Concussion is considered to be a relatively benign injury with an expected full recovery within 4 weeks; however, up to 20% of those diagnosed with a concussion will experience ongoing symptoms and related disability. These delayed or incomplete recoveries are associated with heightened emotional distress, loss of or impaired function, and an inability to return to preinjury work levels.

In 2017, WorkSafeBC had over 2700 claims accepted for concussion. Approximately 50% of workers with a concussion injury returned to work within 2 weeks; however, up to 35% experienced greater than 12 weeks of work disability after their injury.

While there are currently no gold-standard treatment protocols for concussion, evidence shows that early education, reassurance, and resumption of normal activities are associated with improved outcomes.

New early concussion management program

The Early Concussion Assessment and Treatment (ECAT) program is a new WorkSafeBC-sponsored health care program designed to support injured workers in BC. A network of 26 providers has been established to deliver the ECAT program across BC.

The Ontario Neurotrauma Foundation Guidelines for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms[1] was used as a primary resource. Additionally, the program was designed in collaboration with physical therapists, occupational therapists, neuropsychologists, and physicians with expertise in concussion management.

The ECAT program provides early assessment, education, reassurance, and intervention, when indicated, for injured workers with confirmed or suspected concussions. The ECAT program is delivered by a treatment team consisting of an occupational therapist and a physical therapist.

During the intake assessment, the occupational therapist will identify cognitive, psychosocial, and vocational barriers that interfere with daily activities, while the physical therapist will complete a musculoskeletal and vestibular assessment. Education, support, and reassurance are embedded in the assessment process, and the team develops a treatment plan in collaboration with the injured worker. The intake report, which includes the clinical findings and treatment plan, is sent to the injured worker’s primary care physician.

Treatment options can be customized to an injured worker’s unique clinical needs for up to 6 weeks, and may include:

Phone support for an injured worker who has remained job attached or has a plan in place for return to work.
Return-to-work services incorporating job site visits and return-to-work planning, implementation, and monitoring.
Structured rehabilitation with clinic-based treatment for an injured worker who has safety-sensitive jobs or barriers that must be addressed before returning to work. These services may also include community integration or group sessions.

The ECAT program is rooted in evidence-based practice and provides education, support, and reassurance to injured workers within weeks of sustaining their injury, with the goal of supporting recovery of function and a safe, sustainable return to work. The ECAT program also aims to identify injured workers who demonstrate signs of potential chronicity so that they can receive comprehensive assessment and treatment.

How to access the program for your patient

Primary care physicians play an important role in identifying and managing injured workers with concussions. We encourage collaboration and communication with the ECAT program to provide consistent messaging, guidance, and reassurance to help injured workers feel positive and safe in their recovery.

Participation in the ECAT program requires a referral from a WorkSafeBC officer. Physicians can support this process by identifying appropriate patients on the Physician’s Report (Form 8/11).

For further information about the ECAT program and other WorkSafeBC programs, please contact a WorkSafeBC medical advisor at any WorkSafeBC office.
—Luisa Johns, BSc, PT

This article is the opinion of WorkSafeBC and has not been peer reviewed by the BCMJ Editorial Board.

References

1. Ontario Neurotrauma Foundation. Guideline for concussion/mild traumatic brain injury and persistent symptoms: 3rd edition, for adults over 18 years of age. Accessed 28 February 2020. https://braininjuryguidelines.org/concussion [9].