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Factors for Delayed Recovery

Identifying and Managing Factors for Delayed Recovery

ACOEM 2nd edition, pp 84-85 defines multiple risk factors for delayed recovery which are viewed as being statistically related to delayed return-to-function; their presence serves as barriers to returning an individual to their work setting. These risk factors include a variety of historical factors, patient’s social factors, personal physical and mental health issues, patient’s beliefs and attitudes, employment related factors, and economic and legal factors. According to MTUS, pp 5-6: Patients not responding to initial or subacute management or those thought to be at risk for delayed recovery should be identified as early as possible….. Those at risk should be aggressively managed to avoid ineffective therapeutic efforts and needless disability. Per ACOEM, pp. 86: If personal or psychosocial factors are contributing to delayed recovery, psychological, psychiatric, or other behavioral health intervention is more appropriate than continuing medication, physical therapy, or surgery; continuing such treatment in the face of treatment failure simply creates the expectation of disability.



Why is the ROC uniquely positioned to identify and manage factors for delayed recovery?

The ROC medical and behavioral health team is uniquely positioned to intervene clinically at all phases of a claim. Preferably, factors for delayed recovery are recognized early and referred for early intervention, maximizing the ability of our team to work with the injured worker and claims management team to collaboratively promote the most effective and goal-directed care. This optimizes the likelihood of efficiently returning the injured worker to their highest level of function.

Historical Risk Factors for Delayed Recovery

  • Prolonged absence from work
  • Delayed reporting of injury
  • Job dissatisfaction
  • Workplace conflict [especially with supervisor(s)]
  • Difficulties at Work [e.g. perception of excessive job demands]
  • No modified work available
  • Chronic (DOI > 6 months ago?)
  • Pain distribution is non-anatomic or described in a bizarre or atypical manner
  • Pain or dysfunction becomes widespread involving other areas of the body
  • Severity of their medical symptoms and pain
  • Experiences increased pain, or at the very least, pain does not decrease over time.
  • Fails to benefit from any, or all, rational therapeutic
  • Interventions
  • Multiple pre-existing and coexisting medical conditions
  • Previous negative experiences with medical care and work-related injuries
  • History of delayed healing
  • Family history of disability
  • Family dysfunction
  • Involvement in financial / disability dispute
  • Smoking
  • Alcoholism
  • Substance abuse
  • Victim of past abuse / emotional trauma
  • History of depression, anxiety
  • Fear of aggravation or re-injury
  • Legal representation or pending litigation