When you choose your desired career, it can be hard to imagine that one day you may have to stop doing it due to an accident at work. This is what happened in one of Vocational Case Manager, Andrea Field’s cases. Her client was crushed by a telehandler forklift on a job as a groundworker, acquiring injuries that would prevent him from being so physically active again. Whilst it was a priority to source the support and treatment that would get him back on his feet, it required Andrea’s expert vocational case management experience to support return to full-time employment, a change of career and empower independence.
Injury Details: Crush injury to left lower leg, foot and ankle, psychological trauma
Background Information
Paul (name changed for confidentiality) had been a trained and respected construction professional for most of his adult life. He was self-employed and had dedicated his career to the duties of a groundworker, including digging, lifting, laying slabs and tarmac and other physically exerting tasks.
Whilst Paul was working on one particular job, he was crushed by a telehandler forklift, fracturing his left lower leg, foot and ankle. As a result of his injuries and the momentum of the forklift, Paul fell to the floor and hit his head, sustaining a laceration on his forehead.
He was immediately taken to hospital in an ambulance where he underwent x-rays of his head and left leg before receiving surgery to implant rods, pins and plates to stabilise the multiple lower limb fractures. He also had 13 stitches for the laceration in his forehead, although no brain injury was identified.
He was discharged with remote weekly NHS physiotherapy and the promise that further surgery would be completed to remove some of the metalwork in his leg and foot further on in the healing process.
At Referral
When Paul was referred to Corporé, he had limited range of movement in his foot and ankle with severe swelling and soft tissue damage, making walking and standing very difficult.
The bones in his leg had healed, though he was still waiting for further surgery to remove some of the metalwork.
Due to these continued physical symptoms, Paul had been signed off work and was currently unemployed.
As keen as Paul was to get back into employment, as the main earner in his household, he did display heightened anxiety about returning to work with big machinery and whether his injuries would affect his ability to work.
The uncertainty of Paul’s recovery caused him to worry about his own and his family’s future. As the carer of his wife who has MS, plus home-schooling a teenage boy in the depths of COVID-19, Paul was feeling overwhelmed and frustrated with his injuries, experiencing trauma symptoms and anger around his accident.
It was imperative that Corporé provided Paul the right support to achieve optimum recovery, coordinating treatment that would help him return to work and regain his confidence and independence.
Rehabilitation Goals
To address Paul’s anxiety and trauma symptoms relating to his accident and restore pre-injury function.
Reduce pain and stiffness and improve mobility in Paul’s left leg, foot and ankle.
Source, apply and obtain employment by February 2023.
Challenges/ Barriers to Recovery
Pain and restriction in left leg, foot and ankle.
Delays in receiving future surgery to remove metalwork.
Access to NHS treatment being delayed due to the COVID-19 pandemic.
Paul’s psychological symptoms.
Paul’s physically demanding job role.
Apprehension about returning to work.
The vulnerability of Paul’s wife restricting treatment to remote services during the COVID-19 pandemic.
Our Involvement
Psychological Support
We arranged for Paul to undergo a psychological assessment that demonstrated:
General Anxiety Disorder (GAD7) score – 21/21
Patient Health Questionnaire (PHQ9) score – 20/27
Impact of Events Scale (IES-r) – 40/88- trauma experienced
Paul was demonstrating extreme levels of anxiety and severe depression, making him feel very low, have a lack of motivation and concentration and feel angry at himself.
12 remote sessions of Cognitive Behavioural Therapy (CBT) were coordinated to help Paul learn to manage his feelings and mood.
Physical Support
Following Paul’s initial physiotherapy via the NHS, he hadn’t received any further support for his injuries for four months.
We tried to continue Paul’s sessions via the NHS with many delays in getting appointments agreed. Therefore, private remote physiotherapy was arranged.
In the first physical assessment, Paul’s pain rating in his foot and ankle was a 3/10 though it was clear he had limited muscle strength and movement.
His foot in particular continued to be swollen, making it difficult for him to walk and put on footwear and whilst the Physiotherapist urged limited time on his feet, this was impossible as Paul was caring for his wife.
The Physiotherapist stated that it was unlikely that Paul’s foot would ever be the same again, so the aim was to gain 80-85% improvement in movement so that he could walk.
Surgery Support
We made regular contact with the hospital to receive updates regarding Paul’s follow-up surgery. This had been delayed due to the COVID-19 pandemic. Paul’s second surgery was completed in May 2021, almost a year after his accident, where most of the metalwork was removed.
Employment Support
Throughout Paul’s rehabilitation, returning to work remained a main goal.
Whilst he was unable to seek employment in the first year of his rehabilitation due to his slow recovery, once his follow-up surgery was complete, it was arranged for Paul to receive vocational support from Vocational Case Manager, Andrea Fields.
Vocational rehabilitation was initiated in February 2022 with a focus on seeking less physically demanding roles for Paul.
Paul expressed an interest in retraining to drive a 360 excavator above 10 tonnes which would mean that he would not need to leave the cab and do groundwork. Andrea researched and booked Paul into training for his licence, broadening his employment opportunities.
She also supported Paul with updating his expired labour cards and sourced further certifications, training and exams to ensure he could continue working as a manual labourer.
To support the application stage of his vocational rehabilitation, Andrea helped sharpen up Paul’s CV and personal statement, creating him a profile on Indeed and other recruitment sites to increase his chances of seeking employment. She also contacted relevant companies not currently advertising roles to highlight Paul’s expertise and skills.
Paul received vocational counselling and assistance with job canvassing, interview skills, training and advice on seeking feedback for his job applications. This was to provide Paul with an understanding of the requirements needed for each of his favoured jobs to help him hone his skills and seek the best role for him.
Outcomes
Psychological Support
Following the completion of 12 CBT sessions in August 2021, Paul’s final assessment scores were as follows:
GAD7 Questionnaire – 14/21
PHQ9 – 16/27
IES-r – 29/88
Paul’s anxiety and depression scores had moderately improved but his impact of events score had significantly decreased, demonstrating a reduction in traumatic feelings associated with his accident.
In addition, Paul also learnt techniques to help him manage his feelings independently and therefore did not need any further sessions.
His improved mood made him even more determined to return to work and routine.
Physical Support
Overall, Paul received 20 remote weekly physiotherapy sessions with daily home exercises included to improve his range of movement and muscle strength in his foot.
He made a 40% overall improvement, with range of movement increased to 75%. Paul was now able to walk without significant pain.
Whilst the swelling of his foot had diminished, it had not completely gone. The Physiotherapist advised that Paul was unlikely to make any further progress and he was happily discharged in June 2022 with self-management advice to continue stabilising and strengthening his leg and foot.
Employment Support
Paul received vocational rehabilitation support for a year, concluding in February 2023.
In that time, he received essential training, advice and support that not just helped him gain the relevant licenses to continue working in his desired profession as a manual labourer, but also provided him essential skills to apply and interview for jobs.
This gave him the confidence to seek new professions on his own. Whilst at case closure he had not successfully sourced a new job, the indispensable skills acquired from his vocational rehabilitation had given him purpose in life to find a career, empowering an independent future.
The Insurer instructing Paul’s case shared with us following case closure:
“I am very grateful to you for all your assistance in this matter, which has been considerable. On behalf of the Injured Party, thank you very much indeed.”
-Insurer customer
Rehabilitation case management success isn’t about returning injured clients back to their pre-injury state. In some cases, this isn’t possible. What Corporé aim to do is understand their clients’ needs and support them to reach the best possible version of that goal. This may mean a change in career path, like Paul experienced following his accident, but it doesn’t diminish from the progress and improvements made by our injured parties in achieving optimum outcomes in their recovery. Through Andrea’s dedicated support, Paul gained independence, confidence, knowledge and momentum to seek alternative opportunities in his professional life. A choice that would support his family and give him purpose once more to live a fulfilled life.
