The effectiveness of standard care, early intervention, and occupational management in Workers' Compensation claims: part 2.
METHODS
A prospective cohort.


OBJECTIVE
To compare the effectiveness of standard care, early intervention treatment, and occupational management in the management of Workers' Compensation injury claims.


BACKGROUND
The current management of occupational back pain and work-related upper extremity disorders with either standard care or early intervention treatment appears to be ineffective.


METHODS
A prospective cohort looked at the effect of one company with access to standard care (primary care) changing to occupational management (worksite encouragement to resume activity and work as soon as safely possible) and then to early intervention treatment (offsite work hardening). This information was then compared with the control company with access to early intervention treatment, which later changed to a combined occupational management/early intervention treatment approach. Survival analysis was used to attempt to explain differences in time to injury claim closure.


RESULTS
Occupational management resulted in lower injury claim incidence, duration, and costs than early intervention treatment. Only the covariate of enhanced physical therapist (work hardening) involvement (2001 hazard rate ratio 17.41, 95% confidence interval 3.72-41.51 and 2002 hazard rate ratio 6.22, 95% confidence interval 2.51-15.40) was associated with delayed time to injury claim closure when the company had access to early intervention treatment. Only the covariate of serious injury was associated with delayed time to injury claim closure in the company when it had access to occupational management (hazard rate ratio 1.67, 95% confidence interval 1.05-27.20).


CONCLUSIONS
It is recommended that an occupational management approach, in comparison to early intervention treatment and standard care, be considered for management of occupational injuries.
Lemstra
Mark
M
College of Medicine, University of Saskatchewan, Saskatoon, Canada.
Olszynski
W P
WP
D000041:Absenteeism; D001134:Arm Injuries / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy; D019567:Back Injuries / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy; D015331:Cohort Studies; D005081:Exercise Therapy; D006297:Health Services Accessibility; D006801:Humans; D033183:Interdisciplinary Communication; D009784:Occupational Diseases / Q000191:economics / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D009786:Occupational Health Services / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000592:standards; D010348:Patient Care Team; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D012525:Saskatchewan / Q000453:epidemiology; D016896:Treatment Outcome; D014942:Workers' Compensation / Q000191:economics / Q000706:statistics & numerical data; D016526:Workload