Traditionally, return to work decisions after an injury or illness have been made by treating physicians. The question is: “What information do physicians typically use to make these decisions?”
My observations over the years have lead me to believe that, most of the time, physicians are depending on medical data or information – such as the patient’s diagnosis, expected surgical healing times, x-rays or other imaging, and/or observations of the patient’s movement and behaviors during the patient’s office. Sometimes, though, physicians will rely on the patient’s opinion by asking: "Do you feel like you’re ready to get back to work?"
The Missing Pieces
While all of this information is valuable, there are a couple of important pieces of missing information. For example, what are the physical requirements of the patient’s job? Most of the time, the physicians do not see job descriptions or a list of physical requirements that patients will have to perform once they return to work. If a patient with a back injury is returning to a sedentary job like computer programming, his challenges will be very different from one who is returning to a heavy job – for example, construction.
The other important missing information is an objective measure of the patients’ physical abilities as they relate to the job. If the job requires lifting 50 lbs., pushing 85 lbs., climbing occasionally, and stooping frequently, can the employee perform those tasks? Research shows that the medical information described above has little correlation to these work related functional abilities.
Patient self-reports about physical abilities are also notoriously inaccurate, influenced greatly by motivation. Patients who are eager to return are prone to overestimate their abilities, while those who want to receive workers’ compensation for a few more weeks are likely to underestimate their abilities. Clearly, the return to work decision is more accurate when based on objective data rather than subjective clinical inferences.
Return to Work Physical Abilities Testing
Increasingly, employers are relying upon return to work Physical Abilities Testing (PAT) to provide the necessary information. The ideal sequence of applying the return to work PAT is to conduct the test prior to the final physician visit. However, occasionally we run into this situation: The physician releases the patient to work before the test is conducted and the employee proceeds to fail the physical abilities test. Employees who are anxious to return to work are confused. The doctor has released them to go back to work, but the test says they don’t have the physical abilities to do the job. Then the question becomes, "Why are the two evaluations producing conflicting results?"
In general, physician recommendations regarding return to work are typically based on medical data and as such, provide a medical assessment of the resolution of the patient’s medical condition. The ErgoScience PAT is a functional assessment based on the employee’s demonstrated ability to perform work-related functions, using research-based algorithms to project performance to the 8-hour work day. To compare the two assessments is like comparing apples to oranges. An employee’s medical condition can be resolved, but due to being relatively inactive during the recuperation process, they may have become deconditioned. When this happens, the test will show that the employee’s physical abilities no longer match the job demands.
Employee Reconditioning Programs
One approach to assist employees in this situation in resuming work safely is to have them participate in a conditioning program and then re-test. Depending on the extent of the deconditioning, the reconditioning program can last between 2-4 weeks. We also recommend that employees participate in these programs under the supervision of a physician and/or physical therapist so that employees are not reinjured in the process of reconditioning. In most cases the program should address strength, flexibility, and cardiovascular conditioning and balance, all of which can be impacted with prolonged recovery.
In summary, both the treating physician and the PAT have vital roles to play in the return to work decision process. Making sure both roles are utilized appropriately is the key.