injured at work

Occupational Epidemiology and Health Outcomes Program

Mission: To reduce the work disability from occupational injuries and illnesses.

Researchers in the Occupational Epidemiology and Health Outcomes Program focus on the use of workers’ compensation data to:

  • Analyze the predictors and burden of long-term work disability
  • Study the outcomes of surgeries, use of opioids, and other treatments for injured workers, particularly regarding reducing and preventing long-term work disability
  • Study occupational health best practices and innovative health care delivery models most likely to prevent long-term work disability

Research

Recent projects

  • Trends in opioid prescribing and the impact of clinical guidelines on opioid prescribing
  • Prediction and prevention of long-term disability in injured workers
  • Evaluation of occupational health interventions

Selected publications

Fulton-Kehoe D, Haight J, Elmore A, Sears JM, Wickizer T, Franklin GM. Association Between Pre-Injury Opioid Use and Opioid Use Patterns After a Work Injury. Am J Ind Med. 2025 Feb;68(2):132-139.

Elmore A, Fulton-Kehoe D, Arewasikporn A, Haight JR, Franklin GM. Associations between psychosocial factors and long-term opioid use among injured workers receiving early opioids. Am J Ind Med. 2024 Nov;67(11):1039-1049.

Padamsee TJ, Montgomery C, Kienzle S, Straughn JB, Elmore A, Fulton-Kehoe DL, Schulman B, Wickizer TM, Franklin GM. Impacts of State-Level Opioid Review Programs on Injured Workers and Their Health Care Providers: A Qualitative Study in Washington and Ohio. Milbank Q. 2024 Sep;102(3):605-631.

Sears JM, Haight JR, Fulton-Kehoe D, Wickizer TM, Mai J, Franklin GM. Changes in early high-risk opioid prescribing practices after policy interventions in Washington State. Health Serv Res. 2021 Feb;56(1):49-60.

Haight JR, Sears JM, Fulton-Kehoe D, Wickizer TM, Franklin GM. Early High-Risk Opioid Prescribing Practices and Long-Term Disability Among Injured Workers in Washington State, 2002 to 2013. J Occup Environ Med. 2020 Jul;62(7):538-0.

Fulton-Kehoe D, Von Korff M, Mai J, Weir V, Lofy KH, Sabel J, Tauben D, Franklin G. Surveillance of Opioid Prescribing as a Public Health Intervention: Washington State Bree Collaborative Opioid Metrics. J Public Health Manag Pract. 2020 May/Jun;26(3):206-213.

Sears JM, Fulton-Kehoe D, Schulman BA, Hogg-Johnson S, Franklin GM. Opioid Overdose Hospitalization Trajectories in States With and Without Opioid-Dosing Guidelines. Public Health Rep. 2019 Sep/Oct;134(5):567-576.

Franklin GM, Mercier M, Mai J, Tuman D, Fulton-Kehoe D, Wickizer T, Sears JM. Brief report: Population-based reversal of the adverse impact of opioids on disability in Washington State workers' compensation. Am J Ind Med. 2019 Feb;62(2):168-174.

Garg RK, Fulton-Kehoe D, Franklin GM. Patterns of Opioid Use and Risk of Opioid Overdose Death Among Medicaid Patients. Med Care. 2017 Jul;55(7):661-668.

Von Korff MR, Franklin G. Responding to America's Iatrogenic Epidemic of Prescription Opioid Addiction and Overdose. Med Care. 2016 May;54(5):426-9.

Fulton-Kehoe D, Sullivan MD, Turner JA, Garg RK, Bauer AM, Wickizer TM, Franklin GM. Opioid poisonings in Washington State Medicaid: trends, dosing, and guidelines. Med Care. 2015 Aug;53(8):679-85.

Franklin G, Sabel J, Jones CM, Mai J, Baumgartner C, Banta-Green CJ, Neven D, Tauben DJ. A comprehensive approach to address the prescription opioid epidemic in Washington State: milestones and lessons learned. Am J Public Health. 2015 Mar;105(3):463-9.

Spector JT, Turner JA, Fulton-Kehoe D, Franklin G. Pre-surgery disability compensation predicts long-term disability among workers with carpal tunnel syndrome. Am J Ind Med. 2012 Sep;55(9):816-32.

Fulton-Kehoe D, Stover BD, Turner JA, Sheppard L, Gluck JV, Wickizer TM, Franklin GM. Development of a brief questionnaire to predict long-term disability. J Occup Environ Med. 2008 Sep;50(9):1042-52.

Turner JA, Franklin G, Fulton-Kehoe D, Sheppard L, Stover B, Wu R, Gluck JV, Wickizer TM. ISSLS prize winner: early predictors of chronic work disability: a prospective, population-based study of workers with back injuries. Spine (Phila Pa 1976). 2008 Dec 1;33(25):2809-18.

Franklin GM, Stover BD, Turner JA, Fulton-Kehoe D, Wickizer TM; Disability Risk Identification Study Cohort. Early opioid prescription and subsequent disability among workers with back injuries: the Disability Risk Identification Study Cohort. Spine (Phila Pa 1976). 2008 Jan 15;33(2):199-204.

Sears JM, Wickizer TM, Franklin GM, Fulton-Kehoe D, Hannon PA, Harris JR, Graves JM, McGovern PM. Development and maturation of the occupational health services research field in the United States over the past 25 years: Challenges and opportunities for the future. Am J Ind Med. 2023 Nov;66(11):996-1008.

Le VT, Fulton-Kehoe D, Sears JM, Nkyekyer EW, Ehde DM, Young M, Franklin GM. Trends and Disparities in the Use of Telehealth Among Injured Workers During the COVID-19 Pandemic. J Occup Environ Med. 2022 Apr 1;64(4):e249-e256.

Wickizer TM, Franklin GM, Fulton-Kehoe D. Innovations in Occupational Health Care Delivery Can Prevent Entry into Permanent Disability: 8-Year Follow-up of the Washington State Centers for Occupational Health and Education. Med Care. 2018 Dec;56(12):1018-1023.

Wickizer TM, Franklin G, Fulton-Kehoe D, Gluck J, Mootz R, Smith-Weller T, Plaeger-Brockway R. Improving quality, preventing disability and reducing costs in workers' compensation healthcare: a population-based intervention study. Med Care. 2011 Dec;49(12):1105-11.

Graves JM, Fulton-Kehoe D, Jarvik JG, Franklin GM. Impact of an Advanced Imaging Utilization Review Program on Downstream Health Care Utilization and Costs for Low Back Pain. Med Care. 2018 Jun;56(6):520-528.

Juratli S, Franklin GM, Mirza SK, Wickizer TM, Fulton-Kehoe D. Lumbar fusion outcomes in Washington State workers' compensation. Spine (Phila Pa 1976). 2006 Nov 1;31(23):2715-23.

Franklin GM, Budenholzer BR. Implementing evidence-based health policy in Washington State. N Engl J Med. 2009 Oct 29;361(18):1722-5.

Functional Recovery Questionnaire

The Functional Recovery Questionnaire (FRQ) was developed based on data from a large prospective study of Washington State workers with work-related back injury claims (CDC/NIOSH grant 5R01 OH004069).1,2

  • Purpose: To identify, soon after a work-related injury, those injured workers at high risk of not being able to work one year later.
  • Assessment Areas:
    • Pain interference with activities- 1 question from the Graded Chronic Pain Scale3,4
    • Pain sites
    • Recovery expectation – 1 question from the Vermont Disability Prediction Questionnaire5
    • Fear avoidance – 1 question from the Fear Avoidance Beliefs Questionnaire6
  • Time required: Less than 5 minutes (6 questions)
  • Accuracy of the predictive model was validated using a 10-fold cross-validation procedure. More detail can be found in Fulton-Kehoe et al. (2008).1

Scoring

An at-risk injured worker is identified by the following responses to questions 1-3:

Question 1: “not working,”

Question 2: a response of 5 or higher, and

Question 3: 2 or more sites selected OR selecting just the Low Back with leg pain option.

The answers to questions 4-6 are not part of scoring. They capture information on availability of modified work, workers' recovery expectations, and workers' fear of worsening their condition with work activities, all of which have been shown to be associated with risk of developing chronic pain and disability.2 This information can help a provider target specific interventions for a worker who has particular risk factors.

Notice of Copyright

The FRQ copyright is held by the University of Washington. The copyright applies to the FRQ and all its derivatives in any language.

Current Use

The Washington State Department of Labor and Industries (lni.wa.gov) added completion of the FRQ as part of the standard work of Health Services Coordinators and as the 4th best practice within their Centers of Occupational Health and Education.

Approved Use by Others

You are welcome to download, copy and use the FRQ as long as the copyright notice remains intact on all copies and we are credited in any publication. Here is an example citation:

This FRQ is Copyright © 2008, 2025 University of Washington. All Rights Reserved. The use of this FRQ is covered by the conditions described at deohs.washington.edu/occepi and is being used with permission from the University of Washington.

What you may not do:

The FRQ may not be modified or translated into another language without express written consent of the copyright holder. Failure to comply may result in legal action. Contact us to obtain permission to modify or translate. You may not use the FRQ commercially or charge a fee.

  1. Fulton-Kehoe D, Stover B, Turner JA, Sheppard L, Gluck J, Wickizer T, Franklin GM. Development of a brief questionnaire to predict long-term disability. J Occup Environ Med 50:1042-1052, 2008.
  2. Turner JA, Franklin G, Fulton-Kehoe D, Sheppard L, Stover B, Wu R, Gluck JV, Wickizer TM. ISSLS prize winner: Early predictors of chronic work disability: A prospective, population-based study of workers with back injuries. Spine 33:2809-2818, 2008.
  3. Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain 50:133-149, 1992.
  4. Von Korff M. Epidemiological and survey methods: assessment of chronic pain. In: Turk DC, Melzack R, eds. Handbook of pain assessment. Second ed. New York: The Guilford Press; 2001:603-18.
  5. Hazard RG, Haugh LD, Reid S, Preble JB, MacDOnald L. Early prediction of chronic disability after occupational low back injury. Spine 21:945-951, 1996.
  6. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52:157–168, 1993.

Our team

Gary M. Franklin, MD, MPH

Director

Deborah Fulton-Kehoe, PhD, MPH

Senior Research Scientist

Andrea Elmore, MS

Research Coordinator

John Haight, PhD, MPH

Research Consultant

Rae Wu, MPH

Research Consultant

Laura Black

Program Operations Specialist

Contact information

Box 359116, Seattle, Washington USA 98195-8772

Email: occepi@uw.edu