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 WorkOSU has been accommodating temporary

restrictions for over 10 yearsFormal 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 restrictions95% of employees with restrictions

accommodatedApplies for occupational and non-

occupational injuriesTime limited –12 weeks

Exceptions—case by case basisShowing 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=lFSCWE

U1IUw&feature=related

Benefits of Transitional Work

On-site Physical Therapy:Services Offered

On-site Physical Therapy ServicesProvided by an Ohio licensed physical

therapistDirect access to services

Referral sourcesPhysiciansDisability Program Managers (case managers)DepartmentsPatientsManaged Care Organization

Services provided as a benefit to University employeesno “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 Workspace

Functional Capacity EvaluationReturn to Work Progression

Acute Injury Management

Evaluation and treatment of injured employees

occ. and non-occ.

Performed at jobsite

Functionally driven

Job AnalysisReview PD, discuss job demands with employees, supervisors

Review DOT classification/job specsDetermine initial list of essential and marginal functions

Shadow employee to determine physical demands assoc. with each EFObjective measurements (weights, distances, frequencies, etc.)

Review findings with supervisor/department

Generate formal report

Ergonomic AssessmentCollect objective information re:

a specific employee, specific job tasks, employee’s workspace

Identify potential risk factors for MSD’sawkward positions, excessive force, excessive repetition, sustained positions, contact forces, etc.

Provide recommendation for improvement to appropriate partiesemployee, department, physician, ADA coordinator

Functional Capacity EvaluationAn objective

measurement of a person’s ability to perform work

Bridges gap between medical and functional

PurposesDetermine if

symptomatic individuals can RTW in any capacity

Determine entry point to WC or WH

Consistency of effort

Job Progression/Transitional Work

Have a starting point—initial restrictionsHave a goal—full duty (based on job

demands, not necessarily no restriction)Identify job tasks that can be:

Performed with current restrictionsThat can be performed with supervisionThat can be “therapeutic”

Outline graded job task/activity progression

Provide coaching/educationIdentify possible job modificationsAdjust 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 areaLow back injury 1.5 years ago

Restrictions standing/walking to occasional level, no bending/twisting/squatting, max lift 20 lbs.

Job analysis performedFCE performed

Case example #1 (con’t):

FCE resultsdemonstrated employee’s ability exceeded

level of restriction.Job match to 90% of job demands

Recommendations:Adjust restrictions to reflect capabilitiesGradual return to work with on-site PT Adjustable work surface for documentationWork 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 functionsProvide direct patient care services within roomSafely transfer/reposition patients Transferring patients on carts/wheelchairs

Referred to job developerAssisted with:

Resume developmentOnline 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 Magnification

“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 Magnification: InterventionsDocument!!!!!

Discrepancies between self-report, musculoskeletal evaluation and functional performanceUse of self-report measures

Unannounced visit

Be PreparedObtain as much information as

possible prior to visitMedical, job information, etc.

Performance IssuesOften see disciplinary/performance issues wrapped in injury claimsEx. Employee facing 3rd disciplinary action injures herself 2 days prior to hearing

Treat 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.

Contact InformationJamie Beadle, PT, OCSbeadle.6@osu.edu614-247-2105

References1. 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.

2. Mittenberg W, Patton C, Canyock EM, Condit DC. Base rates of malingering and symptom exaggeration. J Clin Exp Neuropsychol. 2002:24:1094-1102.