During the initial assessment it is important to consider:

• the worker's activity, participation capabilities and restrictions
• the worker’s perspectives on their experience
• pathobiological mechanisms (tissue healing and pain mechanisms)
• physical impairments and associated structure/tissue sources
• all symptoms
• behaviour of symptoms
• contributing factors to the development and maintenance of the worker's problems
• the worker’s profile (ie, age, lifestyle, fitness)
• precautions and contraindications to physiotherapy examination and treatment
• prognosis for recovery
• management/treatment selection
• capacity and return to work
• use of relevant outcome measures
• 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.

A physical examination should include:

• posture assessment
• functional assessment
• active movement testing
• palpation and soft tissue assessment
• passive movement testing (physiological, accessory, stability tests)
• assessing muscle function (eg, resisted static contraction for possible source of symptoms, and motor control, endurance, strength, power and length, for possible contributing factors)
• neurodynamic assessment
• neurological assessment
• fitness/cardiovascular assessment.

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
• develop a physiotherapy assessment of the worker’s pain or disability experience comprising a summary of the worker’s activity and participation capabilities and restrictions, and their perspectives on their experience (eg, understanding, beliefs, fears, expectations and goals)
• consider the natural history for recovery of the injury and, if appropriate, reassure the injured worker that they will recover quickly
• 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
• consider treatment options related to physiotherapy diagnosis (and associated physical impairments), environmental influences and psychosocial influences as assessed in the worker’s pain or disability experience
• provide an explanation of assessment findings and recommended management with consideration of their goals and lifestyle requirements
• collaboratively determine the course of management to be followed and agree on specific short and long-term goals
• encourage self-management as early as appropriate and address management of any physical, environmental or psychosocial contributing factors to minimise the risk of recurrence
• 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, when appropriate
• 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 completing a physiotherapy functional notification form to communicate any yellow flags to the treating medical practitioner
• 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.

Clinical framework for the delivery of physiotherapy services to injured workers

The Clinical framework has been established to:

• optimise return to work outcomes 
• inform physiotherapists of WorkCoverSA’s expectations for the management of injured workers
• provide a set of guiding principles for the provision of physiotherapy services for workers, physiotherapists, other health professionals and WorkCoverSA agents.

Clinical framework for the delivery of physiotherapy services to injured workers [550 KB]

Below is a presentation on the clinical framework which outlines the background, survey findings and implementation of the framework.

Clinical framework educational outreach presentation [1.1MB]

• Note the time that has elapsed since the injured worker's date of injury.
• Assess progress against expectations including symptom level, control and functioning.
• Review original views
    - the diagnosis
    - yellow and red flags
    - expected progress
    - return to work
    - the worker's activity level and functioning (including feedback from others involved)
    - the worker's perceptions of treatment, diagnosis, prognosis and progress.
• Yellow and red flag issues may become more evident if there is lack of progress.
• Review the management plan and consider any small or major changes that may be needed.

Note: All services must be billed in line with the WorkCover Physiotherapy fee schedule.

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.