THE LEADER in Work Injury Management & Prevention Systems

Functional Testing in Rehabilitation
Vol. 26 • Issue 3 • Page 19 

Niche Markets

It wasn't long ago that employers would wait to return workers to their jobs until they were "100 percent," i.e., the doctor fully released them for work. Today, the story is a different one. The majority of employers return their employees -- even with significant work restrictions -- to some form of work as soon as possible.

This is seen as a necessary cost-control measure. Unfortunately, the conservative nature of work restrictions often acts more as a barrier than an assist with return to work.

Work restrictions frustrate all parties concerned -- the medical practice that dreads the additional paperwork, the human resource personnel and supervisors who must interpret them, and the employee who is pressured to abide by them at work and home.

A Missed Opportunity?

A snapshot of most therapy centers today would likely reveal a less-than-focused approach to getting patients back to work as expediently as possible. With insurance company statistics still indicating that musculoskeletal injuries are among the most costly to employers, more focus on return to work (RTW) is warranted.

However, documentation with objective data about a patient's job is rarely provided, and therapists are rarely called upon to advise regarding RTW during a typical course of therapy treatment.

This represents a missed opportunity to improve return-to-work outcomes with the assistance of therapists. Like physicians, therapists are typically providing care and setting treatment and functional goals with no objective information regarding the physical demands of the patient's job. Insurers and employers lament the high cost of therapy services and lack of successful RTW, but do not proactively provide this vital job information.

Therapy centers providing occupational services tend to address job function at the front end -- when an employee is in the hiring and placement process -- or at the back end, when care for an individual's injury or illness is at an endpoint and a final decree of the patient's work ability is needed.

This focus is understandable, since some form of a "big picture" physical demands summary is made available for post-offer testing and standardized evaluation procedures are used to measure functional capacity. Post-offer employment testing services can assure a good match between worker abilities and work demands, thus reducing injuries.

The functional capacity assessment (evaluation) addresses disability and case closure questions. However, there is a big void where a specific job-function test could make a significant impact: during the course of usual and customary medical care and treatment.

Specific Strategies

In order to improve RTW outcomes, the workers' compensation system would benefit if employers willingly provided clear and useful job-specific physical demand information to the medical community. A format that allows for matching the patient (a worker) to the critical functions or tasks that he is expected to perform would expedite return to work.

It is the employer that has the authority to allow access to or provide accurate and useful information about critical job functions and physical demands. If the employer does not provide or allow access to this information, then medical providers really have only two choices: either ask the patient or worker -- the most knowledgeable person about the job that they are communicating with -- or take a conservative approach, and wait until the medical issue has satisfactorily resolved before releasing the patient back to normal duty. Neither is usually expedient.industrial rehab

Therapists are in a position to use job-function information and make return-to-work recommendations using an "abilities" model in lieu of a "restrictions" model. Therapists routinely work with patients to identify when therapeutic exercise and activity are submaximal, maximal, or safe, or require modification.

These skills can be successfully applied to RTW testing and recommendations. When therapists are provided with accurate job-function information -- similar to sport-specific information used in sports medicine and rehabilitation -- return to work can be facilitated. RTW can also be recommended in a graduated method if the job functions and associated physical demands are organized in logical tasks (functions) and the focus is on more than just a "big picture" summary.

Therapy practices that offer employers the services to obtain function-based job information will provide significant benefit to employers, the practice, their patients, and the community at large.

The process of working with a company to develop even one job-function description can show an employer the multiple ways in which the information from this document can be used beneficially -- return to work, hiring and placement, injury prevention and early intervention strategies, training, education and more. The practice providing these services also develops an alternate revenue stream that is not insurance reimbursement-dependent.

A Challenge Worth Taking

The opportunity to provide these services does not come easily -- it requires working diligently to develop relationships with employers and educating physicians about how they may be assisted. A practice must be willing to reach out to employers, physicians, case managers and insurers through appropriate channels when a patient presents as unable to work full-duty.

A practice must also be willing to develop relationships with the employer community through educational opportunities and relationship-building at local professional association meetings such as the SHRM (Society for Human Resource Management), ASSE (American Society of Safety Engineers), and local chapter of the Chamber of Commerce.

Today's therapy practices should consider how to add this vital component of work-injury management and work-injury prevention to their repertoire of services. It is no easy challenge -- but it is one worth taking.

Ginnie Halling is CEO of DSI Work Solutions Inc., Bowling Green, Ky.

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