By Eric Edelman, PT
Each year, one in 100 workers in this country suffers a work-related injury or illness that is severe enough to result in at least one missed day of work. These injuries and illnesses affect the employee, their families, the place of business, and society in general. Physical therapy can help explore the worker-job-environment relationship and facilitate the return to work, or determine if reasonable accommodations can provide the needed support to resume work. The individual can receive physical therapy in the acute, subacute, or chronic phase of the healing process. To explore a working model of this process, this article examines the Work Rehabilitation Program at Peak Physical Therapy & Sports Performance, Norwell, Mass.
The program developed at this practice focuses on improving function and ability to return to work through therapeutic activities and work-simulated tasks. Most of the work-related injuries seen by therapists at the practice are back problems—just as common among workers who sit at a desk all day as those who perform more physical tasks.
Initially, a 60-minute evaluation is conducted to determine the primary cause of pain. An assessment is made of the spine, associated muscles and other joints, areas of weakness and lack of flexibility, as well as asymmetries that may have led to the injury in the first place. Once the primary cause of injury is discovered, therapists can properly treat the condition and come to full resolution. The plan of care addresses mobility and flexibility, strength, cardiovascular and muscular endurance, safety, ergonomics and body mechanics, injury prevention, home exercise programs, and tolerance to work requirements.
The following companies offer products and services that can be helpful for industrial rehabilitation and work injury assessment:
DSI Work Solutions Inc
WorkWell Prevention & Care
Prevention in Action
Often, poor ergonomics is the direct cause of workplace injury. As such, therapists at the practice provide patients with fundamental principles of proper desk ergonomics, with attention on body posture while seated; proper spacing for legs, knees, and thighs; and the appropriate distance between the body and monitor.
If the injured party does not work primarily at a desk, that individual is educated about proper lifting and carrying techniques, always geared toward the most appropriate approach for their specific job duties.
Educating and training the employee to use safe and proper posture and body mechanics for various work-related tasks to avoid re-injury is an important aspect of a comprehensive program. Among practices that offer work rehabilitation programs, there are those that visit client businesses to assess surroundings, layout of equipment, etc, and recommend ways to prevent injury or re-injury. Such practices also maintain direct communication with the referring medical doctor, as well as the employer, to ensure a smooth transition back to work and help with recommendations about modified duty as needed.
In terms of equipment used during the rehabilitation process, therapists at Peak Physical Therapy & Sports Performance typically employ a mix of basic apparatus, including ladders, stairs, hand trucks, crates, push/pull sleds, shelving, free weights, and barbells. The practice primarily uses a variety of products, including lift boxes, weight and push/pull sleds, and hand gauges from Bailey Manufacturing, Lodi, Ohio. Over the years, we have found the wide range of highly durable equipment offered by Bailey to be first-rate; also, the price point is comparable to other manufacturers/distributors of physical therapy and sports medicine products.
While the equipment used may vary from patient to patient, the goal for all is the same—to help maximize the employee’s functional capacity to safely, efficiently, and thoroughly complete their job requirements. Therapists also strive to educate and train the employee to use safe and proper posture and body mechanics for various work-related tasks to avoid re-injury.
Injury and the Modern Workforce
Since back injury represents many of the work-related problems seen at our clinics, we routinely make patients aware of several eye-opening statistics that likely have contributed to their situation. Chief among them is the fact that people look at their phones 150 times a day, on average; bend improperly 2,000 times a day; and use media, including computers and tablets, 11 to 15 hours per day, on average.
It’s important to underscore that during the initial stages of rehab, patients undergo very limited work-simulated activities due to lack of strength, range of motion, endurance, or other issues; this next level of rehabilitation is reserved for later in the rehab process as pain begins to subside. At that time, simulated work activities that resemble the injured patient’s actual job tasks are included in the therapy to help restore physical tolerance, productivity, and functionality. This is a gradual process and one that also includes educating the patient about proper body mechanics and injury-prevention techniques.
Time is a vital factor of a rehabilitation program. The sooner the injured party returns to work, the better—for many obvious reasons. Similarly, the earlier a rehabilitation program is started, the better; the most efficient outcome occurs when intervention immediately follows an injury. Early rehab will aid motion, thereby reducing pain and swelling. This proactive measure also offers a psychological assist, as it promotes a measure of normalcy following an abrupt interruption in routine.
While this practice does not directly address the emotional impact of work-related injuries, its physical therapists are acutely aware of the negative effects interruption to daily activities can bring—particularly when physical pain accompanies the disruption to normalcy. Therapists recognize that an injury can carry much weight, including the burden of worry regarding potential permanent damage.
The objective of this practice’s work rehab program is to help restore an employee’s functional ability to pre-injury levels. That said, there are times when the practice must refer a client to a work hardening program if a more intensive rehab environment than what we can provide is required. This occurs when an injured worker meets established short- and long-term goals but is still unable to return to work. These patients can typically benefit from a higher level of therapeutic intervention designed specifically with a primary goal of returning to work. Injured workers who benefit most from these programs are usually at least 30 days out from their injury and have a medium or higher physical demand category job.
Job descriptions and tasks continue to evolve as traditional manufacturing work gives up ground to employment based in technology and service industries. That does not mean, however, that work-related injuries will subside so much as that they will take on a different face. Fortunately for employers and workers, physical therapy practices continue to provide an affordable and effective resource to prevent workplace injury, and guide injured workers back to productivity under a safe and structured protocol. PTP
Eric Edelman, PT, is the owner of Peak Physical Therapy & Sports Performance with locations in Scituate, Norwell, Quincy, and Hanover, Mass. For more information, contact PTPEditor@medqor.com.
Getting Started with Industrial Rehab
Branching out into the work injury specialty can strengthen a practice’s bottom line by following a few key steps for success
Several providers of work injury-based programs were surveyed by Physical Therapy Products to learn how physical therapy clinics might launch their own industrial rehabilitation services, or expand existing programs. Included on this panel of experts are Virginia “Ginnie” Halling, PT, chief executive officer of DSI Work Solutions Inc, Bowling Green, Ky; Deborah E. Lechner, PT, MS, president of ErgoScience, Birmingham, Ala; and Kristen Cederlind, OTR/L, director, WorkWell Quality Provider Network, WorkWell Prevention & Care, Duluth, Minn.
What process should a clinic use to evaluate whether an industrial rehab program is a good fit?
Ginnie Halling: There are several things to consider. First, do they have a staff member who has interest and will champion the program? This is a critical first step. Second, they should think about competition: What will make their program unique, and how will they demonstrate success to customers and their referral community? Third, it is important to consider space and staff availability: How will they design their program to maximize success?
Deborah Lechner: Determine whether at least one clinician wants to develop deep expertise in work-related injury prevention. Without serious passion for this niche area, even the best-designed program will fail. Next, conduct an objective audit of the businesses in the area. Are there self-insured companies with physically demanding jobs and a strong safety culture that may want to provide additional prevention programs, such as pre-hire screens, job analysis, ergonomics, early intervention, or training? For a clinic to attract patients with work-related injuries for treatment, return-to-work screens, or work conditioning, it needs to be located within a reasonable geographic distance.
Kristen Cederlind: The clinic should be familiar with its referral base and local community industries to see whether there are potential opportunities to support expanded service offerings. Providers should have a genuine interest in helping injured workers return to work, and in helping employers address injury-prevention efforts. They should be effective communicators with both workers and employer stakeholders. The clinic should ensure there is sufficient staffing and clinic space to expand services.
How might a clinic get started with the right program or expand an existing program?
Ginnie Halling: Identify the needs of the referral community and business community. This requires communication with physicians (a good start is with the business/office manager), case managers, and employers (workers’ comp, safety, or human resource manager) to find out what they like about the services they receive in the community and what is missing.
Deborah Lechner: Start with what you know. If you are already treating patients with work-related injuries, the easiest first step is to get trained in performing a functional capacity evaluation that can be used for return-to-work screens as well. Performing a functional return-to-work screen as part of your discharge evaluation, toward the end of an episode of outpatient physical therapy, can provide the physician with objective data on which to make the return to work decision and set your clinic apart.
Kristen Cederlind: Identify which services your clinic would like to provide/add. If you currently treat injured workers, consider expanding into functional capacity evaluations. FCE knowledge and processes can be utilized with all patient populations. If you currently do not have any formal industrial rehab offerings, consider beginning with job analysis and/or ergonomics, both of which can be good launching points for expansion. Research program training and resource options for the services you would like to offer. Gain the education and training you need and practice newly learned skills in your own clinic, even if you do not immediately have employer clients to work with.
What approaches can be used to market an industrial rehab program, and gather referrals?
Ginnie Halling: This is a relationship business. It is important to get to know those referral sources in the community and provide them with above-and-beyond service. Follow up on existing patients who could benefit and offer assistance. Key staff should attend professional meetings and host continuing education events (at the rehab facility and/or at their meetings/facilities).
Deborah Lechner: Marketing for post-injury industrial rehabilitation services needs to be directed toward physicians who treat workers’ compensation patients, workers’ compensation case managers, and workers’ compensation insurance adjustors. Injury prevention services, in contrast, should be marketed directly to employers. In smaller companies, the chief executive officer or president may be the final decision-maker. In large companies, the vice president of risk management or the director of safety may spearhead a decision-making team that includes human resources executives, corporate legal counsel, safety, and risk management. Large companies with multiple locations will often want to work with a local clinic group who has connections to a nationwide provider of these services and who can roll out the programs to additional locations. Joining, participating, and presenting at meetings for self-insured employers and workers’ compensation associations is a good way to get exposure and establish yourself as the local clinical experts.
Kristen Cederlind: Examine existing treatment referral sources, and begin reaching out to those groups about services your clinic can offer to assist with injury prevention and management efforts. Connect with physician and case management referral sources to share your services. When working with injured workers in your clinic, build functional activities into your rehab process and document those elements concisely. Your documentation can help facilitate return-to-work processes through clear communication with physicians and case managers. Employers will be pleased with good therapeutic outcomes, and this can help direct more cases your way, not to mention give you the opportunity to approach employers about injury prevention services you can provide on-site. Be prepared to offer samples of job analysis or ergonomics reports. Advertise services on your website.
Are there special considerations for billing or documentation?
Ginnie Halling: Billing will likely be a mix of billing insurance and billing employers for services such as job analysis and post-offer testing. Prior authorization is critical for services such as Functional Capacity, work conditioning, and work hardening, and is important for relationship building as well. Evaluation and Treatment documentation needs to reflect work ability and progress toward return-to-work goals. Also, Job Analysis documentation needs to be timely (translation: early in a work injury case), and easily interpreted by all stakeholders—in particular, the employee and employer representatives making return-to-work decisions.
Deborah Lechner: When billing for post-injury services, be aware of the state’s workers’ compensation fee schedule and the fact that most post-injury services require prior approval from the insurance adjustor. Most adjustors and case managers require frequent communication regarding patient progress. Employers pay directly for injury prevention services, so prevention services are a great source of cash-based revenue.
Kristen Cederlind: Therapy treatment billing will be done according to pertinent coding requirements in your state. Treatment documentation must be concise and functionally oriented. When billing for cash-based or direct bill to employer services, set an hourly rate or job rate. Provide estimates and confirm with the payor source prior to performing services. Confirmation can occur in the form of a simple proposal.