Physical therapists visiting and treating workers on-site is proving to be both profitable and effective.

It’s 5:30 AM, and I’m driving to a local delivery hub. I’m still a bit sleepy. Once I hear the conveyor belt noise, I’ll wake up. My job this morning is to watch the employees who sort packages into different conveyor belts based on Zip codes. The people I work with are no strangers to physical therapy. All of the people I see this morning have had significant work-related injuries that were very costly, but many of them have never worked with a physical therapist on their job site. It’s one thing to educate a patient on body mechanics; it’s another to see them in action.

If you have never treated a patient outside of the PT clinic, you probably have a lot of questions. Why is this necessary? Does the employee benefit from this program? Is the program cost-worthy? As a therapist working on the job site, my questions are a bit different. Has the injured employee had training in safety and body mechanics? Is there carryover to the job site? Does this employee have the endurance to continue to use the proper body mechanics throughout the shift? Does he still follow the home exercise program given to him by his therapist?

As therapists working in the clinic, we may have difficulty progressing a patient with a work-related injury. A job description may or may not be available. The injured worker may have difficulty articulating the essential functions of his job. We feel as if we have hit a wall. We get so locked into the clinic setting that we forget about the real world. We work on strength, AROM, and proprioception. How do we know if any of the training has carried over into the patient’s work environment?

We can assume and guesstimate; however, being on the job site will help the employee be confident he can overcome any obstacle he may encounter on the job. If the treating therapist chooses to venture outside the clinic for the purpose of progressing the injured worker back to a more functional level, while increasing safety and decreasing the threat of future work injuries, this therapist will have a plethora of options. These can include job-site assessment, development of a job description, observation of body mechanics, educational classes, and advancement of home exercise programs.

Ergonomic Assessment

This entails the physical therapist going into the work environment to look at the arrangement of a specific job with a specific employee. Initially, the therapist will observe the job and the surrounding environment. Following this assessment, the therapist can suggest adjustments to make the workstation less physically demanding for the employee using this station. If the workstation is not set up for optimal ergonomic efficiency, the injured worker may return to an environment in which he is more at risk for injury or reinjury.

A perfect example is a secretarial type of position. Carpal tunnel syndrome (CTS) may come to mind when mentioning a clerical job. Proper ergonomic setup can have an enormous impact in reducing the incidences of this diagnosis. In addition to CTS, we can also prevent postural imbalances, sprains, strains, and tendinitis with similar ergonomic modification. Ergonomic assessment is not merely limited to deskwork. The same principles can be applied when assessing a warehouse environment, driving a truck, or working in a checkout line.

Physical Capabilities Screening

This begins with the analysis of a specific job such as a loader, a driver, or an emergency medical technician, and it is taken a step further. The essential functions of a job are broken into measurable components, and a job description can be formulated. For example, a warehouse worker may have to unload pallets from the floor to overhead shelving. This individual may also need to push and pull a handcart loaded with packages.

First, take your measurements. Measure the distance the individual lifts the packages, the minimum and maximum weight of the packages, and the force generated to move the hand cart with a full load. From this, you can begin to develop a job description or a physical capabilities screen. In addition, you will want to break these tasks down into occasional, frequent, or constant classifications. By establishing these parameters, you help the company find the right job for each employee they hire. If a potential employee cannot perform a specific component within the screen, the employer might modify the job to make sure the employee will not be placed in a suboptimal work environment. However, if the job cannot be modified, this individual typically will not be hired for the job for which he was screened, but may be better suited for a different job within the same company.

Job Site Observation

On-site examination is a wonderful way to have a single physical therapy session on the job site. This option is best suited to the injured worker who is on modified duty and is fearful of returning to regular-duty activities. The injured worker should have achieved all or almost all of his physical therapy goals, and he is just anxious about regular duty activity. Most of the time, the employee is excited to show his therapist what activities he has to do while at work. Going on-site with the injured worker can be a wonderful confidence booster and is less expensive than another 2–3 weeks of physical therapy in the clinic. 

Back Education Classes

During the past several years, the Occupational Health and Safety Administration has shown an increase in back injures in specific occupations, including nurses and certified nursing assistants. Considering the short supply of nursing staff, and the increasing demands of the aging and dependent patient populations, it is not difficult to imagine that people working in direct patient care jobs have an elevated level of risk for back injuries.

One option to decrease workplace back injuries is to ensure the staff is properly trained to safely perform activities of daily living with their clients, such as transfers, bed mobility, dressing, and toileting. Initially, this training should be basic enough to address different health care settings. When required, the training can be tailored to the specific employee’s work environment.

Home Exercise Programs

Some employees may have experienced an injury several years ago that impacted their work capacity. At that time, they may have gone through a formal rehabilitation program and were instructed in a home-exercise program (HEP) for maintenance of their condition. Now, a few years down the road, they would like to progress their HEP, but do not know how to safely advance their program. These individuals may have an injury, such as spondylolisthesis, in which certain movements are contraindicated. Their bodies may have accommodated to the old exercises. They no longer feel challenged by them. Who better than a trained PT to safely advance their HEP? 

You are probably wondering what the response is from the employer and the employees. Overall, companies respond well to having a physical therapist in the work environment. Many employers understand the cost of an on-site visit is about as much as a PT session in the clinic, and the carryover into the work environment is much greater. Many company supervisors enjoy learning more about the human body. They want to know why it is more efficient and safer to lift in certain positions rather than others. These employers are motivated to invest in their employee’s health the same way they do in their 401(k).

Employees are also happy with the program. They are often nervous about being observed. However, once they understand that the physical therapist is with them to help make their job easier and improve their safety, many become more open to suggestions. Oftentimes, the employee is under the impression that he is bad or he is in trouble, which is never the case. These individuals may just need a little help with safety or their lifting techniques, or maybe a few workstation modifications. These few suggestions and teaching opportunities can ward off an excess of aches, pains, and compensation claims.

The big question: Does it work? In addition to decreasing compensation claims, cost per claim, and case duration, the company has someone it can call on when an ergonomic issue arises. With increased familiarity, the workers begin to feel comfortable asking questions about how to better perform their job. They ask how to be safer in the work environment, and which exercises are best for them when considering their prior injuries and the type of work that they do. A trusting relationship begins to build where the therapist can act as a mentor to an injured worker, a division of workers, or even an entire hub of employees.

This is not a perfect system. Frequently, the physical therapist is faced with challenges, such as disgruntled employees, unions, case workers, doctors, and reluctant employers. The best course of action is to educate employers regarding the benefits and cost-effectiveness of our services. We must continue to pursue whatever treatment will most benefit our patients. Furthermore, we must educate the public about the importance of our role in the workplace. Once we change the perception of our role from that of merely a clinic provider of care to one that is more integrated into the workplace, we will see an improved ability to close our complicated cases and minimize reinjury.

The key to making an impact in the recovery of the injured worker is a genuine interest in the employee. Let the people you are working with know you are there to help them overcome the obstacles they encounter, not just in your physical therapy clinic but also in their work environments. You are there to refine or issue a HEP, which will target their weakness and improve their ability to function on the job and at home. Once you have the key, you can unlock the door to injury prevention and maximize recovery.

Christine Thomas Dunham, DPT, is an on-site physical therapy specialist practicing out of Concentra Medical Centers in Pittsburgh. She can be contacted at cetpt@aol.com.