9.5 - Work Hardening & Conditioning

Work Hardening

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 program is to restore physical capacity and function to enable the injured worker to return to his or her pre-injury job.

• Multidisciplinary (PT, OT, vocational rehab or social/psychological services)

• Sound vocational directing with measurable outcomes

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

When is a patient ready for work conditioning?

• After a plateau with OP therapy has been reached but difficulties with the demands of their job are still present (cannot meet full work demands)

• Case manager can make a referral (after DR writes med prescription)

Components of Work Hardening

 Orientation

 Specific Flexibility Program

 Strengthening Program

 Cardiovascular Conditioning

 Therapeutic Activities

 Functional Job Simulation Activities

 Education/Body Mechanics/Ergonomics Training

What is the role of work conditioning (in comparison to OP therapy)?

 Bridges that 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

What is the role of OP therapy (in comparison to work conditioning)?

 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 hardening does not address the issues of productivity,

safety, physical tolerances and worker behaviors.

False

What is the criteria for being in a work hardening program?

 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)

Although the a physician, claims manager, case manager, employer, or a vocational counselor can make initiate the referral to w Work Hardening Program, the attending physician must approve the WHP POC and agree to the job specific goal.

True

Who is on a WHP team?

• Social worker

• PT and PTA

• OT and COTA

• Psychologists

• Rehab Physicians

• Vocational Counselors

What is a functional capacity evaluation (FCE)?

*Components can vary depending on purpose but includes:

• Starts with client interview, med record review, and musculoskeletal screening

• Includes graded material-handling activities ()lifting, carrying, pushing, balancing, etc.)

• Pain monitoring and documentation

• Examine and eval of hand dex, coordination, endurance, etc.

• Includes overall physical demand level, job specific physical abilities, summary of performance, job match info, adaptations to enhance performance, rx recommendations

What is the role of a PTA in regards to work hardening?

Perform interventions, progress interventions as allowed by the established POC by PT, patient ed