Preventing delayed recovery by adopting a biopsychosocial … · 2018-10-29 · OBJECTIVES 01....
Transcript of Preventing delayed recovery by adopting a biopsychosocial … · 2018-10-29 · OBJECTIVES 01....
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Preventing delayed recovery by
adopting a biopsychosocial approach
IFDM 2018
October 15, 2018
Vancouver, BC
Marcos Iglesias MD, MMM, FAAFP, FACOEM
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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
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Expected recovery Delayed recovery
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DELAYED
RECOVERY
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IWs WHO RTW –
BY QUARTERS
AFTER DOI
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]
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 2 3 4 5 6 7 8
IAIABC Disability Management and Return to Work Committee, 2016
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NEEDLESS DISABILITY
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.
to 60% 80%
Jurisic M, et al. The Personal Physician’s Role in Helping
Patients with Medical Conditions Stay at Work or Return to Work. JOEM. 2017
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WORKLESSNESS
2-3 X | 2-3 X | 6 X | 120%
WARNING
Not working may be harmful to your health
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Biochemistry
Anatomy
Physiology
Pathology
Diagnostics
Therapeutics
Pharmacology
BIOMEDICAL MODEL
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The body as a machine
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The good physician treats the
disease; the great physician treats
the patient who has the disease.
Sir William Osler
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Function Psycho Social
Bio
BIOPSYCHOSOCIAL APPROACH
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Risk factors for disability are the
same regardless of the nature of the
condition
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FLAG SYSTEM
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Age
Gender
Comorbid conditions
Obesity
Diabetes
COPD
Smoking Opioids
Red flags
BIOLOGICAL RISK FACTORS
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Compensation
Administrative delays
Iatrogenesis
Black Flags
NOMOIATROGENESIS
SYSTEM RISK FACTORS
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Job Dissatisfaction
Unsupportive work environment
Work overload and pressure
Blue Flags
Workplace climate
Belief that work may cause injury
CONTEXTUAL OBSTACLES
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Blue Flags
Heavy manual job
Long commute distance
CONTEXTUAL OBSTACLES
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Fear Catastrophic thinking
Recovery expectation
Perceived injustice
Maladaptive coping
Absence of positive adaptive behaviors
Yellow Flags
PSYCHOSOCIAL BARRIERS
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Yellow Flags
Low social support
Dysfunctional family situation
ACE
PSYCHOSOCIAL BARRIERS
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Progression to chronic low back pain was more
closely dependent on demographic, psychosocial and
occupational factors than on medical characteristics.
Valat et al, 1997
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Psychosocial risk factors play a
dominant role in developing chronic
low back pain disability.
Spine, 1995
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PSYCHOSOCIAL BARRIER
PSYCHOLOGICAL SYMPTOM
PSYCHIATRIC DISORDER
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Depression
MDD
Anxiety
Anxiety disorders
Poor coping
Adjustment disorder
Unpleasant experience
Traumatic experience
PTSD
Maladaptive behavior
Personality
disorder
Absence of positive adaptive behaviors
Job avoidance
Orange Flags
PSYCHIATRIC ILLNESS
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DATA
TEXT
SCREENING TOOLS
FORMAL ASSESSMENT
GUT FEEL
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SCREENING TOOLS: GENERAL
Orebro
STarT
Back Disability Risk Questionnaire (Shaw)
Acute Low Back Pain Screening Questionnaire
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SCREENING TOOLS: SPECIFIC FACTORS
Pain catastrophizing
Perceived injustice
Fear avoidance
PCS
IEQ
TSK, FABQ
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SCREENING TOOLS: SPECIFIC FACTORS Depression
Anxiety
Alcohol and substance abuse
PHQ-9; PHQ-2; BDI
GAD-7; Beck Anxiety Inventory
CAGE; AUDIT
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Interventions
Rapid return to work
Activity
Motivational interviewing
Health/RTW coaches
Cognitive behavioral therapy
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THANKS!