In rehabilitation case management, our team do so much more than seek treatment for physical injuries. Our approach is holistic, providing support for many areas of a person’s life that have been affected by their accident or injury. This includes return to work support, an aspect of this case that was important to our injured client. Discover how Clinical Lead for the Desktop Team, Jane Rees, coordinated many different elements in this case to help her client gain independence to his life once more.
Case Summary
Case Manager: Jane Rees
Gender: Male
Injury Details: Right ankle ligament injury
Background Information
John* works as an HGV driver for a haulier company. One day, as he was walking to his cab across the yard to start his shift, he tripped on some uneven ground made by a pothole that had been intended to be fixed by the company for the last six months. In tripping, John fell over, twisting his ankle as he stumbled.
Immediately following his accident, he was taken to hospital by one of his colleagues, where he underwent a routine x-ray and advised of a ligament injury to his right ankle.
The hospital provided John with home exercises and stated he needed no further treatment.
After a couple of weeks of routinely undergoing the exercises provided by the hospital, John was observing no improvements to his ankle. In fact, John felt that his ankle was getting worse, but following a visit to his GP for advice, no onward referral was made for further treatment.
To add to John’s concerns, he’d taken time off work due to the pain in his ankle, making him incapable of driving an HGV lorry, unable to climb in and out of the cab, not able to help with the loading and unloading of the lorry, and unable to even make the commute to work thirty minutes from his home.
Without any further support from the NHS, and the mounting concerns surrounding his ability to ever drive again, that would affect both his livelihood and his independence, John sought the support from his insurance provider to assist with his rehabilitation and return to work.
At Referral
At the time that John was referred to Corporé for clinical rehabilitation support by the insurance provider, one month following his accident, and therefore 4 weeks out of work, the pain in his right ankle had got much worse, and he was experiencing chronic pain with intermittent sharp shooting pains in his right foot. He had very limited movement in his right ankle and didn’t feel stable when walking as the pain became unbearable.
From the Initial Needs Assessment (INA) conducted virtually by Jane Rees, the Rehabilitation Case Manager instructed to support the case, it was determined that when resting, the pain score in his ankle was a 2 out of 10. However, when he moved it at all, his pain score increased to 10 out of 10. To be able to return to his job that heavily relied upon movement from his right ankle, it was crucial that John was provided the right treatment, and also support to be able to regain control of his work and lifestyle.
Even though it was clear to Jane in her meetings with John that he was starting to feel very low and frustrated with the lack of progress being made, he scored 0 on both the GAD-7 anxiety disorder severity scale and the PHQ-9 depression severity scale, meaning there were no signs of psychological concern and therefore he did not require psychological treatment and support.
The areas where John did require support and treatment included:
- More in-depth treatment of his right ankle, which would not only help to alleviate pain but help him return to activities impacted by his injury, such as housework, driving and hobbies
- Walking and standing for prolonged periods of time
- Walking on uneven/sloping surfaces
- Helping him return to his pre-injury job as an HGV driver
- Help with being able to return to carrying and lifting- a requirement of his pre-injury job
Barriers to Recovery
- Deteriorating health due to injury worsening over time with no additional treatment, making John unable to move properly.
- Unable to return to work with current injury due to the physical demands of his job.
Rehabilitation Goals
With John’s involvement and consent, a rehabilitation plan was agreed based on the goal to facilitate and monitor timely and effective treatment to maximise recovery and return John to his pre-injury role as an HGV Driver within 3 months.
Our Involvement
Physical Treatment
Due to the lack of NHS referrals in place, Jane arranged, with the consent of the insurer, for John to attend private Physiotherapy sessions. This was the best option for John since a routine NHS referral can take 12-20 weeks to approve, and that sort of delay would have escalated John’s symptoms and kept him off work longer than he was able to afford.
Following an initial assessment, the Physiotherapist recommended 8 sessions for mobilisation, exercise and massage, whilst also providing home exercises to improve range of motion, build strength and balance.
Jane remained in contact with the Physiotherapist and John throughout these sessions to determine progress and ensure his rehabilitation needs were being met, reporting all information back to the insurer.
Medical Review
Jane also collaborated with John’s GP, gaining further information on his diagnosis, the prognosis, any restrictions to achieving recovery and his medical history.
This information helped Jane to better understand any potential barriers to recovery and personalise John’s rehabilitation plan to ensure the support provided would achieve the best possible outcomes for him and his needs.
Return to Work Support
To ensure a suitable return to work plan was put in place, Jane liaised with an Occupational Health specialist, HR and John’s manager at the company to create a phased return to work plan. This plan demonstrated to the company John’s intention and determination to return to his pre-injury role whilst ensuring a stepped approach was created to avoid damaging his ankle further.
Outcomes
Physical Outcomes
Even after 2 physiotherapy sessions and regular home exercises, John felt more positive and really pleased with the physiotherapy, noticing an improvement with his ankle. At this stage, he was still unable to return to his pre-injury role as he required more strength and stability for climbing in and out of the cab and lorry and for driving.
After the completed 8 sessions of physiotherapy, the Physiotherapist reported that John had recovered full strength and range of movement in his ankle and noted that his sleep had also improved.
They stated that John’s ankle had made a full recovery and he was able to return to work as long as he continued his home exercises.
Job Outcomes
Once the Physiotherapist had signed off on the sessions, an Occupational Health assessment was completed with the support of Jane to receive complete confirmation of John’s ability to work again.
Once this had been agreed, John was accepted back to work, driving only small journeys with the support of a colleague in the cab for three weeks.
This meant John was able to practice using his ankle again without overuse, switching places with his colleague once he felt his ankle got too tired.
Following these three weeks, Jane and the Occupational Health specialist reviewed John’s injury once again, reporting that there seemed to be no recurring symptoms or regression in his ankle and therefore John would be able to take longer drives, and start loading and unloading lorries once again, returning to his pre-injury duties.
Without Jane’s support and expertise to manage this case, John would have endured pain in his ankle and eventually would’ve had to give up his job as an HGV driver and seek less physical employment.
With our support and collaboration with specialists, we were able to alleviate John’s physical symptoms whilst providing him with the confidence and ability to resume his pre-injury role, empowering his independence to achieve an optimum return to function.
*Name changed for confidentiality
