concepts in work hardening
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8/3/2019 Concepts in Work Hardening
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Concepts inWork
Hardening
Dr. Shyam Krishnan K (MPT OHPT
& CBR)
Dr. Tapan S (MPT Geriatrics)
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Work hardening is a highly structured,
goal oriented, individualized treatment
program designed to maximize theperson's ability to return to work. Work
hardening programs are multidisciplinary
in nature with the capability of
addressing the functional, physical,behavioral, and vocational needs of the
person served.
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Work hardening provides a transition
between the initial injury management
and return to work, while addressing theissues of productivity, safety, physical
tolerance, and work behavior
Work hardening programs use real or
simulated work conditions in a relevant
work environment in conjunction with
physical conditioning tasks if necessary.
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The activities are used to progressivelyimprove
biomechanical, neuromuscular,
cardiovascular-metabolic,
behavioral,
attitudinal and
vocational functions of the personserved.
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The origins of work hardening are foundin the United States in the early 1900's.The program as part of Industrialrehabilitation began in response to the
large number of World War I disabledveterans.
In the 1940's the first ´work evaluationµprogram was established at theRochester Rehabilitation Center in NewYork
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´Work Hardeningµ was introduced as anew occupational rehabilitation
program model in 1976 . Developed atRancho Los Amigos in California, thismodel utilized functional capacityevaluation to identify the appropriate
level of physical challenge to bepresented to the injured worker ingraded work simulations and structuredphysical conditioning tasks
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Job demand analysis
Work conditioning
Functional conditioning
Functional restoration
Pain management programs
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Job demand analysis is an objective and
systemic procedure to identify the
demands of a particular jobx Physical
x Mobility requirements
x Sensory/Perceptual demands
x Vocational Demands
x Environmental conditions
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The Work and Functional ConditioningIndustry (NSW) (1998) defined ¶work conditioning programs· as ¶work related·,
physical rehabilitation with the goal of
restoring the client·s physical capacity and
function so s/he can be returned to,maintained at or upgraded at work
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These programs emphasis on the
physical conditioning of the worker using
exercise equipment and aerobicconditioning, with less use of work-
related tasks than work-hardeningµ.
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The Work and Functional Conditioning
Industry (NSW) (1998) defined functional
conditioning as ¶function related·, inwhich the objective was ¶to restore the
client·s physical capacity and maximize
function·.
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The methods employed were similar to
those employed in work conditioning
programs, especially through the use ofphysical rehabilitation, except that in this
case return to work was an indirect
rather than direct goal
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Functional restoration is defined as anyintervention aimed at restoring a
reasonable functional level for daily living. These programs are usually multidisciplinary
in staffing. There is a heavy emphasis onphysical rehabilitation through the use of
muscle training addressing coordination,trunk control, lumbar flexibility, aerobiccapacity, lifting capacity and sittingtolerance
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Pain management programs were primarilydeveloped in pain clinic and rehabilitation
settings with patients reporting untreatablechronic pain conditions .
Restoration of function has usually beenseen as a primary goal rather than pain
relief, although in most pain managementprograms withdrawal from unhelpfulmedication and improvement in moodhave also been common goals.
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physical therapists,
occupational therapists,
psychologists
vocational specialist
Stress management specialists
Nutritionists & registered dieticians
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Out of work >= 3 month
Special needs of the person
Compromised cardiovascular status
Faulty body mechanics & posture
Questionable feasibility for employment
Still experiencing pain, especially when
active Possible psychosocial dysfunction
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Decreased overall body
conditioning/weight gain
Poor physical/ muscular flexibility Complicated needs including
physiological & psychological deficits
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Job demand analysis
¾ Task Identification
¾ Frequency designation31012010618.jpg¾ Strength analysis31012010622.jpg
¾ Mobility requirements
¾ Sensory perceptual requirements
¾ Work environment
¾ Conditions of work
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History Medical status Systems review
Selected tests to measure«.. functional work capacity musculoskeletal status behavioral and attitudinal status as it relates
to the work injury vocational status cognitive/perceptual status
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Functional de-conditioning
Erosion of self-efficacy.
Abandonment of the occupational role.
Addiction to palliative measures
Development of psychological disability
Development of behavioral disability.
Mismatch between residual capacity
and job demands
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Occupational Role Development(Goal
development & work simulation)
Self-Efficacy Development(SerialFunctional Testing & progressive
functional Challenge)
Symptom NegotiationDevelopment(Work Pacing and Micro-
breaks, Tool or Job Modification ).
video.mp4
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Work simulation includes««
Relevant work environment
Work rules & hours
Work procedures
Work titles
Work tasks
EquipmentEasyGuide_06.wmv
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Flexibility, mobility, strength and aerobic
conditioning
¾ To improve postural adaptation, selectivestrengthening of body areas, workingthrough specific areas of deficits andsupport general improvement
¾ Preparation for job simulation
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Development of program goals andoutcomes in relationship to specific job
requirements Interventions to develop joint integrity
and mobility, motor function (motor control and motor learning), muscle
performance (including strength, power,and endurance), range of motion, andcardiovascular/pulmonary capacityrelated to the performance of work tasks
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Practice, modification, and instruction in
simulated or real work activities
Training for safe job performance andinjury prevention
Provision of behavioral and vocational
services as determined by the respectiveWork Hardening provider
Promotion of patient/client responsibility
and self-management
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The physical therapist determines that
the patient/client will no longer benefit
from physical therapy services
The patient/client declines to continue
intervention
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The patient/client fails to comply with the
requirements of participation
The patient/client is unable to continueto progress toward goals and outcomes
because of medical or psychosocialcomplications or because
financial/insurance resources have been
expended
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Fulfillment of established program goals
can be used as an indicator of
effectiveness of the work hardeningprogram
The most prized measure is return towork(RTW)
Efficiency reflects total cost and time
utilized to achieve established goals andoutcomes
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PHYSICAL
CAPABILITIES
SUPPORT STRUCTURES
SELF-MANAGEMENT SKILLS
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There are 3 categories«
Clinical measures- RTW and % of
reinjuary Satisfaction surveys ² client & referral
source
Follow-up client reports- 6 & 12monthspost RTW
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Length of time b/w start of work
retraining & RTW
Length of time b/w injury & start of work retraining
Program components administered
Re-injury rates RTW status
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Attendance record
Days in the program
Having reached or not reached goal
Reason for discharge
Date of injury to date of admission into
program Having completed or not completed
program
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Symptom magnification syndrome
Pacing problems ² affects feasibility
Family issues
Financial difficulties
Lack of education
Clients· unknown fears
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Age, gender, health status
Extended sick leave
Strongest negative predictors of RTW are
o Individual·s expectations,
o Days of sick leave,
o Somatic disorders,
o High-level of life satisfaction,
o Sense of coherence
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Need
Evaluation and program structure
Termination guidelines
Outcome
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Abenhaim L, Rossignol M, Valat J-P, Nordin M,
et al. The role of activity in the therapeutic
management of back pain: Report of the
International Paris Task Force on Back Pain.Spine 2000; 25: 15-335
Carter, Birrell (2000). Occupational healthguidelines for the management of low back
pain at work: Evidence review and
recommendations. Faculty of occupational
Medicine, London.
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Coe G. Report on Work Conditioning
Programs for Disabling Chronic Low Back
Pain: its application to S22 clients.
Commonwealth Rehabilitation Service,1995
Cohen M, Nicholas M, Blanch A. Medical
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Occupational Health & Safety-Aust, NZ 2000;
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Compensable Injuries and Health Outcomes.
Health Policy Unit, The Australasian Faculty of
Occupational Medicine, The Royal
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Haldorsen EM, Grasdal AL, Skouen JS, Risa AE,
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Hansson, T.H. and Hansson, E.K. (2000) The
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