nil

1. Work Hardening
Arbeitsbezogene
Rehabilitation
(ABR)

2. Work Hardening
 The focus of this treatment is to build
capacities for quick and safe return to
work.

3. Milestones in the development
of Work Hardening
 L. Matheson (Ende 70er-Jahre)
 Work Hardening-Programm = Work oriented
program that has an outcome which is
measured in terms of improvement in the
client’s productivity
 T. Mayer und R. Gatchel (1988)
 Functional Restoration for Spinal Disorders.
The Sport Medicine Approach

4. Milestones ...
 S. Isernhagen 1991
 Functional Capacity Evaluation and Work
Hardening Perspectives
 L. Darphin (1995)
 Work-Hardening and Work-Conditioning
Perspectives
 M. Nordin (Campello et al 1998)
 Approaches to improve the outcome of patients
with delayed recovery

5. In Switzerland
 Ergonomie-Trainingsprograms since 1995
 Rehaklinik Bellikon
 Unispital Zürich
 Klinik Valens
Growing need for new clinics…

6. Guidelines, Accreditation
 Commission for Accreditation of
Rehabilitation Facilities CARF (1988)
 American Physical Therapy Association
APTA (1991)

7. Work Hardening OT/PT ("work
conditioning")
Requires a specific return to work goal. No specific return to work goal is required.
Recognized as a specific treatment
program by Labor and Industries —
program standards have been
established.
Not recognized as a specific treatment
program by Labor and Industries — specific
standards have not been established.
Reimbursed according to the work
hardening fee schedule.
Reimbursed according to the physical and
occupational therapy WAC in the medical aid
rules and fee schedule.
Addresses physical, functional,
behavioral and vocational needs of the
worker.
Addresses physical and functional needs of
the worker.
Multi-disciplinary. May be provided by one discipline.
Utilizes real or simulated work activities
with some physical conditioning.
Utilizes physical conditioning and functional
activities related to work. May or may not
include education.
Includes education (e.g., body
mechanics, work pacing, safety and
injury prevention).
May or may not include an educational
component.
Begins at 4 hours/day and builds to 8
hours/day over the course of 4 to 8
weeks.
4 hours or less per day.
Note: reimbursement limits for outpatient
occupational and physical therapy do not
typically cover four hours per day.

8. Guidelines APTA: Definition
 Work Hardening is a highly structured goal-
oriented, individualized treatment program
designed to return a person to work. Work
Hardening programs, which are interdisciplinary
in nature, use real or simulated work activities
designed to restore physical, behavioral, and
vocational functions. Work hardening addresses
the issues of productivity, safety, physical
tolerances, and worker behaviors."

9. Guidelines APTA: Treatment
Work Conditioning
 Undisciplinary
Work Hardening
 interdisciplinary

10. Guidelines APTA: Treatment
Work Conditioning
 Work Conditioning
Assessment
 Physical Conditioning
 Work related functional
Aktivities
Work Hardening
 Work Hardening
Assessment
 Work related physical
Conditioning
 Real or simulated
workability
 Psychosocial Interventions

11. Guidelines APTA: Triage for
Work Conditioning and Work
Hardening
Accident Evaluation
Acut
treatment
Work
Work
Conditioning
Work
Work
Hardening
Work

12. Criteria for admission to 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 based
on a screening process.
 The worker has still a Job (= not
unemployed)

13. Basic elements for Work
Hardening
Global goals for Rehab
1. Zielorientierung
 Goaling process:
functional and
work related
goalsetting
 Work with weekly
goals
 “Self Efficacy”

14. Basic elements ...
2. Painmanagement
and coping with pain
 Information and
practical teaching
about pain coping
strategies

15. Basic elements...
3. Work related Assessment
 The Base:
Evaluation der funktionellen Leistungsfähigkeit
EFL
 Important:
Evaluation of symptom magnification

16. Baseline Tests
 Complete patient history related to current diagnosis and any past
medical history important to the FCE evaluation.
 Cardiovascular response to activity
 Pain intensity and PACT-questionnaire pre and postrehab
 Assessment of fine motor skills
 Assessment for balance
 Positional tolerance testing
 Material handling test
 Musculoskeletal evaluation if there is evidence of symptom
magnification or submaximal effort
Functional Capacity Evaluations are performed by Occupational Therapists
and Physical Therapists who have had specific training in performing Functional
Capacity Evaluations.

18. Individualized programs
include:
 Simulated job activities with body
mechanics instruction to prevent re-injury
 Aerobic conditioning
 Flexibility and strengthening exercises
 Learning about pain coping strategies
 Relaxationtechniques
 Sports and leisure time activities

20. Some actual job simulations
include:
 Material Handling
 Janitorial Services
 Delivery Jobs
 Construction Tasks
 Clerical Task
 Packaging Operations
 Electrical Wiring
 Climbing Ladders
 Packaging Jobs
 Simulated Truck Cab
 Stocking of Shelves
 Wallboard Installation
 Brick/Block Building
 Electronic Assembly
 Use of Shovels &
Rakes
 Use of Drills & Saws
 Use of Hammers &
Screwdrivers

24. Specific job simulations allow
the patients to place their bodies
similar to those of their actual jobs

25. “Work is the grand cure of all
maladies and miseries that ever
beset mankind.”
Thomas Carlyle, 1866

26. Wenn ich dass gewusst hätte das
ich 100-jährig werde, hätte ich
besser auf meinen Körper
geachtet
- ein 100-Järige Kinese -