Feasibility and Acceptability of an Evidence-Informed Virtual Intervention to Reduce Perceptions of Injustice Following Work Injury

There is increasing evidence that perceptions of injustice can contribute to adverse recovery outcomes in individuals with disabling musculoskeletal conditions. Individuals who obtain elevated scores on measures of perceived injustice also report more severe pain, reduced participation in important activities of daily living, prolonged work disability, and the persistence of symptoms of mental health problems such as depression and post-traumatic stress disorder. Recent reviews of the literature have concluded that perceptions of injustice are strong predictors of disability and depression in individuals with musculoskeletal conditions. The emerging pattern of findings suggests that perceived injustice triggers a cascade of cognitive (i.e., rumination), emotional (anger, depression) and behavioural (i.e., activity withdrawal, medication overuse) reactions that can impede recovery. The relation between perceived injustice and adverse recovery outcomes has been demonstrated in individuals with work-related low back pain, whiplash injuries, catastrophic injuries, traumatic head injuries, fibromyalgia, sickle cell disease , osteoarthritis, and rheumatoid arthritis.

Although there are currently no intervention programs that have been developed specifically to modify perceptions of injustice following work injury, there are indications that treatment-related reductions in perceptions of injustice are prospectively associated with more positive rehabilitation outcomes. For example, one study reported that reductions in perceptions of injustice predicted occupational re-engagement in work-disabled individuals participating in a 10-week behavioural activation program. In the latter study, reductions in perceived injustice predicted return to work even when controlling for treatment-related reductions in pain severity. In a separate study, treatment-related reductions in perceptions of injustice were found to prospectively predict reductions in depressive symptom severity in work-disabled individuals with Major Depressive Disorder. The research that has accumulated to date suggests that an intervention specifically designed to reduce perceptions of injustice could contribute to more positive recovery outcomes in individuals who have sustained debilitating musculoskeletal injuries.

The purpose of the proposed study is to test the feasibility and impact of a 4-week psychosocial intervention, delivered remotely, designed to reduce perceptions of injustice following occupational injury. The intervention consists of 4 30-minute virtual meetings with a psychologist trained in the delivery of the intervention protocol. The intervention protocol has been termed, 'Managing Post-Injury Challenges' (MPIC). The intervention protocol is manualized and combines several evidence-supported treatment elements including validation, motivational interviewing, acceptance and problem-solving. The intervention protocol will be delivered concurrently with physiotherapy treatment.

Participants

The study sample will consist of 75 individuals who are absent from work due to a musculoskeletal injury. All participants will be receiving primary care physical therapy from one of 4 clinics. Eligibility criteria will include 1) receiving or having applied for time-loss benefits from the WSIB for a musculoskeletal injury to the back or neck, 2) date of injury less than 6 weeks prior to enrolment in the study, 3) a score above risk threshold on a self-report measure of perceived injustice, and 4) working knowledge of French or English. Individuals who are currently receiving psychological treatment will not be considered for participation.