Waltham, MA – Sept. 18, 2025 — Psychosocial factors such as fear of movement, poor coping skills, and low mood play a strong role in the recovery from knee and shoulder injuries, according to a new study from the Workers Compensation Research Institute (WCRI). The study finds psychosocial risk factors are widespread among injured workers with knee and shoulder injuries and are associated with poorer functional recovery.

”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.

The study, Psychosocial Factors and Functional Outcomes Following Physical Therapy, addresses the following questions:

  • How prevalent are psychosocial risk factors in knee and shoulder patients receiving physical therapy, particularly among workers’ compensation cases?
  • Does the prevalence of these risk factors vary across different payor types (including private insurance) and patient groups?
  • Do injured workers with and without psychosocial risk factors recover differently? How large is any difference? And do these relationships differ between workers’ compensation and other payors?

The study examines a large sample of patients with knee and shoulder pain using data from Focus on Therapeutic Outcomes (FOTO), collected from 2021 to 2024. The dataset for the study includes approximately 65,000 episodes each of knee and shoulder physical therapy. Among these, more than 8,000 shoulder and 5,000 knee episodes were covered under workers’ compensation. The large sample enables a robust examination of differences in psychosocial risks and functional outcomes by payor type.

The report is free for WCRI members and can be purchased by nonmembers here. The study was authored by Vennela Thumula, Te-Chun Liu, and Randall D. Lea.

ABOUT WCRI

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Waltham, MA. Organized in 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.

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