ßack to Work: Important Roles for Rehab Does return to work matter and how can rehab protessionals mai<e a ditference?
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ßack to Work: Important Roles for Rehab Does return to work matter and how can rehab protessionals mai<e a ditference?
Ginnie iHalling, PT, evaiuates storeroom ergonomics.
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The latest Liberty Mutual Workplace Safety Index data (2009) show that the number 1 top ranked injury category is still overexertion inju- ries (lifting/carrying,
pushing/pulling, holding, or throwing are specifically mentioned). This remains the costliest injury category by far at $13 billion. It is nearly double that of number
2. In addition, number 4, bodily reaction injuries (bending/reaching, sitting/standing, climbing, and slipping/tripping without falling) costs amount to $5.28 bulion.
These numbers can be reduced by improved injury pre- vention and return to work (RTW) processes. Managing the physical demands of work—lifting, car- rying, pushing,
pulling, bending, reaching, sitting, standing,
Januory/February 2013
climbing—is the root of preventing these injuries and successful return to work postinjury. Yet still today, they remain mainly unmeasured and only vaguely described
in most workplace docu- ments. Getting a job’s physical demands accurately measured and documented is critical to understanding what an injured worker a) was doing
when the injury occurred, b) needs to be able to do to return to work. This documentation is the communication link—the language—that links the medical and employer
side. Step One: Identifying and measuring work demands. If employers had functional/physical demands documentation on each of their jobs, they could take action and
reduce exposure to high physical demands. Rehab professionals are perhaps the most expert at helping employers develop these documents
Rehab Management
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in the form of job function descriptions. Therapists are also experts at identifying where high physical demands are associ- ated with overexertion and bodily reac-
tion injuries, since they rehabilitate these injuries routinely. Step Two: Use the job functions to create tests for workers to match them to jobs. While therapists
develop job descriptions, they can also develop match- ing tests. Using the testing at hire, with legal compliance, can reduce the injury rates for newly hired
employees. When injuries happen, the job function testing becomes the compass that guides the team forward in the return to work process. It provides the worker,
employer, and medical team with the information for efficient yet safe return to work.
THE RETURN TO WORK TEAM This team exists whether or not all members are aware of each other’s pres- ence. Each member can speed up or slow down the workers’
compensation process. Each, if armed with the appropriate information, can spur the return to work
process forward, especially if they know who all the team members are and what they have to offer. Employer and physician communica- tions in RTW: The medical
practitio- ner estimates work restrictions and the employer tries to fit that information to specific jobs. This is difficult because the languages of medical
restriction and work tasks are different. Also, because there is often subjectivity in this system, delays occur and trust may be lost between parties. However, with
use of functional work testing, specific to the job, the worker becomes involved and understands their physical progress compared to the job. The physician has more
information, as the work tasks have been identified and measured against. The employer has the benefit of receiving job-specific ability information, which allows
placement of the employee at work with the tasks that can be done safely, while limiting activ- ity in job tasks not able to be done yet. Recovery and retesting
continue until a full return to work.
Three options are available: • Recovery duty: a job or job tasks designed around using abilities that are present, while protecting the injured part when the injury
needs healing time. • Transitional duty: combining recov- ery duty with normal work assignments to begin the progression toward normal job duty. • Full duty: normal
work activities resume. This can happen even if medical care needs to continue for a short time. Note: When functional testing is reserved only for the end of a work
injury case, much work opportunity will have been missed. Employees: In the old system, they were somewhat on the outside, waiting for paperwork to be completed that
would assign restrictions or release to work. The employee knows the most about their job and appreciates a system that also takes into consideration the real job and
the worker’s ability. In addition, the RTW plan based on this job testing is appreci- ated by the employee as they are defined by abilities, not restrictions.
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32 January/February 2013 Rehab Managennent
Therapists: Therapists treat overexer- tion and bodily reaction injuries. Astute therapists use job testing and goals from the beginning, even in the acute stages.
This points both the treatment team and the worker toward a work function goal in addition to the normal motion or pain goals. Job-specific test findings are reported
to the physician for work release recommendations. Therapists also use the test results in their plan of care to facilitate RTW along with more traditional
rehabilitation. Therapists can identify temporary job modifications as well. If the therapist has developed the job description, they know the worksite. If not, they
can go to the worksite to do job analysis, which improves their testing and work rehab goals. Insurers/TPAs: Approving payment for the plan of care is critical and, if
not timely, can be costly in and of itself. If an objective job function description/test is not available, it should be requested and paid for by the insurer. Less
than $1,000 for this information can save tens of thousands of dollars in lost time or restricted duty costs. Case managers: Excellent, cost-effi- cient medical care
and expedient return to work are what this professional must facilitate. As the case manager strives to manage the plan of care, they strive to manage the plan of
work. Using therapists for objective testing of the work demands helps to plan and communicate with all parties for successful RTW.
TEAM MANAGEMENT EXAMPLE: MILD LUMBAR STRAIN FROM LIFTING A worker lifts a heavy object at work and experiences immediate spasm. He is clearly unable to work and is
sent by his supervisor to an occupational medi- cine clinic. The physician diagnoses a lumbar strain and refers the patient to physical therapy. The physician requests
a job function test as soon as feasible. The therapist evaluates and begins care. By the third visit, the employee is no longer in spasm. The job function test is
conducted and the therapist notes the employee can do three of the six work functions. The physician makes the RTW recommenda- tion for transitional duty (three
functions only). The therapist continues rehabili- tation and incorporates the remaining
functional activities into the plan of care. As the employee is able to do more work functions, the therapist updates the physician who then updates the work activity
level with the employer. Within 2 weeks, the patient has recovered mobility and strength, has significantly reduced discomfort, and has demonstrated full ability to do
all job functions. He returns to normal duty and sees the therapist and physician once more prior to discharge.
TEAM MANAGEMENT EXAMPLE: CRUSH INJURY OF THE HAND WITH MULTIPLE FRACTURES A worker’s hand is caught in a banding machine. Fractures require external fixation. A case
manager is assigned. The surgeon will allow only one-handed duty during the fracture healing time. The surgeon refers the patient to therapy. There is no physical
demands analysis available. The therapist discusses it with
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Functional Capacity Assessment: the most evidence based & functional
Job analysis & job function descriptions …onsite in industry
Post offer job function testing
EARLY return to work ** This is the ONLY program of its kind: employers want this
NEW: WORKING ONSITE IN INDUSTRY ….an in-industry experience
Webinars for continuing education: call or visit our website for the full list of webinars available to you: Ergonomics, aging worker, job analysis, onsite therapy,
difficult FCA, ADA updates and NEW this year: Transitional duty, patient handling job analysis, the NEW work conditioning, case management for chronic conditions,
disability laws
Receive our free email newsletter & more information: sisernhagen@dsiworksolutions.com
iv..-
Dennis & Sue Isernhagen
fVf \^ P: 218-625-1051 -F: 218-625-1052» www.dsiworksolutions.com fi iinliilil ^”^””^ -‘- Isernhagen, PT • sjsernhagen@dsjworksolutions.com 5 Dennis D. Isernhagen, PT
• disernhagen@dsiworksolutions.com
www,rehabpub.com January/February 2013 33
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the surgeon and the case manager. The case manager obtains approval from the insurer and employer for the analysis. The therapist then arranges with the employer to go
on-site to conduct the analysis and design job-specific testing. The team agrees that for the extent of the “recovery duty” phase, office support in the employee’s
department is the best approach. Two weeks postin- jury, the employee returns to work. After 10 weeks of recovery time, the surgeon allows the thera- pist to test the
patient’s functional ability with both hands. The therapist identifies six of nine functions the employee can do. RTW is split between the six regular job functions
and office support. The therapist incorporates the other functional activities into the treatment plan and on a weekly basis repeats the remain- ing functional tests.
The patient is progressed in work activity as more functions are demonstrated. At week 15, the patient is able to return to full duty. Therapy does continue an
additional 3 weeks to maximize gains in mobility and strength.
IMPACT OF REHAB’S JOB FOCUS Liberty Mutual notes that overall costs have been trend- ing downward; however, there remains significant room for improvement. Therapists
have an important role to play in improving the efficiency and reducing the cost of work injuries. We must simply be as willing to go to the workplace in the same way
we are willing to go to our patients’ homes and to the athletic fields. Developing objective testing adds work specificity and credibility for a safer yet expedient
return to work.
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Partnering with Industry
Job Analysis Pre-employment Screens Return-to-Work Screens
Ergonomics Functional Evaluations Impairment Ratings
Science’ www.ergoscience.com 205-879-6447
34 January/February 2013 Rehab Management
The statistics were developed from Liberty Mutual’s workers’ compensation claims plus data from the US Bureau of Labor Statistics and the National Academy of Social
Insurance, RM
Ginnie Hailing, PT, owns Work Therapeutics Inc in Bowling Green, Ky, and specializes in injury prevention and management. She consults with employers, insurers, case
managers, vocational rehabilitation specialists, attorneys, physicians, and individual workers. Reach her at ginnie@worktherapeutics.com
Susan J. Isernhagen, PT, is co-owner of DSI Work Solutions Inc in Duluth, Minn. She has developed advanced programs in functional testing, work injury management, and
prevention. She presents nationally on newest approaches to injury reduction and costs. She consults to medical providers and employers. Reach her at
sisernhagen@dsiworksolutions.com
Interactive Edition Extras:
• Designing and implementing work injury management systems
• Learn more about reducing the disabling effects of low back pain (LBP) in workers
• Explore Functional Capacity Evaluation’s role in determining a client’s work-related ability
Why it’s good to be eccentric
eccentric: adj. departing from the norm, not concentric, utiiizing negative resistance for better outcomes.
I Turn to inside front cover for fuii story.
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