Work hardening

Related learning objectives

•Recognize work hardening and ergonomic interventions
•Describe the indications for placing a patient in a work hardening program
•Identify the components of a functional capacity evaluation
•Define the role of a physical therapist assistant in carrying out a work hardening program designed by a physical therapist
•Demonstrate the ability to educate a mock patient on the principles of body mechanics during work or functional activities

What is work conditioning?

An intensive, goal-oriented conditioning program designed to restore neuromuscular and musculoskeletal function including strength, power, endurance, joint mobility, ROM, motor control, cardiovascular endurance and functional abilities. The primary objective of the Work Conditioning program is to restore physical capacity and function to enable the injured worker to return to his or her pre-injury job.

When is a patient appropriate for work conditioning?

•When the worker may have reached a plateau from traditional outpatient therapy, but continues to have difficulties with the physical demands that are required for work.
• When unable to progress beyond a light or modified duty work assignment.
•When unable to meet the full duty work demands.


Case manager or adjustor can refer the
worker to a clinic, provided that a physician
write a medical prescription for the service

Components - Work Conditioning

•Orientation
• Specific Flexibility Program
•Strengthening Program
•Cardiovascular Conditioning
•Therapeutic Activities
•Functional Job Simulation Activities
• Education/Body Mechanics/Ergonomics Training

Work Conditioning vs. Outpatient physical therapy

Work Conditioning:

•Bridges the gap between outpatient therapy and the physical demands of the job

•5 days per week, 2 to 4 hours per day

• Isolated strengthening for the injury site

•General total body strengthening

• Endurance and aerobic capacity training

• Specificity of Training - functional job specific

• work simulation

Outpatient:

•Effective with acute and post surgical phase

• of injury

• 2-3 days per week

•Active range of motion, joint mobilization,

•Modalities, stretching & strengthening,

• education

Work Conditioning

•Bridges the gap between outpatient therapy and the physical demands of the job
•5 days per week, 2 to 4 hours per day
• Isolated strengthening for the injury site
•General total body strengthening
• Endurance and aerobic capacity training
• Specificity of Training - functional job specific
• work simulation

Outpatient

•Effective with acute and post surgical phase
• of injury
• 2-3 days per week
•Active range of motion, joint mobilization,
•Modalities, stretching & strengthening,
• education

What is work hardening?

•An occupational rehabilitation program that is focused on assisting the injured worker to return to the job while minimizing the risk of re-injury.
• This is a program with a sound vocational direction with measurable outcomes.
• A rehabilitative approach performed by a multidisciplinary team of professionals
• Services such as physical therapy, occupational therapy, or vocational rehabilitation and social or psychological services are included in a work hardening program.

Important concept

•Work hardening addresses the issues of productivity, safety, physical tolerances and worker behaviors.

Criteria for participation in work hardening

•The worker is able to participate in a progressive rehabilitation program for a minimum of 4 hours a day, three to five days a week.
•A specific return to work goal is identified.
• Ability to benefit from the program is based on a screening process (FCE) to establish a baseline level of functioning.
•The injury is less than two years old (typically)

The physician, claims manager, case manager, employer, or vocational counselor may initiate referral to a Work Hardening Program. The attending physician must approve the work hardening plan of care and agree to the job specific goal.

Who makes up the work hardening Team?

Work hardening equipment

Work Hardening

•Progressive multi-hour sessions
•4-8 hours/day, 3-5 days/week
• Up to 8 weeks max

What is a functional capacity evaluation? Source- aota.org

•The components of the FCE will vary based on the purpose of the assessment.

•The FCE typically begins with a client interview, medical record review, and musculoskeletal screening.

•Functional testing may include graded material-handling activities such as lifting, carrying, pushing, and pulling; and positional tolerance activities such as sitting, standing, walking, balancing, reaching, stooping, kneeling, crouching, crawling, object handling/manipulation, fingering, hand grasping, and hand manipulation.

•Pain monitoring is frequently performed during the FCE to document client-reported levels of pain during various activities as well as to manage pain.

•The FCE may also include evaluation of an individual's hand dexterity, hand coordination, endurance, and other job-specific functions.

•The FCE report includes an overall physical demand level (U.S. Department of Labor, n.d.), a summary of job-specific physical abilities, a summary of performance consistency and overall voluntary effort, job match information, adaptations to enhance performance, and treatment recommendations, if requested.

Role of the PTA in Work hardening

•PTA works under the supervision and direction of the supervising physical therapist
•PTA can perform interventions, progress interventions as allowed by the established POC, patient education