As we know, occupational or physical therapy is "outcome oriented," which means therapists help clients work toward achievable performance goals. Obviously, the nature of the therapy depends on the individual and his or her environment, and as therapists, we consider the whole person when developing a therapy plan, often collaborating with physicians and other health care professionals to ensure a comprehensive approach.

Relative to work-related injuries, some of the keys to working toward the ultimate goal of returning a patient to work following an injury are assessing the client and forming a professional perspective of a person's priorities and needs, and setting collaborative goals for intervention. This includes focusing on wellness and prevention as well as the recovery to a normal life.

The primary intervention to prevent workplace injuries is education, proper staffing, and proper body mechanics. Many injuries occur secondary to shortness of staff and/or improper body mechanics, whether a client is fatigued or just unable to perform the tasks with one person.

NECESSARY STEPS

The first question to answer is, is it always the goal to get the injured worker back to work as quickly as possible? "Not necessarily as quickly as possible, because if they're not ready to go, the potential for reinjury is there," says Maureen Ziegler, OTR/L, of the Rehabilitation Institute of Chicago's (RIC) Spine & Sports Rehab Center. "I really prefer that we get them back where they can return safely to work," she adds. Ultimately, Ziegler explains, she'd like to have a formal job description in hand from the employer stating what the essential functions the employees have to meet in order to be able to do their jobs effectively and safely. "If they meet those job requirements, based on how they perform—in a work conditioning or hardening program, for example—then we can say, yes, they can go back to work and do that job." RIC is a leader in patient care, advocacy, research, and educating health professionals in physical medicine and rehabilitation, with more than 30 locations in the Chicago and southern Illinois areas.

"Back injuries from lifting are the most common in terms of manual labor types of things we see," Ziegler says. "Then we see a lot of neck and shoulder pain from people who have been sitting at their desks too long."

Research shows, at least with low back injury, that the longer someone is off of work the higher the probability that he or she will not return to prior work function.

IMPAIRMENT VERSUS DISABILITY

When working with disability/workers' compensation systems, a distinction is usually made between impairment and disability. "Every client receives an initial evaluation which determines their clinical diagnosis," says Kristen Tompkins-Sepesky, MPT, THE pt GROUP Physical Therapy in Greensburg, Pa. "The difference between an impairment and disability is that a disability pertains to a client's ability to perform their occupational duties. This rating is typically performed by a physician, but can be performed by a therapist as well," she adds. Impairment relates particularly to the patient's physical loss to the body. "As an example, an accountant or a sedentary desk job client who lost a leg will have a permanent impairment relating to the fact that there was a loss to the body. However, they may not suffer any disability as related to their job," Tompkins-Sepesky explains.

WORK CONDITIONING OR HARDENING PROGRAM

"We have various workstations that people can do simulated job demands so that if they're trying to get back to a specific job, we can tailor their exercise routine more toward what they would have to do on the job," Ziegler says. "So let's say, if somebody has to dig ditches, there's a shoveling station where they can work on doing some shoveling, for example, or repetitive lifting, or something like that. It's a little bit more functionally based than a regular exercise routine where they're on the treadmill or lifting weights on a universal gym." Ziegler stresses that the clients are usually there every day anywhere from 4 to 8 hours because they are trying to get their endurance back up to be able to handle getting back to work.

"Early return-to-work programs—light duty or modified duty—are replacing the 'work hardening program,' " notes Brian R. Hagen, DPT, MS, OCS, FAAOMPT, clinical assistant professor, regional director and facility director, CRS/UPMC, and program administrator, UPMC Center for Sports Medicine, Pittsburgh. "When a work hardening program is properly designed, it is highly effective and valuable in return of the employee to work or identification of limitations," he says.

TRACKING PROGRESS

Progress is measured daily, but can vary on each individual case. A functional capacity evaluation (FCE) is done initially so there is an idea of what clients' baselines are. The exercise routine is based off of where they start from, and ideally, you would increase that every week.

Hagen has had referrals for a work hardening program for as short as three visits and as long as 6 weeks. The therapist evaluates the patient, determines the goals, and establishes the expected time frame for achievement. "We like to evaluate short-term goals on a weekly basis. If a patient is not achieving weekly goals, the program may be modified as needed. A consistent failure to reach goals over a 2- to 3-week period needs to be assessed for reasons why the person is not achieving goals as initially expected," he says. "Formal re-evaluations are done at 4 weeks typically but can be sooner if need be."

Sometimes functional capacity is often used in conjunction with an independent medical exam to determine whether or not employees can do a job or their original job, or at least go back to doing something.

PREVENTION

THE pt GROUP offers multiple forms of occupational solutions where they are able to go into specific work environments and educate the staff or make suggestions as to how their physical setup may be better for their employees ergonomically. "We also do specific lectures for specific injury prevention for employers that may have a high percentage of one or two types of injury. Included in this analysis and/or lecture is education on proper body mechanics to include lifting and bending," Tompkins-Sepensky notes.

To maintain a proper safe work environment, you need good body mechanics and ergonomics. "Although we educate on the ideal environment, not all work environments are easy to maintain those proper body mechanics in. We do offer suggestions as to how they may adapt those to their specific work environment for a specific task," Tomkins-Sepensky says. "Although education is ideal in all settings, we acknowledge that not all occupations are set up to perform in these situations. We can always offer suggestions for improving clients' work environments without altering from the primary goal for their specific jobs."

Nina Silberstein is a contributing writer for Physical Therapy Products. For more information, contact .