Clinical Management in Worker Rehab

Nicole Matoushek, PT, MPH, CSHE, CEES

ErgoRehab, Inc.

The first step in developing clinical expertise in the skilled therapy for the injured worker is to understand the definitions, goals and differences of skilled therapy and worker rehabilitation.

First, "Skilled therapy" is defined by Medicare as: a service where the inherent complexity of the service is such that it can be performed safely and/or effectively only by or under the general supervision of a skilled therapist. Skilled therapy refers to the physical, occupational or chiropractic therapy performed by a licensed rehabilitation professional. It involves the evaluation and treatment of neuromusculoskeletal injuries. The goals of skilled therapy focus on addressing the pain and inflammation, promoting healing, and restoring the range of motion, strength and function of the individual who has sustained an injury or medical condition.

Additionally, "Worker Rehabilitation" is defined as providing skilled therapy services to the patient who has sustained a work-related injury. The goals of Worker Rehabilitation include:

1.) Injury Healing: applying clinical knowledge and skill to treat musculoskeletal injuries and conditions.
2.) Restoration of function: applying concepts in exercise science and therapeutic techniques to restore and promote maximal levels of function.
3.) Patient satisfaction: providing high quality care to make sure the patient feels they have received the best treatments available.
4.) Return to work: modified or full duty: promoting the safe, prompt and appropriate return to work.
5.) Identification of appropriate candidates for specialized return to work programs in order to promote return to work. These programs include:
*Functional Capacity Evaluations
*Work Hardening
*Work Conditioning
*Ergonomics Services
*Independent gym/fitness programs

Worker rehabilitation differs from standard skilled therapy by also including goals and treatment planning involving return to work. The rehabilitation professional performing skilled therapy services to the injured worker will enhance their service outcomes and effectiveness by including work-specific therapy activities and goals in rehabilitation.

THERAPIST RESPONSIBILITIES IN WORKER REHAB
The next step in developing clinical expertise in the clinical management of skilled therapy for the injured worker is to understand the professional responsibilities of the rehabilitation provider treating the injured worker. The therapist has specific responsibilities in the treatment of the injured worker. These professional responsibilities are defined by the American Physical Therapy Association (A.P.T.A.) as:

1.) Provide the evaluation, intervention and therapy plan of care that is based on the diagnosis, prognosis and clinical findings of the individual patient.
2.) Provide treatment plan modifications that reflect the medical necessity of the individual patient.
3.) Perform regular assessments, using tests and measures in order to document status, monitor progress and evaluate the patient's response to treatment.
4.) Update goals on a regular basis reflecting patient's progress and functional status.
5.) Provide medical records, including:
- Initial evaluation
- Progress notes
- Discharge status
- Recommendations for further intervention

In addition, the therapist is responsible for providing only treatments that are medically necessary in order to meet rehabilitation goals. Appropriate visit and modality utilization is a professional responsibility as defined by the American Physical Therapy Association's Code of Ethics.

• "A physical therapist shall avoid under utilization of physical therapy services".

• "A physical therapist shall avoid over utilization of physical therapy services".

The overall responsibilities of the therapist or rehabilitation professional in worker rehab are summarized by this position of the A.P.T.A.: "The global outcomes of effective physical therapist management of the injured worker are to optimize work performance and minimize the development of work-related occupational disability".

By practicing in accordance with the standards of clinical practice and abiding by the defined responsibilities of the therapy professional, the therapist will achieve optimal levels in patient care, clinical efficiencies and functional outcomes in worker rehab.

CLINICAL MANAGEMENT STRATEGIES
It is important that the therapist treating the injured worker identify and apply the appropriate clinical management strategies to therapy treatments. Clinical management in skilled therapy involves actively managing the therapy treatments, goals, and outcomes in accordance with clinical standards of practice.

The clinical management of skilled therapy in worker rehab results in:

1.) Cost effective therapy services.

2.) High quality care that is based on the medical necessity of the patient.

3.) Superior functional and return to work outcomes.

4.) High patient satisfaction.

5.) Reduction in re-injury rates upon return to work.

6.) Enhanced opportunities for worker rehab program marketing.

7.) Identification of appropriate candidates for additional work injury management programs and services: FCEs, return to work programs, ergonomics services, gym/fitness programs.

Providing active clinical management to skilled therapy in worker rehab means:

- Being a "thinking therapist".

- Assessing function/progress on a regular basis.

- Modifying goals and treatment on a regular basis.

- Discussing progress and goals with patient.

- Communicating findings frequently with the parties who are involved with the case.

- Applying clinical management strategies in order to achieve optimal levels in worker rehab outcomes.

These Clinical Management Strategies in worker rehab include:

* Provide therapist driven treatment plans.

* Build inherent flexibility in plan of care.

* Ensure patient responsibility and independence.

* Provide home exercise program.

* Provide goal directed therapy.

* Provide work-specific activities.

* Clinically manage surgical protocols.

* Clinically manage complications.

* Focus treatment on functional restoration.

* Do not focus on pain/passive treatments.

* Identify plateaus in progress.

* Be proactive with therapy discontinuations and discharges.

* Prepare the patient for discharge.

* Provide effective communication.

Achieving clinical expertise and optimal levels of functional outcomes in worker rehab requires that the rehabilitation professional actively clinically manage their cases.

By applying specific clinical management strategies to worker rehab and abiding by the clinical practice guidelines, the rehabilitation professional can achieve all the goals of worker rehab in an efficient and effective manner.

Nicole Matoushek, MPH, PT, CEES, CSHE

More information about ErgoRehab, Inc. courses

Other articles by Nichole:

Prompt Return to Work

Injury Prevention: The Shoulder Joint

Anthropometrics and Ergonomics

The History of Ergonomics

Why Offer Return-to-Work Programs?

What is Ergonomics?

Work Injury Prevention and Management

The Cost of Work Related Injuries

Ergonomics and Work Efficiency

Functional Outcomes in Worker Rehab

Conquering Barriers in Worker Rehab

Maximizing Reimbursement in Worker Rehab

Clinical Management in Worker Rehab

Work Injury Consultants

Marketing and Selling Ergonomics and Worker Rehab Services

The Economic Burden of Workplace Injuries

Keyboard Design

Health Ergonomic Objectives

Ergonomics: Work Design Principles

Ergonomics and Muscle Fatigue

Work Modifications using Administrative Controls

Ergo Guidelines for Seating Equipment

Office Setting Ergonomics

Ergonomics: Evaluating Mouse Features

Ergonomics: Evaluating Keyboard Features

Ergo Guidelines for Input Devices

Ergo Guidelines for Office Accessories

Ergonomics/Posture Tips for Laptop Users

Laptop/ Computer Keyboard Design

Sports Medicine Approach to Industrial Rehab