Reducing Time Off Work Through an Integrated Care Pathway for Shoulder Injuries: Evidence from a Workers' Compensation Cohort Study.

Abstract

Purpose: To determine the effect of implementing a care pathway on return-to-work (RTW) levels and identify prognostic factors among workers filing their first shoulder injury claim.

Methods: This retrospective cohort study included 5075 workers with a first claim for shoulder injury: 2593 workers (2004-2008) received standard of care consultations, while 2482 workers (2014-2018) underwent specialized shoulder assessments through a care pathway that also included collaborative planning for RTW. Multinomial logistic regression determined the effect of implementing a care pathway on RTW levels and identified demographics, injury, occupational and program factors associated with RTW.

Results: The most common injuries were traumatic (92.4%) and sprains/strains (64%). Median claim duration was 114 days (IQR = 140), with 80.6% receiving wage replacement benefits. The care pathway cohort was younger with shorter claim duration than the pre-care pathway cohort. They had 1.8 times (95% confidence interval (CI) 1.4; 2.3) greater risk of returning to modified duties than the pre-care pathway cohort. Days receiving wage replacement benefits 12-month post-claim closure were similar between cohorts (p = 0.8). RTW outcomes were impacted by demographics, injury, occupational, and program factors, with interpreter use, prolonged claims, poor compliance, and delayed treatment most strongly associated with failure to RTW at pre-accident levels.

Conclusions: The findings demonstrate that the care pathway cohort was associated with quicker return to modified duties without compromising long-term RTW outcome. This underscores the importance of proactive intervention strategies like care pathways in optimizing workplace rehabilitation outcomes and minimizing long-term disability. Clinical Trial Number Not applicable.