Alsu presentation 10 14-10-b


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  • CA
  • Occupational Injuries/Illnesses (give examples) Open wound, sprain/strain of shoulder, lumbosacral sprain/strain, neck sprain/strain, lumbar sprain/strain. Open wound-needlestick, nicking themselves with a scalpel Shoulder – heavy linen bags or trash custodial workers need to lift Back injuries- related to patient handling
  • Provide a little comic relief, here’s something we ran across as we researched and pulled information for today’s presentation, Enjoy!
  • Job Security Financial independence Positive contact with co-workers Proactive, engaged participation in rehabilitation Relieves stress and job insecurity Enhanced self-esteem Employees and their families maintain routines Continuation of employee benefits, pension, insurance and medical plans Retain experienced workforce Keeps the employee fit and healthy, both physically and mentally, by utilizing work as a therapy Offers employee exposure to different jobs supporting professional development Helps employee to regain full salary sooner Allows employee to receive accommodation and remain productive at work while managing a medical condition No reduction in pay Reduces chance for disability separation (loss of benefits) or termination Improves self-esteem Opportunity to have exposure to different job tasks Provides sense of pride, worth and importance Keeps employee fit and healthy, physically and mentally
  • Alsu presentation 10 14-10-b

    1. 1. Rehabilitation Beyond the Clinic On-site Physical Therapy:
    2. 2. Objectives: <ul><li>Describe the Transitional Work Program at The Ohio State University. </li></ul><ul><li>Define the role of the onsite physical therapist, the services provided, and the method of service delivery. </li></ul><ul><li>Identify differences between typical clinic based therapy services and on-site therapy services. </li></ul><ul><li>Describe some of the unique barriers to recovery in patients with a work related injury. </li></ul>
    3. 3. Transitional Work: <ul><li>Keeping employees healthy and working </li></ul>
    4. 5. History of Transitional Work <ul><li>OSU has been accommodating temporary restrictions for over 10 years </li></ul><ul><ul><li>Formal policy est. 2007 </li></ul></ul><ul><li>Offers employees the opportunity to return to work with temporary restrictions even if their home department cannot accommodate them by finding other work within the University </li></ul>
    5. 6. RTW Hierarchy
    6. 7. Transitional Work Overview <ul><li>Any employee with medical restriction is eligible </li></ul><ul><ul><li>Physical </li></ul></ul><ul><ul><li>Mental health </li></ul></ul><ul><li>Does NOT necessarily have to be BWC or disability claim </li></ul>
    7. 8. Transitional Work Overview <ul><li>OSU Transitional Work Policy 2.45- we do accommodate temporary restrictions </li></ul><ul><ul><ul><li>95% of employees with restrictions accommodated </li></ul></ul></ul><ul><li>Applies for occupational and non-occupational injuries </li></ul><ul><li>Time limited –12 weeks </li></ul><ul><ul><li>Exceptions—case by case basis </li></ul></ul><ul><ul><li>Showing progress toward full duty </li></ul></ul><ul><li>Since full implementation in 2007, cost savings of over $7 million </li></ul>
    8. 9. Most Common Occupational Diagnoses
    9. 10. How it happened? <ul><li> </li></ul>
    10. 11. Benefits of Transitional Work
    11. 12. On-site Physical Therapy: <ul><li>Services Offered </li></ul>
    12. 13. On-site Physical Therapy Services <ul><li>Provided by an Ohio licensed physical therapist </li></ul><ul><li>Direct access to services </li></ul><ul><ul><li>Referral sources </li></ul></ul><ul><ul><ul><li>Physicians </li></ul></ul></ul><ul><ul><ul><li>Disability Program Managers (case managers) </li></ul></ul></ul><ul><ul><ul><li>Departments </li></ul></ul></ul><ul><ul><ul><li>Patients </li></ul></ul></ul><ul><ul><ul><li>Managed Care Organization </li></ul></ul></ul><ul><li>Services provided as a benefit to University employees </li></ul><ul><ul><li>no “billing” </li></ul></ul><ul><li>Can be (and preferred to be ) performed concurrently with clinic based therapy </li></ul>
    13. 14. On-Site Physical Therapy <ul><li>Physical Therapy Services provided to employees at work site </li></ul><ul><li>Includes </li></ul><ul><ul><li>Acute Injury Management </li></ul></ul><ul><ul><li>Job Analysis </li></ul></ul><ul><ul><li>Ergonomic Assessments of Workspace </li></ul></ul><ul><ul><li>Functional Capacity Evaluation </li></ul></ul><ul><ul><li>Return to Work Progression </li></ul></ul>
    14. 15. Acute Injury Management <ul><ul><li>Evaluation and treatment of injured employees </li></ul></ul><ul><ul><li>occ. and non-occ. </li></ul></ul><ul><ul><li>Performed at jobsite </li></ul></ul><ul><ul><li>Functionally driven </li></ul></ul>
    15. 16. Job Analysis <ul><ul><li>Review PD, discuss job demands with employees, supervisors </li></ul></ul><ul><ul><li>Review DOT classification/job specs </li></ul></ul><ul><ul><li>Determine initial list of essential and marginal functions </li></ul></ul><ul><ul><li>Shadow employee to determine physical demands assoc. with each EF </li></ul></ul><ul><ul><ul><li>Objective measurements (weights, distances, frequencies, etc.) </li></ul></ul></ul><ul><ul><li>Review findings with supervisor/department </li></ul></ul><ul><ul><li>Generate formal report </li></ul></ul>
    16. 17. Ergonomic Assessment <ul><li>Collect objective information re: </li></ul><ul><ul><li>a specific employee, specific job tasks, employee’s workspace </li></ul></ul><ul><li>Identify potential risk factors for MSD’s </li></ul><ul><ul><li>awkward positions, excessive force, excessive repetition, sustained positions, contact forces, etc. </li></ul></ul><ul><li>Provide recommendation for improvement to appropriate parties </li></ul><ul><ul><li>employee, department, physician, ADA coordinator </li></ul></ul>
    17. 18. Functional Capacity Evaluation <ul><li>An objective measurement of a person’s ability to perform work </li></ul><ul><li>Bridges gap between medical and functional </li></ul><ul><li>Purposes </li></ul><ul><ul><li>Determine if symptomatic individuals can RTW in any capacity </li></ul></ul><ul><ul><li>Determine entry point to WC or WH </li></ul></ul><ul><ul><li>Consistency of effort </li></ul></ul>
    18. 19. Job Progression/Transitional Work <ul><ul><li>Have a starting point—initial restrictions </li></ul></ul><ul><ul><li>Have a goal—full duty (based on job demands, not necessarily no restriction) </li></ul></ul><ul><ul><li>Identify job tasks that can be: </li></ul></ul><ul><ul><ul><li>Performed with current restrictions </li></ul></ul></ul><ul><ul><ul><li>That can be performed with supervision </li></ul></ul></ul><ul><ul><ul><li>That can be “therapeutic” </li></ul></ul></ul><ul><ul><li>Outline graded job task/activity progression </li></ul></ul><ul><ul><li>Provide coaching/education </li></ul></ul><ul><ul><li>Identify possible job modifications </li></ul></ul><ul><ul><li>Adjust as needed according to progress </li></ul></ul>
    19. 20. On-Site PT and Clinic Based PT: Concurrent Services <ul><li>Use job demands in goal setting </li></ul><ul><li>Assess and document functional abilities relevant to job demands </li></ul><ul><li>Communicate specific impairments that may be prohibiting progress in RTW </li></ul><ul><li>Be aware of TW timeline </li></ul><ul><li>Provide job assessments at (or close to) initial clinic visit </li></ul><ul><li>Communicate specific functional limitations that could be addressed in clinic therapy </li></ul><ul><li>Provide on-site visits for job coaching, workstation assessments </li></ul><ul><li>Clinic Based PT </li></ul><ul><li>On-site PT </li></ul>
    20. 21. Case example #1: <ul><li>45 year old nurse in pre-operative area </li></ul><ul><li>Low back injury 1.5 years ago </li></ul><ul><ul><li>Restrictions standing/walking to occasional level, no bending/twisting/squatting, max lift 20 lbs. </li></ul></ul><ul><li>Job analysis performed </li></ul><ul><li>FCE performed </li></ul>
    21. 22. Case example #1 (con’t): <ul><li>FCE results </li></ul><ul><ul><li>demonstrated employee’s ability exceeded level of restriction. </li></ul></ul><ul><ul><li>Job match to 90% of job demands </li></ul></ul><ul><li>Recommendations: </li></ul><ul><ul><li>Adjust restrictions to reflect capabilities </li></ul></ul><ul><ul><li>Gradual return to work with on-site PT </li></ul></ul><ul><ul><li>Adjustable work surface for documentation </li></ul></ul><ul><ul><li>Work conditioning </li></ul></ul>
    22. 23. Case example #1 (con’t) : <ul><li>Results: </li></ul><ul><ul><li>Able to RTW full duty in 8 weeks. </li></ul></ul>
    23. 24. Case example #2: <ul><li>51 year old female nurse </li></ul><ul><ul><li>Severe diabetic neuropathy affecting right LE. </li></ul></ul><ul><ul><li>Permanent restrictions of no prolonged walking/standing, no lifting of patients, no pushing/pulling </li></ul></ul>
    24. 25. Case example #2 (con’t) <ul><li>Job Analysis Performed </li></ul><ul><ul><li>Unable to perform essential functions </li></ul></ul><ul><ul><ul><li>Provide direct patient care services within room </li></ul></ul></ul><ul><ul><ul><li>Safely transfer/reposition patients </li></ul></ul></ul><ul><ul><ul><li>Transferring patients on carts/wheelchairs </li></ul></ul></ul><ul><ul><li>Referred to job developer </li></ul></ul><ul><ul><ul><li>Assisted with: </li></ul></ul></ul><ul><ul><ul><ul><li>Resume development </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Online application process </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Interviewing skills </li></ul></ul></ul></ul>
    25. 26. Case example #2 (con’t) <ul><li>Result: </li></ul><ul><ul><li>JD identified open position that had less physical requirements. </li></ul></ul><ul><ul><ul><li>No patient handling, ability to alternate between sitting/standing as needed </li></ul></ul></ul>
    26. 27. Patients with Work Related Injuries: <ul><li>Unique Barriers to Recovery </li></ul>
    27. 28. Symptom Magnification <ul><ul><li>“ intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives, such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs” 1 </li></ul></ul><ul><ul><li>Probable prevalence in workers comp, personal injury, and disability claims estimated between 25-30% 2 </li></ul></ul>
    28. 29. Symptom Magnification: Interventions <ul><li>Document!!!!! </li></ul><ul><ul><li>Discrepancies between self-report, musculoskeletal evaluation and functional performance </li></ul></ul><ul><ul><ul><li>Use of self-report measures </li></ul></ul></ul><ul><ul><li>Unannounced visit </li></ul></ul><ul><li>Be Prepared </li></ul><ul><ul><li>Obtain as much information as possible prior to visit </li></ul></ul><ul><ul><ul><li>Medical, job information, etc. </li></ul></ul></ul>
    29. 30. Performance Issues <ul><li>Often see disciplinary/performance issues wrapped in injury claims </li></ul><ul><ul><li>Ex. Employee facing 3 rd disciplinary action injures herself 2 days prior to hearing </li></ul></ul><ul><ul><li>Treat in good faith </li></ul></ul><ul><ul><li>Communicate with all parties (case manager, physicians, supervisors/departments, employees) </li></ul></ul><ul><ul><li>Set clear expectations for employee and department </li></ul></ul>
    30. 31. Wrap-Up
    31. 32. <ul><li>Transitional work allows injured workers to return to work sooner, resulting in better patient outcomes, and decreased cost to the employer. </li></ul><ul><li>On-site PT helps to match the patients functional status to the job demands. </li></ul>
    32. 34. Contact Information <ul><li>Jamie Beadle, PT, OCS </li></ul><ul><li>[email_address] </li></ul><ul><li>614-247-2105 </li></ul>
    33. 35. References <ul><li>Fishbain DA, Cutler RB, Rosomoff HL, Rosomoff RS. Chronic pain disability exaggeration/malingering and sub maximal effort research. Clin J Pain. 1999; 15:244-274. </li></ul><ul><li>Mittenberg W, Patton C, Canyock EM, Condit DC. Base rates of malingering and symptom exaggeration. J Clin Exp Neuropsychol. 2002:24:1094-1102. </li></ul>