This is pilot intervention study based on the recent emergence of patient-based health outcomes assessment and present availability of the Worker-based outcomes assessment system (WBOAS), a validated instrument developed at the New England Medical Center Health Institute which measures overall health, mental health, pain symptom and fear/avoidance attitudes, provider performance, and employee work role performance across five specific work task/activities. Study subjects are medical center employees of Fletcher Allen Health Care (Burlington, VT) with the work-related musculoskeletal injuries including strain/sprain, cumulative trauma (upper extremity, lower extremity, lower back), tendinitis, and carpal tunnel syndrome. The study tests the utility of the WBOAS, the significance of which for workplace health improvement is great considering the nationwide rise in both injury incidence and injury management and lost productivity costs. The study aims (long term) to further the development and adoption of worker based outcomes assessment for the purpose of improving work role performance and reducing employee injury and re-injury rates and related employer treatment and lost productivity costs and (specific) to demonstrate the full effectiveness of a WBOAS based on the primary care provider as gatekeeper for occupational health care and for the management of work-related musculoskeletal injuries. The study employs a double cohort external control design, the strongest possible quasi-experimental (non-randomized control) design possible, staggered so as to strengthen inference such that in study phase 3 the phase 1-2 control cohort joins the test cohort as a test site as well. The intervention combines information and action. Physical/occupational therapists thus use the WBOAS a) to collect subject-reported baseline, treatment period, and post-treatment period data on the overall health, mental health, pain symptom and fear/avoidance attitudes, provider performance, and work role functioning of injured employees, b) to set and re-set injury treatment and re-injury prevention plans at each visit, and c) to refer subjects as indicated for adjunctive mental health care and workplace redesign. It is expected that, controlling for such covariates as subject demographics, injury severity, comorbidities, and practice variation, compared to control.
