toolkit for return to work & injury prevention part 1

1

Your Toolkit for Return to Work and Injury Prevention

PART I

Presented by: Nathan Birtch

• Work Hardening

• Functional Abilities Evaluation

2Enjoy health through physiotherapy

Challenges

Return to work challenges faced daily• Unclear what employees are physically

capable of • Discrepancies between an employees

perception and their physical capabilities• Unclear medical reports• Vague FAF’s• Psychosocial factors involved


Effects of disability on likelihood of return to work

6 months 12 months 2 years

10%20%

30%

50%

Amount of time off work due to disability

% L

ikel

ihoo

d of

re

turn

to w

ork

20%

10%

40%

50%

60%70%


Timing of Intervention and Impact

0

20

40

60

80

100

Prob

abilit

y of

RTW

(in

%)

0 3 6 9 12 15 18 21 24 36

Duration of absence (in months)

Probability of Returning To Work


Costs of Disability

• In Ontario MSD’s account for 42% of all lost time claims and 50% of lost time days (averages from 1996 –2004)

• These claims represent approximately 27 million lost days

• Direct costs estimated at more than 3 billion• Total costs estimated to be more than 12

billion (direct costs + indirect costs)


The Iceberg Effect

Direct costs• Wage Replacements• Treatment• Evaluations & examinations• NEL/ FEL awards

Indirect Costs• Lost Productivity• Replacement workers / training• Accident investigation• Case management time• Productivity/ Quality issues

Indirect costs – estimated to be 4 –7 x’s thedirect cost


HELP!?!?!

The Toolkit!- Work Readiness Program- Functional Abilities Evaluation- Physical Demands Analysis- Ergonomic Assessments- Post-offer Pre-placement Screening- Independent Medicals


• overcome all barriers preventing successful return to full employment

Work Readiness (WR) Program Goals

• prepare people for work roles

• achieve full pre-injury functional status


The Work Readiness Program

PHILOSOPHY:• Early intervention, including functional

conditioning is key to successful return to work and reactivation into normal life

• More than work specific physical conditioning; it extends to mental toughening as well - not necessarily resulting in less pain but in better management of that pain relative to tolerating work activities.


The Work Readiness Program

A Good Candidate: Individuals with musculo-skeletal injuries, general health

problems or emotional conditions that limit ability to return to pre-injury level of function

Having difficulty returning to work/ unsuccessful attempts at RTW

Individuals returning to heavy jobs or challenging life circumstances

Have completed acute stage of rehab but require more aggressive functional conditioning

Those who could benefit from a structured, daily program

Program Components

Physical Therapeutic

Exercise Program

Biomechanics Retraining / Relaxation Techniques

Functional Conditioning

Comprehensive Evaluation

Personal Functional Goal Setting

Stress / Anger / Pain Management

Liaison with Physician,

Employer and Funder

CLIENT EMPOWERED FUNCTION RESTORED

CASE CLOSED

Client Education

Vocational Conditioning

Client Centered Results

Phases of Work Readiness Program

S M T W TH F S

Wk ?-?

Wk ?-?

Phase 1: Review of Referral Information

Phase 2: Initial Assessment

Phase 3: Establish Initial Targets

Phase 4: General Conditioning• Monitor progression to targets weekly• FAE reassessment every 2 wks •Physio reassessment every 2-4 wks

Phase 5: Functional Conditioning

Includes FAE


Evaluation tools during program

• Functional Abilities Evaluations – initial evaluation completed within first week, then every 2 weeks subsequently

• Physiotherapy Re-Assessments- every 2-4 weeks depending on client progress/ barriers

• Goal setting – revised weekly• BTE evaluations


Education

Education

1 on 1

Video Group

Psychology

Body Mechanics & Lifting

Back & Neck conditions

Core StabilityStretching

Relaxation Techniques Soft Tissue Healing

Avoiding RSI’s

Pain management


Job Site Coaching

• Job site coaching to ensure carry over of learned skills and techniques

• Ensure safe job performance


Program Duration

• Usually between 6 – 12 weeks• Usually half day but can be full day• Can be used in conjunction with graduated

return to work plan


Reporting

• Complete Initial Assessment and Individual Work Readiness Plan

• Progress reports every 2 weeks including updated functional and physical progress

• BTE Work Simulator report• Job site coaching report• Final Report and recommendations


What the research says

• Significant difference in the subjects' “physical demand characteristic” level before and after the work hardening program.

• 75% of the subjects who completed the work hardening program were able to resume employment.

“Outcome evaluation of work hardening program for manual workers with work-related back injury.” From Work: 2005;25(4): 297-305, Sang LS, Ying Eria LP, Occupational Therapy Dept,United Christian Hospital, Kowloon, Hong Kong, China


What does the research say?

• “The effectiveness of a comprehensive work hardening program as measured by lifting capacity, pain scales, and depression scores.” Work 2005;24(1):21-31, Baker P, Goodman G, Ekelman B, Bonder B, Cleveland Clinic Foundation, Occupational Therapy Dept.

• Pre- and post-scores for subjective measures of pain - Oswestry Back Pain Scale

• Pain- the Beck Depression Inventory, the Waddell Sign• Pre- and post-scores of several physical performance tasks (lifting,

carrying, etc)

• Results- Significant post program improvements in all 6 tests!


Key Questions

• Do you currently have problems getting people back to work?

• Are people on modified duties for an extended period of time?

• Are your light jobs all full?• Are the doctors dictating RTW programs

that don’t seem reasonable?

Employee on Modified Duties and Hours (working 4 hrs/day)

Employee working full hours on modified duties

Employee modified duties, working 4 hrs/day and attending WREP 3 hrs/day for 8 weeks

Employee Wage 300/wk 600/wk 600/wk

Wage for additional worker

600/wk 600/wk 600/wk for 8 weeks only

WSIB Surcharge x 3 900/wk

Cost of WREP $3,850

Total Costs during 8 week program

$14,400 $9,600 $13,450

Total over 6 months $46,800 $31,200 $24,250

Total over 1 year $93,600 $62,400 $39,850

Cost Savings Breakdown

Based on $15 /hr wage

The BTE System

The BTE System

http://www.btetech.com/simulatorII/gallery/pages/BTE_SimulatorII_Gallery_12_jpg.htm










FUNCTIONAL ABILITIES EVALUATION


What is a FAE? • An objective detailed assessment of an

employee’s ability to perform functional work tasks


• Lifting • Carrying (bilateral/ unilateral)• Push/ Pull (bilateral / unilateral)• Reaching (multi-level)• Hand dexterity• Walking• Stair climbing• Balance• ROM• Grip Strength• Strength testing• Etc.

What is a FAE? (con’t)


Use of tools and protocols based on publishedresearch to ensure that the testing and theoutcome are:• objective• valid• reliable • defensible



Defensible?

• FAE’s done by the ARCON system were used in these cases:- ANGELO TSIMIDIS (Appellant) and LIBERTY

MUTUAL INSURANCE COMPANY (Respondent) BEFORE: Stewart M. McMahon, Directors Delegate August 28th 2000


• Consistency of effort checks throughout testing to ensure maximal effort is put forth.

• Use of outcome measures to match perceived capacity with actual physical capacity.



How a FAE is different than a FAF

FAF General Vague Limited information for

the employer Can be subjective

(depending on who fills out)

FAE More comprehensive Consistency checks In conjunction with

impairment testing State of the art

computerized ARCON system

Very detailed report of information for employer

Very objective

36

PDD / PDA

JOB MATCHFAE


Why have a FAE for my employee?

1. To determine if a person is ready to return to work

2. To assess what jobs the worker is suited for3. To clarify appropriate work restrictions4. To clarify if modifications or accommodations

need to be made to prevent further injury5. Assist with treatment recommendations6. Assess the validity of a disability


How do you perform the evaluation?

PDD (if provided) Used to determine the nature of the testing

protocol Also used for job matching portion


Biomechanical Testing Performed by a Physiotherapist Provides biomechanical diagnosis to plan

the nature of the testing ROM testing, Strength Testing


Static Functional Testing ARCON technology used to assess

lifting, pushing, pulling, grip and force generation

Sufficient static force with good body mechanics, qualifies the client to proceed to dynamic functional tasks

Heart rate monitor used at all times.


ARCON TESTING


Dynamic Functional Testing Conducted using functional

equipment in the lab (weights, push/pull cart, toolbox etc.)

Custom lifting, pushing, pulling, and carrying to match the specific requirements of the job

Heart rate monitor used at all times

How do you perform the evaluation? (con’t)

Dynamic Lift


Occupational Testing Testing designed to

assess job specific tasks to simulate work environment

i.e.- assembly, typing, painting, etc

How do you perform the evaluation? (con’t)


Test End Points

Self Limited By Subjective Complaints (Psychophysical)

Physiological

Biomechanical Safety


How long?

Time from evaluation to report- 10 business days

1 Day FAE = 3 hrs 2 Day FAE = 3 hrs each day = 6 hrs


When should a FAE be done?

1. During return to work planning Unsure on what the worker is functionally capable of Unsure on the validity of the workers injury Unsure on where to place the worker in the job

environment

2. To measure progress during the rehabilitation process FAF's are too vague and not specific enough Treatment is prolonged

3. When validity of a disability is questioned Inconsistencies in reports, demonstrated ability,

observation


Report Information

Job match status Impairments Rehab/ treatment recommendations Return to work recommendations Ergonomic recommendations Consistency of effort Functional abilities

ReportPULL IN (Pounds)

08

16243240

0 1 2 3 4 5

PUSH OUT (Pounds)

01632486480

0 1 2 3 4 5

FLOOR LIFT (Pounds)

020406080

100

0 1 2 3 4 5

H FLOOR LIFT (Pounds)

08

16243240

0 1 2 3 4 5

Report

ReportSTANDARD (L) (Pounds)

0285684

112140

0.0 0.5 1.0 1.5 2.0 2.5 3.0

Report


What to do with all the Information

• Look for consistency of effort checkpoints, how has the evaluator interpreted them

• Look at the evaluator’s return to work recommendations and job matching comments

• Compare the functional ability result to the job demands (PDD/PDA)


What to do with all the Information

JOB MATCH?

If yes, return to work

If no, can the jobbe modified or adjusted?

Based on current functional ability level


What do I do with all the Information?

ERGO and TreatmentRecommendations

Is further treatmentRecommended?

Are modifications to job or work station

recommended?

Work ReadinessProgram?


Questions and Answers


The Toolkit- Part 2?

• In the new year we will explore:• Physical Demands Descriptions• Ergonomic Assessments• Post Offer Pre-Placement Screening

…and more

toolkit for return to work & injury prevention part 1

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