Rehabilitation Beyond the Clinic On-site Physical Therapy:
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Rehabilitation Beyond the Clinic
On-site Physical Therapy:
Objectives:Describe the Transitional Work Program
at The Ohio State University.Define the role of the onsite physical
therapist, the services provided, and the method of service delivery.
Identify differences between typical clinic based therapy services and on-site therapy services.
Describe some of the unique barriers to recovery in patients with a work related injury.
Transitional Work:Keeping employees healthy and working
History of Transitional WorkOSU has been accommodating temporary
restrictions for over 10 yearsFormal policy est. 2007
Offers employees the opportunity to return to work with temporary restrictions even if their home department cannot accommodate them by finding other work within the University
RTW Hierarchy
Transitional Work OverviewAny employee with medical restriction is eligiblePhysicalMental health
Does NOT necessarily have to be BWC or disability claim
Transitional Work Overview
OSU Transitional Work Policy 2.45- we do accommodate temporary restrictions95% of employees with restrictions
accommodatedApplies for occupational and non-
occupational injuriesTime limited –12 weeks
Exceptions—case by case basisShowing progress toward full duty
Since full implementation in 2007, cost savings of over $7 million
Most Common Occupational Diagnoses
How it happened?http://www.youtube.com/watch#v=lFSCWE
U1IUw&feature=related
Benefits of Transitional Work
On-site Physical Therapy:Services Offered
On-site Physical Therapy ServicesProvided by an Ohio licensed physical
therapistDirect access to services
Referral sourcesPhysiciansDisability Program Managers (case managers)DepartmentsPatientsManaged Care Organization
Services provided as a benefit to University employeesno “billing”
Can be (and preferred to be ) performed concurrently with clinic based therapy
On-Site Physical Therapy
Physical Therapy Services provided to employees at work site
IncludesAcute Injury ManagementJob AnalysisErgonomic Assessments of Workspace
Functional Capacity EvaluationReturn to Work Progression
Acute Injury Management
Evaluation and treatment of injured employees
occ. and non-occ.
Performed at jobsite
Functionally driven
Job AnalysisReview PD, discuss job demands with employees, supervisors
Review DOT classification/job specsDetermine initial list of essential and marginal functions
Shadow employee to determine physical demands assoc. with each EFObjective measurements (weights, distances, frequencies, etc.)
Review findings with supervisor/department
Generate formal report
Ergonomic AssessmentCollect objective information re:
a specific employee, specific job tasks, employee’s workspace
Identify potential risk factors for MSD’sawkward positions, excessive force, excessive repetition, sustained positions, contact forces, etc.
Provide recommendation for improvement to appropriate partiesemployee, department, physician, ADA coordinator
Functional Capacity EvaluationAn objective
measurement of a person’s ability to perform work
Bridges gap between medical and functional
PurposesDetermine if
symptomatic individuals can RTW in any capacity
Determine entry point to WC or WH
Consistency of effort
Job Progression/Transitional Work
Have a starting point—initial restrictionsHave a goal—full duty (based on job
demands, not necessarily no restriction)Identify job tasks that can be:
Performed with current restrictionsThat can be performed with supervisionThat can be “therapeutic”
Outline graded job task/activity progression
Provide coaching/educationIdentify possible job modificationsAdjust as needed according to progress
On-Site PT and Clinic Based PT:Concurrent Services
Use job demands in goal setting
Assess and document functional abilities relevant to job demands
Communicate specific impairments that may be prohibiting progress in RTW
Be aware of TW timeline
Provide job assessments at (or close to) initial clinic visit
Communicate specific functional limitations that could be addressed in clinic therapy
Provide on-site visits for job coaching, workstation assessments
Clinic Based PT On-site PT
Case example #1:45 year old nurse in pre-operative areaLow back injury 1.5 years ago
Restrictions standing/walking to occasional level, no bending/twisting/squatting, max lift 20 lbs.
Job analysis performedFCE performed
Case example #1 (con’t):
FCE resultsdemonstrated employee’s ability exceeded
level of restriction.Job match to 90% of job demands
Recommendations:Adjust restrictions to reflect capabilitiesGradual return to work with on-site PT Adjustable work surface for documentationWork conditioning
Case example #1 (con’t):Results:
Able to RTW full duty in 8 weeks.
Case example #2: 51 year old female nurse
Severe diabetic neuropathy affecting right LE.
Permanent restrictions of no prolonged walking/standing, no lifting of patients, no pushing/pulling
Case example #2 (con’t)Job Analysis Performed
Unable to perform essential functionsProvide direct patient care services within roomSafely transfer/reposition patients Transferring patients on carts/wheelchairs
Referred to job developerAssisted with:
Resume developmentOnline application process Interviewing skills
Case example #2 (con’t)Result:
JD identified open position that had less physical requirements.No patient handling, ability to alternate between
sitting/standing as needed
Patients with Work Related Injuries:
Unique Barriers to Recovery
Symptom Magnification
“intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives, such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs”1
Probable prevalence in workers comp, personal injury, and disability claims estimated between 25-30%2
Symptom Magnification: InterventionsDocument!!!!!
Discrepancies between self-report, musculoskeletal evaluation and functional performanceUse of self-report measures
Unannounced visit
Be PreparedObtain as much information as
possible prior to visitMedical, job information, etc.
Performance IssuesOften see disciplinary/performance issues wrapped in injury claimsEx. Employee facing 3rd disciplinary action injures herself 2 days prior to hearing
Treat in good faithCommunicate with all parties (case manager, physicians, supervisors/departments, employees)
Set clear expectations for employee and department
Wrap-Up
Transitional work allows injured workers to return to work sooner, resulting in better patient outcomes, and decreased cost to the employer.
On-site PT helps to match the patients functional status to the job demands.
Contact InformationJamie Beadle, PT, [email protected]
References1. Fishbain DA, Cutler RB, Rosomoff HL,
Rosomoff RS. Chronic pain disability exaggeration/malingering and sub maximal effort research. Clin J Pain. 1999; 15:244-274.
2. Mittenberg W, Patton C, Canyock EM, Condit DC. Base rates of malingering and symptom exaggeration. J Clin Exp Neuropsychol. 2002:24:1094-1102.
Related Documents
