A new study by the Workers Compensation Research Institute (WCRI) highlights how psychosocial risk factors, such as fear of movement, poor coping skills and low mood, can significantly impact recovery from knee and shoulder injuries, leading to slower recovery and higher claims costs.

The study, “Psychosocial Factors and Functional Outcomes Following Physical Therapy,” authored by Vennela Thumula, Te-Chun Liu, and Randall D. Lea, examines the prevalence of psychosocial risk factors in knee and shoulder patients receiving physical therapy, particularly among workers compensation cases, to evaluate the impact on different payor types and patient groups.

Widespread among the studied patients, the behavioral impact of such factors is associated with poorer functional recovery. This finding could impact how insurers handle these types of claims in the future, with carriers potentially integrating behavioral screening at the onset of treatment through provider incentivization and claims staff training.

“Behavioral health’s impact on recovery has been a hot topic in workers compensation recently. Psychosocial risk factors were front and center in discussions. Building on WCRI’s earlier findings of recovery from low back injuries, this new study extends the scope to include common musculoskeletal conditions,” said Sebastian Negrusa, WCRI’s vice president of research.

Data from a large sample of patients with knee and shoulder pain were collected between 2021 and 2024. The dataset for the study includes approximately 65,000 episodes of knee and shoulder physical therapy. More than 8,000 shoulder and 5,000 knee episodes were covered under workers compensation.

The findings showed nearly 46 percent of workers comp patients displayed poor coping skills, another third showed fear of re-injury, and 8 percent demonstrated depression.

Physical therapy improvement sank 40 percent when all three risk factors were present.

The psychosocial risk factors led to limited function in some patients: 5 percent of knee injury patients and 10 percent of shoulder injury patients.

The decline was similar for private patients with shoulder injuries (32 percent) but less for knee injuries (27 percent), “indicating a stronger association between psycho-social risk factors and functional outcomes in workers compensation knee cases,” the report noted.

Carriers can address these issues early on to curb the impact on functional recovery and limit indemnity periods and higher medical costs. Communication among all stakeholders, especially at the onset of a work injury, can help patients understand their injury, treatment, and recovery.

Readers can learn more or request their own copy: https://www.wcrinet.org/reports/psychosocial-factors-and-functional-outcomes-following-physical-therapy. The study is free for WCRI members and available to non-members for a nominal fee.