Approximately 3.8 million workers were injured while on the job in 2007.* Many of those people suffered injuries that made it difficult or impossible to continue working. More than 40 percent of the injuries and illnesses were sprains or strains with back and shoulders being the most affected parts of the body.

 

A Physical Therapist or Occupational Therapist will use the latest therapy techniques, modalities and patient education to treat the injury. In addition, there is a high degree of focus on job-simulated tasks for the ultimate goal of return to work (RTW). At the completion of traditional therapy, an Industrial Rehabilitation Program may be indicated to allow the injured worker to progress toward a normal workday and full RTW duties.

 

An industrial rehabilitation program can include any one of the following: physical reconditioning program, work conditioning program, or work hardening program.

 

A physical reconditioning program is a focused, work-related program designed to restore physical functions to enable the patient to return to work. A work conditioning program has the same focus and goal of the physical reconditioning program, but is specifically for patients who are more than 180 days post-injury. The specific frequency and duration is based on individual findings but most patients participate 2-4 hours per day for 3-5 days per week. The maximum duration of services is usually 60 hours during a 5-to 6-week period, unless exceptional arrangements are made. They are labor-intensive, job-simulated programs that address all facets of the injured worker, including cardiovascular fitness, flexibility, strengthening and patient education. The goal is to return the injured worker to a full 8-hour work day at their previous level of function.

 

Work hardening is the third industrial rehabilitation program offered. While the same components of the work conditioning program are addressed and treated within a single discipline (Physical Therapy or Occupational Therapy), work hardening is very comprehensive with multiple disciplines (Therapy, Vocational Services, Medical Management, Psychology etc). Work hardening is indicated for the patient who is greater than 180 days post-injury, whose position was eliminated or filled by another, and who is experiencing a psychological compromise secondary to their injury.

 

Functional Capacity Evaluations (FCEs) can be conducted to provide objective documentation for RTW issues or case closure. The FCE is an intensive, systematic evaluation process to determine an injured employee's physical and functional ability to perform work. In addition, the evaluation offers insight into behavior, motivation, sincerity of effort and pain tolerance. In the arena of rehabilitation for an injured worker, there may be multiple reasons why a FCE may be indicated: to ensure that a worker's current Physical Demand Level matches that of their work duties for full RTW; to establish RTW restrictions/modifications; to determine capabilities for vocational rehabilitation or job search; if the patient reaches a plateau in functional gains; subjective complaints do not correlate with objective findings (evaluate effort or determine symptom magnification); client has reached MMI; and to help establish a disability rating. The FCE report should include a narrative report with objective descriptions, and a set of graphs and tables to help display the areas of strength and weakness. Complete testing takes approximately 4 hours.

 

We have all seen cases where the diagnostic tests show significant organic pathology yet the patient reports no noticeable pain or change in daily activities. From discussions you can tell that the patient is not fully truthful in their pain level and may be attempting to RTW before they are safe to do so. You also know the family situation requires that this person continue to work for financial reasons.

 

To the contrary, we've also experienced situations where diagnostic tests show no pathology yet the patient exhibits great pain behaviors and reports no tolerance for usual activities.

 

How can we know what our patient's abilities are? Is there another diagnosis yet to be determined? Is the patient willing to risk his or her health by performing unsafe tasks? Or is the patient looking for ways to avoid unpleasant tasks (i.e. work)?

 

Scenarios like this would warrant a professional examination on physical performances. This is the purpose of the Functional Capacity Evaluation (FCE).

 

As mentioned above, the FCE is also helpful to establish physical abilities for the patient who has reached a plateau in their physical recovery. Patients with work injuries often need objective testing to confirm that they can safely return to their previous job tasks. If returning to work is not feasible, the FCE can also assist the physician in establishing maximum medical impairment ratings.

 

The FCE includes assessments of strength, flexibility and endurance. Beyond the standard goniometric and manual muscle testing measures, the FCE assesses performance in actual tasks such as reaching, bending, squatting, lifting, carrying, etc. These tasks are then identified as something the patient could safely do either occasionally, frequently or constantly. Other qualifiers may also be appropriate, such as the degree of reaching or lifting. For example: 'Test results indicate that the patient is able to sit, walk reach, squat [50% range] consistently; walk and squat frequently; lift up to 25lb occasionally.'

 

If there are particular areas of interest based on either the job description or physician request – other areas can also be tested. A job simulation can be developed to better test specific components or work activities.

 

With this type of information it is easier for the physician to identify work restrictions or limitations as appropriate. It is also easier for the employer to place a worker back at work with concrete information about the worker's abilities. For those 'special' cases, the FCE is able to identify and document examples of inconsistency. This is also helpful in complex cases that need objective documentation of performance.

 

It is evident that the rehabilitation of the injured worker is critical to the employee as well as the employer. The employee has a need to generate income and the employer relies on a healthy employee to generate revenue. Therapists at Brooks recognize this symbiotic relationship and strive to get the injured worker back to work quickly and safely.