279: REPLICATION OF EARLY MATCHED PYSCHOSOCIAL INTERVENTION IN WORKERS WITH ACUTE INJURY-RELATED PAIN

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Psychology, Non-pharmacological treatments, Physiotherapy (e.g. exercise, rehab)

Background and Aims: Delivering early psychosocial interventions for those at risk of delayed recovery with acute injury-related pain is challenging. Two approaches have been described: (1) Stratified care is provided according to assessed group level of risk but, despite initial promise, subsequent studies have been disappointing1. (2) Matched care tries to match the intervention to the psychosocial risk factors at the individual level2. Promising results were reported in an Australian study3, but it needs replication. Using injured workers assessed as being at high-risk of delayed recovery, this study evaluated the same matched protocol2 but in a different industry and with different treatment providers

Methods: A 2-group prospective design was used with a national employer. Participants were allocated to Intervention or Control conditions based on which state they worked in. High-risk workers were identified by the OMPSQ-SF within 10-days of injury. All high-risk participants from both conditions received usual care, including surgery, from their medical, surgical, allied health, and rehabilitation providers. Those in Intervention states were also offered a coordinated intervention by a psychologist and a work rehabilitation provider in collaboration with the workplace, GP and physiotherapist. These interventions were matched to identified individual psychological and workplace risk factors. Follow-up was to 1-year.

Results: 75 workers consented to the Intervention and their outcomes were compared with 189 Controls. After 1-year, time to return to pre-injury work hours, total costs, and medical costs were significantly less in the Intervention group, relative to the Controls. Having surgery was associated more lost time from work, but surgical cases in the Intervention group had significantly less lost time than similar cases in the Controls. Five sessions with a psychologist were associated with significant improvements in the psychological measures, including the OMPSQ-SF scores. These changes were consistent with the hypothesized basis for targeting these heightened psychological factors in treatment.

Conclusions: Overall, the findings replicated those reported in an earlier study3 within a different industry where the same selection and psychosocial risk-based intervention protocol was tested against a usual (stepped) care management. Taken together, these findings provide further support for the hypothesis that brief psychological risk factor screening, combined with a protocol for active collaboration between key stakeholders to address identified psychological and workplace risk factors, can achieve better return to work and financial outcomes than usual (stepped) care2,3. A new finding was that this outcome was also demonstrated in those having surgery for their injuries, but this needs further testing.

References: 1. Croft P, Croft P, Hill J, Foster NE, Dunn KM, van der Windt DA. Stratified health care for low back pain using the STarT Back approach: Holy Grail or doomed to fail? PAIN 2024; 165(12):2679-2692
2. Linton SJ, Nicholas MK, Shaw W. Why wait to address high-risk cases of acute low back pain? A comparison of stepped, stratified, and matched care. PAIN 2018; 159: 2437-2441.
3. Nicholas MK, Costa DSJ, Linton CJ, Main CJ, Shaw WS, Pearce G, Gleeson M, Pinto RZ, Blyth FM, McAuley JH, Smeets RJEM, McGarity A. Implementation of early intervention protocol in Australia for “high risk” injured workers is associated with fewer lost workdays over 2 years than usual (stepped) care. J Occ Rehab 2020; 30:93–104.

Presenting Author: Michael Nicholas
Submitting Author: Michael Nicholas

Senior Author: Michael Nicholas

IASP 2026 Global Year theme of Neuropathic Pain: No

• Melanie Iannsen: BSc - Australia Post
• Daniel Costa: PhD - University of Sydney
• Manasi Mittinty: PhD - University of melbourne
• Lauren Morgan: NA - Australia Post
• Natasha Rae: NA - Australia Post
• Thomas O'Neill: MPsychol - Private consultancy
• William Shaw: PhD - University of Connecticut (Rtd)
• Chris Main: PhD - Keele University
• Steven Linton: PhD - Örebro University