Considering biopsychosocial factors

Indicators

• Serious pathology
• Pre-existing or co-morbid mental and physical health conditions
• Failure of treatment

Indicators

• Beliefs, attitudes and expectations (for instance, about pain, injury and compensation)
• Catastrophising
• Fear avoidance
• Perceived injustice
• Unhelpful coping strategies
• Personality predispositions (ie, optimism, positive or negative affect, hostility, locus of control)
• Passive role in recovery
• Confidence in ability to manage (self-efficacy)
• Past experience of similar or dissimilar situations
• Past history of trauma
• Depression, anxiety and stress secondary to injury

Indicators

• Low social support at home
• Attitudes, beliefs and expectations of partner/significant other/carer regarding pain, illness and compensation
• Illness or pain behaviour reinforced by family/social environment
• Partner/significant other overly involved in claim and injury management (should be considered in the context of cultural, ethnic, religious or linguistic background)
• Hostile response from partner/significant other
• Financial stress
• Low educational background

Indicators

• Attitude of employer to return to work
• Social support from colleagues/employer
• Belief that work is harmful, will do damage or be dangerous
• Availability of suitable (or alternative/modified) duties
• Job dissatisfaction
• Excessive work demands (lifting, manual handling, extended sitting/standing, constrained or sustained posture, inflexible work schedule)
• Work history includes a pattern of job changes and/or poor vocational direction.

Indicators

• Beliefs, attitudes and expectations about compensation
• Disputes over causation, liability and return to work
• Negative experience of claims process leading to stress
• Salary commensurate compensation may reinforce illness behaviour
• Legal influences may reinforce illness behaviour (multiple specialist assessments, preservation of injury)

Indicators

• Prolonged medical investigation in pursuit of physical cause (may reinforce illness beliefs)
• Dis-continuity of care (changing general practitioners, specialists)
• Poor communication between health providers
• Experience of conflicting diagnosis or explanation for pain
• Reliance upon passive treatment
• Continued symptom focussed treatment in the absence of functional improvement/ongoing benefit
• Sustained use of painkillers, opiates, benzodiazepines

Indicators

• Catastrophisation of injury/pain by health provider
• Health provider emphasises biomedical processes
• Health professional sanctioning disability (providing medical certificates indicating total incapacity)
• Treating doctor fails to respond to communication by case manager/other providers/return to work professionals
• Adversarial attitude toward insurer/compensation authority
• Blurring health issues with industrial/human resources issues

1. Foreman P, Murphy G, Swerissen H. Facilitators and barriers to return to work: A literature review. Melbourne: Australian Institute of Primary Care, LaTrobe University; 2006.