Managing Employee Stress and Anxiety Following a Worker-Related Injury

Our Director of Workers’ Compensation Quality and Education, Chris Scoma PT, DPT, COMT, OCS, CEAS, CDNT and our Vice President of Employer Solutions Brian Murphy PT, DPT, OCS, MTC recently co-wrote and published content featured in two publications:

• Orthopaedic Physical Therapy Practice — The Publication of the Academy of Orthopaedic Physical Therapy and associated with the American Physical Therapy Association
• TN Bureau of Workers’ Compensation for their REWARD program

Take a look at our featured piece and learn how healthcare providers and employees can help address stress and anxiety and the effect they have on workers’ compensation claims and a timely return-to-work outcome.

Introduction

For stakeholders in the workers’ compensation system, it is well known that patients receiving care for a work-related injury generally take longer to return to work, and return to their preinjury levels of employment at an overall lower rate, when compared to other patient populations¹. A common, inaccurate assumption is that secondary gain issues such as monetary awards are the primary driver for these poorer results. While this can be a factor in a minority of cases, there are many other factors that can contribute to poorer functional outcomes. These additional factors must be understood by all stakeholders, so that effective strategies can be implemented to improve outcomes.

In the paragraphs ahead, we’ll discuss how two often overlooked factors — stress and anxiety — contribute to employee health, and what employers and healthcare providers can do to prevent this mental strain from hindering a rehab process and delaying return-to-work.

Stress and the Body

When a person experiences prolonged mental stress or anxiety, a variety of systems are activated within the body. This includes our fight/flight system, and a series of other hormone response systems. The result is a body that heals slower, responds poorly to physical stress, and encourages the development of depression and despair.²

When it comes to rehabilitating an injured worker, the negative consequences listed above delay return-to-work, extend case duration, and contribute to poor long-term outcomes. So, what can be done by workers’ compensation stakeholders to reduce factors that contribute to injured workers’ anxiety?

First Line of Defense — Employer Empathy

Step one is to demonstrate empathy. Employers that prioritize their employees’ health and wellbeing, ultimately gain trust and confidence from them. This results in greater employee engagement and motivation, and has been shown to decrease overall costs associated with a workplace injury³. Timeliness is also crucial. Engaging the injured worker early boosts resilience and trust, and has been shown to help improve recovery while also reducing costs⁴.

By demonstrating empathy and coordinating care early, employers learn about the unique concerns of each individual injured worker. Employers can address misconceptions, provide guidance on next steps, ensure the employee has a point of contact for questions, and set expectations as the injured worker moves through the workers’ compensation system.

For a moment, put yourself in the shoes of the injured worker. You’ve had an injury, you’re uncertain whom to contact, your pain is persisting, you’re unable to work, and you’re uncertain about the next steps. Sounds stressful doesn’t it? For many workers, a work-related injury and the associated process is completely foreign to them. The system and rules can be complex, and without a proper resource to manage the injured worker’s needs, stress and its negative consequences, will result.

Luckily, employers can intervene. By being involved and attentive to the needs of their employees, employers can develop a positive culture in the workplace. This has been shown to be good for business (improved retention, productivity, and overall job satisfaction³). Making all workers feel like they are assets to the employer has a positive impact on outcomes, should an injury occur ⁵.

Second Line of Defense — Payer Empathy

This “employee first” approach is not only crucial for employers, but for insurance adjusters as well. If employers fail to find insurance carriers that share their values and prioritize employee health, negative outcomes can result regardless of the steps taken by the employer. In fact, evidence suggests that involvement in the workers’ compensation system contributes to poorer outcomes, and that the interactions between insurers and injured workers are often “pathogenic” and contribute to secondary complications rather than facilitating recovery⁶. Think about that; involvement with the system designed to help the injured worker has resulted in the opposite.

So, what can be done? Payers, like employers, must learn to demonstrate empathy to all injured workers, and commit to communication early and frequently throughout the claims process. By doing so, payers can facilitate a positive environment for the injured worker to heal. This “positive claims experience” has been shown in the research to be strongly associated with earlier return to work after a work-related injury⁷.

First Line of Offense — Healthcare Providers and a Biopsychosocial Approach

Regardless of how engaged and proactive an employer is in developing a safe working environment, accidents may still occur. How those injuries are managed contributes greatly to the outcome. As mentioned in the paragraphs above, empathy and engagement from the employer and payer are important. While empathy contributes to positive outcomes, it fails to address the actual injury.

This is where healthcare providers, and often physical therapists (PTs), become important for recovery. PTs, by nature of the time spent with the injured worker (often several hours/week during treatment), are in a prime position to educate, listen, coach, and manage the ups and downs of an injured worker as they progress through rehabilitation. In short, PTs are able to implement a biopsychosocial approach to care (a model of care that promotes that a medical injury is more than just biological factors, but also psychological and social).

Why is this important? Because by being actively involved and collaborating with the injured worker regularly, the physical therapist demonstrates empathy and provides a support system, thereby reducing stress. PTs can also provide education to the injured workers that can reduce their worries and anxieties. For example, the soreness that an injured worker may feel after therapy isn’t a new injury, but just part of the healing process. Therapists can also advise injured workers on stress-mitigating techniques (like meditation) to manage pain and improve function. While exercise, hands-on therapy, and other modalities are certainly implemented as part of the treatment program, PTs and their ability to emphasize a biopsychosocial approach to care serves the injured worker well by also treating the injured worker as a whole, not just their injury.

Summary

Employers, payers, and healthcare providers can improve functional outcomes and facilitate faster return-to-work by being conscious of the role stress plays in delaying return-to-work. By demonstrating empathy, listening to the specific needs of the injured worker, and providing education and support, the injured worker can return to work at a faster rate, and at a reduced cost^3,8. It’s a win-win.

Disclaimer: The content above was previously published in the TN Bureau of Workers’ Compensation REWARD program publication. This content was a summary of a separate article published in the Orthopaedic Physical Therapy Practice.
Disclaimer: The opinions expressed within the content are solely the author’s and do not reflect the opinions of the Academy of Orthopaedic Physical Therapy or the American Physical Therapy Association
Disclaimer: The opinions expressed within the content are solely the author’s and do not reflect the opinions of the Tennessee Bureau of Workers’ Compensation.

1. Gruson KI, Huang K, Wanich T, Depalma AA. Workers’ compensation and outcomes of upper extremity surgery. J Am Acad Orthop Surg. 2013; 21(2):67-77. doi: 10.5435/JAAOS-21-02-67
2. Butler D, Moseley L. Explain Pain. 2nd ed, NOIgroup Publications; 2013
3. Texas Mutual Workers’ Compensation Insurance. The secret to improving worker’s compensation outcomes and how to get started. Accessed April 27, 2022. https://www.texasmutual.com/blog/posts/2018/11/the-secret-to-improving-workers-compensation-outcomes-and-how-to-get-started
4. Grant GM, O’Donnell ML, Spittal MJ, Creamer M, Studdert DM. Relationship between stressfulness of claiming for injury compensation and long-term recovery: a prospective cohort study. JAMA Psychiatry. 2014;71(4):446-453. doi:10.1001/jamapsychiatry.2013.4023
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7. Collie A, Sheehan L, Lane TJ, Gray S, Grant G. Injured worker experiences of insurance claim processes and return to work: a national, cross-sectional study. BMC Public Health. 2019;19(1):927. doi:10.1186/s12889-019-7251-x
8. Netterstrøm B, Friebel L, Ladegaard Y. Effects of a multidisciplinary stress treatment programme on patient return to work rate and symptom reduction: results from a randomised, wait-list controlled trial. Psychother Psychosom. 2013;82(3):177-186. doi:10.1159/000346369