Facet

Description

Program outline

The Work Injury Screening and Early intervention (WISE) [16] study was a trial conducted across 17 public hospitals (intervention and control hospitals) in New South Wales, Australia. It involved early identification of injured workers at high risk of delayed recovery/return to work (RTW) and provided early intervention by clinicians and the workplace.

Initial screening / triage

•Screening tool: 10-item Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-SF)

•Method: Administered over the phone by insurance case manager within 1-3 weeks of claim notification

•Protocol: Workers scoring ≥50/100 on ÖMPSQ-SF were identified as high risk and offered the early intervention protocol
 

Matched care intervention

1.Overall system:

•High-risk workers offered assessment with designated psychologist

•Early review by Occupational Physician

•Regular contact between worker, RTW coordinator, GP, and insurance case manager, as needed with psychologist

2.Psychosocial counselling:

•Up to 6 weekly sessions with psychologist

•Focus on psychosocial barriers to RTW

•Brief, present problem-focused interventions

3.Extra healthcare support:

•Early review by IMC Occupational Physician (4-6 weeks post-injury),

•Contact with GP and sharing of report

4.Extra workplace support:

•RTW coordinator addressed workplace issues

•Regular contact with worker and their supervisor

5.Case manager's role:

•Administered screening

•Arranged Occupational Physician review

•Coordinated with other stakeholders
 

Training and Capacity Building

1.Training provided to RTW coordinators, case managers, and psychologists on the WISE protocol

2.Psychologists trained in brief, problem-focused cognitive-behavioural interventions with RTW focus

3.Regular review meetings with RTW coordinators
 

Outcome measures

•Pre-post questionnaires: ÖMPSQ-SF, DASS-21, Pain Self-Efficacy Questionnaire (PSEQ), Brief Pain Inventory (BPI), Pain Catastrophising Scale (PCS)

•RTW outcomes: Days of work lost over 2 years

•Cost outcomes: Total claim costs

Continuous Quality Improvement

•Regular meetings of steering committee to review progress and address difficulties

•Ongoing monitoring by Research/Implementation Manager

•Feedback from participating hospitals led to protocol modifications and wider implementation

•Claim cost growth plateaued for the intervention group around 9–11 months, whereas it continued rising for controls group.  

Results

1.Return to Work (RTW) Rates:

•The intervention group had significantly fewer lost work days compared to the control group over 2 years (32 days vs 67 days)

•By 3 months post-injury, 94% of the intervention group had returned to work, compared to 81% of the control group

2.Cost Outcomes:

•At 24 months, the mean total costs for the intervention group were $16,443 compared to $23,405 for the control group, a 30% reduction

•The intervention group's costs plateaued at around 9-11 months, while the control group's costs continued to rise

3.Psychological Outcomes:

•Significant improvements were observed in all psychological measures after treatment:

•ÖMPSQ-SF scores reduced from high-risk (mean 59) to low-risk range (mean 35)

•Improvements in depression, anxiety, stress (DASS), disability (BPI), pain self-efficacy (PSEQ), and pain catastrophising (PCS) with large effect sizes

4.Long-term Outcomes:

•By 30 months post-injury, all intervention group participants had returned to work

•Control group participants were still experiencing intermittent work absences up to 45 months post-injury

5.Other Outcomes:

•Reduced variability in outcomes for the intervention group, suggesting more predictable and consistent results

•Improved working relationships between workplace and claims teams for the intervention hospitals

•Positive feedback from injured workers about the early intervention approach

•High acceptability of the protocol, with all participating hospitals choosing to continue using it after the study

System-wide Impact:

•Based on the success of the trial, NSW Health implemented the WISE protocol as "Business as Usual" from July 2015 (though the program was degraded after the new model of claims management was introduced with the transition to the icare

•The protocol was extended to all public hospitals across the state