Work Solutions Insight

Scientific reviews identify barriers in return to work:

DSI recommends objective rather than subjective solutions
By Susan J. Isernhagen PT C.O.O.
Excellent papers by William S Shaw of Liberty Mutual and colleagues have been published in SPINE, AAOHN and the Journal of Occupational Rehabilitation. A recent publication in Physical Therapy May 2011 Vol 91, Addressing Occupational Factors in the Management of Low Back Pain called upon rehabilitation professionals to understand the barriers to return to work and to take part in providing best care. Shaw, Main and Johnston reported results of systematic research reviews. Factors shown to be significant barriers to return to work are:

Patient report of heavy physical demands,
inability to modify job tasks,
work stress,
lack of organizational support,
job dissatisfaction,
poor expectations for resuming usual work
fear of reinjury

The author’s primary recommendations include self-report questionnaires on his/her physical job demands, interviewing patients to identify return to work concerns, discussions on job modifications and including return to work information in medical/rehab progress reports. DSI also believes these to be baseline necessities for those working with injured or ill workers. At the basic level, all of these should be implemented.

However, our experience has led us to even stronger solutions. While the above recommendations are good, estimates of job demands or a person’s physical abilities are still not objective measures. In doing job analyses, it is clear that many employers’ job descriptions are incomplete and often incorrect on what physical capacities a job requires. On questionnaires employers and workers often differ in describing a job’s physical requirements. That is why specific measured Job Function Descriptions, done at the site, and validated by workers and supervisors have been commissioned. Objective JFD’s are the foundation of work information for all parties in return to work.

Estimates of physical abilities are also often subjective. In facilities where strong functional evaluation is possible, the JFD is used to develop an objective job specific Job Function Test. This allows the worker, often for the first time, to participate in finding out their ability levels and point the way toward return to work (with or without job modification). Again, this is objective and worker centered. With this test information, workers, medical providers and employers all see job specific information that is not susceptible to pressures that can arise when a subjective system is used.

DSI commends Dr Shaw and Dr Pransky of Liberty Mutual for leading the way in pointing out the systemic flaws in return to work and advocating for better practices.
DSI, with its outcome based Job Function Matching® program puts objective solutions into play to answer the primary issues research has identified.
To highlight the areas that Job Function Matching® can address and those it cannot, we review the issues again:

Patient report of heavy physical demands: Workers are pleased when an accurate job function description accompanies their medical evaluations. Medical providers have objective information and know what the worker actually does
inability to modify job tasks: The Job Function Matching process uses the JFTest scores and identifies job task specific modifications. The releasing physician and the employer both can use the information in returning the worker to work. In addition, this specificity protects the worker as modifications are written and known to all
work stress: This may by only partially addressed. But, at the least, the worker returns to a job he/she can physically perform and with the support of the employer
lack of organizational support: Employers who utilize JFM have committed to support the return to work process using JFM. Processes are stronger and more cohesive.
job dissatisfaction: As in work stress, JFM only would not address this specifically. However it does provide a better match of worker and work. JFM clearly identifies whether or not a person can do his/her work and how it can be modified, so the return to work process is not manipulated as a result of dissatisfaction
poor expectations for resuming usual work: All parties see exactly how a person can be returned to work; medical providers and employer management can much more easily raise reasonable expectations of a smoother RTW
fear of reinjury: If the worker cannot do a task, this is identified and modifications are suggested. If a workers tests as able to do a task, it removes the fear.

This is an example of researchers and best practice promoters clearly identifying the issues. DSI looks forward to the ability to participate in primary research to accompany the already excellent outcomes of JFM.

2 DSI providers receive national recognition. Jim Milder and Nancy Nesbitt: Read below:

Jim Milder PT, of Carol Stream IL was awarded the highest honor in the American Physical Therapy Association Private Practice Section. At the Nov. national meeting in Seattle, Jim received the Robert G Dicus award which is presented annually to recognize a private practice physical therapist who has contributed to the profession and the professional association. Jim was recognized for his years of service as a Director of the American Physical Therapy Association, the Illinois Physical Therapy Association and the Private Practice Section and for service on state and national political action and legislative committees. Jim’s comments affirmed his commitment to the profession and urged all rehabilitation professionals to commit to their respective professional association, to work toward use of the best practices for patient care, and to work for accountability and responsibility to shape health care delivery. He spoke to the need for all to be involved in answering the challenges of “healthcare reform”. Jim provides DSI programs in industrial settings and performs DSI Functional Capacity Assessments in IL. We congratulate him for this recognition.

Nancy Nesbitt DPT of Back n Action clinic in Park Falls WI was recognized for her contribution to industrial physical therapy and occupational health in her community. Rehab Management Solutions, in recognizing Nancy’s contributions, wrote “Industrial programs and paradigms continue to evolve, yet some therapists still struggle”….Yet, Nancy succeeds. Nancy has written, ” I realize that not having the additional industrial skills was actually holding me back” …Being specialty trained and implementing an industrial rehab atmosphere and facility for our patients has improved practice greatly”. Nancy also made the comment after her DSI training, that she expanded her view of her patients. She now sees “workers”. For example, instead of a shoulder patient, she now sees a construction worker. This ability to see the “whole” working person and not just the injury is the key principle in the goal of return to work in addition to healing. Nancy, you bring excellence to the workers and industries in your area. Congratulations.

Change work goal from punching in to producing results!

What is work about? Is it about being at your desk or about getting things done? How many of us know workers that show up at work but often fritter away their time. We know others who, when given a task, get it done both well and quickly. And, in these times of desiring “healthier workforce”, do either of these have health consequences?

A study published in late 2011 by Moen, Kelly, and Tranby in the Journal of Health and Social Behaviour, described a study done at Best Buy headquarters in Richfield MN. They used a process called ROWE (Results Only Work Environment). 659 employees participated. Half were enrolled in ROWE and half worked normally. They all completed a web survey at the end of the six month study period. ROWE employees could choose when and where they worked and were only measured by their productivity. They did not need to notify or seek permission from a manager.

Findings in the group that practiced ROWE reported they had nearly an hour longer sleep on nights before work, were more likely to avoid working when sick, were more likely to go to a physician when sick and did not return to work before they were better. It also had a positive effect on work-life balance. They could choose the time they worked, thus could arrange their work time so it didn’t interfere with home or family time. This improved their individual healthy responsibilities and decreased their exhaustion and psychological distress.

The study workers were mostly educated with white collar office jobs. It may not be applicable to workers with other personal characteristics and couldn’t apply to more service oriented jobs such as healthcare, food services, assembly manufacturing and jobs where others count on a worker to be present during certain hours. It is also unknown if the health benefits last beyond the 6 months. To measure cost effectiveness, one would need to be able to translate the perceived health benefits to actual healthcare reductions in cost.

This study reinforces previous work which shows that workers who have more control over their work schedule were happier and less likely to be physically injured or ill at work. It presents ideas on new methods of win/win. Workers win because they are healthier and less stressed but continue to have pride in productive ability. Employers win because this increases workers morale and maintains or increases productivity. It also may lower health care costs if stress, lack of sleep, and lack of control affect healthcare use. It will be interesting to see how and if these principles bring about a change in applicable workplaces and continue to benefit workers health.

Key facts

Moen P, Kelly EL, Tranby E, et al. Changing Work, Changing Health: Can Real Work-Time Flexibility Promote Health Behaviors and Well-Being? Journal of Health and Social Behavior 2011; 52(4):404–29. doi:10.1177/0022146511418979

Exercise has health impact than weight.

Which is more important? Stepping on the treadmill or stepping on the scale? A new study shows that those who maintain or improve their fitness level, even if body weight increases or remains stagnant, can reduce their risk of death. The study was published in the December 2011 issue of Circulation: Journal of the American Heart Association.

"This is good news for people who are physically active but can't seem to lose weight," says Duck-chul Lee, PhD, the study's lead researcher and physical activity epidemiologist in the Department of Exercise Science at the University of South Carolina Arnold School of Public Health, Columbia, SC. "You can worry less about your weight as long as you continue to maintain or increase your fitness levels."

Lee and his team examined 14,345 adult men. The participants were an average of 44 years old, mostly white, and middle or upper class. The researchers used maximal treadmill tests to estimate physical fitness, and height and weight measurements to calculate body mass index (BMI). They recorded changes in BMI and physical fitness over 6 years and performed more than 11 years of follow-up.

Maintaining or improving fitness was associated with a lower death risk even after controlling for BMI change. Also, for every unit of increased fitness, measured as metabolic equivalent of task (MET), over 6 years was associated with a 19% lower risk of heart disease and stroke-related deaths and a 15% lower risk of death from any cause. Becoming less fit was linked to a higher death risk, regardless of BMI changes, they found.

Other factors were accounted for, including BMI change, age, family history of heart disease, beginning fitness level, changes in lifestyle factors such as smoking and physical activity, and medical conditions such as high blood pressure or diabetes.

Lee adds that it is difficult to know whether the results apply to other racial and socioeconomic groups, although he says women would likely have similar results as the men.

[Source: Circulation: Journal of the American Heart Association]

Washington State�s work comp network mandate:

Washington's Department of Labor & Industries (L&I)is creating a statewide network of providers for treatment of work-related injuries and illnesses. It is seeking public comments on draft standards for health-care providers who treat injured workers on workers compensation and those covered by self-insured employers. It will be enacted to improve workers' return to work outcomes. Washington State has sponsored the forward thinking “Centers of Occupational Health and Education (COHEs)”. They have worked on the best methods to improve return to work.

In February 2012, L&I will begin enrolling providers in the new network which includes physicians, chiropractors, naturopathic physicians, podiatrists, advanced registered nurse practitioners, physician assistants, dentists and optometrists. Other providers will be added later and can continue to treat normally until network standards are set. Starting Jan. 1, 2013, injured workers can choose to see a non-network provider for the initial visit but must go to a network provider for ongoing care.

Because of COHE’s excellent ground work, standards for the network most likely will provide a positive experience for workers and their providers in the effort for efficient safe return to work. The proof of effectiveness will be in work comp savings and satisfaction surveys of workers, employers and medical providers. Standardized care process is a first step to identifying best practices over time.

DSI Work Solutions National Conference to be held September 2012.

Planning stages have begun for the DSI Work Solutions conference September 21-22 in Minneapolis MN. The broad theme will be “Objective information and the team approach reduce injury and improve return to work”. Specific topics will include

Ergonomics and Job Safety Analysis
Functional Testing for return to work and FCA for disability prevention,
Hiring and training: the full prevention program
Maintaining a healthy workforce
Measuring outcomes in injury prevention, workers compensation and healthcare

Details will be available spring 2012.
For applications to speak or attend, please contact Sue Isernhagen sisernhagen@dsiworksolutions.com.