In the PT world, there are many areas of specialization. While lots of therapists tend to gravitate toward Sports Medicine or Pediatrics, fewer therapists choose to specialize in Occupational Health PT (actually a sub-specialty of Orthopedics). But those who do specialize in treating industrial athletes can find that it’s especially rewarding.
If you have treated patients with work related injuries, no doubt you have encountered a patient who was not giving full effort. Did you write him off as a faker, someone trying to game the system? Or did you stop to think about why he might not be giving full effort?
When doing Functional Capacity Evaluations (FCE) some clinicians and FCE vendors pull a bit of a testing protocol from here and a bit of another from there, slap it together and call it a defensible, functional test. While that might get the job done, is it an accurate test? And what makes a test accurate anyway?
An FCE is not an easy assessment to perform. The evaluator is assessing complex movement patterns that occur over a matter of seconds. Each task is evaluated for a brief period and then the patient’s abilities must be extrapolated to the 8-hour day. The secret to making those extrapolations accurately and performing a defensible FCE is using a system that is well-designed.
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How do I unravel the secrets and find an FCE that is well-designed and evidence-based?
Features to look for…
I can’t tell you how many times, when I’ve recommended a Functional Capacity Evaluation (FCE) or a Return-to-Work Physical Abilities Test, the question is raised:
When you see that patient with a work-related injury on your schedule, what is your initial reaction? Are you excited to help the patient get back on his/her feet and working again? Do you prepare for a battle of wills? Are you expecting exaggerated symptoms? Do you worry the patient will be reinjured when trying to return to work? 
You may be treating a few patients with work-related injuries but it’s not your focus or your main source of referrals. So, even though you’re frustrated with your treatment outcomes, you’re wondering if additional training in treating and managing these patients will really help.
Worker’s Compensation Myths
You’ve probably heard…
We hear these statements often, but that doesn’t mean they are true. These “rumors” can be dispelled with basic facts.
Collaborate with Other Professionals for Optimal Results
For instance, while it is true that there are multiple players involved management of the patient with a work-related injury, simply understanding the role of the workers’ compensation case manager, insurance adjuster and physician can make working with these individuals much easier. Knowing what information they need and how often they need it to ensure patient progress will help you build healthy and productive relationships that can lead to additional referrals.
Assessing and Dealing with Motivational Challenges
Many clinicians assume that patients with work-related injuries don’t want to get back to work, or that they won’t give a full effort during treatment. This is not always the case. It is not easy to support a family on 60% or 70% of your regular pay. Many patients can’t afford to be out of work. So, some of them can be more motivated than many of your non-work comp patients.
Of course, you may have some patients that are not motivated. We understand, nothing’s more frustrating than to be treating a patient who doesn’t seem to want to get better. It can become an unpleasant power struggle. Learning to approach the patient with appropriate boundaries and strategies so that you’re dealing directly, objectively and effectively with motivational issues can help to alleviate this frustration.
Focus on Work-Related Function
As a therapist, you are already well trained in treatment of musculoskeletal disorders of the neck, back and extremities as well as cumulative trauma syndromes to help improve movement, mobility, and strength. And when you address function with patients whose injuries occur outside the workplace, it’s often in the context of activities of daily living (ADLs). However, when treating patients with work-related injuries there should be an emphasis on work-related function.
Treatment should follow a regime designed to give them the function necessary to safely perform the tasks of their job. Requesting a job description or spending some time talking with your patient about his job duties will help guide the treatment plan. After the standard outpatient physical rehabilitation, a work conditioning program may be necessary. Work conditioning programs use both exercise and simulated work activities to help restore physical functions and progress the patient towards capability of performing duties for an eight-hour workday.
Becoming the Expert
Developing expertise in treating patients with work related injuries can change the outcome for the better – for both you and your patient. You’ll need to know:
Since most of this information is not covered in the typical entry-level coursework for your DPT, you’ll need to acquire this knowledge through continuing education. This education can shed new light on treating patients with work-related injuries, making the process both easier and more rewarding for therapist and patient.
The Role of Functional Capacity Evaluation (FCE)
Many clinicians think only of a lengthy 3 to 4-hour test when they hear the term FCE. And if a full FCE is ordered, that may certainly be the case. However, a well-designed Functional Capacity Evaluation can also be pared down to a brief 20 to 30-minute RTW screen. Using a RTW screen which provides objective information regarding the match between a patient’s work-related physical abilities and his/her job demand will help you and the physician feel more confident in return-to-work recommendations for your patients.
What about Return-to-Work Screens?
Have you ever disagreed with or worried about a return-to-work decision on one of your work comp patients but felt powerless to influence the decision? By performing a brief RTW screen as part of your discharge evaluation and comparing the results to the patient’s job demands, you’ll be able to clearly and objectively show whether return to work is appropriate. And you’ll have some direction for work conditioning if the additional treatment gets approved. If you include a consistency of effort test in the mix, you’ll also be providing some extra support for your feelings about the patient’s level of effort – good or bad.
If you have put time and effort into growing the workers’ compensation referrals for your clinic, are you really providing the full scope of services that these patients need? Of course, they need outpatient therapy, but there are additional services
that will help these patients recover more effectively.
