Danny Sanchez of PhysNet Physical Therapy will be participating in the physical therapy portion of the Industrial Rehab Discussion at the WCI tradeshow. Here’s an overview of the discussion. Focused primarily on Return to Work (RTW) programs.

The first question to ask is what is a work program?

Industrial Rehab Return to Work programs combine work conditioning and work hardening therapies. 
Work conditioning uses strengthening and conditioning tasks to restore function. Work hardening takes conditioning to the next level by increasing resistance and intensity. 
Here’s an example schedule for these types of programs:

• Work Conditioning: 
• 2-4 hours per day
•  3-5 days per week
•  2-4 weeks single discipline – PT or OT only
• Work Hardening:
• 4-8 hours per day
• 5 days per week
•  4 weeks
•  Multiple disciplines involved – psychologist, vocational specialist, nutritionist, and PT or OT, accredited program

There is a certain amount flexibility involved due to the specific needs of the client. Here are areas where you may need to adjust.

• Frequency and duration - How long the sessions, how many and how often. Determined by an individual analysis. Adjustments are based on the evaluation, treatment plan, and the possibility of work reintegration.
• Type of therapy - Usually only one discipline, but others can be added as need.
• Job Requirements - The goal is always to get the patient capable of performing their specific job.

Successful Outcomes for RTW programs

The first step is to know what a successful outcome is. You don’t know if something works if you haven’t defined the parameters for a successful result. For RTW work programs Sanchez defines a successful outcome in two ways: 

• The patient must meet the physical demands of the job they were injured doing.
• For a general program the physical requirements should be 1-2 levels higher.

Once you have your goal you now need a way to measure them. Here are a handful of ways to measuring your outcomes:

• Physical demand category
• Lifting ability
• Non material handling tolerance

When to refer an injured worker to a return to work program.
Communication is key to programs like this. Look at the criteria for participation for the worker and decide if the program is the best option. The main two criteria for moving to a program are:

• Traditional, skilled PT no longer needed
• Still unable to return to work due to physical or functional deficits

FCE

FCE stands for Functional Capacity Evaluation. An FCE is a diagnostic tool that measures an individual’s ability to perform work activities.

An impartial physical therapist performs the evaluation. It’s important to know what kind of assessment to do - either a general one, or a job specific one. An FCE can actually be performed at several different intervals throughout the life of the claim:

• Pre-surgical – To measure Strength and ROM prior to surgery as a baseline
• Post-surgical – To measure results of effective surgery
• Pre-work conditioning –To offer a baseline, prior to WC
• Post-work conditioning – To provide effective measurement of WC

Mr. Sanchez summed up the program and the importance of industrial rehabilitation with the statement:

"Industrial Rehabilitation should be the standard in any return to work program. Injured workers should be receiving care that takes into consideration the physical and positional demands of their job. Akin to professional athletes receiving focused rehabilitation that targets their ability to get back on the playing field, a sound Industrial Rehabilitation program will ensure that injured workers are back on the job in no time"