Benefits of a Structured Biopsychosocial Approach to Workplace Rehabilitation for Musculoskeletal Injury

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Victoria, Australia.

Many work-related injuries develop complexities that impede recovery. For this reason, compensation schemes have encouraged a biopsychosocial injury management approach. However, the lack of improvement in work outcomes over recent decades may indicate that a comprehensive biopsychosocial approach is rarely applied. There is often provision of services to address the physical, psychological and work factors particular to each individual yet commonly missing is recognition that the worker needs to understand the relationships between and influence of these bio-psycho-social interactions. The insight gained from this understanding provides the motivation to learn strategies to better selfmanage the barriers to recovery. This thesis examines current biopsychosocial approaches and describes a rehabilitation model in which psychosocial triage, assessment and self-management coaching are linked to provide tailored intervention following musculoskeletal injury. The thesis examines whether this approach could potentially deliver improved Workplace Rehabilitation outcomes. The first study develops a comprehensive instrument to screen for multiple psychosocial processes that contribute to pain and disability—the Abilita Rehabilitation Index (ARI)— which was found to be reliable and valid. The second study develops a triage tool to identify individuals who require ARI assessment. The third study evaluates the psychosocial and work outcomes following self-management coaching (n equal 423). Statistically significant change is seen in the mean ARI score, and this is associated with early referral and highest post-coaching work hours. The participants provide high ratings for the program’s helpfulness and their satisfaction. The benefits and challenges of implementing a structured approach are investigated through a qualitative study that interviews rehabilitation consultants (n equal 13) who have used any biopsychosocial resources to provide psychosocial assessment and self-help skill development within their RTW programs. This research draws on the varied perspectives of many researchers in pain management, injury management and the biopsychosocial model. That knowledge, viewed through the lens of an experienced workplace rehabilitation professional, has led to new insights into the challenges and potential solutions for improved management of work disability.