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Toolkit For Return To Work & Injury Prevention Part 1

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The document discusses tools and programs for return to work and injury prevention, including: 1) A Work Readiness Program that uses functional conditioning over 6-12 weeks to prepare injured employees to return to their pre-injury level of function. 2) Functional Abilities Evaluations (FAEs) that objectively assess what jobs an employee is physically capable of through tests using specialized equipment. 3) How the results of a FAE can be used to determine job matching, accommodations needed, and effectiveness of treatment programs.

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Your Toolkit for Return to Work and Injury Prevention PART I Presented by: Nathan Birtch Work Hardening Functional Abilities Evaluation
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 FAFs 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 % Likelihood of return to work 20% 10% 40% 50% 60% 70%
Timing of Intervention and Impact 0 20 40 60 80 100 Probability 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 MSDs 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 xs the direct 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 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 S F TH W T M S Wk ?-? Wk ?-?
Program Outline Review of Referral Information - Phase I Identify issues to be addressed based on available medical, physiotherapy and vocational history provided by referral source and the family doctor as needed.
Program Outline Initial Assessment - Phase II Physical and Biomechanical Assessment (conducted by our Physiotherapist) Functional Abilities Evaluation Using the Active protocol BTE testing (work simulator). Work Behaviour Attitudes (Motivation) Self Evaluation of Skills, Capabilities, Future Goals
Program Outline Establish Individual Targets - Phase III Short term and Long Term goals set based on assessment findings, client needs, employer needs Definitive time frames Strategies developed to optimize client efforts (i.e. address potential barriers)
Program Outline General Conditioning - Phase IV Physical reconditioning: restore strength and flexibility deficits Education- posture, etc Cardiovascular conditioning Explore key challenges that client is facing
Program Outline Functional Conditioning - Phase V Strengthening to specifically meet the physical demands of the job Work Simulation Education on safe body mechanics Gradual increase in physical demands Empowering client to challenge barriers
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 Stability Stretching Relaxation Techniques Soft Tissue Healing Avoiding RSIs 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 dont seem reasonable?
Cost Savings Breakdown Based on $15 /hr wage $39,850 $62,400 $93,600 Total over 1 year $24,250 $31,200 $46,800 Total over 6 months $13,450 $9,600 $14,400 Total Costs during 8 week program $3,850 Cost of WREP 900/wk WSIB Surcharge x 3 600/wk for 8 weeks only 600/wk 600/wk Wage for additional worker 600/wk 600/wk 300/wk Employee Wage Employee modified duties, working 4 hrs/day and attending WREP 3 hrs/day for 8 weeks Employee working full hours on modified duties Employee on Modified Duties and Hours (working 4 hrs/day)
The BTE System
The BTE System
FUNCTIONAL ABILITIES EVALUATION
What is a FAE? An objective detailed assessment of an employees 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? (cont)
Use of tools and protocols based on published research to ensure that the testing and the outcome are: objective valid reliable defensible What is a FAE? (cont)
Defensible? FAEs 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 28 th 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. What is a FAE? (cont)
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
JOB MATCH PDD / PDA FAE
Why have a FAE for my employee? To determine if a person is ready to return to work To assess what jobs the worker is suited for To clarify appropriate work restrictions To clarify if modifications or accommodations need to be made to prevent further injury Assist with treatment recommendations 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? (cont) 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? (cont)
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? 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 To measure progress during the rehabilitation process FAF's are too vague and not specific enough Treatment is prolonged 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
Report Report
Report Report
What to do with all the Information Look for consistency of effort checkpoints, how has the evaluator interpreted them Look at the evaluators 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 job be modified or adjusted? Based on current functional ability level
What do I do with all the Information? ERGO and Treatment Recommendations Is further treatment Recommended? Are modifications to job or work station recommended? Work Readiness Program?
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

More Related Content

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
  • 2. 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 FAFs Psychosocial factors involved
  • 3. 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 % Likelihood of return to work 20% 10% 40% 50% 60% 70%
  • 4. Timing of Intervention and Impact 0 20 40 60 80 100 Probability of RTW (in %) 0 3 6 9 12 15 18 21 24 36 Duration of absence (in months ) Probability of Returning To Work
  • 5. Costs of Disability In Ontario MSDs 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)
  • 6. 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 xs the direct cost
  • 7. HELP!?!?! The Toolkit! Work Readiness Program Functional Abilities Evaluation Physical Demands Analysis Ergonomic Assessments Post-offer Pre-placement Screening Independent Medicals
  • 8. 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
  • 9. 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.
  • 10. 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
  • 11. 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
  • 12. Phases of Work Readiness Program 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 S F TH W T M S Wk ?-? Wk ?-?
  • 13. Program Outline Review of Referral Information - Phase I Identify issues to be addressed based on available medical, physiotherapy and vocational history provided by referral source and the family doctor as needed.
  • 14. Program Outline Initial Assessment - Phase II Physical and Biomechanical Assessment (conducted by our Physiotherapist) Functional Abilities Evaluation Using the Active protocol BTE testing (work simulator). Work Behaviour Attitudes (Motivation) Self Evaluation of Skills, Capabilities, Future Goals
  • 15. Program Outline Establish Individual Targets - Phase III Short term and Long Term goals set based on assessment findings, client needs, employer needs Definitive time frames Strategies developed to optimize client efforts (i.e. address potential barriers)
  • 16. Program Outline General Conditioning - Phase IV Physical reconditioning: restore strength and flexibility deficits Education- posture, etc Cardiovascular conditioning Explore key challenges that client is facing
  • 17. Program Outline Functional Conditioning - Phase V Strengthening to specifically meet the physical demands of the job Work Simulation Education on safe body mechanics Gradual increase in physical demands Empowering client to challenge barriers
  • 18. 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
  • 19. Education Education 1 on 1 Video Group Psychology Body Mechanics & Lifting Back & Neck conditions Core Stability Stretching Relaxation Techniques Soft Tissue Healing Avoiding RSIs Pain management
  • 20. Job Site Coaching Job site coaching to ensure carry over of learned skills and techniques Ensure safe job performance
  • 21. 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
  • 22. 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
  • 23. 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
  • 24. 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!
  • 25. 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 dont seem reasonable?
  • 26. Cost Savings Breakdown Based on $15 /hr wage $39,850 $62,400 $93,600 Total over 1 year $24,250 $31,200 $46,800 Total over 6 months $13,450 $9,600 $14,400 Total Costs during 8 week program $3,850 Cost of WREP 900/wk WSIB Surcharge x 3 600/wk for 8 weeks only 600/wk 600/wk Wage for additional worker 600/wk 600/wk 300/wk Employee Wage Employee modified duties, working 4 hrs/day and attending WREP 3 hrs/day for 8 weeks Employee working full hours on modified duties Employee on Modified Duties and Hours (working 4 hrs/day)
  • 30. What is a FAE? An objective detailed assessment of an employees ability to perform functional work tasks
  • 31. 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? (cont)
  • 32. Use of tools and protocols based on published research to ensure that the testing and the outcome are: objective valid reliable defensible What is a FAE? (cont)
  • 33. Defensible? FAEs 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 28 th 2000
  • 34. 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. What is a FAE? (cont)
  • 35. 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. JOB MATCH PDD / PDA FAE
  • 37. Why have a FAE for my employee? To determine if a person is ready to return to work To assess what jobs the worker is suited for To clarify appropriate work restrictions To clarify if modifications or accommodations need to be made to prevent further injury Assist with treatment recommendations Assess the validity of a disability
  • 38. How do you perform the evaluation? PDD (if provided) Used to determine the nature of the testing protocol Also used for job matching portion
  • 39. Biomechanical Testing Performed by a Physiotherapist Provides biomechanical diagnosis to plan the nature of the testing ROM testing, Strength Testing
  • 40. 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.
  • 42. 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? (cont) Dynamic Lift
  • 43. 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? (cont)
  • 44. Test End Points Self Limited By Subjective Complaints (Psychophysical) Physiological Biomechanical Safety
  • 45. How long? Time from evaluation to report- 10 business days 1 Day FAE = 3 hrs 2 Day FAE = 3 hrs each day = 6 hrs
  • 46. When should a FAE be done? 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 To measure progress during the rehabilitation process FAF's are too vague and not specific enough Treatment is prolonged When validity of a disability is questioned Inconsistencies in reports, demonstrated ability, observation
  • 47. Report Information Job match status Impairments Rehab/ treatment recommendations Return to work recommendations Ergonomic recommendations Consistency of effort Functional abilities
  • 50. What to do with all the Information Look for consistency of effort checkpoints, how has the evaluator interpreted them Look at the evaluators return to work recommendations and job matching comments Compare the functional ability result to the job demands (PDD/PDA)
  • 51. What to do with all the Information JOB MATCH? If yes, return to work If no, can the job be modified or adjusted? Based on current functional ability level
  • 52. What do I do with all the Information? ERGO and Treatment Recommendations Is further treatment Recommended? Are modifications to job or work station recommended? Work Readiness Program?
  • 54. The Toolkit- Part 2? In the new year we will explore: Physical Demands Descriptions Ergonomic Assessments Post Offer Pre-Placement Screening and more

Editor's Notes

  • #13: Review of Referral Information - Phase I Identify issues to be addressed based on available medical, physiotherapy and vocational history provided by referral source and the family doctor as needed. Initial Assessment - Phase II A thorough assessment is completed to establish a biomechanical diagnosis and baseline measures. Physical and Biomechanical Assessment (conducted by our Physiotherapist) Functional Abilities Evaluation Using the Active protocol as well as BTE Technology . Work Behaviour Attitudes (Motivation) Self Evaluation of Skills, Capabilities, Future Goals
  • #52: Job match? If so, return to work If not, can the job be modified or adjusted to the employees current functional ability level Is there a different job the employee could do instead that would fit with the current functional ability level?
  • #53: Look at the ergonomic and treatment recommendations Is further treatment recommended? Work Readiness Program? Are there modifications to the job/ workstation/ way the job is performed by the employee that would speed up the return to work?