Treating Work-Related Injuries:  Is your focus too narrow?

[fa icon="calendar'] Jan 31, 2022 8:39:31 AM / by Erin Norton

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. 

Adding these services will also make your clinic a one-stop shop for referral sources:   

1) physicians with a large caseload of patients who are insured by workers’ compensation 

2) the case managers and insurance adjusters who help manage their medical care.   

3) A one-stop shop also positions you and your clinic as the work comp expert in your geographic footprint. 

So, what are Industrial Rehab Services that you can offer?   

Let’s explore the options. 

Physical/Occupational Therapy Acute Outpatient Care

As with other orthopedic outpatients, you will obviously be providing treatment for patients with work-related injuries or cumulative trauma disorders of the neck, back and extremities.   As with other orthopedic outpatients, you and the patient are tackling the obvious goals of increasing movement, mobility, and strength and decreasing pain.  But a unique point of focus for patients with work-related injuries is understanding the physical requirements of the job and working with the patient to make sure he/she can perform those physical requirements when they are released to return to work.   

The physical requirements of the job may not be something on which you’ve typically focused with patients whose injuries aren’t directly related to work.  So how do you get this information?  This dilemma offers a great opportunity to talk directly with case managers, adjustors or employers who can help you information about the physical requirements of the work.  And you’ll differentiate your services just by asking for job requirement information.   

Return-To-Work screens 

Once you have information on the physical requirements of the job, you’ll be in a much better position to evaluate whether your patient has the physical abilities to match his/her job requirements.  Return-to-work (RTW) screens are simple functional tests lasting from a half hour to an hour that objectively and accurately answer the all-important question: is this employee ready to get back to work?  

This shorter screening is cost-effective and more efficient than a full Functional Capacity Evaluation (FCE) and doesn’t require a separate physician referral. You can do it periodically throughout your inpatient treatment or it can be done as part of your routine discharge evaluation.   The return-to-work screen (also called fitness-for-duty testing) might be the most valuable part of your discharge assessment for the patient because it takes the guesswork out of the return-to-work process.  If you utilize a well-designed, validated FCE system, developing an objective RTW screen is just a matter of selecting the appropriate tasks from the FCE system.   

Work Conditioning/Work Simulation 

 Work conditioning is typically done after the patient has already completed a standard outpatient physical therapy program.  Having the patient go through a RTW screen may indicate that he/she cannot safely perform the basic tasks of his/her job.  Additional work-related exercises may be necessary to help the patient overcome functional deficits and achieve their full work potential.  The goal of work conditioning is to improve work capabilities by strengthening and conditioning.  This can be done with standard exercise equipment and/or with work simulated tasks (i.e. lifting, carrying, pushing, pulling, reaching, squatting, bending etc).   

When simulating work tasks, the closer the activity mimics the work -  with regard to weight, height, distance, repetitions, durations, rest breaks – the more realistic and meaningful it will be for the patient.  Some companies are willing to loan equipment for the purpose of performing work-related activities.  Many therapists use a combined approach – some work conditioning (exercises) plus some work simulation (activities).    

Work conditioning/simulation sessions may last from 2-6 hours as patients progress towards the goal of returning to full time work.  

Temporary Modified Duty or Transitional Duty Programs 

 When employees finish outpatient care but are deemed unable to return to work, whether due to MD restrictions or failing their RTW test, then what?  Are they sent home to wait until their strength and stamina returns?  If they continue with work conditioning, what do they do with the remaining hours of the day? 

Some of the most effective return to work programs will combine work conditioning/simulation with a temporary modified duty or transitional duty program.  These programs can involve returning temporarily to an alternative job or returning to the same job with job requirements altered – other workers assume responsibilities that exceed injured worker’s abilities; work hours may be shortened; or pace of work may be altered.   

Functional Capacity Evaluations (FCE) 

 A cornerstone of industrial rehabilitation, FCEs assess an individual's level of function or physical ability to do a specific job or activity in a more comprehensive way than a RTW screen. FCEs are typically used when the patient has been out of work for a longer period of time and more in-depth analysis of function is needed for return-to-work.  Alternatively, they can be used when return to a former job is not feasible and employers are exploring permanent alternative work.  In cases where the employee is engaged with a legal challenge, FCEs can be used in case resolution, vocational assessment, and disability determination.  This test often lasts 3-4 hours and covers a variety of work activities. Each task is evaluated for a brief period and then performance must be extrapolated to the 8-hour day.  It is important to choose a well-designed FCE system that will allow you to build other services around it.   

Features of a well-designed FCE include:  

  • Comprehensive (covers all work tasks defined by the US Dept of Labor) 
  • Standardized (procedures, verbal instructions, scoring) 
  • Flexible enough for job-specific testing (ability to select individual tasks) 
  • Feasible/Practical (test length/cost) 
  • Reliable (consistent) 
  • Valid (accurate)

With a customizable FCE system, you can use parts of the system for return-to-work screens, work conditioning and objectively determining consistency of effort. 

Full Suite of Services for the Industrial Athlete   

When a professional sports athlete gets injured, his/her rehab doesn’t end at the acute outpatient stage. The sports athlete goes on to sports-specific conditioning and may not be required to play “modified duty” for a while.  In your clinic does the industrial athlete get as much attention and as many treatment options as the sports athlete?  Given that industrial athletes fuel our economy and provide countless basic services upon which we rely, the same focus and delivery of the full suite of services is certainly warranted.  

If you need guidance in providing the full suite of services for patients with work-related injuries, contact ErgoScience to learn how we can help. 

Erin Norton

Written by Erin Norton

Erin help clinics find the best solution to fit their needs from functional capacity evaluations, to job analysis, pre-employment screens or impairment ratings.

----------------------