Personal expectations and injury recovery outcomes

A recent study* confirmed what many of us expected, based on experience at the coalface: an injured person’s expectations regarding recovery are a far better predictor than anything else for the course of their recovery.

People who expect to do well generally do so, despite other ‘flags’ indicating a poor likelihood of return to work. People with expectations that were not as good had poorer outcomes.

Much poorer outcomes.

This is not “just another study”. It was well designed by one of the most respected research organisations in the world, studying a population that is demographically and culturally about as close to Australia as anything you’ll find overseas. The results they found weren’t just a matter of some statistical calculation.

The effect of expectations was four to five times the impact of any other predictor they studied.

So why aren’t we paying better attention to expectations?

I’ve had significant musculoskeletal injuries more than once. The expectations that were set for me by the healthcare professionals I encountered were... guarded. Doctors, physios and others were concerned not to set expectations at a level that might lead to disappointment (or perhaps they were afraid that I’d sue if my expectations were too high).

At the same time, the television was full of ads about people who needed lawyers to make their harm right. Helpful neighbours and friends were quick with their stories, and most people remember the bad more quickly than the good.

Perhaps most difficult was the total lack of attention to fear-avoidance behaviour that had crept into my life. The doctors were done with me when the medical problem was fixed. The physical medicine practitioners stopped having time for me when I had recovered some function and showed signs of continuing my exercises.

But no-one helped me get through the fear of moving, the fear of whether I would ever be the same, or the fear of how I would cope with limitations.

I had to look outside of the health professions for help in finding assurance that it was safe to move again, and that I needn’t fear re-injury if I was sensible.

There is no shortage of negative messages out in the world that will tend towards reducing the expectations people have for their lives after injury. There is no shortage of people in the business of healing who think the job is done when they have helped the body as much as they can.

Those messages need to be actively countered. You may not have a counselling role, but your job is not done until you find a way, through questions, stories or shared experience, to help the injured get over the fears that they may have acquired. My helper was a trusted yoga instructor who gently helped me test my limitations. Perhaps you can play that role for someone else.

The takeaway from this study is that you can make a genuine difference in the lives of injured people, merely by guiding them to believe that they will recover and return to a life they will consider meaningful and fulfilling.

That’s not always easy, given all the forces sending the opposite message. But the effort spent will reward you many times over.

Now there’s a positive thought.

*Vocational Rehabilitation Program Evaluation: Comparison Group Challenges and the Role of Unmeasured Return-to-Work Expectations. Sears JM1, Rolle LR, Schulman BA, Wickizer TM. J Occup Rehabil. 2014 Mar 30.

Rob  Aurbach, contributor to Return to Work Matters, has spent 15 years as the chief legal and policy development officer for an American statutory compensation authority. During the last decade Rob has assisted 10 governmental entities in reviewing and revising their workers compensation systems as a consultant. In Australia, he has worked as a consultant for various commercial and governmental clients, including Comcare, the Department of Veteran’s Affairs and WorkCover NSW.

Rob’s independent research focus has been on understanding the factors that allow some people to recover from physical and psychological injury as expected, while others do not. He has written more than 50 published articles and book chapters, and speaks internationally on rehabilitation, disability management and personal injury system design.

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