The concepts of work hardening and work conditioning programs have been in the spectrum of rehabilitation services since the late 1970s. The primary intention was to reduce the costs associated with the failure of an individual to return to work after a work-related injury or illness.
These programs were designed to be initiated when patients failed to return to work after a traditional episode of care concluded -- usually because an employer would not accept the employee back to the job unless released to perform 100% of the job requirements, or an employee was not willing (for one of a number of reasons) to return to work.
Early on, these services were defined as separate programs that varied in the intensity of treatment (session length and duration), as well as the professional service level. Work hardening was developed first -- it was defined as an intensive, multi-disciplined approach that included PT and OT professionals.
Work conditioning was differentiated later -- circa 1991 -- and distinguished from work hardening as requiring only one discipline (usually a physical or occupational therapist) and being shorter in duration.
Employers are Stakeholders
In 2011, the Occupational Health Physical Therapy Advanced Work Rehabilitation Guidelines were adopted. One intention of the guidelines was to drop distinguishing lines between work hardening and work conditioning programs (now referred to as advanced work rehabilitation), and to assure that each patient's needs were met with the focus on returning to work.
Of significance is that the employer is specifically mentioned in the guidelines and included as a stakeholder in the return-to-work process. Also of significance is that this service level still begins once traditional treatment goals have plateaued or been met, and return to work full-duty has not been accomplished. Therefore, today's therapy centers often continue to separate evaluating patients for return to work from "traditional" therapy.
A large percentage of physical therapists interface with individuals whose ability to work has been temporarily or permanently affected. Although therapists are aware of these return-to-work programs, a relatively low percentage have experience with them, and in many treatment settings these services may not be readily available.
Change continues to drive new thinking, however, as employers are encouraged to bring workers back to restricted or modified duty earlier than ever. This is often made evident to the therapist during an episode of care -- at times by a distressed patient.
Furthermore, third-party payers and employers often consider light duty as a form of work re-conditioning and are foregoing formal work rehabilitation even when it is recommended.
Work as Function
These changing events are driving a need for the integration of job function testing and job function matching into the traditional physical therapy treatment model. The use of job function testing during a traditional episode of care can drive return-to-work goals alongside treatment goals, and facilitate return to work in a manner that keeps workers as safe and as productive as possible.
The Americans with Disabilities Act recognizes work as a major life function, further emphasizing the need for physical therapists to address return-to-work job function goals in addition to traditional treatment goals and interventions.
This chain of events is creating the opportunity for close collaboration between physical therapy practices and employers in the community. To facilitate return to work at this level, objective information is needed that is clearly job-relevant to all parties -- in particular, the worker/patient and the supervisor. Content-valid workplace measurements and content-valid functional testing can be followed by including job function-related elements in the treatment plan conducive to documenting work activity recommendations.SEE ALSO: Building a Work Performance Program
This information is useful to all stakeholders, including physicians authorizing return-to-work activity levels, payers authorizing treatment, and the supervisor and the patient/worker managing return-to-work activities in the workplace.
Studies continue to show that removing a patient from their work environment comes at a high cost to all stakeholders. Within as little as four weeks, the risk of long-term incapacity to work begins to rise substantially. By six months, as many as 50% of patients will not return to work. Time is of the essence.
Be a Resource
One challenge for practices is to develop long-term relationships with employers so they're in position to provide this support. The employer needs to see the practice as a resource, not only for injury management, but for wellness and workplace injury prevention.
Another challenge for practices is to develop a service arm that can deliver services to employers at their place of business. A key service includes physical demands analysis that can be developed into a job function description and job function test. Also of interest to employers is job-specific educational programming and job coaching services for both injury prevention and return-to-work support.
The need for advanced work rehabilitation post-traditional episode of care will not go away. However, its use can be more readily justified if return-to-work objectives are addressed and readily apparent at the forefront of an episode of care.
All of the services mentioned have the potential to be paid by the third-party payers in workers' compensation cases. Authorization should always be obtained for reimbursement purposes and to keep the lines of communication open with stakeholders.
In a non-work related injury, it's far more difficult to get the insurance company to authorize services because the services are often not seen as a form of direct treatment of disease or injury. That doesn't mean, however, that the forward-thinking employer isn't willing to pay for these services directly through their safety or human resources budgets.
The opportunity created by today's workers' compensation environment can enhance return-to-work services and improve outcomes. Physical therapy practices must go to the drawing board and develop a strategy to provide service at this level. The benefits will extend to all members of the community, and to the practice itself.
Virginia 'Ginnie' Halling is CEO of DSI Work Solutions Inc., Bowling Green, KY.Source: http://physical-therapy.advanceweb.com/Features/Articles/Advanced-Work-Rehabilitation.aspx