alsu presentation 10 14-10
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 Work OSU has been accommodating temporary restrictions for
over 10 years Formal 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 restrictions 95% of employees with restrictions accommodated
Applies for occupational and non-occupational injuries
Time limited –12 weeks Exceptions—case by case basis Showing 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=lFSCWEU1IUw&feature=related
Benefits of Transit ional Work
On-site Physical Therapy:Services Offered
On-site Physical Therapy Services Provided by an Ohio licensed physical therapist Direct access to services
Referral sources Physicians Disability Program Managers (case managers) Departments Patients Managed Care Organization
Services provided as a benefit to University employees no “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 WorkspaceFunctional Capacity EvaluationReturn to Work Progression
Acute Injury ManagementEvaluation and
treatment of injured employees
occ. and non-occ.Performed at
jobsiteFunctionally driven
Job AnalysisReview PD, discuss job demands with
employees, supervisorsReview DOT classification/job specsDetermine initial list of essential and marginal
functionsShadow employee to determine physical
demands assoc. with each EFObjective measurements (weights, distances,
frequencies, etc.)Review findings with supervisor/department Generate formal report
Ergonomic Assessment Collect objective information re:
a specific employee, specific job tasks, employee’s workspace
Identify potential risk factors for MSD’s awkward positions, excessive force, excessive
repetition, sustained positions, contact forces, etc. Provide recommendation for improvement to
appropriate parties employee, department, physician, ADA coordinator
Functional Capacity Evaluation An objective measurement of a
person’s ability to perform work
Bridges gap between medical and functional
Purposes Determine if symptomatic
individuals can RTW in any capacity
Determine entry point to WC or WH
Consistency of effort
Job Progression/Transit ional Work Have a starting point—initial restrictions Have a goal—full duty (based on job demands, not
necessarily no restriction) Identify job tasks that can be: Performed with current restrictions That can be performed with supervision That can be “therapeutic”
Outline graded job task/activity progression Provide coaching/education Identify possible job modifications Adjust 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 area Low back injury 1.5 years ago
Restrictions standing/walking to occasional level, no bending/twisting/squatting, max lift 20 lbs.
Job analysis performed FCE performed
Case example #1 (con’t):
FCE results demonstrated employee’s ability exceeded level of restriction. Job match to 90% of job demands
Recommendations: Adjust restrictions to reflect capabilities Gradual return to work with on-site PT Adjustable work surface for documentation Work 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 functions Provide direct patient care services within room Safely transfer/reposition patients Transferring patients on carts/wheelchairs
Referred to job developer Assisted with:
Resume development Online 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 Magnif ication
“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 Magnif ication: InterventionsDocument!!!!!
Discrepancies between self-report, musculoskeletal evaluation and functional performance Use of self-report measures
Unannounced visit
Be Prepared Obtain as much information as possible prior to visit
Medical, job information, etc.
Performance IssuesOften see disciplinary/performance issues
wrapped in injury claimsEx. Employee facing 3rd disciplinary action injures
herself 2 days prior to hearingTreat 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.
References� 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.
9 Mittenberg W, Patton C, Canyock EM, Condit DC. Base rates of malingering and symptom exaggeration. J Clin Exp Neuropsychol. 2002:24:1094-1102.