On the Job

A clinical practical perspective for the treatment of the injured worker.

By Larry Briand MS, PT, ATC and Emily Monson, PT

You will quickly recognize that managing a worker’s compensation patient often requires a greater level of commitment to communication, as there are many parties involved in the care and recovery. Physicians, case managers, insurance adjusters, and employers are all included in the evolution and advancements in a plan of care, including physical therapy. A physical therapist specializes in movement and functional performance of daily living, and provides us successful outcomes for all types of injuries; whether caused by poor posture, body mechanics, repetitive overuse, or trauma. We have a terrific opportunity to impact work-related injuries and we must focus on all components of a work-recovery care plan. This includes details, such as the specific job demands, current functional limitations of our individual patients, related to his or her work duties, and recognizing all of the key players involved in his or her recovery.

To identify all variables in a worker’s compensation case, seek to gain a full understanding of the job demands. Creating and utilizing intake forms provides a thorough history incorporating job specific questions [(figure 1)] and allows us to gather information pertaining to a patient’s job demands, including lifting, pushing/pulling, reaching, carrying, and the weight and frequency to which the tasks must be performed. Complementing documentation can include job descriptions obtained from the patient’s employer. If this is not available, the Dictionary of Occupational Titles (DOT) can also provide more general information on the physical demand level of the particular job. A best strategy to gain accurate and detailed information on an injured worker’s job expectations is through an on-site visit to the workplace. This strategy allows the therapist to obtain a complete appreciation and understanding of the worker’s duties needed to fully rehabilitate that patient back to their prior level of function.

On-site visits allow us the most accurate means of visually assessing a worker to their job. There are many benefits to scheduling a site visit early in the plan of care, including being able to incorporate this information into the treatment plan. The information collected from your created job demands form at the evaluation can be an essential tool in alerting you in advance of what you should look for on your visit. Having the patient accompany you to the visit is a helpful way to gather additional knowledge by looking specifically at them in their work environment. Studying the patient’s work station, posture, work set up, ergonomic situation, physical job demands, and rate as to which they are needed to perform their job tasks, will allow you to better conclude functional goals, work simulation tasks, and determine potential modifications to prevent future injury.

Job site visits require time out of the clinic, so training another licensed professional, such as an athletic trainer, exercise physiologist, or a physical therapy assistant on how to properly complete this assessment can be of great value. The data collected can establish more functional tests as you create progress notes to update their physician and case manager as to how they are doing. With a more functional progress note, we are able to objectify our patient’s progress with comparable data specific to work movements, material handling requirements, and progress to specific movement needs. This is more specific than typical measures of range of motion, manual muscle testing, and pain. The combination of these efforts will allow you to best understand and simulate job tasks within the clinic environment and help you determine when a Work Conditioning/Work Hardening (WC/WH) program is appropriate for more dedicated attention to obtain full return to work at their previous level of function.

Job simulation is imperative in successfully returning the patient to work safely and efficiently. It also provides an opportunity to get the patient physically and psychologically ready for the work that had initially caused injury. A comparable example is the athlete that will return to a court sport. This individual must have confidence with running, jumping and cutting needs prior to any sport return. This will take place in a safe and controlled environment like your clinic. An “industrial athlete” is no different. Physical capabilities are important to accomplish, not only for modification updates and future release of work restrictions, but also for the psychological readiness that goes into work return. The opportunity to practice his or her job prior to return with tools or materials from the company is an excellent way to accomplish this. A more dedicated program that includes work simulation and work time is a work hardening and conditioning (WH/WC) program. Once the program is complete, a functionally-based discharge summary will measure the progress and/or any limitations. This information will assist and facilitate physicians more accurately and specifically determine work restrictions/modifications or disability ratings as they return our patient back into the work environment.

The more specific and function-based documentation that is generated will assist the patient, the physician, the case manager, employer and payer. Proactively offering in-depth communication with the case manager and payer will help them better understand the patient’s need for therapy, securing claim status. The employer will also benefit from proactive communication as it shows the level of involvement invested in the care of their employee. By showing the value of your services through the worker’s treatment, you may develop future opportunities for on-site work including educational seminars, stretching programs and ergonomic training. Becoming further involved with the employer may also lead to additional therapy opportunities to becoming the preferred provider of choice by the employees and their families.

Understanding and incorporating a patient’s specific job demands into the care plan so we may better return them to work in a safe and timely manner. Implementing the information early including the job demands questionnaire, a job description, and performing an on-site visit to give us a full appreciation of the worker’s tasks and assist us in creating a well-rounded plan of care. By incorporating all of these pieces into the worker’s compensation case, we have the ability to show the true value of our services, while returning the injured worker safely back into the workforce.

Emily Monson, PT, is an Impact editorial board member and owner of Clear Lake Physical Therapy and Rehab Specialists. She can be reached at emily@therapy1.net.

Larry Briand, MS, PT, ATC, is a PPS member and chief executive officer of Rehab Management Solutions in Sturtevant, Wisconsin. He can be reached at lbriand@rehabmgtsolutions.com.