During the initial assessment it is important to consider:

• the history of the presenting condition
• past medical history, including other work-related injuries/conditions
• current symptoms and whether the symptoms are improving, stable or worsening
• methods used for management of symptoms, use of medication (prescribed and non-prescribed)
• review treatment procedures undertaken to date and current treatment procedures
• workplace factors (ie, pre-injury duties, physical demands)
• the worker's perspective on whether alternative duties are available in the workplace
• the worker's views about when they will be able to return to some form of work
• capacity and return to work
• tolerances in activities of daily living (ie, activities currently performed, support mechanisms in place, tolerance for physical demands)
• red flags - identification of potentially serious conditions that require further investigation or specific treatment
• yellow flags - these factors are considered important in the risk of an acute condition becoming chronic
• using relevant outcome measures
• performing an assessment using tools and techniques relevant to the nature of the injury to determine a baseline of clinical measures and functions.

As part of this phase, it is important to:

• review all available medical information
• consider information contained in the WorkCover Medical Certificate, if available
• develop a substantive diagnosis
• consider the natural history for recovery of the injury and reassure the worker that they will recover quickly
• encourage self-management as early as appropriate and address management of any physical, environmental or psychosocial contributing factors to minimise the risk of recurrence
• consider whether observed and reported functional tolerances are consistent with results of formal examinations/assessments; if not, discuss these with the worker and determine appropriate interventions to overcome the inconsistencies
• together with the worker, agree on treatment goals and steps to achieve the goals
• choose and implement treatment tools and techniques that are relevant and appropriate to the injury type, facilitating active management, with a focus on early self-management
• provide an explanation of assessment findings and recommended management with consideration of their goals and lifestyle requirements
• provide education in safe biomechanics, work simplification and use of equipment, where relevant
• consider return to work options with the worker and implement safe, early return to suitable duties based on progress in treatment
• re-assess for red flags
• re-assess for yellow flags – if yellow flags are present consider if a more detailed assessment or psychological intervention is appropriate
• consider referral for further opinion if recovery is not progressing as expected
• maintain communication with other relevant parties involved in the management of the worker.

• Regularly review progress and the treatment regime, modifying the techniques/intervention, as required, ensuring that the treatment goals are achieved.
• Include reassessment of the worker’s understanding of their pain or disability experience (eg, beliefs, fears, expectations and goals) that may have been addressed as part of the educative management.
• Use the same standardised outcome measurement tools, used to set a baseline when measuring progress.
• Consider using the Occupational therapy functional estimation form to notify the treating medical practitioner of any potential barriers or concerns.
• Liaise with relevant treating practitioners about the worker's treatment progress and the potential for upgrading activities at work.

A clinical justification flowchart has been developed for information.

Note: All services must be billed in line with the WorkCover Occupational therapy fee schedule and guidelines.

If there is a delay in improvement conduct a full review, allow for a longer consultation time and:

• review the diagnosis
• review treatment objectives
• review the effectiveness of therapies and treatment and ensure treatment is clinically justified
• review red and yellow flags
• gauge the worker’s perspective
• contact other parties involved in the management of the worker
• consider arranging a case conference, workplace visit or workplace assessment
• if necessary, refer the worker to a medical specialist or psychologist
• continue to promote self-management techniques
• identify activity issues and problems
• set defined goals for the next few weeks
• consider the need for engaging a workplace rehabilitation provider
• update the management plan.

If progress has not met expectations at 12 weeks, consider the following:

• Do you have the correct diagnosis?
• Do you have the correct treatment?
• Do you require a second or specialist opinion?
• Is there an issue in the workplace not previously identified or resolved?
• stepping up the approach to care
• multi-factorial and interdisciplinary intervention – consider meeting all relevant health providers, the worker, the employer and case manager in a case conference
• a structured, supervised, active treatment program
• a structured return to work program, focused on a gradual increase in duties
• a referral for workplace rehabilitation (if not already underway)
• psychological intervention.