagement in own recovery Flag identification and discussion - yellow flags need to be addressed

17 Activity Modification Underscores the temporary nature of the injury and provides a level of safe activities for the worker Graded activity progressively increases activity from a baseline toward pre-determined goals. This has been shown to reduce pain, disability and absence from work If worker has yellow flags, task-specific rehabilitation should be done in a more supportive and supervised manner

18 Exercise Focus on restoring range of motion and strength using functional exercises as early as possible toward taskfocussed rehabilitation. Exercises should be: Individualized to the worker and to functional requirements Aimed at maintaining or restoring normal activity, movement and function Functional exercises are often complex Supervised and reinforced Progressive, with increasing intensity as the worker improves

19 Manipulation/Mobilization To assist joint range of motion and help other tissues regain normal length and structure after an injury Evidence present for acute MSK injury in several body regions

20 Massage Evidence supports its use in pain reduction Specific technique to be determined by provider

21 Electro/Thermal Modalities Ice Heat Electrotherapeutic modalities May be included for pain reduction as part of the rehabilitation plan

22 Immobilization through Bracing Some injuries to extremities may benefit from temporary immobilization The benefits of temporary immobilization include to maintain activity and usual functioning while protecting the site of injury Use of brace, cast or splint can be considered

23 Returning to Work Enhances recovery Part of the rehabilitation process and can be effective in reducing work disability Things to consider: RTW goals Current work status Previous work history Completed FAF and treatment reports Self-reported functional tolerance using the Patient- Specific Functional Scale

24 Reporting & Communication Timely and effective communication is important to the success of the worker in the POC The frequency of the communication will depend on the individual circumstances of the worker and the extent of the progress achieved. Communication includes: written reports; phone conversations and one-on-one discussions Health professional communication during the POC may include: Worker Employer WSIB service delivery team Health professionals involved

25 Reporting & Communication In the MSK POC, measuring change and recovery is an important aspect of treatment: Initial assessment: baseline information collected to enable treatment planning Discharge process: Care and Outcomes Summary form is a summary of the worker s achieved recovery

26 Reporting & Communication Health professionals must notify the WSIB Case Manager by the end of week 6 of MSK POC treatment where a worker is not expected to be able to return to work with all regular duties and hours by the completion of the POC.

27 Fee Schedule The block fee includes the assessment and treatment Maximum 8 weeks Minimum 6 visits Meet treatment and reporting requirements $500 Meet treatment and reporting requirements and worker returns to full hours and duties Meet treatment requirements but no communication to WSIB that patient will not return to full hours and duties $600 $400 Care and Outcomes Summary Report $40

28 Interaction with other POCs Upper Extremity and Lower Extremity injury POCs are being retired Up to two POC s can be delivered at once Low Back + Shoulder Low Back and MSK MSK + MSK

29 Evaluation The MSK POC will evolve based on: Clinical and program outcome measurements Emergence of new evidence The satisfaction of worker, health professional and employer will be evaluated, as will outcome improvements at the worker, health professional and program level

30 Q & A Here to answer your questions: Anthony Tibbles (OCA) Bob Haig (OCA) Jennifer Holstein (OPA) Christie Brenchley (OSOT) Debbie Wilcox (RMTAO) Jill Haig (RMTAO) Frank Gielen (WSIB)

31 Thank you! Presented by: