Friday, September 21, 2012

What were the rehabilitation and return-to-work highlights from the PIEF Conference?

I’ve recently returned from speaking at the Personal Injury Education Foundation (PIEF) conference in Brisbane, Queensland, Australia. PIEF has no exact counterpart in Canada or the United States. It was established in 2006 as a not-for-profit organization by a consortium of Australian and New Zealand accident compensation regulators, insurers, and claims management organisations. They wanted to create programs, initiatives and events focused to raise the common standard of knowledge, skills, and professionalism in the personal injury industry, which covers what North Americans would think of as workers’ compensation, transport accidents compensation, and other injury compensation programs.

My assignment as a keynote speaker was to give a North American perspective on rehabilitation and return to work. (In the interest of full blog disclosure, PIEF funded my travel and registration costs while WorkSafeBC funded salary and other expenses). Highlights for me included hearing the other presenters in the concurrent sessions, other keynote speakers in plenary sessions, and the discussions in the halls, meals, and social events.

The conference opened with a brief talk from an injured worker, Edward Bailey — an ex-pat Canadian who suffered severe back injuries and surgeries that left him unable to work in his 30-year career as a mechanic. He relayed how scary this was, how depressed he became and how the assistance he received to be a trainer and assessor as well as his additional work he does as a technical writer have made all the difference. He said the pain is still there but the rewards of his work allow him to carry on.

That theme of "work being important and good for you and your recovery" was echoed in many sessions. The employer representative who spoke next was Amy Sproule, the Health and Wellness coordinator for Carlton United Brewers — supplier or a quarter of Australia’s beer. She outlined their extensive program which includes on-site physiotherapists (PT) and access to Occupational Therapy (OT), physiatrists, and other allied professionals. She noted that some of the costs for referrals are picked up by WorkCover or by their benefits program but some are just absorbed as an HR cost. She acknowledge that onsite PT was expensive but said it was a visible commitment to early intervention, prevention and RTW — part of a culture they have and want to foster. She concluded that the program makes good business and good moral sense.

The next speaker was Jon Schubert, the president and CEO of the Insurance Corporation of British Columbia (ICBC). He gave a detailed talk focused on transport accidents but some of the research he presented certainly got a reaction from the delegates. For example, he showed how whiplash claims frequency were the lowest in Quebec, a province with a no fault system. He spoke about the Quebec taskforce on whiplash that is widely used for neck pain and the work he was involved in with Saskatchewan that has gone beyond that to focus on a functional model. Interestingly, following the research leads to some surprising outcomes. He noted that some interventions, such as early fitness programs, actually delay recoveries and others have no effect. It raises important questions about what should be funded. Are we doing harm by funding interventions that delay recover, increase disability, or have no effect?

The third keynote speaker in this two-day conference was Professor Sir Mansel Aylward CB, Chair, Public Health Wales and Director, Centre for Psychosocial and Disability Research, Cardiff, Wales. His talk was primarily based on the bio-psycho-social model but his message was clear: We have to change our current thinking and models of disability. He called this focus on outcomes, on health and work, “a moral obligation”. He noted that the bio-psycho-social model is now supplanted the standard medical model and has the published, peer-reviewed data with biochemical, neurotransmitter, and other evidence to back it up. “There is a limited correlation with illness, disability and the capacity for work,” he said — a statement that most in the field of vocational rehabilitation would agree with. He advocates return-to-work outcomes becoming an objective of primary care.

Other topics at the conference included how to define and measure client outcomes, the effects on health, psychological, and work status following compensable injury, and predicting common law claims. I took copious notes at this event and know I will be following up on much of what was presented.

Although the event is only held every two years, based on having attended two of the last three I have no hesitation in recommending the PIEF conference. The next one will be Auckland and will be held in conjunction with the International Forum on Disability Management (IFDM). ​

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