Principle 3: Empower the injured person to manage their injury

Key messages

Empowering the injured person to manage their injury is a key treatment strategy and should be incorporated in all phases of injury management.
The main ways to empower an injured person are education, setting expectations, developing self-management strategies and promoting independence from treatment.
Healthcare professionals need to empower an injured person to actively participate in activities at home, work and in the community as part of their rehabilitation.

Education and setting expectations

Education, setting expectations and actively involving the injured person in their treatment is an important component of effective rehabilitation. The injured person is empowered when they:

are educated about the:
- respective roles of the injured person and the healthcare professional
- nature of their injury, expected recovery timeframes and prognosis
- importance of actively participating in activities at home, work and the community as part of rehabilitation
- risks of prolonged inactivity
- risks and benefits of the treatment proposed
develop collaborative treatment goals and timeframes to achieve these goals with their healthcare professional
have appropriate and effective self-management strategies (including the management of relapses)
have a healthcare professional that does not encourage or reinforce dependence and instead supports independence from treatment when appropriate
learn to manage their condition as independently as possible

For children or people with severe injuries, it is also important that healthcare professionals empower carers and family members to support the injured person to be as independent as possible.

Setting expectations about discharge from treatment should commence early in the treatment phase. While it may be difficult to know exactly how long it will take to achieve an optimal recovery, it is important to inform the injured person that when recovery plateaus, their needs will be reassessed to determine whether any ongoing intervention will assist in their participatory or functional status. A lack of understanding about this change can cause unnecessary frustration for an injured person at the natural conclusion of the rehabilitation phase.

Influencing beliefs

An injured person may have or develop restrictive or counter-productive beliefs leading to entrenched feelings of distress and behaviours that do not support recovery, independence and return to work. Restrictive beliefs can be a major obstacle to an injured person’s ability to participate in activities at home, work or in the community. These beliefs may include:

fear-avoidance: Increased pain means I’ve made my injury worse, so I must avoid any activity that aggravates my pain
catastrophising: My symptoms are severe and I will never be able to work again
lack of acceptance: I need to get in control of my symptoms before I can think about anything else
low self-efficacy: I can’t do any work because of my pain
blame: It’s their fault and so I need a lot of time away from work
perception of injustice: I was unfairly treated and will not improve until this is redressed

Education and motivational strategies can help an injured person to understand their injury and its management, make choices, challenge and overcome restrictive beliefs, and modify their behaviour, leading to improved functional outcomes. All healthcare professionals have a role to play in positively influencing beliefs. Some injured people may require more specialised psychological intervention to change beliefs about recovery. The following strategies may be useful in influencing restrictive beliefs:

improving awareness of the beliefs and their negative impact
reviewing and testing their accuracy
generating alternative beliefs that are open to change
reinforcing and practising alternative beliefs in everyday settings
providing information such as written materials

Facilitating self-management

Self-management strategies are an essential part of any management plan. The injured person should be encouraged to take control of their rehabilitation and drive their recovery by using strategies to control their symptoms and learning to function despite their symptoms. The following are examples of individually tailored self-management strategies. Some options may require training from a specialist healthcare professional:

collaborative goal setting
activity scheduling
observing, monitoring and challenging restrictive beliefs
problem solving
pacing strategies to minimise risk of relapse
homework
relaxation techniques
ergonomics
use of equipment
exploration and management of potential barriers to recovery
a regular exercise program
managing medication use
establishing a healthy and consistent sleeping routine
learning acceptance of the injury
exposure-based approaches to feared and/or avoided situations
planned reduction in treatment frequency to support the development of self-management skills

As recovery progresses active strategies that support self-management and independence should increase, and passive strategies (such as, supportive counselling or hands-on treatment) that require intervention by a healthcare professional should decrease.

Managing relapses

An exacerbation of symptoms or a relapse of a previous injury may be triggered by unaccustomed or overly vigorous physical activity, for example lack of pacing, or stressful life events. For people with persistent pain or a psychological injury, relapses are common. Treating healthcare professionals need to educate injured people to expect relapses and understand the reasons why they occur. They should provide injured people with strategies to manage these episodes. In addition to the self-management strategies above, useful strategies for relapses include:

reassurance that relapses are possible and, in the case of persistent pain, common
awareness of triggers and encouragement to adopt coping strategies early to avoid the escalation of stress, pain or other symptoms
written plans about how to implement self-management steps during relapses
communication with significant others, such as family, co-workers, employers and medical practitioners, about their role in helping the injured person to manage relapses.

Sometimes injured people present with health problems that are unrelated to the compensable injury. Treating healthcare professionals should aim to identify and, as far as possible, separate issues that are not directly related to the compensable injury. They should also advise the injured person about options for the assessment and treatment of these unrelated issues.

Independence from treatment

The key measure of treatment effectiveness is the ability of the injured person to manage their condition as independently as possible and participate in activities at home, in the community and at work. Independence does not mean being symptom free, but rather living a functional and productive life while self-managing symptoms if they arise. Failure to empower an injured person to become independent may result in dependency on treatment, which reinforces illness behaviour and can lead to persistent pain or long-term disability.

By following a biopsychosocial approach and the principle of empowerment, health professionals, families and other key parties (such as employers), can support injured people to become independent in their health and injury management.


Principle 3: Empower the injured person to manage their injury Key messages Empowering the injured person to manage their injury is a key treatment strategy and should be incorporated in all phases of injury management. The main ways to empower an injured person are education, setting expectations, developing self-management strategies and promoting independence from treatment. Healthcare professionals need to empower an injured person to actively participate in activities at home, work and in the community as part of their rehabilitation. Education and setting expectations Education, setting expectations and actively involving the injured person in their treatment is an important component of effective rehabilitation. The injured person is empowered when they: are educated about the: respective roles of the injured person and the healthcare professional nature of their injury, expected recovery timeframes and prognosis importance of actively participating in activities at home, work and the community as part of rehabilitation risks of prolonged inactivity risks and benefits of the treatment proposed develop collaborative treatment goals and timeframes to achieve these goals with their healthcare professional have appropriate and effective self-management strategies (including the management of relapses) have a healthcare professional that does not encourage or reinforce dependence and instead supports independence from treatment when appropriate learn to manage their condition as independently as possible For children or people with severe injuries, it is also important that healthcare professionals empower carers and family members to support the injured person to be as independent as possible. Setting expectations about discharge from treatment should commence early in the treatment phase. While it may be difficult to know exactly how long it will take to achieve an optimal recovery, it is important to inform the injured person that when recovery plateaus, their needs will be reassessed to determine whether any ongoing intervention will assist in their participatory or functional status. A lack of understanding about this change can cause unnecessary frustration for an injured person at the natural conclusion of the rehabilitation phase. Influencing beliefs An injured person may have or develop restrictive or counter-productive beliefs leading to entrenched feelings of distress and behaviours that do not support recovery, independence and return to work. Restrictive beliefs can be a major obstacle to an injured person’s ability to participate in activities at home, work or in the community. These beliefs may include: fear-avoidance: Increased pain means I’ve made my injury worse, so I must avoid any activity that aggravates my pain catastrophising: My symptoms are severe and I will never be able to work again lack of acceptance: I need to get in control of my symptoms before I can think about anything else low self-efficacy: I can’t do any work because of my pain blame: It’s their fault and so I need a lot of time away from work perception of injustice: I was unfairly treated and will not improve until this is redressed Education and motivational strategies can help an injured person to understand their injury and its management, make choices, challenge and overcome restrictive beliefs, and modify their behaviour, leading to improved functional outcomes. All healthcare professionals have a role to play in positively influencing beliefs. Some injured people may require more specialised psychological intervention to change beliefs about recovery. The following strategies may be useful in influencing restrictive beliefs: improving awareness of the beliefs and their negative impact reviewing and testing their accuracy generating alternative beliefs that are open to change reinforcing and practising alternative beliefs in everyday settings providing information such as written materials Facilitating self-management Self-management strategies are an essential part of any management plan. The injured person should be encouraged to take control of their rehabilitation and drive their recovery by using strategies to control their symptoms and learning to function despite their symptoms. The following are examples of individually tailored self-management strategies. Some options may require training from a specialist healthcare professional: collaborative goal setting activity scheduling observing, monitoring and challenging restrictive beliefs problem solving pacing strategies to minimise risk of relapse homework relaxation techniques ergonomics use of equipment exploration and management of potential barriers to recovery a regular exercise program managing medication use establishing a healthy and consistent sleeping routine learning acceptance of the injury exposure-based approaches to feared and/or avoided situations planned reduction in treatment frequency to support the development of self-management skills As recovery progresses active strategies that support self-management and independence should increase, and passive strategies (such as, supportive counselling or hands-on treatment) that require intervention by a healthcare professional should decrease. Managing relapses An exacerbation of symptoms or a relapse of a previous injury may be triggered by unaccustomed or overly vigorous physical activity, for example lack of pacing, or stressful life events. For people with persistent pain or a psychological injury, relapses are common. Treating healthcare professionals need to educate injured people to expect relapses and understand the reasons why they occur. They should provide injured people with strategies to manage these episodes. In addition to the self-management strategies above, useful strategies for relapses include: reassurance that relapses are possible and, in the case of persistent pain, common awareness of triggers and encouragement to adopt coping strategies early to avoid the escalation of stress, pain or other symptoms written plans about how to implement self-management steps during relapses communication with significant others, such as family, co-workers, employers and medical practitioners, about their role in helping the injured person to manage relapses. Sometimes injured people present with health problems that are unrelated to the compensable injury. Treating healthcare professionals should aim to identify and, as far as possible, separate issues that are not directly related to the compensable injury. They should also advise the injured person about options for the assessment and treatment of these unrelated issues. Independence from treatment The key measure of treatment effectiveness is the ability of the injured person to manage their condition as independently as possible and participate in activities at home, in the community and at work. Independence does not mean being symptom free, but rather living a functional and productive life while self-managing symptoms if they arise. Failure to empower an injured person to become independent may result in dependency on treatment, which reinforces illness behaviour and can lead to persistent pain or long-term disability. By following a biopsychosocial approach and the principle of empowerment, health professionals, families and other key parties (such as employers), can support injured people to become independent in their health and injury management.