Recovery following a musculoskeletal injury is shaped by more than the injury itself. Psychological, social and workplace factors including distress, low confidence, unhelpful beliefs about pain, workplace challenges and fear of further injury, can influence a person’s recovery and return to work.
For workplace rehabilitation professionals, this raises an important question: how can we identify the people most at risk of delayed recovery and act before temporary work absence develops into longer-term disability?
The Work Injury Screening and Early intervention (WISE) study offers a valuable example of how early identification, targeted support and collaboration can be translated into practice.
Recognising the person at risk of delayed recovery
Traditionally, psychological support has often been introduced only after pain has persisted or recovery has stalled.
However, research has shown that psychological and social factors can be important predictors of delayed recovery and pain-related disability.
Applying psychologically informed interventions to everyone with an acute injury has not consistently improved outcomes. The greater opportunity may lie in identifying people experiencing specific barriers to recovery and matching support accordingly.
The WISE study was designed to test this approach within the NSW workers compensation system.
Workers who had taken time away from work following a soft-tissue injury completed a brief screening questionnaire within the first week. Those identified as being at greater risk of delayed recovery or return to work were offered an early assessment with a psychologist.
Importantly, the intervention did not prescribe one standard treatment. Support was based on the individual worker’s circumstances and the particular obstacles affecting their recovery and return to work.
A coordinated approach to recovery
WISE was not simply a referral pathway or psychological treatment program. It was a system-based intervention involving active collaboration between:
- the injured worker
- healthcare professionals
- the workplace and return-to-work coordinator
- the insurer
- the nominated treating doctor.
Psychologists provided brief, targeted support while working with the other stakeholders to address psychological, social and workplace barriers.
This collaborative approach recognised that no single practitioner, or single intervention, could address every factor affecting a person’s recovery.
It also reinforced the importance of looking beyond a diagnosis or injury to understand the person, their environment and the systems influencing their recovery.
What did the study find?
Early findings from the WISE study showed encouraging improvements in return-to-work outcomes, disability, depression, pain catastrophising and pain self-efficacy.
At the two-year follow-up, workers who received the early-intervention protocol had fewer than half the mean lost workdays of those receiving usual stepped care. Their claim costs were also reported to be 30 per cent lower.
These findings suggest that brief screening, targeted support and active collaboration between stakeholders may improve outcomes for workers at greater risk of delayed recovery.
However, the researchers also emphasised that the protocol was not a simple or standalone solution. Its success relied on engagement from the worker, healthcare professionals, workplace and insurer, as well as a shared commitment to addressing the barriers identified.
What can workplace rehabilitation professionals take into practice?
1. Look beyond the injury
A person’s recovery may be influenced by their thoughts, emotions, confidence, relationships, work environment and previous experiences, not only their physical symptoms.
2. Identify barriers early
Healthcare and rehabilitation professionals do not need to wait until pain has become persistent before exploring the factors that may be affecting recovery.
3. Match support to the person
Not everyone needs the same intervention. Screening, listening and meaningful conversations can help identify who may benefit from additional or more targeted support.
4. Work collaboratively
Recovery is rarely the responsibility of one practitioner. Communication across disciplines and with the person’s workplace, insurer and broader support system, can be essential.
5. Build confidence and capability
Supporting a person to understand their pain, participate in decisions and build confidence in managing their recovery is central to person-centred care.
Bridging knowing and doing
The WISE study illustrates an important shift from knowing that psychosocial and workplace factors matter to building a system that identifies and responds to them in practice.
For workplace rehabilitation professionals, bridging knowing and doing means recognising potential barriers early, listening to the individual and coordinating action across the people and systems influencing their recovery.
OPEN’s Clinical Pain Management Training Program supports healthcare and rehabilitation professionals to translate contemporary pain knowledge into practical, person-centred care.
Explore the original resources
- Preventing disabling chronic pain by engaging psychologists in the acute phase — Australian Psychological Society
- Implementation of an early-intervention protocol for high-risk injured workers — Painaustralia
- Explore Professor Michael Nicholas’s webinars and professional profile — Mental Health Professionals’ Network
This article provides a summary of previously published research and professional resources. Readers should consult the original research and current clinical guidance when making practice decisions.
