The following factors predict delayed functional recovery after neck WAD continued…
- Delayed claim settlements
- Problematic treatment approvals by insurance companies/ compensation boards
- Higher use of sick leave prior to the MVA
- Pre-injury use of multiple health care providers (e.g. PT, Chiro, massage, naturopath)
- Pre-injury elevated use of medications
(Clue: The above 5 factors are all True! Meaning all of them predict delayed recovery to some degree.)
Risk factors 1 &2: Delayed claim settlements and problematic treatment approvals are partially due to the fact that insurance companies and workers compensation want to protect themselves from fraud. There are regrettably clinics, health care providers and individuals who participate in fraud, forcing third party payers to be more scrupulous before approving every claim. I have no idea what we can do as clinical PTs to eliminate this risk factor.
Risk factor 3: Individuals who were used to taking regular sick leave prior to their MVA are more likely to have longer disability post MVA. I realize that this is controversial, but I have noticed that my self-employed patients return to work sooooooo much faster that my patients who are part of a union or work for the government. I have no idea what we can do as clinical PTs to reduce this risk factor.
Risk factors 4 & 5: When I find out that prior to the MVA the patient was dependent on various passive treatments such as massage, manual therapies, herbs, and pain meds, I know that they already had some pre-existing pain issues and I suspect that they may have passive coping skills.
We already know that passive coping skills are risk factors to persistent disability. As PTs we can surely educate patients on the importance of active coping skills and promote self-management strategies. I hate being negative, but some people I just cannot change …they rely on being “adjusted” “released” and “realigned” on a regular basis, while others rely on having their “energy fields” corrected and some search for a new magic potion endorsed by Dr. Oz.
Reference: Ritchie C, Sterling M. Recovery Pathways and Prognosis After Whiplash Injury. J Orthop Sports Phys Ther. 2016 Oct;46(10):851-861.