Mental motivation is key

The general principle that rehabilitation can be effective is now widely accepted within the insurance community. One insurer reported recently that a review of around 50 randomly selected claims showed average cost savings of £120,000 for spinal injuries, £110,000 for back injuries and £95,000 for lower limb injuries where rehabilitation was applied.

Other insurers might take a less dramatically positive view, but the general proposition that rehabilitation works is now uncontroversial.

Without wishing to sound a negative note, however, I believe that much of the money insurers currently spend on rehabilitation services is effectively wasted.

A whole industry has grown up around case management and rehabilitation, and many people are making a good living from this new sector. But the value of the services offered by different providers varies widely. Some are excellent. Others contribute little or nothing.

If insurers wish to realise the kind of savings highlighted above, they need to understand the difference between, on the one hand, providers who apply a tick-box approach to reporting and a generalist approach to rehabilitation, and on the other, those who offer a more specialised and patient-focused approach.

Why does this distinction matter? Because attempting to apply a generic one-size-fits-all approach is more often than not simply a waste of time and money.

In my experience, the providers who add most value are those who are prepared to get their hands dirty. Applying the right specialist expertise for the injuries in question can transform the effectiveness of the rehabilitation process.

But so too can taking the time and trouble to understand the circumstances and the psychology of the individuals concerned.

There is a growing recognition in theory now of the strong psychosocial aspect to the recovery process following a life-changing accident.

But in practice there is still far too little account taken of the need to help motivate individuals to get well again. Providing them with effective encouragement to play as full and active a part in life as their injuries will allow requires a more sophisticated and tailored approach.

As head of the specialist spinal injuries team at Fletchers Solicitors, I have witnessed time and again how important a role personal motivation plays in the recovery process. But I also have some first-hand experience.

Seven years ago I was involved in a serious motorcycling accident that left me paralysed from the waist down. In many ways I was one of lucky ones.

My work as a solicitor is essentially sedentary, so I knew straightaway that there was no good reason why I should not ultimately return to work. For many, however, a serious injury can stop their previous professions dead in their tracks.

In the days after my accident I found myself on a ward with a bricklayer, a postman and a roofer. None of them could expect to go back to their former jobs. At a stroke they had been cut adrift from what was not only their livelihood but also a major source of personal identity and pride.

We all received excellent post-accident medical treatment and rehabilitation at a specialist spinal injuries unit at Stanmore hospital. But I was very much aware of how galvanising it was to have the attainable goal of getting back to a job I loved.

But personal motivation need not spring from something directly work-related. It could be a recreation or a hobby – anything that engages the injured person positively on an emotional level.

There is really no reason why something that was person’s passion pre-accident should not continue to be their passion post-accident – though perhaps in a somewhat modified form. For example, there are now well-established wheelchair versions of virtually any sport you can name. Many of the people who sustain serious spinal injuries are bikers, and for them the prospect of getting back on the road – perhaps on a specially adapted bike or trike – can prove a powerful source of motivation.

Any assistance seriously injured people can be given in finding a way back into a former pursuit will pay major dividends in re-engaging them with an active purposeful life and ultimately getting them back into gainful employment and self-sufficiency.

The key thing in encouraging rapid and successful rehabilitation is to reconnect people with a source of inspiration and empowerment. As I found in the early days of my injury, when the simple act of getting up in the morning involves several hours of awkwardness and discomfort you really need a bit of inspiration.

Timing is also crucial. Rehabilitation remains a discipline in its infancy, and there is a dearth of solid statistical data on which to base reliable conclusions as to what does and does not work. One provider recently concluded, from a sample of around 800 files, that cases referred within the first three months were settled in half the time taken

by those where referral took place after

18 months or later. But other similar reports are hard to find.

All I can say with confidence is that I know – from personal experience and from working with many injured individuals – that early intervention makes a crucial difference.

Limited window

I believe there is a limited window of opportunity for intervention. Exactly how long this window remains open depends on the nature of the injury and the psychology of the injured person, but in broad terms I would say that if someone has not found something they can focus on to give them a source of inspiration and invigoration within six to nine months of their injury, then the moment may already have passed.

Of course there can be such a thing as intervening too soon – particularly if the approach is inappropriate. If an insensitive case manager starts talking aggressively about getting someone back into the workplace when they are still struggling to re-establish their identity and sense of self worth, the effect can easily be counter-productive.

But where intervention is injury-appropriate and genuinely patient-focused, the sooner it begins the better.

The more switched-on insurers and rehabilitation providers do now seem to be moving towards a more sophisticated and less wasteful approach to rehabilitation. As they compile, and hopefully share, more statistics on how different rehabilitation and case management approaches translate into settlement figures and timescales, we should all be in a better position to ensure everyone gets value for money from rehabilitation.

In the meantime I would simply say let’s throw out the tick-boxes, discard the one-size-fits-all mentality, and concentrate on applying specialised resources where and when they will really make a difference.

Investing wisely in giving injured individuals the support and the motivation they need to lead constructive and purposeful lives can and does deliver significant and tangible returns for all concerned. IT

‘ Ed Fletcher is a partner at Fletchers Solicitors