THE pt GROUP offers injured workers a chance to return to the job.

A physical injury can be life changing, requiring weeks of recovery from the initial incident, physical therapy, and, sometimes, long-term alteration of one’s lifestyle. Added to this is the very real fact that an injury could limit or preclude a person’s ability to work. But for injured workers in the Pittsburgh area, THE pt GROUPSM has been getting them back on their feet and back on the job for the past 28 years. The group, which specializes in outpatient physical therapy, has 20 locations and about 85 employees scattered throughout western Pennsylvania.

No matter the injury, workers follow the same path as those who may have been injured due to sports, accidents, or old age. “We have specific pathways designed to relieve pain, increase range of motion, mobilize joints, and improve strength,” says Dale Cordial, PT, founder, president, and CEO of THE pt GROUP.

Regardless of the injury type, the rehab program is individualized for each patient. The approach is aggressive, aimed at getting patients back to normal or, at the very least, their highest functional level in a few weeks. Patients typically see the therapists at THE pt GROUP two to three times per week, depending on the case, for 2 to 4 weeks. In addition, all the patients have home programs. “We give them what we call ‘table exercises,’ ” says Joe Chrillo, MSPT, a partner and manager of the group’s Murrysville and Apollo offices. “This consists of stretching, using therapy bands, and doing isometric exercises.”

Each office offers much the same type of rehab experience, including a range of exercise equipment, such as treadmills and weight machines. In addition, the PTs offer a full gamut of rehab services, including various mobilization techniques, manual techniques, and modalities (such as ice packs and electrical stimulation).

Once the normal round of physical therapy has ended, the patient may go back to work or move into a work-conditioning program. It all depends on the results of his or her functional capacity evaluation (FCE).

FCE

To perform an FCE, THE pt GROUP needs to see the patient’s job description. Based on that, the patient is put through a battery of physical tests that mimic what he or she does during the day—sitting, standing, lifting—and this data is then tabulated. From this data, it can be extrapolated whether or not the patient is capable of performing the requirements outlined in his or her job description. The test results are reported to the physician and employer as part of the evaluation process.

The test consists of materials handling, lifting, nonmaterials handling, behavioral testing, a validity profile—whether or not the test accurately represents the patient’s current capabilities—and a physical-capabilities sheet.

Materials handling includes lifting capabilities from the floor to above the patient’s head, carrying, pushing, and pulling. Nonmaterials handling includes the testing of hand function, sitting, standing, bending, reaching, climbing, squatting, kneeling, walking, crawling, balancing, and range of motion for the arm and leg movements.

Behavioral testing involves the Ransford Pain Drawing, the visual analog, the Borg Pain Scales, the Inappropriate Illness Questionnaire, and the Oswestry Questionnaire—pre-examination and postexamination. The Somatic Amplification Rating Scale and Waddell’s Testing are also used during the physical examination. These tests determine if a nonorganic or behavioral issue needs to be considered during testing.

The validity profile is used to determine the patient’s effort during the testing. This profile is combined with the behavioral tests to determine whether the test is valid. If the test is invalid, this typically means a behavioral aspect needs to be taken into account.

The test can be performed at either the job site or one of the group’s clinics. In the past, the clinical testing has led to some unusual FCE situations. “We’ve had several school cafeteria workers, so we would rent stoves and have them prepare food for us,” says Steve Teitel, PT, partner and manager of the Irwin and Jeannette/Harrison City offices. At one time, the group had a number of simulators to most accurately mimic the patient’s real-world job. For instance, there was a truck cab in which drivers could be observed and challenged by adding weight to the steering wheel and foot pedals. The group has also brought in hospital beds and has had injured health workers demonstrate how they make beds and transfer patients.

If the patient does not measure up to the job description, then he or she will be enrolled in a work-conditioning program and be restored to his or her highest functional level. “It’s almost like taking someone from crawling to running, [but] in a safe environment,” says Robert Brett, PT, partner and office manager of the McKeesport and Munhall offices.

Worker Specific

In the 1980s, THE pt GROUP established the Work Recovery Center. It was first designed to provide work hardening, but for a variety of reasons—primarily the trend toward earlier intervention in workers’ compensation cases—there was no longer a market for these programs.

Today, THE pt GROUP offers work conditioning to its worker clients. And unlike the center, which had a variety of specialized equipment and simulated work areas, the equipment used now is on the basic side. “We use boxes with weights in them,” Brett says. “It’s not fancy equipment, but we also incorporate general conditioning into the program.”

In addition, the PTs may visit the patient’s workplace and observe how he or she does his or her job. Their aim is to understand how the patient may have been injured so they can prevent another injury from occurring. “Basically, what we do is educate,” Teitel says.

That education entails correcting bad habits, such as poor body mechanics. The PTs also address behavioral aspects that may be affecting a patient’s recovery, which has as much to do with basic psychology as good salesmanship. “You have to do as much as possible to convince patients of the value of [return-to-work physical therapy], because a lot of people are skeptical,” Brett says.

Injuries know no professional boundaries; office workers are as apt to be clients as those on factory floors. “It can be heavy or light work that’s repetitive,” Cordial says. “It can range from the sedentary to heavy, such as steel manufacturing.”

Though workers’ compensation patients account for only about 25% of the practice—the majority of cases are orthopedic—THE pt GROUP pursues and services this stream of patients in a variety of ways.

Worker Community

In Pennsylvania, patients come to physical therapy practices via several avenues, including direct access, which has been available for only about a year and a half. But the majority of patients still come to THE pt GROUP the old-fashioned way—through referrals. Cordial says that the practice works with a network of about 1,100 physicians.

It gets many of its workers’ compensation patients through a network of 600 to 700 employer panels, on which THE pt GROUP offices are listed for common sprains and strains. The panel physicians evaluate the workers’ injuries and refer them to the appropriate caregivers. The practice has helped employers set up a number of panels, which include PTs and physicians.

Among the services that the group offers employers is help writing job descriptions to make sure that they accurately describe the job requirements. The group will also do work-site, light-duty, and ergonomic evaluations.

Under the workers’ compensation panel rules, workers have to go to physical therapy providers on the panel for up to 90 days; afterward, they are free to go to whomever they wish, according to Cordial.

Cordial describes the group as “very successful” at closing cases and returning clients to their preinjury job.

Success Rate

The aggressive, preventive approach to rehab is part of the reason why the group is seeing an extremely high success rate. However, some cases remain open because patients reach a plateau and cannot return to their preinjury job for many reasons.

If a patient stops progressing, then he or she has to be evaluated. “There’s no easy answer for that,” Teitel says. “From our standpoint, we try to get patients to their highest level.” This level may be full recovery, or it may be below that target.

But whether the patient is fully recovered from an employer standpoint, he or she will usually find other benefits—such as better physical conditioning. “It’s a plus on a plus,” Brett says. “They get a new interest in exercise … it’s a gain they don’t expect.”

But success for the group is measured not only in its number of closed cases, but also in its ability to attract an ongoing stream of referrals.

Secret of Success

Chrillo credits the offices’ business success to good communication with referral sources. “We pride ourselves on good communication with the doctors,” he says. This communication is typically in written reports that are promptly faxed to the physicians’ offices.

Teitel adds that a good rapport with patients is helpful as well. He also notes that the large number of referral sources helps ensure that the stream will not dry up.

Marketing is another key to the group’s success, Teitel says. For the worker-rehabilitation service, the group markets directly to businesses’ human resources staff. It also markets to physicians, many of whom are seeking help on where to send their workers’ compensation patients. The group also is able to assure employers and physicians that the injured worker will be held to a high standard. “We market the fact that we have objective measures to monitor whether the patient is giving his or her best effort, and that he or she is really trying to go back to work,” he says.

While worker rehabilitation is an important part of the group’s practice, a variety of other services are offered as well.

Other Services

The majority of cases that THE pt GROUP sees are orthopedic—including shoulder injuries, meniscus tears, strains, and sprains. According to Cordial, 80% to 85% of the patient base is orthopedic. The remaining patient breakdown includes women’s health issues (5% to 10%); vestibular rehab (5%); and worker rehab, which compose the balance. To care for these patients, the group accepts all forms of insurance, including Medicare and workers’ compensation.

In addition to the above programs, the group offers a variety of seminars primarily to help avoid workplace injuries. These seminars are geared to the prevention of orthopedic injuries, such as those to the back, neck, and upper extremities—and emphasize ergonomics, exercise principles, and fatigue-control techniques.

To effectively manage all of the individual offices, THE pt GROUP has centralized the administrative functions to permit the therapist to spend more time with patients. It oversees all of the marketing, purchasing, quality assurance, billing, and human resources, and collects data to monitor each office’s effectiveness.

Ultimately, THE pt GROUP’s success may be tied to the fundamental factor of providing progressive, individualized rehabilitation programs based on the necessary functional activities that the patient needs to perform.

C. A. Wolski is a contributing writer for Physical Therapy Products.