The biopsychosocial approach substantially improves injury recovery outcomes.
WATCH: Dr Amy Bright introduces the Biopsychosocial Approach.
What is the biopsychosocial approach?
The biopsychosocial model of healthcare recognises that health is influenced by biological, psychological and social factors, which are deeply interrelated. Each of these three components may present barriers to, as well as enablers of, recovery.
In workers’ compensation, biopsychosocial influences emerge in the domains of scheme regulation, case management, the workplace and healthcare, and within individual injured workers. Each domain of the return-to-work ecosystem can influence the others. For instance, delays and disputes, perceptions of fairness, and overly bureaucratic processes can result in reduced motivation and distress in an individual worker, leading to poorer recovery and delayed RTW.
Individual factors such as poor or passive coping, unhelpful beliefs about pain and injury, poor recovery expectations, adverse life experiences, anxiety and mood disorders can all contribute to delayed recovery and RTW. Importantly, however, many of these biopsychosocial factors are modifiable.
The biopsychosocial model of care has been discussed for decades, but recent evidence shows that application of the model can contribute to significant improvements in both worker health and scheme costs.
How do we implement and embed the biopsychosocial approach?
Systematic implementation of the biopsychosocial approach can lead to better health outcomes, increased return to work rates, and reduced claim costs.
The It Pays to Care policy paper suggests a collection of evidence-based, practical actions to improve work injury management. Examples include:
Early screening and targeted intervention. Implement systematic screening for psychosocial risk factors within the first few weeks of injury using validated tools such as the short-form Orebro Musculoskeletal Pain Questionnaire. Research suggests workers identified as high-risk through early screening, who then receive targeted interventions, had significantly better return to work outcomes. Targeted support and interventions for high-risk workers, such as early referral to psychological services and pain education, are effective means of reducing time off work.
Enhanced case management practices. Develop comprehensive training programs for case managers focusing on identifying and addressing psychosocial barriers, effective communication, and collaborative problem-solving. In one study, a multifaceted case management approach incorporating these elements reduced claim costs by 30% and improved return to work outcomes. Ensure case managers have manageable caseloads and access to specialist support. Additionally, encourage supportive communication between case managers and injured workers, which is associated with a 25% increase in the likelihood of return to work.
Promote work-focused, value-based healthcare. Educate healthcare providers on the health benefits of work and encourage early discussions about return-to-work plans. Implement funding models that incentivize functional outcomes rather than service volume. The Washington State Centers of Occupational Health and Education model, which includes financial incentives for occupational health best practices, has been shown to reduce work disability by 30%. Regular case conferences between healthcare providers, employers, and insurers align goals and strategies are also effective in reducing work disability.
Positive workplace practices. Train supervisors and return to work coordinators in supportive communication techniques and the provision of suitable duties. Research showed supervisor training in communication and problem-solving skills reduced work absence due to pain by 50%. Employers can assess and improve their psychosocial safety climate. Organisations with higher psychosocial safety climate scores have significantly lower rates of work disability.
References
These are indicative references only. For complete reference list, please see the It Pays to Care policy paper.
- Iles RA, Wyatt M & Pransky G. Multi-faceted case management: reducing compensation costs of musculoskeletal work injuries in Australia. Journal of Occupational Rehabilitation. 2012.
- Linton SJ, Boersma K, Traczyk M, Shaw W & Nicholas M. Early Workplace Communication and Problem Solving to Prevent Back Disability: Results of a Randomized Controlled Trial Among High-Risk Workers and Their Supervisors. Journal of Occupational Rehabilitation. 2016.
- Nicholas M, Costa D, Linton S, et al. Implementation of Early Intervention Protocol in Australia for 'High Risk' Injured Workers is Associated with Fewer Lost Work Days Over 2 Years Than Usual (Stepped) Care. Journal of Occupational Rehabilitation. 2019.
- Nicholas M, Pearce G, Gleeson M, Pinto R & Costa D. Work Injury Screening and Early Intervention (WISE) Study. Preliminary Outcomes. Presentation to Rehabilitation Psychologists’ Interest Group: Sydney. 2015.
- Wickizer T, Franklin G & Fulton-Kehoe D. Innovations in Occupational Health Care Delivery Can Prevent Entry into Permanent Disability: 8-Year Follow-up of the Washington State Centers for Occupational Health and Education. Medical Care. 2018.