Physiotherapy management plan
The Physiotherapy management plan should be completed where more than 10 treatment sessions will be delivered within a practice, or as
requested by the case manager.
ReturnToWorkSA expects physiotherapists to integrate the principles of the Clinical Framework for the Delivery of Health Services (2012) in their
daily practices and reflect these principles within this management plan.
Claims agent lodgement and contact details:
Employers Mutual
Post
GPO Box 2575, ADELAIDE SA 5001
Email
faxes@employersmutualsa.com.au
Fax
(08) 8127 1200
Phone
(08) 8127 1100
Gallagher Bassett
GPO Box 1772, ADELAIDE SA 5001
wcsa@gbtpa.com.au
(08) 8177 8451
(08) 8177 8450
EnABLE Unit
GPO Box 2668, ADELAIDE SA 5001
EnABLE@rtwsa.com
13 18 55
(08) 8233 2051
Worker and employment details
Name:
Claim number:
Date of injury:
Case manager (if known):
Pre-injury employer:
Occupation/title:
Current hours/week:
Pre-injury hours/week:
Current duties status:
Pre-injury duties
Alternative/modified duties
Unfit for work
Other, explain:
Do you have an understanding of the critical physical demands of the pre-injury role?
Yes
No
If no, please give details:
Clinical assessment
Your diagnosis:
Is your diagnosis different to the worker’s medical certificate?
Yes
No
Specific area(s) being treated:
If the worker is currently unable to participate fully at work, what key physical impairments prevent their full participation?
Psychosocial screening
Have you used any psychosocial screening tools?
Psychosocial screening tool(s) used
Yes
No
Previous/Baseline
EVALUATION
Date
Score
Update
Date
Progress
Score
Yes/No
Yes
No
Yes
No
Yes
No
Have you identified other non-injury barriers or issues that may impede the worker’s recovery and return to work (e.g. worker’s beliefs
about pain/pathology, workplace matters)?
Yes
No
If yes, please outline:
Outcome measures
Have you measured the benefits of your management in restoring functional capacity?
Outcome measure(s) used
Yes
Previous/Baseline
Date
Score
EVALUATION
No
Update
Date
Progress
Score
Yes/No
Yes
No
Yes
No
Yes
No
Goal setting
Goals should relate to return to work, function or other relevant activity participation, be SMART and be developed in collaboration with
the worker.
Work and functional goals
Estimated date of achievement
1.
2.
3.
Management to date (at this practice)
(If treatment has NOT been provided prior to this plan, go to Proposed management section below)
Date of this practice’s initial physiotherapy consult:
Has the worker made the progress you expected?
If no, outline relevant factors:
Total treatments to date at this practice:
(include consults, aquatic & exercise sessions):
Yes
No
PLANNING
Proposed management (at this practice)
Proposed number of treatments to be delivered
(include consults, aquatic and exercise sessions):
treatments over
Plan commencement date:
Expected discharge date:
weeks (12 weeks maximum plan duration)
Briefly outline proposed treatment strategies:
Are your exercise strategies occupationally–specific so as to improve the worker’s capacity to meet the physical demands of their pre-injury
duties or suitable employment?
Yes
No
If yes, please outline:
Briefly outline your management of any identified psychosocial factors:
Do other parties need to be notified/identified to address these psychosocial factors?
Case manager
Treating doctor
Return to work consultant
Yes
No
Other, please outline:
If action is recommended, please outline:
How is your management plan progressing the worker to self-management and independence?
Return to work
If the worker is currently unable to participate fully at work, do you think the worker will return to full pre-injury duties and hours?
Yes
No
If yes, in what timeframe?
If no, outline why:
Do you recommend a graduated return to work schedule for the worker?
Yes
Have you communicated your recommendations or the graduated return to work to the treating doctor(s)?
No
Yes
No
Treating physiotherapist’s details
Print name:
Practice name:
Address:
Phone number:
Email:
Fax number:
How would you prefer the case manager to notify you of the receipt of the plan?
Email
Fax
The worker has been involved in the development of this management plan
Yes
A copy of this plan has been provided to the case manager, treating doctor and worker
Yes
Treating physiotherapist’s signature:
Date:
Claims Agent use only
Physiotherapist notified of receipt of plan
Yes
Date notified:
Case manager name:
Phone
Post
Physiotherapy management plan – explanatory guide
The Physiotherapy management plan should be initiated
and completed by the treating physiotherapist when
more than 10 treatments are required to manage a worker
with an injury.
The completed plan should be submitted to the relevant case
manager, and copies provided to the treating doctor and
worker.
The plan should be invoiced using item number PTMP.
Please note: Management plans are practice-specific for individual workers.
Worker and
• It is expected that the physiotherapist will gain an understanding of the worker’s pre-injury role to ensure delivery of
employment details
physiotherapy management that is focused on early return to work and restoration to usual functional activities.
• Modified duties refer to any changes or restrictions that are applied to a worker’s pre-injury duties to facilitate work
participation where the injury prevents full participation.
• Alternative duties refer to the worker performing different duties to those in their pre-injury role.
Clinical assessment
• Your diagnosis may differ from the certifying doctor’s injury description on the Work Capacity Certificate. This information will
assist the claims management process by highlighting the need to obtain clarity around the diagnosis.
• If your diagnosis differs from that of the certifying doctor, it may be appropriate to have a verbal conversation in which this
diagnosis or appropriative management can be clarified for consistency.
• Key physical impairments refer to the physical deficits resulting from the work-related injury that are impeding the worker’s
functional capacity to participate in their pre-injury role or suitable duties:
e.g. Unable to lift >5 kg - Store person with a lower back injury
Unable to walk greater than 5 mins and kick start work scooter – postman with a knee injury.
Psychosocial
screening
(Principle 2 of
Clinical framework)
• Poor or delayed recovery can sometimes be explained by biological factors such as serious injuries or conditions, however
psychosocial (non-injury) factors often contribute to poor recovery and RTW outcomes for workers.
• Psychosocial risk factors can be screened early using psychosocial questionnaires such as, but not limited to:
–
Orebro Musculoskeletal Pain Questionnaire (state version used in management plan)
–
Tampa Scale for Kinaesiophobia
–
Pain Catastrophisation Scale
–
Pain Self Efficacy Questionnaire.
• Interviewing techniques and comprehensive history taking in the assessment phase can also be used to identify risk factors.
• Identification of risk factors early in the assessment phase should inform and guide the physiotherapist’s treatment.
• Psychosocial risk factors may include severe pain and disability reporting, low worker expectations about return to work,
greater treatment requirements, low job satisfaction, low self-efficacy, fears and anxieties or workplace matters.
Outcome measures
(Principle 1 of
Clinical framework)
• The outcome measure(s) used should be reliable, valid and sensitive to change.
• They should relate to the worker’s injury, the functional goals of treatment and functional demands of the pre-injury duties.
• Baseline measurement of the worker’s functional capacity should be performed at the commencement of treatment and then
serially re-measured to assess and demonstrate the benefit of treatment in improving their functional capacity.
• Outcome measures used may include, but not limited to:
– Standardised and area-specific questionnaires (e.g. Neck Disability Index (NDI), Shoulder Pain and Disability Index
(SPADI))
– Patient-Specific Functional Scale (PSFS)
– Work-specific physical capacity measures (e.g. lifting capacity, walking distance or sitting tolerance) such that
improvements in these measures should reflect increases in work capacity.
• Physical impairment measures (such as ROM, numerically-rated pain scores, etc.) are clinically useful to track changes within a
treatment session, however they do not reflect activity limitations, work capacity or participation restriction and therefore
should not be used in isolation.
Goal setting
(Principle 4 of the
Clinical framework)
• Physiotherapy goals should relate to function and return to work.
• Early and collaborative goal setting ensures that the worker and physiotherapist are focused on similar objectives to achieve
recovery and return to work.
• Goals should be specific, measurable, appropriate, relevant and timed (SMART).
• Examples of SMART physiotherapy goals include:
–
To return to work within in 2 weeks on modified duties with lifting capacity of 5kg
–
Increase work hours from 10 hours/ week to 20 hours/week by 31 December
Management to
date
• If treatment has been provided prior to this management plan, confirm the date of initial consultation and the total number of
treatments provided to date.
• A ‘treatment’ refers to all consultation types (initial, standard subsequent and long subsequent), all individual and group
aquatic physiotherapy sessions and all individual and group exercise sessions.
• The physiotherapist should indicate whether their treatment to date has achieved the expected recovery in the timeframe they
estimated and if the worker has not made the expected progress briefly outline why they think this may be the situation.
• Physiotherapy management that has failed to make measured progress towards functional goals, activity-related or
participation related goals may be inappropriate for a number of reasons. In these circumstances, it is expected that the
physiotherapist will reassess the treatment approach, consider other strategies which may include ceasing treatment.
Proposed
• Outline the proposed number of treatments required, the duration of the treatment and the anticipated treatment completion
date.
• Briefly outline proposed treatment strategies. It is expected that passive treatment strategies are used appropriately as the
injury demands and that there is timely progression to more active and self-efficacious strategies (such as exercise).
• The physiotherapist should outline how their exercise strategies will address the worker’s physical impairment findings
reported under the Clinical assessment section. Exercises should be condition-specific and occupation- specific so that they
simulate work postures, tasks and loads. Successful participation in the exercise program should result in corresponding
improvement in technique, physical conditioning and confidence for work-specific tasks.
• If psychosocial screening indicates the presence of non-injury risk factors to poor or delayed recovery, outline these risk factors
and the physiotherapy management strategies recommended (eg. improve the worker’s understanding of their
injury/pathology or pain thereby promoting empowered decision-making and active coping responses). Psychosocial barriers
pertaining to industrial matters, the claim / compensatory system or psychological barriers should be brought to the attention
of the case manager, treating doctor / relevant health provider or other relevant party for assessment.
• Outline the strategies implemented to support the worker’s self-management and reduced dependence on professional
support. Physiotherapy management should work towards a model of self-management and independence. It is expected that
physiotherapists will not facilitate patient dependency on passive techniques by administering regular ongoing treatment for a
prolonged period. Workers should be provided with sufficient skills for self-management.
management
(Principle 2, 3, 4
and 5)
Return to work
• The physiotherapist should provide their opinion about the likelihood of the worker returning to full pre-injury capacity. An
understanding of the critical physical demands of the pre-injury role or suitable duties is presumed (refer to Work details
section). Where this outcome is likely, the physiotherapist should outline the estimated timeframe for full participation at work.
• If the physiotherapist feels that the worker may not be able to return to their pre-injury duties this should be indicated with the
relevant factors that lead them to this opinion.
• The physiotherapist is expected to provide information to the treating doctor to assist them certify the capacity of the worker.
Treating
• Following review of the management plan the case manager will notify the treating physiotherapist to acknowledge receipt of
the plan and support of the proposed management. The physiotherapist should indicate their preferred method of
communication for this process.
• It is important that the worker is actively involved in the development of the management plan and that a copy of the plan is
made available to them.
• A copy of the plan is required to be sent to the case manager and the treating doctor or referrer.
physiotherapists
details
The following free information support services are available:
If you are deaf or have a hearing or speech impairment you can call ReturnToWorkSA through the National Relay Service (NRS):

TTY users can phone 13 36 77 and ask for 13 18 55.

Speak & Listen (speech-to-speech) users can phone 1300 555 727 and ask for 13 18 55.

Internet Relay users connect to NRS on www.relayservice.com and ask for 13 18 55.
For languages other than English call the Interpreting and Translating Centre on 1800 280 203 and ask for an interpreter to call ReturnToWorkSA on
13 18 55. For Braille, audio or e-text call 13 18 55.
ReturnToWorkSA
Enquiries: 13 18 55
400 King William Street, Adelaide SA 5000
info@rtwsa.com
www.rtwsa.com
© ReturnToWorkSA 2015
Amended: March 2015