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Physiotherapy for Recovery and Return to Work

Physiotherapy for Recovery and Return to Work

Physiotherapy for Recovery and Return to Work

  • The independent clinical assessor’s role is to thoroughly explore the injury and claim situation to disclose any bio- and                          -psychosocial barriers, and provide recommendations to the referrer with intent to maximise recovery from injury and promote return-to-work in a timely fashion.
  • Broadly speaking, an ICA is requested when the injured worker does appear to be making adequate or as-expected progress with their recovery. In other claim situations, unique circumstances might exist that focus investigative  attention on other and more specific issues.  
  • The service must be approved and referred by the insurer/claims manager but request or recommendation for the service might arise from insurer/claims manager, rehabilitation provider, employer, injured worker or treating practitioner.



Explanation and informed consent:
  • The injured worker will receive an explanation from the independent assessor as to the purpose and likely content of the assessment. The difference between an independent and treating practitioner will be explained. Their rights and responsibilities are explained. They are at liberty to ask questions. The injured worker’s written consent will be required before proceeding.
Screening questionnaires:
  • The injured worker will be requested to complete a series of standard psychosocial screening questionnaires that seek to disclose and categorise any non-injury barriers to recovery.
Interview (subjective examination):
  • The interview involves the gathering of information and exploration of the worker’s thoughts, opinions and perspective on relevant matters. This is often a dialogue-rich portion of the assessment. 
  • This includes but is not limited to information about history - the circumstances of the injury - the resultant pain and the injury’s impact on functional capacity - the examinations and treatments since undertaken, and effect  - their understanding of the treating practitioners' opinions - their knowledge, beliefs and opinions about the medical condition, recovery potential, pain, safety of  physical activity etc - coping strategies - emotions - their perspective on the work situation - their opinion regarding any barriers to recovery and return-to-work - their preferences and recommendations for optimising outcomes etc.
Physical examination:
  • Functional assessment is performed to determine the injured worker’s ability to adopt work-specific postures and perform work-specific actions and tasks. The content of the functional assessment is determined by the nature of compensable condition and the functional demands of work. This might include review of sitting, standing, bending, walking, stepping, squatting, climbing, reaching, gripping, lifting etc. Any tests procedures which are deemed to be a potential threat to the injured worker’s body are judiciously administered and controlled by the injured worker. This is not a Functional Capacity Evaluation (FCE); the functional component of the ICA is more a qualitative rather than quantitative assessment.
  • Clinical assessment represents a more in-depth exploration of the status and health of muscles, joints, nerves and other body structures for diagnostic purposes.
  • Radiological assessment and other studies are given consideration, where clinically-indicated and within scope of the independent assessor’s expertise.
Communication with practitioners or other parties:
  • Where indicated, attempts are made to communicate with treating practitioners to appreciate their perspective on matters.
  • This might be prompted by request of the referrer, or in a situation where the injured worker’s hearsay opinion needs to be cross-checked or balanced by the practitioners’ direct opinion.
  • Note: the injured worker's written consent is a prerequisite for any communication.
Report
  • The report attempts to collate, interpret and communicate information, findings and opinions from numerous sources in order to develop a medical expert opinion about matters impacting recovery and return-to-work. The report seeks to be  objective, fair, defensible, medico-legally robust and address the referrer’s enquiry and contribute content that is relevant to achieving positive outcomes. 
  • The report is submitted within 10 business days to the referrer, not the injured worker. Distribution of the report is at the referrer’s discretion and responsibility, within legislative requirements.
Associated services
  • To accompany the ICA the referrer may request a worksite assessment to view and analyse work duties demands, and propose a graduated return to work plan, and/or attend a case conference.

  • Clinical assessments are performed at Kings Park Health at 309 Goodwood Road, Kings Park SA 5034. The physiotherapy section is located front-right of the building. The clinic is located 5 km south of the CBD on the east side of Goodwood Road, just 200m north of McDonald's on corner of Cross and Goodwood Road. It is opposite the Clarence Park Church of the Trinity. Parking is available on site around perimeter of the Kings Park Health clinic or in neighbouring side streets. The closest bus stop on Goodwood Road, either direction, is STOP 8.
  • However, at referrer's request, the assessment can be performed at the workplace if suitable facilities are available (e.g. a private room with desk, chairs and space for examination plinth) or in a rural location away from the metropolitan area.
  • Please feel free to discuss referral for on-site assessment with the Office Manager at David Annells Consulting.
Specialist checking women shoulder for injuries

What if I don’t know what service I require?
  • Referrers are very welcome and indeed encouraged  to discuss the de-identified case with the independent assessor to provide a synopsis of claim events and highlight the main concerns and the brief for the assessment.
  • In this manner the independent assessor can recommend the preferable approach and advise whether his/her professional specialty, experience, services etc are best-suited to the case and/or whether other persons, services or strategies would be preferable to achieve the desired outcomes in a quicker, simpler or more cost-effective manner.

Can I modify the content of the service?
  • Yes. Please feel free to discuss this matter with the independent assessor
  • The purpose of the ICA assessment and report is to satisfy the referrer’s enquiry. It follows that the above-described  standard format, at referrer’s discretion, is modifiable to a certain extent, while not impacting the essence of the assessor’s independent opinion.

What information do I need to provide as part of the referral?
  • A written (mail or email etc) referral is required to proceed, containing detail  of key points that need consideration in the assessment and report, any specific assessment instructions, communication instructions and any specific questions to direct the independent assessor’s response.  
  • The referrer is also at liberty to personally discuss the situation and special requirements for the service with the independent assessor.
  • If pre-reading/enclosures are to be provided, please forward with enough time before the assessment for these documents to be reviewed. The referrer should only send necessary and relevant information so as not to unnecessarily complicate the situation and because time taken to read the enclosures is billable and adds cost to the service.  

Why is the ICA assessment and report service so long?
  • Uncomplicated cases don’t require an ICA; by default the cases that require referral are complicated in some way and/or lacking clear directions and/or recalcitrant and/or disputed and/or stakeholders are polarised in their opinions etc.
  • Broadly speaking these complications manifest as lack of recovery and lack of return-to-work and the longer that continues the more potential there is for development of chronic pain behaviours, and adversarial and litigious complexity.
  • Many variables conspire to complicate the human experience of injury and pain including yellow flags, blue flags, black flags, orange flags and practitioner flags. Exploration for and of these barriers is inherently a complex process, requiring thoroughness to ponder, deliberate, review, collate and interpret information and then reproduce and summarise information and recommendations in a report which must be fair, objective and medicolegally-robust; ICA assessments and reports are inherently lengthy.
  • Two (2) hours is allocated for the clinical assessment alone, plus phone calls, and report-writing is 2-3 times longer than the assessment. Typically, total billing is between 6 and 9 hours, sometimes more, sometimes less.


But the RTWSA gazette says ICA billing should be capped at 4 hours
  • Currently the RTWSA gazette advises that the PT780 Independent Clinical Assessment and Report service is to be billed at the gazetted rate for a maximum of 4 hours. However, the norm rather than the exception is that the SERVICE DESCRIBED ABOVE WILL NOT BE PRODUCIBLE WITHIN THIS TIMEFRAME and so David Annells Consulting will seek the referrer’s approval to bill for the actual work performed before agreeing and proceeding. 
  • The referrer is both welcome and encouraged to discuss this matter with the independent assessor before confirming the referral. 
  • If the referrer choses to pay no more than 4 hours for the service then the independent assessor will reconsider the file and see if a robust examination and report can be produced within this time, or not. If not then the independent assessor will decline the service so the referrer can seek-out a less expensive options.
  • If the referrer provides approval to bill for actual work performed, then any billing over and above the 4 hours will be judicious. Be assured that David Annells Consulting is eager to provide a quality service, which achieves its objectives, at a fair price and referrers are satisfied by value for money. 


What happens after the report is submitted?
  • The report should be read by the referrer to ensure that their questions have been answered and any solutions, where available, have been proposed.
  • The referrer is both welcome and encouraged to speak to the independent assessor if they have any questions or concerns or need further clarification of information.
  • It is the referrer’s responsibility to distribute the report to the injured worker as the legislation dictates, and also to other stakeholders that they are seeking to inform or influence to produce better recovery and return-to-work outcomes; see below.
What happens if the treating practitioners pay no attention to, or disagree with the report?
  • This eventuation should be presumed.
  • To get best ‘value’ out of the ICA service, it is recommended, where appropriate, to request the independent assessor to attend a follow-up case conference with key stakeholders to enable rapport-establishment and present-in-person the findings and  recommendations. This approach also permits robust discussion and debate with intent to resolve a working plan for  treatment and return-to-work.
  • A referral for case conference is at discretion and invitation of the insurer/claims manager.


Can I request the independent assessor to provide advice and treatment to the injured worker?
  • No.
  • The independent assessor is not a treating practitioner, so cannot be requested by the referrer to provide recommendations, treatment etc, or  change the injured worker’s treatment or work certification. 
  • A case conference is the best forum in which the independent assessor can present his/her opinion for discussion and debate, to key stakeholders, to achieve influence, while remaining submissive to and respecting the position of the treating practitioners.


What happens if I cancel the appointment or the worker does not attend?
  • David Annells Consultancy’s contract of service is with the referrer, not the injured worker. Once the booking is made it is the referrer’s responsibility to inform the injured worker about the referral and provide date, time and attendance instructions etc. David Annells Consulting will assist in this endeavour by sending a booking confirmation letter by email once the booking is confirmed which contains all essential information (in MS Word format) to pass-on to the worker, plus the worker can be directed to this website for more information. A nominal 2-hour fee applies to the referrer for late cancellations within 48 hours of the appointment or non-attendances.  
How do I refer?

For all enquiries about David Annells Consulting services and bookings, please feel free to ...
Phone 08 8357 9000
Post PO Box 370, Goodwood SA 5034
Fax 08 8172 0723


Why have I been referred for an ICA? 


How long does an ICA assessment take?
  • Allow 2-3 hours for the assessment; it will be shorter if the situation is less-complicated.
  • It is important that workers are not late for the appointment.


Can I bring someone with me?
  • A support person is permitted to accompany the worker throughout the assessment, but they are requested to refrain from contributing to or influencing the worker’s opinions and responses. 
  • It is inappropriate to bring young children to the appointment; your undivided attention is required.

Do I need an interpreter?
  • Given the dialogue-rich nature of the assessment, any literacy and communication barriers need to be declared to enable the referrer to organise an interpreter, if needed. Some aspects of examination might be modified in this circumstance.

Who is the independent assessor working for?
  • The independent assessor is, as the name suggests, independent. His/her ‘agenda’ is to disclose and disseminate information and recommendations that promote best-practice management of work injury, recovery and return-to-work. 
  • All independent assessors are people that have beliefs and opinions; this independent assessor’s philosophies (about work, pain and treatment) can be seen under “Philosophies”
  • The Supreme Court of South Australia considers the independent assessor to be an ‘Expert Witness’ in the field of his/her speciality. The expert’s obligation is to the Court, and does not act as an advocate for the referrer, worker, employer or any other stakeholder. 

Will the independent assessor explain the process to me?
  • Yes.
  • The independent assessor will explain the difference between a treating and independent practitioner, and the implications for the manner in which the assessment, reporting and communication is conducted. The independent assessor will not be providing treatment. 
  • The likely content of the interview and physical examination will be explained. The worker’s rights and obligations will be explained. The worker will be advised that they are expected to contribute to physical test procedures to the best of their ability and to a confidence, and to a comfort level deemed appropriate by the worker, and the worker will not be forced, or their body forced, into any harmful situations.
  • While every effort is made to respect the injury and pain, it is not unusual, given the volume of assessment, for the worker to experience temporary provocation of symptoms. The worker is to speak to the independent assessor, prior to assessment, if they have any concerns.
  • The independent assessor will seek the worker’s informed written consent to proceed.


Do I need to consent to exchange information?
  • The independent assessor, at the beginning of the appointment will explain that it is often necessary or at least preferred to communicate with treating practitioners and/or other stakeholders in order to gather information and understand the situation in greater detail; this assists in forming a more meaningful, objective and robust opinion. However, this is entirely at discretion of the worker and if for whatever reason the worker declines authority, then the independent assessor must respect this, and the only communication that occurs is with the referrer who requested the service.


Will I be requested to remove clothes?
  • To perform an appropriately-through examination it is preferable for the independent assessor to visually sight the body parts he/she is examining, so please wear suitable clothing. The worker is at liberty to bring a chaperone to the assessment. The worker will not be forced to disrobe beyond that which they feel comfortable. 


Do I get a copy of the report?
  • The report will be sent to the referrer, not the worker. This means the worker should not contact the independent assessor’s office to request the report. 
  • Under workers’ compensation law in South Australia, the referrer must forward a copy of the report to the worker. The referrer might also elect to forward the report to treating and certifying practitioners they wish to inform and influence via the report.


What if I don’t agree with the report?
  • Common-sense dictates that if the worker feels the independent assessor has provided incorrect information, or misrepresented an opinion etc, then they are entitled to express that concern, in writing, to the referrer. The referrer may ask the independent assessor to review their findings and recommendations in light of that concern, or any new information, if the concern is an important issue and has potential to substantively changes the essence and outcome of the report.


Does the independent assessor hold power over my doctor and physiotherapist?
  • No.
  • The independent assessor’s involvement is not intended to be adversarial, although it may be interpreted that way, on occasions, by other parties. The independent assessor has no power or jurisdiction over the treating practitioners; they are under no direct obligation to consider or respect the opinions and recommendations of the independent assessor. 
  • However, it would be appropriate for the treating practitioners to give due consideration the independent assessor’s perspective given the thoroughness of assessment and its objective to enlighten a different perspective and possibly new information and recommendations to promote recovery and return to work.


Can I transfer my treatment to the independent assessor?
  • No.
  • Once the independent assessor has acted in that role then he/she cannot be a treating practitioner in that case; that is both a conflict of interest and is seen as procurement of business, which is unprofessional.

What is the purpose of functional testing?
  • To compare the body's physical capabilities with the physical demands of a job, e.g. a store person job might require the worker to stand, walk, climb stairs, squat/kneel, lift 3-25 kg between ground and shoulder level, push/pull <20-30 kg at waist height, elevate shoulders <135° through flexion and abduction, wrist dexterity, heavy gross gripping etc. The worker's physical capacity to meet to those demands can be assessed, either in the format of a pre-employment screening for a prospective worker, or an assessment of the impact of an injury on an existing worker, attempting to return-to-work or upgrade work participation.
  • The objective is to define safe and sustainable work capacity. Work capacity might be impacted by the compensable injury, and/or other non-work-related conditions. Equally work capacity might be effected by bio- and -psychosocial variables.
  • Functional testing is tailored to suit the situation, e.g. functional testing to assess a worker's capacity to perform a heavy manual job would be different to functional testing to assess a worker's ability to perform a process-line role requiring fine dexterity.

What's involved in functional testing?
  • Almost invariably, functional testing would be performed as a tailored-extension of an Independent Clinical Assessment, e.g. referral would be for Independent Clinical Assessment with Functional Testing.
  • Before any loaded functional tests are performed, the worker would be clinically-assessed to determine the presence of any bio- and -psychosocial factors that might influence their experience and expression of pain and disability resultant on the work injury, i.e. see 'What's involved in an ICA assessment and report?' above. Derived through clinical assessment is essential information that the examiner needs to determine the extent to which they physically-challenge the worker's body during functional testing, e.g. an injured worker who has undergone revision surgery for a large rotator cuff repair would not reasonably be expected or asked to perform any heavy overhead lifting.
  • Then the worker would perform a series of tests featuring specific postures, actions and loads, depending on the specifics of the situation. It is usual that the referrer provides a clear description of the physical demands of the prospective job, whether that be the pre-injury role or another role, to guide the examiner in designing a relevant functional assessment. At other times the referrer's physical capacity enquiry is general, and information is sought as to the worker's physical capabilities for a range of general postures, actions and loads, to assist with suitable job matching.
  • Tolerance for static postures, e.g. sitting, standing, bending, are assessed through observation; there might be a time component included. The worker's capacity for movements, e.g. bending, squatting, stepping, reaching, climbing are assessed through observation where range, quality and quantity can be assessed. Tolerance for loads, e.g. gripping, pushing/pulling, lifting/carrying etc are assessed through progressive exposure, i.e. starting at low loads and then performing repetitions as loads are progressively increased to the extent deemed safe and appropriate by the examiner, and within the worker's comfort, capacity and confidence levels. An amount of creativity is required on the examiner's behalf to ensure the functional test performed reflects the work tasks that the referrer is enquiring after.

What information do I need to provide as part of the referral?
  • See 'What information to need to provide as part of the referral?' Under ICA assessment and report above.
  • For the examiner to tailor the functional assessment to satisfy the referrer's enquiry, the referrer should provide a professional-quality job analysis or worksite assessment describing the physical demands of the job. If this is unavailable, then examiner can also perform a job analysis, at the referrer's request.
  • At other times, in absence of the above information, the functional assessment is tailored to reflect the worker's description of the job (if known) and/or the examiner's knowledge of that job through prior experience
  • The referrer is both at liberty and encouraged to discuss the referral with the examiner to ensure the assessment is tailored to suit their enquiry.
Why is the functional assessment and report so long?
  • See "Why is the ICA assessment and report service so long?' 
  • See "But the RTWSA Gazette says ICA billing should be kept at 4 hours'; the same applies for functional testing.
  • Almost invariably, functional testing would be performed as a tailored-extension of an Independent Clinical Assessment, e.g. examiner would perform Independent Clinical Assessment plus functional testing, including performance of sufficient posture, action and load tests to satisfy the referrer's enquiry.
  • Content and therefore duration of assessment and report can be discussed between referrer and examiner.
How is the functional assessment billed?
  • Because David Annells Consulting does not use a proprietary, validated functional capacity evaluation system, the service is not billed as a 'WA150A functional capacity evaluation and report', but an Independent Clinical Assessment with functional testing, but this remains entirely at discretion of the referrer.
  • The method of functional testing performed by David Annells Consult is simply a qualitative and quantitative extension of a normal clinical assessment, tailored to the situation; expertise is required in extrapolating result of the clinic-based functional testing to the real-life work situation, and this is often an estimate that requires ongoing practitioner involvement and monitoring.
Is there a risk of re-injury to worker through functional testing?
  • Yes, is the short answer. And this is because the examiner needs to expose the worker's body to progressive load in an endeavour to determine the safe extent of their physical ability to posture, move and exert forces, often in context of residual impairment due to injury.
  • The matter of risk management is clearly identified and discussed with the worker at outset of the assessment, before any physical testing is performed. Workers are encouraged to proffer an earnest effort that reflects the safe extent of their comfort, capacity and confidence, but they are asked to not exceed those limits; in short, the worker only participates to the extent they determine. And equally, the examiner, with their medical and biomechanical knowledge, will continually monitor the worker's task performance in an endeavour to ensure they only demonstrate biomechanically-safe postures, actions and load handling capabilities.
  • Almost invariably, the worker reports soreness night-of and day-after testing, and on most occasions this is simply unaccustomed muscle activity that settles quickly, but on some occasions it does represent irritation of the compensable or other condition. The latter is however actively avoided as it is not examiner's intention to cause strain. This is a difficult issue to manage as the worker's propensity to report examination-induced pain and strain is variably-effected by tissue- and non-tissue-based factors.
  • Routinely, the worker is requested to ring the day after testing to report their body's response, and this is factored into the equation.



What is the purpose of a Treatment Review?
  • Where an insurer/claims agent has concerns or questions about the appropriateness and necessity of ongoing treatment, or where independent opinions and recommendations about treatment are required, a Treatment Review may be requested. 
  • The independent assessor does not and will not provide the treatment.


What’s involved in Treatment Review service?
  • ‘Over-the-phone’ Treatment Review: A Treatment Review might simply involve the independent assessor ringing the treating practitioner to talk-over the treatment in order to gather information.This does not personally involve  the injured worker.The independent assessor will seek to understand the treating practitioner’s opinion about the diagnosis, their identification of bio- and -psychosocial barriers, their treatment content and structure, the effect of their treatment, their future treatment plans, any concerns the treating practitioner has about diagnosis/treatment etc, their advice and recommendations to worker etc. While obvious problems with the delivery of treatment can be identified using the ‘over-the-phone’ approach, and treatment’s compliance with the Clinical Framework Guidelines can be largely ascertained, only gross opinions can be formulated about the ‘necessity and appropriateness’ of treatment. Without personally examining the injured worker the independent assessor is somewhat limited in his/her ability to provide precise opinion and recommendations about treatment … but this form of assessment is quicker and less-expensive (than ‘clinical assessment’ format) and may be adequate to satisfy the enquiry at hand, or screen for and identify problems that need further investigation.
  • ‘Clinical assessment’ Treatment Review: The more-common form of Treatment Review is in essence an Independent Clinical Assessment where the focus is on diagnosis and treatment matters. This involves the independent assessor personally performing a thorough examination to identify bio- and -psychosocial barriers to recovery in order to devise and propose a tailored treatment plan to meet the specific needs of the situation. Treatment review is usually a subcomponent of an ICA.


What if the treating practitioner is not a physiotherapist?
  • Treatment Reviews performed by physiotherapists are usually  requested where the treating practitioner is a physiotherapist. While Gallagher Bassett and EML, under RTWSA's directive, might be more-inclined to match like-for-like when requesting a Treatment Review, there is no reason why an independent physiotherapy assessor couldn’t be requested to review treatment provided by any physical therapist (chiropractor, osteopath, massage therapist, exercise physiologist etc) because the philosophy and detail of the treating practitioner’s discipline is not the subject of exploration and challenge. The necessity and appropriateness of the therapy is assessed against Clinical Framework Guidelines, which involves assessment of evidence-based rehabilitation principles that transcend inter-professional differences.


Why can’t treatment simply continue if it relieves pain?

There are established rules, guidelines and best-practice strategies that your treating practitioner should be aware of, and support, which shape and impact the delivery of insurer-funded treatment services to injured workers. This includes but is not limited to the Return to Work Act 2014,  the Physiotherapy Code of Conduct, the Clinical Framework Guidelines  and the RTWSA Fee Schedule gazette. 

Legislation (Return to Work Act 2014, under Section 33 'Medical expenses') decrees the following in relation to entitlement for insurer-funding for treatment of the compensable condition:
  • Injured workers are entitled to receive “reasonably incurred” services to treat the compensable illness. Equally, the  insurer is not obliged to pay for treatment services that are deemed “unnecessary or unreasonably incurred”.
  • For "non-serious injury" (ie. < 30% whole person impairment), and depending on the situation, up to three (3) years of insurer-funded treatment is permitted. Special provisions are made for "seriously injured" workers (Part 2, Division 4, Section 21).
  • In short, insurer-funding for treatment of work injury for the non-seriously-injured workers are intended to be finite, not ongoing.
This is advice of a general nature and applies only to those claimants whose work injury is covered under the Return to Work Act 2014. The claimant's case manager or legal representative should be conferred if information specific to their circumstances is required.

While legislation is clear in defining the maximum length of time that insurer-funding covers reasonably incurred treatment, it is not clear or explicit in defining what constitutes ‘reasonably incurred’ treatment. This uncertainty is part-addressed within the five (5) principles of the Clinical Framework (see below), but interpretation is required:
1. Measure and demonstrate the effectiveness of treatment 
2. Adopt a biopsychosocial approach 
3. Empower the injured person to manage their injury 
4. Implement goals focused on optimising function, participation and return to work
5. Base treatment on the best available research evidence


1. Measure and demonstrate the effectiveness of treatment
  • The treating practitioner is expected to demonstrate to the insurer that the treatment they are providing is ‘effective’. This is for both therapeutic and fiscal reasons, ie. treatment should not be funded if it is not beneficial to the injured worker, and treatment which is not beneficial is a waste of money. Treatment should only continue to be funded by insurer if it is advancing recovery or progressively advancing the worker towards an outcome. Treatment that maintains rather than advances should not be considered effective.
  • Pain is not an appropriate parameter for measuring effectiveness of treatment  because pain is a personal and subjective experience, pain is not measurable, and pain does not predict recovery and return-to-work prognosis. While the treating practitioner will almost certainly endeavour to treat and reduce your pain and ask you about your pain, pain reduction per se is only a means to an end, and that end is to improve the body’s ability to function at work, home and play. 
  • Treating practitioners are expected to measure the effectiveness of their treatment in functional terms, and to do so will utilise ‘Outcome Measure Tools’ which are standardised and validated questionnaires that ask questions about a certain body region's physical ability to function. In short, if the treating practitioner’s treatment is advancing the capacity of the injured worker’s body to function, then treatment is considered effective. Even if treatment reduces pain, but that pain relief is transient-only and/or doesn’t translate to increased functional capacity, then treatment is generally not considered effective. 
  • Serially re-measuring functional capacity as a demonstration of effectiveness of treatment also enables the treating practitioner to recognise when the condition has arrived at maximal medical improvement, ie. is no longer improving. In this situation treatment should be wound down. 
  • It is worth noting that for many and varied reasons the pain associated with a work injury does not always fully resolve, so it might be inappropriate to presume to continue to deliver treatment for so long as pain exists; this might infer never-ending treatment which is incompatible with legislation, the best-practice guidelines, and common-sense.
2. Adopt a biopsychosocial approach 
3. Empower the injured person to manage their injury
  • Best-practice management of pain, particularly in a compensation system, is to educate and empower the worker to understand their condition in a wholesome and constructive manner, promote active contribution,  develop resilience,  pain-related self-efficacy and self-determination to equip for self-management and thereby avoid iatrogenic (practitioner-caused) treatment dependence. Empowering an injured worker to be self-sufficient has been demonstrated to reduce pain severity, increase functional ability and improve psychological well-being with reductions in stress levels, anxiety and depression.
  • From the outset of the treatment relationship the treating practitioner should make the worker aware of the inevitability of eventual cessation of insurer-funding of treatment, and promote the health benefits of independence from treatment. The treating practitioner should provide the necessary investigative and treatment services in a timely manner then transition to active rather than passive rehabilitation as soon as is practical.
  • Education is a very important component of empowering an injured worker to self-manage their condition. Factual, balanced and non-threatening medical information should be provided by the treating practitioners to reduce any unnecessary fears about pain and activity and promote sensible, activity-based rehabilitation and continued participation in life’s activities at work, home and play. 
  • Given that pain arising in a workers’ compensation environment might be part-related to work injury and part-related to non-work-variables (eg. age, prior physical and mental health problems, postural dysfunction, degenerative changes, and lifestyle variables such as smoking, physical inactivity, dietary problems and raised BMI etc), it is important that workers receive a balanced account of the key causative factors that influence their recovery potential, so the worker’s locus of control can be focussed on addressing matters within their realm of responsibility and influence.
  • It should also be noted, as detailed in the RTWSA fee schedule gazette, that the insurer will not pay for services that are focussed on improving a worker’s general level of health, fitness and wellbeing; fitness for work remains the responsibility of the worker.
4. Implement goals focused on optimising function, participation and return to work
  • The focus of treatment should be on restoring function, and the relief of pain might or might not be necessary or achievable in order to pursue this goal.
  • The worker’s attention should be directed to ongoing participation in physical activity and home, work and play within sensible limits for injury-type and stage of recovery.
  • The worker should be expected and recruited to actively-participate in rehabilitation, and share the responsibility for achieving positive outcomes.
  • SMART goals should be set collaboratively between treating practitioner and worker that are specific, measurable, achievable, relevant and timed. Progress towards achievement of these goals should be regularly assessed. Achievement of these goals should translate to meaningful advancement in worker’s ability to participate in lifestyle activities, including work, and prompt advances in work capacity certification.
  • These SMART goals should be represented in the exercise programme, eg. if the SMART goal is to increase lifting capacity to 10kg between floor and chest level (which reflects work demands) by say, 6 weeks’ time, then these actions and loads should appear in the exercise programme.
5. Base treatment on the best available research evidence
  • Evidence-based treatment involves decision-making processes that integrate the best available evidence, with practitioner expertise and other resources, and with the preferences of those parties who will be affected.
  • Applying evidence-based principles to development of a rehabilitation plan ensures that the treatment  has the best chance of success, avoids treatment that is likely to be ineffective or harmful, increases the likelihood that treatment complements and assists other evidence-based medical and allied healthcare treatments that the injured person is likely to access.
Johnston V, Jull G, Sheppard D, Ellis N. Applying principles of self-management to facilitate workers to return to or remain at work with chronic musculoskeletal condition. Manual Therapy 18 (2013) 274-280


What is the purpose of an WSA?
  • Worksite assessments are performed where there is a need to identify, measure and describe the demands of the work role. This ‘demand’ information can then be compared against the body’s ‘supply’ to determine whether, in context of the injury, the job is achievable, safe and sustainable so as to promote remain-at-work or return-to-work, or alternatively, to prompt redeployment to an alternative and more suitable role.
  • As a physical therapist involved in the management of work-related musculoskeletal injury, the WSA revolves largely around defining the physical demands of the role including:
  1. static body postures adopted, eg. sitting, standing, bending, squatting, reaching etc
  2. movements and actions required to perform the tasks, eg. truncal bending and twisting, walking, stepping, squatting, lunging, climbing, turning neck, looking overhead, reaching, rotating forearm, gripping, pinching etc.
  3. volumes of work performed, eg. lifting up to 10kg between floor and chest level, pushing 30kg over a 20m run, 10 times per hour, produce 40 units per hour, drive 4 hours before 15 minute break etc.
  4. special requirements, eg. repetition and monotony, exposure to vibration/jolting forces, balance, working at heights or in confined spaces, environmental demands such as exposure to inclement weather, airborne particulates, chemicals etc.
  5. ergonomics; the manner in which the injured worker interacts with their work environment, ie. the posture and movement strategies they deploy to complete the task – is there a better way? And, is there a need for any adjustments to the physical work environment, either minor changes (eg. avoiding storing items on the highest shelves) or major infrastructure changes (not usually welcomed by employers), the provision of tools, aids, supports, equipment etc (eg. chair, safety step  etc).
  • Where the assessor has a knowledge of the worker’s injury (the diagnosis, prognosis, stage of recovery and physical capacity) and knowledge of the job (from a WSA), a graduated return to work schedule can be compiled for consideration by the certifying doctor.
  • A WSA might be performed with one particular body area in mind that reflects the worker’s injury (eg. assessment confined to walking, squatting and low-level lifting demands for a particular worker’s knee injury). Alternatively, the whole-body demand of a particular job can be described with no reference to particular person, injury or body part; this might be called a job analysis or job dictionary, and becomes a useful resource for the employer, that can be subsequently used again if injury under their employment occurs in future.


Return to Work Services

David Annells Consulting is approved to provide the following Return to Work Services
  • Pre-injury Employer Services
  • Fit for Work Services
  • Return to Work Assessment services


  • Essentially the same as an Independent Clinical Assessment in the worker's compensation system, an 'Initial Needs Assessment' is the term used by some insurers in the Income Protection/Life/TPD insurance arena for an assessment of their customer, the claimant.
  • The Initial Needs Assessment as performed by a physiotherapist seeks to understand the customer's injury and its impact on their ability to earn an income, in context of the wording of the particulars of their policy. 
  • Primarily, opinion is sought by the referrer (the insurance company) in relation to information about the injury, its diagnosis, its prognosis and any treatment necessary for the medical condition and/or have the potential to positively influence the extent and timeliness of any recovery. 
  • Inherent in the assessment of the injury, and the resultant pain and disability, is screening across the biopsychosocial spectrum in order to identify any barriers to recovery that might benefit from the tailoring of a treatment/rehabilitation programme to overcome those barriers and promote recovery, work and income-earning ability.
  • As well as the medical aspect of the assessment, within the Initial Needs Assessment is an interview to gather information about the customer's education, and  their employment and income-earning details, and the impact of their injury, pain and disability on work and income-earning capacity. Additionally the domestic situation is explored to appreciate the extent to which the injury, pain and disability has impacted their functional ability to perform their typical activities of daily living.
  • The extent of the examination and the specific lines of enquiry are set by the insurance company and are reflective of the terms and conditions of the customer's insurance.


Education services

Over many years David Annells has provided education to various stakeholders providing treatment and return-to-work services to injured workers. This includes physiotherapists, agents/self-insured employers and their case managers and rehabilitation consultants, etc.  Topics relate to the management of work injuries and return-to-work. More specifically this might include:
  • Understanding musculoskeletal injury
  • Understanding the physiotherapist's role in rehabilitation of the injured worker
  • Determining 'necessary and appropriate' treatment
  • Understanding the biopsychosocial approach to examination and treatment of work injuries
  • Understanding the Clinical Framework Guidelines
  • Physiotherapy Management Plans etc

The content and delivery can be as casual or formal as required. A casual presentation might be the monthly in-house staff education session, or a Q&A session. A formal presentation might require one or more PowerPoint presentations, or an training/education series.

Wherever possible education is provided without cost in a vision to share and disseminate contemporaneous information about effective injury and return-to-work management, but this does depend on the amount of time required to prepare and deliver the presentation. Please feel free to discuss  education services with David Annells Consulting.


David Annells Consulting | dacon
Physiotherapy for Recovery and Return to Work
08 8357 9000