We believe better outcomes are achieved through targeted clinical approaches to care. In fact we know, the science is clear, matching clinical profiles to treatment pathways produces better health and cost results. 

All clinical guidelines recommend interventions that consider the whole person (i.e., biopsychosocial). We can no longer only assess and treat medical factors and expect to achieve good outcomes. Rather an integrated approach to care has been recommended by the most notable clinical guidelines that influence decision making in workers' compensation, disability and commercial health. 

Needless work disability is on the rise despite advances in medical care. Millions of workdays are lost every year and clinical resources are scarce to address this costly problem.  The opioid crisis also represents a major costly health problem. Many would argue that the health care system and compensation claims industry has inadvertently contributed to increased disability with these populations. Most health professionals have been trained in models of disability that suggest that disability arises from specific health or mental health impairments. These models have given rise to the view that effective management of disability requires the reduction or eradication of impairment. However research has demonstrated that traditional health care approaches are not effective for the 10-15% of claims that cost 80% of the spend.

Research has also demonstrated that early identification and strategies that target psychosocial risk factors for disability are effective for those “at risk” or for those with chronic disability.  Our assessments and interventions target the most robust psychosocial risk factors that impact work disability and pain-related opioid dependency such as Catastrophic Thinking, Perceived Injustice, Fear Avoidance and Disability Beliefs. 

Applying methods proven in research can be challenging in practice. However we have successfully implemented evidence-based programs throughout the U.S. Our specific assessments and interventions are listed in:

  • MTUS Guidelines

  • The Official Disability Guidelines

  • ACOEM Guidelines

*The biospsychosocial approach to assessment and treatment has robust support in guidelines such as ACOEM, ODG, Colorado, MTUS and many other guidelines. Please ask us for specific articles and additional references. Our team members, partners and collaborators have contributed to the scientific literature and published in peer-reviewed journals including the MTAP, PGAP, functional restoration, physical rehabilitation and more. 

Below are peer-reviewed articles that directly support our assessments and interventions.

Click here for Empatha programs in the guidelines

Click here for PGAP Evidence

PGAP/PDP Peer-Reviewed Publications

Sullivan, M.J.L., Timothy H. Wideman, Nathalie Gauthier, Pascal Thibault, Tamra Ellis and Heather Adams (2022). Risk-targeted behavioral activation for the management of work disability associated with comorbid pain and depression. BMC 2022 23:219.

Yamada, K., Adams, H., Ellis, T., Clark, R., Sully, C., Sullivan, M.J.L. (2020). Reductions in fatigue predict occupational re-engagement in individuals with workrelated musculoskeletal disorders. Journal of Occupational Rehabilitation, 30, 135–145.

Sullivan, M.J.L, Adams, H., Yamada, K., Kubota, Y., Ellis, T., Thibault, P. (2020). The relation between perceived injustice and symptom severity in individuals with major depression: A cross-lagged panel study. Journal of Affective Disorders, 274, 289–297.

Yamada, K., Adams, H., Ellis, T., Clark, R., Sully, C., Sullivan, M.J.L. (2020). Fatigue adds to the burden of disability associated with musculoskeletal pain. Journal of Occupational Rehabilitation, 30, 135–145. 

Sullivan, M.J.L., Adams, H., Ellis, T., Clark, R., Sully, C., Thibault, P. (2017). Treatment-related reductions in catastrophizing predict return to work in individuals with post-traumatic stress disorder. Journal of Biobehavioral Research, DOI: 10.1111/jabr.12087.

Adams, H., Thibault, P., Ellis, T., E. Moore, E., Sullivan, M.J.L. (2017). The relation between catastrophizing and occupational disability in individuals with major depression: Concurrent and prospective associations. Journal of Occupational Rehabilitation, 27, 405-412.

Sullivan, M.J.L., Adams, H., Ellis, T. (2013). A Psychosocial Risk-Targeted Intervention to Reduce Work Disability: Development, Evolution and Implementation Challenges. Psychological Injury and Law, 6: 250-257.

Sullivan, M.J.L., Adams, H., Ellis, T. Targeting Catastrophic Thinking to Promote Return to Work in Individuals with Fibromyalgia. Journal of Cognitive Psychotherapy. Volume 26, Number 2, 2012.

Summary of chronically work disabled for 2 ½ years  (1 year follow-up results):

Returned to Work

  • Low Back Pain 50%

  • Fibromyalgia 23%

Michael J.L. Sullivan, Heather Adams. Psychosocial Treatment Techniques to Augment the Impact of Physiotherapy Interventions for Low Back Pain. Physiother Can. 2010; 62:180 - 189.

Summary of Subacute work disabled clients (injured 4-12 wks) with Low Back Pain 1 year follow-up results:

Returned to Work

  • PGAP and Active PT 87%

  • Active PT only 62%

Treatment Reduction

  • PGAP and Active PT 79%

  • Active PT only 50%

Still using Medication

  • PGAP and Active PT 33%

  • Active PT only 62%

Adams, H., Ellis, T., Stanish, W.D., Sullivan, M.J.L. Psychosocial Factors Related to Return to Work  Following Rehabilitation of Whiplash Injuries. Journal of Occupational Rehabilitation, 17, 305 - 315, 2007.

Summary: 

Returned to work

  • Subacute (4-12 weeks) 80%

  • Early chronic (12 weeks- 6 months) 72%

  • Chronic (Greater than 6 months) 32%

Sullivan M.J.L., Adams, H., Rhodenizer T, Stanish W. A psychosocial risk factor targeted intervention for the prevention of chronic pain and disability following whiplash injury. Physical Therapy; 86: Pages 8-18 2006.

Summary (Chronic - greater than 6 months):

Returned to work

  • PGAP and Active PT 75%

  • Active PT 50%

Returned to work (Clients who had severe psychosocial profiles)

  • PGAP and Active PT 57%

  • Active PT 25%

*These data suggest that people who have severe psychosocial risk profiles are particularly resistant to treatment and that the probability of return to work can be significantly augmented by the addition of a psychosocial risk factor–targeted intervention.

Sullivan, M.J.L., Ward, L.C., Tripp, D., French, D., Adams, H., Stanish, W.D. Secondary prevention of work disability: community-based psychosocial intervention for musculoskeletal disorders. Journal of Occupational Rehabilitation: 15: Pages 377-392.

Summary Chronic (Average 7 months work disabled):

Returned to work

  • PDP and Active PT 63.7%

  • Program acceptance rate 89%

Significance: Outcomes of rehabilitation programs for work disability might be improved by incorporating interventions that specifically target catastrophic thinking. Community-based models of psychosocial intervention might represent a viable approach to the management of work disability associated with musculoskeletal disorders.

*Also see the Progressive Goal Attainment Program (PGAP®) in the Official Disability Guidelines

Multidimensional Task Ability Profile (MTAP) Peer-Reviewed Publications

  1. Matheson LN, Verna JL, Saunders-Enright D, Gherscovici E, Kemp B, Mayer JM. Development and validation of a method to screen for co-morbid depression by non-behavioral health practitioners treating musculoskeletal pain. Work, 2020;67(1):55-65.

  2. Verna JL, Matheson LN, Scherer S, Mayer JM. Validity of the Multidimensional Task Ability Profile. Journal of Occupational Rehabilitation, 2019;29(4):822-31.

  3. Verna JL, Matheson LN, Gobbi, Lane J, Bruga DS, Gherscovici E, Mayer JM. Are self-reported measures becoming more objective for determination of functional and work capacity? Sphera Medical Journal, 2015;July.

  4. Verna JL, Matheson LN, Gables S, Hause R, Mayer JM. Development and Reliability Testing of Spanish Language and English Language Versions of the Multidimensional Task Ability Profile. Journal Occupational Rehabilitation, 2013 Jun;23(2):220-7.

  5. Mooney V, Matheson LN, Verna JL, Leggett S, Dreisinger T, Mayer J. Performance-integrated self-report measurement of physical ability. The Spine Journal 10 (2010) 433–440.

  6. Matheson L, Mayer JM, Mooney V, Sarkin A, Dreisinger T, Verna J, Leggett S. A method to provide a more efficient and reliable measure of self-report physical work capacity for patients with spinal pain. Journal of Occupational Rehabilitation, 2008;18(1):46-57.

  7. Mayer JM, Mooney V, Matheson LN, Erasala GN, Verna JL, Udermann BE, Leggett S. Continuous low-level heat wrap therapy for the prevention and treatment of delayed onset muscle soreness of the low back muscles Archives of Physical Medicine and Rehabilitation, 2006;10.

  8. Mayer JM, Ralph L, Look M, Erasala GN, Verna JL, Matheson LN, Mooney V. Treating acute low back pain with continuous low-level heat wrap therapy and/or exercise: A randomized controlled trial. The Spine Journal 2005;5(4):395-403.

  9. Mayer JM, Mooney V, Matheson LN, Leggett S, Verna JL, Balourdas G, DeFilippo G. The reliability and validity of a new computerized pictorial activity and task sort. Journal of Occupational Rehabilitation, 2005;15(2):185-95.

  10. Matheson LN. History, design characteristics, and uses of the pictorial activity and task sorts. Journal of Occupational Rehabilitation, 2004;14(3):175-95.

*Also see the Multidimensional Task Ability Profile (MTAP) in the Fit for Duty, Pain, Low Back, functional improvement measures sections of the Official Disability Guidelines

Functional Restoration Programs Peer-Reviewed Publications

  1. Gatchel, RJ, Okifuji, A. Evidence-Based Scientific Data Documenting the Treatment and Cost-Effectiveness of Comprehensive Pain Programs for Chronic Nonmalignant Pain. The Journal of Pain, Vol 7, No 11 (November), 2006: pp 779-793. Summary: A comprehensive review was conducted of all studies in the scientific literature reporting treatment outcomes for patients with chronic pain. This review clearly revealed that CPPs offer the most efficacious and cost-effective treatment for persons with chronic pain, relative to a host of widely used conventional medical treatment.

  2. Gatchel, RJ; Bruga, DS. Multi- and Interdisciplinary Intervention for Injured Workers with Chronic Low Back Pain. SpineLine NASS. Volume VI Issue 5, 8-13. September/October 2005.

  3. Guzmán J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain. Cochrane Database Syst Rev. 2002;(1):CD000963

  4. Stanos S, Houle TT. Multidisciplinary and interdisciplinary management of chronic pain. Phys Med Rehabil Clin N Am. 2006 May;17(2):435-50, vii.

  5. Multidisciplinary and interdisciplinary pain management programs incorporate a biopsychosocial model in assessing and treating pain and result in pain reduction, improved quality of life, and psychosocial functioning.

  6. Flor H, Fydrich T, Turk DC. Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain. 1992 May;49(2):221-30.

  7. The beneficial effects of multidisciplinary treatment were not limited to improvements in pain, mood and interference but also extended to behavioral variables such as return to work or use of the health care system.

  8. Guzman J, Esmail R, Karjalainen K. et al. Multidisciplinary Rehabilitation for Chronic Low Back Pain: Systematic Review. BMJ 2001;322:1511-1516.

  9. Schonstein E, Kenny D, Keating J, Koes B, Herbert RD. Physical conditioning programs for workers with back and neck pain: a cochrane systematic review. Spine. 2003 Oct 1;28(19):E391-5

  10. Buchner M, Zahlten-Hinguranage A, Schiltenwolf M, Neubauer E. Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients. Scand J Rheumatol. 2006 Sep-Oct;35(5):363-7.

  11. Buchner M, Neubauer E, Zahlten-Hinguranage A, Schiltenwolf M. The influence of the grade of chronicity on the outcome of multidisciplinary therapy for chronic low back pain. Spine. 2007 Dec 15;32(26):3060-6.

  12. Gatchel RJ, Mayer TG, Theodore BR. The pain disability questionnaire: relationship to one-year functional and psychosocial rehabilitation outcomes. J Occup Rehabil. 2006 Mar;16(1):75-94.

*Also see Functional Restoration Programs and Chronic Pain Programs in the Official Disability Guidelines