Belinda Gabbe - Monash University - Returning to work after traumatic injury


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Belinda Gabbe delivered the presentation at the 2014 Return to Work Forum.

The 2014 Return to Work Forum brought together speakers from multiple sectors to share best practice in return to work, injury management and rehabilitation.

For more information about the event, please visit:

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Belinda Gabbe - Monash University - Returning to work after traumatic injury

  1. 1. Returning to work after serious traumatic injury Professor Belinda Gabbe Head of Prehospital, Emergency and Trauma Research School of Public Health and Preventive Medicine Head of Prehospital, Emergency and Trauma Research
  2. 2. Overview of the presentation 1. Placing serious injury in the context of the wider injury population 2. Introduce the Victorian State Trauma Registry2. Introduce the Victorian State Trauma Registry 3. Provide the numbers 4. Discuss patient experiences with return to work 2
  3. 3. Serious injurySerious injury 28th February 2011Presentation title 3
  4. 4. Injury Pyramid Increasingseverity Deaths Major trauma Other hospital admissions Increasingfrequency Increasingseverity Emergency Department visits Specialists Community-based professionals (GP, physiotherapists, chiropractors, podiatrists, etc) First aid providers Pharmacies, self-treatment, no treatment Increasingfrequency
  5. 5.  Serious injury is life changing event  Seriously injured patients often require prolonged treatment and rehabilitation, and access to disability services  Consequences of injury are many and varied  Potential for prolonged and lifelong disability Potential for prolonged and lifelong disability  Employment and economic impacts are common – Prolonged absences from work – Risk of substantial financial burden  Complex funding of injury treatment and rehabilitation – TAC, WSV, Medicare, DVA, Private health insurance 5
  6. 6. Victorian State TraumaVictorian State Trauma Registry 6
  7. 7. Victorian State Trauma Registry  Population-based trauma registry, integrated into the state’s trauma system  Receives data from all 138 trauma-receiving hospitals in the state  Uses an opt-off consent process  Collecting data since July 2001 Collecting data since July 2001  Data collected includes pre-hospital (ambulance), all acute hospital admissions, and post-discharge outcomes  Unique registry due to the focus on all phases of care and the routine collection of long term functional, quality of life and return to work outcomes
  8. 8. VSTR routine follow-up  Focus on brief, validated, inexpensive instruments where formal training or accreditation not required  Centralised location for follow-up and trained interviewers  6-months, 12-months and 24-months post-injury  Adult cases Adult cases – GOS-E, global measure of function – SF-12 and EQ-5D, generic measures of health-related quality of life – Pain – Pre-injury work status and occupation, and return to work  Linkage with the deaths registry (Gabbe et al. J Trauma 2010;69:532-536)
  9. 9. What are the return to workWhat are the return to work numbers? 28th February 2011Presentation title 10
  10. 10. 7135 major trauma patients Jul 2007-Dec 2011 18-64 years of age 7135 major trauma patients Jul 2007-Dec 2011 18-64 years of age 11 468 (7%) in-hospital deaths 468 (7%) in-hospital deaths 6667 (93%) survivors to discharge 6667 (93%) survivors to discharge 79% working for income prior to the injury 79% working for income prior to the injury
  11. 11. Profile of major trauma patients Characteristic Age Mean (SD) years 37.1 (13.6) Sex Male 81% Injury Severity Score Median (IQR) 17 (14-24) Type of injury Multi-trauma (no neurotrauma) Head and other injuries 44% 25 %Head and other injuries Isolated head injury Orthopaedic injuries only Chest/abdominal injuries Spinal cord 25 % 11% 11% 6% 3% Injury intent Unintentional 88% Cause of injury Motor vehicle Motorcycle High fall Struck by/collision with Low fall Pedal cyclist 29% 17% 11% 11% 7% 7% 12
  12. 12. Compensable status 7% 4% 13 49% 40% TAC Medicare WorkSafe Private
  13. 13. Occupation group 32% 9% 5% 3% Tradespersons Professionals Production and transport workers 14 13% 13% 13% 10% workers Clerical/sales/service workers Associate professionals Managers and administrators Self-employed - NFS Labourers and related workers
  14. 14. Return to work by occupation group 30 40 50 60 70 80 90 %returnedtowork 15 0 10 20 30 %returnedtowork 6-months 12-months 24-months
  15. 15. Return to organisation & role at 24-months 16
  16. 16. Key predictors of return to work  Women have 50% lower adjusted odds of RTW  Odds of RTW decline 4% with each increased year of age  Improved odds of return to work with time since injury  Type and severity of injury impacts on likelihood of return to work  80% lower odds of RTW if intentional self-harm and 65% lower if an 80% lower odds of RTW if intentional self-harm and 65% lower if an assault victim  TAC and WorkSafe patients have 80% lower odds of RTW than non- compensable patients  Higher odds of RTW with better levels of education, managerial, professional and associate professional roles compared with tradespersons  Independent of occupation and other factors, higher SES associated with much higher odds of RTW 17
  17. 17. What do patients tell us?What do patients tell us? 28th February 2011Presentation title 18
  18. 18. Qualitative study • In-depth personal interviews of 120 trauma survivors • Recorded via telephone • Adult, blunt trauma patients • 1 to 2 years post-injury• 1 to 2 years post-injury • Purposeful quota sampling • 60 of each gender, major trauma hospital, and compensable status evenly represented across age groups • Topic guide • Interviews transcribed and coded • Thematic coding frame applied to coded text
  19. 19. Financial burden is common  81% reported financial implications  Issue for working age patients caused by prolonged inability to work  Patients with less time at their place of employment vulnerable  Reliance on savings and loans from family members/friends  Careful budgeting required  TAC patients largely protected but doesn’t cover full salary and other implications of receiving TAC loss of earnings payments  Income protection insurance valued by those that had it  Work impacts extend beyond the patient 20
  20. 20. 21
  21. 21. Perceptions of return to work  Most reported their injury negatively impacted on work  Positive support from the employer or workplace crucial – Use of sick, annual and long service leave – Providing a “back to work” program – Able to perform alternative duties – Additional financial support– Additional financial support  Barriers to return to work – Employer not listening to needs or having unrealistic expectations – Employer not understanding physical limitations – Employer ignoring GP recommendations for the worker – Employer failing to approve sick leave – Inability to access retraining at all or inappropriate retraining  Missed job opportunities and promotions while recovering 22
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  23. 23. What have we learned?What have we learned? 24
  24. 24.  Seriously injured patients of working age – Predominantly male – Road trauma dominates – TAC and Medicare primary funders – Half have manual jobs  29% not returned to work at 2 years  30% have changed workplace or organisation 30% have changed workplace or organisation  If return to same workplace, 89% resume the same role  Vulnerable patients with lower odds of return to work – Age, gender, injury intent, compensable status, SES, occupation, injury type  Particular patient groups at high risk of substantial financial impact 25
  25. 25. Closing comments  Return to work important for economic, psychosocial and physical reasons  Facilitating return to work clearly needed and workplace/employer support critical in the process  Job retraining and return to work programs important but many patients Job retraining and return to work programs important but many patients do not meet the criteria for commonwealth work rehabilitation programs and opportunities limited particularly where not in the compensation system  Improved access to return to work services needed  TAC and compensation schemes, and supportive workplaces, limit financial burden 26
  26. 26. This project is funded by the Transport Accident Commission (TAC), through the Institute for Safety, Compensation and Recovery Research (ISCRR).
  27. 27. This project is proudly supported by the Transport Accident Commission
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