Clinicians Blog

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…

• “Treating patients with work-related injuries is complicated. There are so many players involved.”
• “Work comp patients don’t give full effort and it’s difficult to confront them.”
• “Treatment of patients with work-related injuries is not really different from treating regular outpatients.”
• “When the outpatient treatment is done the doctor makes the return-to-work decision and I really don’t have any input.”

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:

• Your options for getting information regarding job requirements.
• Effective communication strategies for case managers and insurance adjustors.
• How to modify your outpatient treatment to include work-related functional testing.
• How to select test items and pass/fail criteria for RTW screens.
• The best approach to communicate RTW Test results to physicians, case managers and adjusters.
• How to transition from acute outpatient therapy to work conditioning.
• How to do a full Functional Capacity Evaluation (FCE), if needed.

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.  

Ever wonder if the work comp patient that you’re discharging is really capable of returning to work? Does he/she have the physical abilities to do the job?

Or have you ever felt the physician was holding the patient out of work too long or sending them back to early?  

Champion your industrial athletes!

The work comp system can be confusing and frustrating to deal with – if you don’t fully understand how it works. The stakeholders and processes are different than for patients insured with private insurance, Medicare or Medicaid.

After you wrap up your outpatient therapy, does the patient still have MD restrictions that prevent return to work? Maybe you’re at a loss for what to do next because the patient’s gained full range and normal strength.

Have you ever disagreed with a return to work decision on one of your workers' compensation patients but felt powerless to influence the decision? What if you had done a Return-to-Work (RTW) screen or mini-FCE as part of your standard discharge evaluation? Could that have made a difference?

Sink or Swim  Just as the Great Depression hit businesses hard, the “Great Pandemic” is shaping up to be a sink or swim period for many companies. Most physical therapy clinics have taken quite a hit during the COVID19 shutdowns and restrictions. As more and more clinics share their stories with us, we are seeing a trend emerge. About 20% of clinics are already swimming and bouncing back. Another 20% are sinking.  They have chosen to stick their head in the sand, waiting for the problem to go away. Still the majority, about 60% of clinics, are just stuck. They want to find a solution and get business back on track, but they just don’t know what to do. These clinics are treading water, barely keeping their heads up, looking for a lifeline.  Where does your clinic fall?

For clinicians, building relationships with the referral source is a vital part of practice. Therapists must first find out who the referral source is, whether it is a physician, claim adjuster, case manager, or third-party administrator. Once that is known, two major components play into building relationships:

• understanding the needs of the referral source
• developing a good line of communication.

When it comes to work comp, referrals won’t come beating down your door unless you know how to bring them in.  It is not difficult to bring them in if you know and understand the needs and interests of the referral source.  This can vary depending on the service.  Let’s focus on post injury services. 

How many hats are you wearing when it comes to treating work comp patients???

It’s true that you can’t be “just” a physical therapist  when working with the “industrial athlete”, but it doesn’t have to leave you crazy! Let’s explore some of the roles you’ll play and how to manage your personal cast of characters.

Do you ever feel like you are shooting in the dark when it comes to the return-to-work process for your workers' compensation patients?

Are your recommendations based more on guesswork than on objective data?

Or maybe you’ve disagreed with a return-to-work (RTW) decision on one of your workers' compensation patients but felt powerless to influence the decision?