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Supporting a Push to Protect Injured Workers from Slide into Chronic Disability

  • Published
  • 26 February 2015
  • Category
  • News

By Peter P. Greaney, M.D.

The National Institute for Occupational Safety and Health (NIOSH) is being urged by occupational medicine practitioners to place a higher priority on research aimed at preventing the conversion of work-related injuries to chronic disability. At WorkCare, we support their position.

In a Feb. 9, 2015, letter to NIOSH, Gary M. Franklin, M.D., M.P.H., medical director, Washington Department of Labor and Industries, and Kathryn Mueller, M.D., M.P.H., president, American College of Occupational and Environmental Medicine, suggest there is need for additional funding to support secondary prevention research. In this context, secondary prevention focuses on early diagnosis and treatment to facilitate safe return to work and recovery.

Secondary prevention is important because the majority of workers who develop chronic low back pain and other disabling conditions initially experience injuries that were not considered serious at the outset. That means factors other than the injury itself contribute to a scenario in which about 80 percent of related workers’ compensation costs are attributed to only about 5 percent of injured employees and productivity loss is measured in years lived with disability.1

“Following the identification of promising approaches to preventing disability, NIOSH, either alone or in collaboration with other institutes, could promote intervention trials to reduce disability in the workplace. These trials would engage NIOSH with employers, workers and workers’ compensation insurers in a common mission,” Drs. Franklin and Mueller say in their letter to NIOSH Director John Howard, M.D., and Dr. Steve Wurzelbacher, director of the agency’s Center for Workers’ Compensation Studies.

At WorkCare, we practice secondary prevention every day.

In the event of a work-related injury or illness that is not an emergency, we offer employers and their employees 24/7 telephonic access to experienced nurses and physicians who are trained to discern the nature of the complaint and provide treatment guidance. In most cases workers follow self-care recommendations and feel comfortable about returning to work with telephonic follow-up provided by our clinical team.

If an injury warrants a clinic visit or the employee chooses to see an offsite provider, our physicians engage in peer-to-peer consultations to educate the treating clinician about how to assess return-to-work options. This intervention helps expedite case resolution and prevent the downward spiral into disability.

We’ve seen it time and again: Employers who fail to recognize that delayed recovery can be anticipated and disability prevented in the majority of workers’ compensation cases bear the brunt of losses and costs. One possible positive outcome of secondary prevention research would be the validation of measures that effectively address medicalization, the process in which non-medical, psychosocial issues become defined and treated as medical problems.

While we support further research, based on our years of experience, we are confident that employers will see improved results if they:

  • collaborate with qualified occupational health professionals who are prepared to address disability warning signs such as depression, poor performance, frequent absences, and inter-personal relationship or financial problems.
  • advocate for a collaborative, cross-disciplinary approach to help minimize the impact of injury, illness, impairment and aging on employees so they can be functional, productive and enjoy their lives.
  • develop comprehensive on-the-job recovery and transitional work programs that support early mobility.
  • tap into human resources expertise; studies show issues such as poor job fit and not getting along with one’s supervisor contribute to a disability mindset.
  • encourage the use of behavioral health and employee assistance programs (EAPs).

Finally, we encourage employers to recognize the powerful influence of intersecting conditions and processes such as the injured employee’s apparent coping skills and resiliency; access to qualified medical professionals; and an understanding of applicable regulations, benefits and labor laws, including protective provisions contained in the Family and Medical Leave Act and the Americans with Disabilities Act.


  1. The State of U.S. Health, 1990-2010, Burden of Diseases, Injuries and Risk Factors; years lived with disability (YLD) 2010 (top three): Low back pain 3.19 million YLD, major depressive disorder 3.05 YLD, other musculoskeletal disorders 2.6 million YLD; JAMA 2013; 310:591-608.

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