Handbook of Complex Occupational Disability Claims Early Risk Identification, Intervention, and Prevention Handbook of Complex Occupational Disability Claims Early Risk Identification, Intervention, and Prevention Edited by Izabela Z. Schultz TheUniversityofBritishColumbia Vancouver,BritishColumbia,Canada and Robert J. Gatchel TheUniversityofTexasatArlington Arlington,Texas 123 Editors Izabela Z. Schultz Robert J. Gatchel University of British Columbia University of Texas Department of Education, Counselling Southwestern Medical Center Psychology & Special Education 5323 Harry Hines Blvd. 2125 Main Hall Dallas, TX 75235 Vancouver, BC V6T 1Z4 USA Canada [email protected] [email protected] ISBN:978-0-387-50167-3 e-ISBN:978-0-387-28919-9 DOI: 10.1007/978-0-387-28919-9 LibraryofCongressControlNumber:2005926893 (cid:1)C 2005 SpringerScience+BusinessMedia,LLC, First softcover printing 2008 Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthe writtenpermissionofthepublisher(SpringerScience+BusinessMedia,LLC,233SpringStreet, NewYork,NY10013,USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation,computersoftware,orbysimilarordissimilarmethodologynowknownorhereafter developedisforbidden. Theuseinthispublicationoftradenames,trademarks,servicemarksandsimilarterms,even iftheyarenotidentifiedassuch,isnottobetakenasanexpressionofopinionastowhether ornottheyaresubjecttoproprietaryrights. Printedonacid-freepaper springer.com Contributors JonathanBorkum,Ph.D. Rene´e-LouiseFranche,Ph.D. HealthPsychMaine InstituteforWorkandHealth Waterville,Maine PublicHealthSciences UniversityofToronto Toronto,Ontario,Canada MarilynL.Bowman,Ph.D. DepartmentofPsychology JohnFrank,M.D.,CCFP,M.Sc., SimonFraserUniversity FRCP(C) Vancouver/Burnaby,Canada InstituteforWorkandHealth PublicHealthSciences NancyCanning,Psy.D. UniversityofToronto AltaBates/Summit Toronto,Canada MedicalCenter–Henrick CampusBerkeley,California GaryM.Franklin,M.D.,M.P.H. SchoolofPublicHealthand JoanCrook,Ph.D. CommunityMedicine SchoolofNursing UniversityofWashington FacultyofHealthScience Seattle,Washington McMasterUniversity UniversityofBritishColumbia Hamilton,Ontario,Canada Vancouver,BritishColumbia,Canada NiklasKrause,M.D.M.P.H.Ph.D. JeffreyDersh,Ph.D. DivisionofOccupationaland ProductiveRehabilitationInstituteof EnvironmentalMedicine DallasforErgonomics(PRIDE) OccupationalEpidemiologyProgram Dallas,Texas UniversityofCalifornia atSanFrancisco Marie-Jose´ Durand,Ph.D. SanFrancisco,California DisabilityResearchand TrainingCenter JacobLazarovic,M.D. DepartmentofCommunityHealth VicePresidentandChiefMedical Sciences Officer Universite´ deSherbrooke BroadspireServices,Inc. Quebec,Ontario,Canada Plantation,Florida v vi Contributors GordonLeeman,M.S. ThomasM.Pendergrass,RN,Ph.D. ProductiveRehabilitationInstituteof UnumProvident DallasforErgonomics(PRIDE) Chattanooga,Tennessee Dallas,Texas CeriJ.Phillips,Ph.D. StevenJamesLinton,Ph.D. CentreforHealthEconomicsandPolicy DepartmentofOccupationaland Studies EnvironmentalMedicine SchoolofHealthSciences O¨rebroUniversityHospitaland UniversityofWalesSwansea DepartmentofBehavioral, Wales,UnitedKingdom SocialandLegal Sciences—Psychology PeterPolatin,M.D. O¨rebroUniversity,O¨rebro,Sweden DepartmentsofPsychiatryand AnesthesiologyandPain PatrickLoisel,M.D. Management DisabilityResearchandTrainingCenter TheUniversityofTexasSouthwestern DepartmentofSurgery(Divisionof MedicalCenteratDallas Orthopaedics Dallas,Texas Universite´ deSherbrooke Quebec,Ontario,Canada RichardC.Robinson,Ph.D. DepartmentsofPsychiatryand ChrisJ.Main,Ph.D. AnesthesiologyandPainManagement DepartmentofBehaviouralMedicine TheUniversityofTexasSouthwestern HopeHospital,SalfordRoyal MedicalCenteratDallas HospitalsNHSTrustand Dallas,Texas HonoraryProfessor(Facultyof Medicine) WandaK.Roehl,C.S.P. UniversityofManchester ManagerofWorkforcePlacement UnitedKingdom RaytheonAircraftCompany Wichita,Kansas DonaldD.McGeary,Ph.D. ClinicalHealthPsychology RonaldM.Ruff,Ph.D. WilfordHallMedicalCenter St.Mary’sHospitalandMedicalCenter 59thMDOS/MMCPH DepartmentofNeurosurgery SanEntario,Texas UniversityofCalifornia,SanFrancisco SanFranciscoClinicalNeurosciences J.MarkMelhornM.D. SanFrancisco,California SectionofOrthopaedics,Departmentof Surgery UniversityofKansasSchoolofMedicine JotiSamra,Ph.D. Wichita,Kansas PrivatePractice Vancouver,BritishColumbia,Canada AkikoOkifuji,Ph.D. PainResearchandManagementCenter RobertJ.Sbordone,Ph.D.,A.B.P.P DepartmentofAnesthesiology PrivatePractice UniversityofUtah LagunaHills,California Contributors vii JeromeA.Schofferman,M.D. PaulWatson,Ph.D.,M.Sc.,Bask TheSanFranciscoSpineInstitute (Hones),MCSP SpineCareMedicalGroup DepartmentofAnesthesia,CriticalCare SanFrancisco,California andPainManagement Leicester-WarwickMedicalSchool IzabelaZ.Schultz,Ph.D.,ABPP, Leicester,UnitedKingdom ABVE DepartmentofEducationaland TravisWhitfill,B.A. CounselingPsychologyandSpecial DepartmentofAnesthesiologyandPain Education Management TheUniversityofBritishColumbia TheUniversityofTexasSouthwestern Vancouver,BritishColumbia, MedicalCenteratDallas Canada Dallas,Texas AlannaWinter,M.A. AlanM.Strizak,M.D. DepartmentofEducationaland CollegeofMedicine CounselingPsychologyandSpecial UniversityofCalifornia Education Irvine,California UniversityofBritishColumbia Vancouver,BritishColumbiaCanada DennisC.Turk,Ph.D. DepartmentofAnesthesiology LarryK.WilkinsonM.D. UniversityofWashington Pro-MedPhysicianServices SchoolofMedicine Wichita,Kansas Seattle,Washington AnnaWrightStowell,Ph.D. JudithA.Turner,Ph.D. DepartmentofPsychiatryand DepartmentofPsychiatryand AnesthesiologyandPainManagement BehavioralSciences TheUniversityofTexasSouthwestern UniversityofWashington MedicalCenteratDallas Seattle,Washington Dallas,Texas Preface The health care, compensation, insurance and legal systems, together with employ- ers, in the Western world are challenged by a “new generation” of complex and multifaceted, yet still inadequately understood, clinical conditions with major oc- cupational impact. These conditions include chronic pain (such as headache, back pain,neckpainandfibromyalgia),repetitivestraininjuries,mildtraumaticbrainin- juries, depression, anxiety and specific posttraumatic stress disorders. The resulting wave of occupational disabilities brought on by these conditions defies traditional but outdated biomedical reductionistic models of identification, rehabilitation and management. These occupational disabilities, which we conceptualize and term in thisHandbookas“biopsychosocial,”havebeenexpandingmorerapidlythanmedi- callybaseddisabilities.Theyhavenowreachedtheverytoprankingsinthehierarchy ofoccupationaldisabilitiesinindustrializedcountries,andareaccompaniedbyspi- ralingcostsfromassociatedhealthcare,compensation,rehabilitation,litigation,and productivitylosses. The last two decades have seen a proliferation of basic science and clinically basedresearchontheseconditions.Despitetheseefforts,theknowledgegeneratedby thisresearchhasnotyetbeenintegratedandtranslatedintoclinicalandcasemanage- mentpractice,policyandnewparadigmsofservicedelivery.Thereisnooverarching conceptualframeworkfordiagnosis,riskidentification,earlyintervention,returnto work and prevention. Rehabilitation and compensation systems, and professionals workingwithinthem,togetherwithemployers,arechallengedbythepressingneed to develop effective clinical and occupational interventions, as well as management and prevention approaches for these complex yet still elusive disabilities. Unfortu- nately, these professionals still have no access to a systematic and integrated body of knowledge that would provide them with conceptual and research support for evidence-based effective practices and policies in this expanding field. This urgent needstimulatedthedevelopmentofthepresentHandbook. Likewise,themanagedcaresystems,insuranceindustry,workers’compensation systems,healthcareandrehabilitationsystems,aswellasourlegalsystem,continue to struggle with the onslaught of these complex, chronic, labor-intensive, poorly understood and costly claims. The absence of evidence-informed paradigms, guide- lines and strategies for early identification, intervention and management of these claims(foruseincompensation,occupationalandclinicalsettings)resultsinmulti- billiondollardisability-relatedeconomiclossesacrossindustrializedcountries.These ix x Preface lossesarealreadyestimatedatseveralpercentofthegrossnationalproductinthose countries, and they are continuing to rise. Moreover, for more than a decade, the system “stakeholders” delineated above have not been able to effectively deal with secondary prevention of occupational disabilities that require a biopsychosocial di- agnostic and intervention framework. Their mandate to facilitate the recovery and return to work of persons with biopsychosocial disabilities (and thereby reducing disabilitycosts)hasthereforebeenseriouslycompromised. The problem continues to escalate despite the proliferation of thousands of studiesonpredictorsandearlyinterventionprogramsforindividualsathighriskfor chronicoccupationaldisability.Theroleofpsychosocialfactorsinthedevelopment ormaintenanceofoccupationaldisabilityisfrequentlyraised,thoughstillpoorlyun- derstood. Explanations of disability as solely, or primarily, motivated by secondary gainorpreexistingpsychologyaboundinthemedico-legalcontext.Yet,nosystem- atic and legally defensible ways of identifying those at risk for disability and then interveningwiththemearlybeforedisabilitysetsin,havebeenimplementedinsuch contexts.Thisisthecurrentstatusinthefield,inspiteoftheconsistentlypromising outcomedataontheuseofaninterdisciplinarymodelofearlyintervention,coupled withtheeffectivenessofcognitive-behavioralapproaches. Amismatchandachasmbetweenthetraditionalbiomedicalmodel,uponwhich healthcare,compensationandlegalsystemshavebeenhistoricallyconstructed,and thenewparadigmrequiredfortheeffectivemanagementofbiopsychosocialdisabil- ities, have been largely responsible for the escalation of this problem. At the same time, the current clinical literature has few examples of attempts at the integration ofresearchevidenceontheseeminglydisparateclinicalconditions(e.g.,non-specific chronicpain,repetitivestraininjuryandposttraumaticpsychologicalandneuropsy- chologicalconditions)forwhichthebiomedicalmodelhasfailedinbothresearchand practice. The major aim of this interdisciplinary Handbook, therefore, is to bridge thegapbetweennewdevelopmentsinthescienceofbiopsychosocialdisabilities,with particularemphasisonmedicineandpsychology,andtheclinical,occupational,or- ganizational,compensation,andcasemanagementpracticesinwhatiswidelyunder- stood as the “disability industry”. This has been accomplished using an integrative biopsychosocialparadigm,asopposedtothetraditionalbutoutdatedunidisciplinary biomedicalmodelfollowingtheanachronisticCartesianmind-bodydistinction.The Handbookfocusesonthetranslationofthescienceofpredictionofworkdisability fromearlymarkerstonewresearchandclinicalpracticemodelsincludingtheclinical, rehabilitation,occupational,casemanagementandcompensationapproachesinthe area of high risk, costly and complex disabilities. Being cognizant of the evidence thatonlyaminorityofindividualswithbiopsychosocialdisabilitygoontodevelop chronicity and fail to return to work, identification of these individuals who are at highestriskforsuchdisabilitybecomescriticallyimportant. Our Handbook has been envisioned as a “transfer of knowledge” project that contributes an integration of the best, state-of-the-art research on the identification of high risk for disability, prediction of occupational disability, and early interven- tion with those who are at risk of failing to return to work following trauma and injury.Thoseindividualsaremostlikelytobecometheinsuranceandrehabilitation industry’s “complex claims”: poorly understood, traditionally treatment-resistant, contentious,litigiousandexpensive.Theyarealsolikelytobecomeemployers’most significant human resource, productivity and “bottom line” economic challenges Preface xi withrespecttoprevention,disabilitymanagementandjobaccommodation.Thein- curringdisabilitycostsmaypotentiallythreatentheircompany’seconomicviability. And,lastbutnotleast,theyaremostlikelytobecomeanobjectoflitigationinvolving employment law, personal injury, workers’ compensation, and long-term disability entitlement. Theseadversescenariosarenotyetfullypreventableinthecurrentsocial,politi- cal,legal,policyandeconomiccontexts.However,majorchangesinsystems,policies andpracticesappliedwiththesedisabilitiescanbeeffectedifnewintegratedevidence- based approaches to prediction, risk identification, early clinical, case management and occupational interventions are applied. Our Handbook constitutes a state-of- the-art, integrated research-based resource to facilitate the transfer of knowledge and the development of new clinical and occupational practices in healthcare, re- habilitation, insurance and workers’ compensation industries. This Handbook also synthesizesandcriticallyreviewsthecurrentresearchonbiopsychosocialconditions, andprovidesanetiologicalandepidemiologicalsynopsiswithimplicationsforearly diagnosis, risk identification, intervention, case management and disability preven- tion. It focuses on the functional and occupational impact of these conditions, as well as the most effective intervention approaches in clinical, workplace and com- pensation environments. The conceptual and methodological issues and controver- sies, together with directions for future research and practice, are also highlighted. Not only will the reader be provided with knowledge of concepts and the empiri- cal evidence gathered to date, in order to guide their practice, but also the neces- sarykeycomponentsofa“how-to”toolboxfortheireverydayworkandforfuture advances. ACKNOWLEDGMENTS Wewouldliketothankalloftheauthorsfortheirvaluablestate-of-the-artcontribu- tions,andformakingthisfirstintegrativeHandbookonabiopsychosocialapproach to early detection and intervention with occupational disabilities come to fruition. We would also like to acknowledge the support and assistance of many colleagues onboththeresearchandclinicalsidesofoccupationaldisabilitythroughdiscussion, exchangeofinformationandsuggestions.Inaddition,wewouldliketothankSharon Panulla, Malcolm Crystal, and Herman Makler of Springer, who supported the vi- sionofthisHandbookandencourageditstimelycompletion.Wearealsoindebtedto AlannaWinter,ResearchCoordinatorattheUniversityofBritishColumbia,forher technicalandresearchcontributionstothedevelopmentofthisbook.Wealsothank the numerous consultants who helped with different aspects of this multifaceted project,includingphysicians,psychologists,vocationalrehabilitationexperts,occu- pationalhealthnurses,researchers,andcompensation/insurancespecialistsspanning theNorthAmericancontinent. IZABELAZ.SCHULTZ ROBERTJ.GATCHEL