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Your Toolkit for Return to Work and Injury Prevention
PART I
Presented by: Nathan Birtch
• Work Hardening
• Functional Abilities Evaluation
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Challenges
Return to work challenges faced daily• Unclear what employees are physically
capable of • Discrepancies between an employees
perception and their physical capabilities• Unclear medical reports• Vague FAF’s• Psychosocial factors involved
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Effects of disability on likelihood of return to work
6 months 12 months 2 years
10%20%
30%
50%
Amount of time off work due to disability
% L
ikel
ihoo
d of
re
turn
to w
ork
20%
10%
40%
50%
60%70%
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Timing of Intervention and Impact
0
20
40
60
80
100
Prob
abilit
y of
RTW
(in
%)
0 3 6 9 12 15 18 21 24 36
Duration of absence (in months)
Probability of Returning To Work
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Costs of Disability
• In Ontario MSD’s account for 42% of all lost time claims and 50% of lost time days (averages from 1996 –2004)
• These claims represent approximately 27 million lost days
• Direct costs estimated at more than 3 billion• Total costs estimated to be more than 12
billion (direct costs + indirect costs)
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The Iceberg Effect
Direct costs• Wage Replacements• Treatment• Evaluations & examinations• NEL/ FEL awards
Indirect Costs• Lost Productivity• Replacement workers / training• Accident investigation• Case management time• Productivity/ Quality issues
Indirect costs – estimated to be 4 –7 x’s thedirect cost
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HELP!?!?!
The Toolkit!- Work Readiness Program- Functional Abilities Evaluation- Physical Demands Analysis- Ergonomic Assessments- Post-offer Pre-placement Screening- Independent Medicals
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• overcome all barriers preventing successful return to full employment
Work Readiness (WR) Program Goals
• prepare people for work roles
• achieve full pre-injury functional status
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The Work Readiness Program
PHILOSOPHY:• Early intervention, including functional
conditioning is key to successful return to work and reactivation into normal life
• More than work specific physical conditioning; it extends to mental toughening as well - not necessarily resulting in less pain but in better management of that pain relative to tolerating work activities.
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The Work Readiness Program
A Good Candidate: Individuals with musculo-skeletal injuries, general health
problems or emotional conditions that limit ability to return to pre-injury level of function
Having difficulty returning to work/ unsuccessful attempts at RTW
Individuals returning to heavy jobs or challenging life circumstances
Have completed acute stage of rehab but require more aggressive functional conditioning
Those who could benefit from a structured, daily program
Program Components
Physical Therapeutic
Exercise Program
Biomechanics Retraining / Relaxation Techniques
Functional Conditioning
Comprehensive Evaluation
Personal Functional Goal Setting
Stress / Anger / Pain Management
Liaison with Physician,
Employer and Funder
CLIENT EMPOWERED FUNCTION RESTORED
CASE CLOSED
Client Education
Vocational Conditioning
Client Centered Results
Phases of Work Readiness Program
S M T W TH F S
Wk ?-?
Wk ?-?
Phase 1: Review of Referral Information
Phase 2: Initial Assessment
Phase 3: Establish Initial Targets
Phase 4: General Conditioning• Monitor progression to targets weekly• FAE reassessment every 2 wks •Physio reassessment every 2-4 wks
Phase 5: Functional Conditioning
Includes FAE
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Evaluation tools during program
• Functional Abilities Evaluations – initial evaluation completed within first week, then every 2 weeks subsequently
• Physiotherapy Re-Assessments- every 2-4 weeks depending on client progress/ barriers
• Goal setting – revised weekly• BTE evaluations
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Education
Education
1 on 1
Video Group
Psychology
Body Mechanics & Lifting
Back & Neck conditions
Core StabilityStretching
Relaxation Techniques Soft Tissue Healing
Avoiding RSI’s
Pain management
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Job Site Coaching
• Job site coaching to ensure carry over of learned skills and techniques
• Ensure safe job performance
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Program Duration
• Usually between 6 – 12 weeks• Usually half day but can be full day• Can be used in conjunction with graduated
return to work plan
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Reporting
• Complete Initial Assessment and Individual Work Readiness Plan
• Progress reports every 2 weeks including updated functional and physical progress
• BTE Work Simulator report• Job site coaching report• Final Report and recommendations
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What the research says
• Significant difference in the subjects' “physical demand characteristic” level before and after the work hardening program.
• 75% of the subjects who completed the work hardening program were able to resume employment.
“Outcome evaluation of work hardening program for manual workers with work-related back injury.” From Work: 2005;25(4): 297-305, Sang LS, Ying Eria LP, Occupational Therapy Dept,United Christian Hospital, Kowloon, Hong Kong, China
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What does the research say?
• “The effectiveness of a comprehensive work hardening program as measured by lifting capacity, pain scales, and depression scores.” Work 2005;24(1):21-31, Baker P, Goodman G, Ekelman B, Bonder B, Cleveland Clinic Foundation, Occupational Therapy Dept.
• Pre- and post-scores for subjective measures of pain - Oswestry Back Pain Scale
• Pain- the Beck Depression Inventory, the Waddell Sign• Pre- and post-scores of several physical performance tasks (lifting,
carrying, etc)
• Results- Significant post program improvements in all 6 tests!
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Key Questions
• Do you currently have problems getting people back to work?
• Are people on modified duties for an extended period of time?
• Are your light jobs all full?• Are the doctors dictating RTW programs
that don’t seem reasonable?
Employee on Modified Duties and Hours (working 4 hrs/day)
Employee working full hours on modified duties
Employee modified duties, working 4 hrs/day and attending WREP 3 hrs/day for 8 weeks
Employee Wage 300/wk 600/wk 600/wk
Wage for additional worker
600/wk 600/wk 600/wk for 8 weeks only
WSIB Surcharge x 3 900/wk
Cost of WREP $3,850
Total Costs during 8 week program
$14,400 $9,600 $13,450
Total over 6 months $46,800 $31,200 $24,250
Total over 1 year $93,600 $62,400 $39,850
Cost Savings Breakdown
Based on $15 /hr wage
The BTE System
The BTE System
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FUNCTIONAL ABILITIES EVALUATION
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What is a FAE? • An objective detailed assessment of an
employee’s ability to perform functional work tasks
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• Lifting • Carrying (bilateral/ unilateral)• Push/ Pull (bilateral / unilateral)• Reaching (multi-level)• Hand dexterity• Walking• Stair climbing• Balance• ROM• Grip Strength• Strength testing• Etc.
What is a FAE? (con’t)
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Use of tools and protocols based on publishedresearch to ensure that the testing and theoutcome are:• objective• valid• reliable • defensible
What is a FAE? (con’t)
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Defensible?
• FAE’s done by the ARCON system were used in these cases:- ANGELO TSIMIDIS (Appellant) and LIBERTY
MUTUAL INSURANCE COMPANY (Respondent) BEFORE: Stewart M. McMahon, Directors Delegate August 28th 2000
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• Consistency of effort checks throughout testing to ensure maximal effort is put forth.
• Use of outcome measures to match perceived capacity with actual physical capacity.
What is a FAE? (con’t)
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How a FAE is different than a FAF
FAF General Vague Limited information for
the employer Can be subjective
(depending on who fills out)
FAE More comprehensive Consistency checks In conjunction with
impairment testing State of the art
computerized ARCON system
Very detailed report of information for employer
Very objective
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PDD / PDA
JOB MATCHFAE
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Why have a FAE for my employee?
1. To determine if a person is ready to return to work
2. To assess what jobs the worker is suited for3. To clarify appropriate work restrictions4. To clarify if modifications or accommodations
need to be made to prevent further injury5. Assist with treatment recommendations6. Assess the validity of a disability
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How do you perform the evaluation?
PDD (if provided) Used to determine the nature of the testing
protocol Also used for job matching portion
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Biomechanical Testing Performed by a Physiotherapist Provides biomechanical diagnosis to plan
the nature of the testing ROM testing, Strength Testing
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Static Functional Testing ARCON technology used to assess
lifting, pushing, pulling, grip and force generation
Sufficient static force with good body mechanics, qualifies the client to proceed to dynamic functional tasks
Heart rate monitor used at all times.
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ARCON TESTING
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Dynamic Functional Testing Conducted using functional
equipment in the lab (weights, push/pull cart, toolbox etc.)
Custom lifting, pushing, pulling, and carrying to match the specific requirements of the job
Heart rate monitor used at all times
How do you perform the evaluation? (con’t)
Dynamic Lift
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Occupational Testing Testing designed to
assess job specific tasks to simulate work environment
i.e.- assembly, typing, painting, etc
How do you perform the evaluation? (con’t)
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Test End Points
Self Limited By Subjective Complaints (Psychophysical)
Physiological
Biomechanical Safety
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How long?
Time from evaluation to report- 10 business days
1 Day FAE = 3 hrs 2 Day FAE = 3 hrs each day = 6 hrs
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When should a FAE be done?
1. During return to work planning Unsure on what the worker is functionally capable of Unsure on the validity of the workers injury Unsure on where to place the worker in the job
environment
2. To measure progress during the rehabilitation process FAF's are too vague and not specific enough Treatment is prolonged
3. When validity of a disability is questioned Inconsistencies in reports, demonstrated ability,
observation
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Report Information
Job match status Impairments Rehab/ treatment recommendations Return to work recommendations Ergonomic recommendations Consistency of effort Functional abilities
ReportPULL IN (Pounds)
08
16243240
0 1 2 3 4 5
PUSH OUT (Pounds)
01632486480
0 1 2 3 4 5
FLOOR LIFT (Pounds)
020406080
100
0 1 2 3 4 5
H FLOOR LIFT (Pounds)
08
16243240
0 1 2 3 4 5
Report
ReportSTANDARD (L) (Pounds)
0285684
112140
0.0 0.5 1.0 1.5 2.0 2.5 3.0
Report
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What to do with all the Information
• Look for consistency of effort checkpoints, how has the evaluator interpreted them
• Look at the evaluator’s return to work recommendations and job matching comments
• Compare the functional ability result to the job demands (PDD/PDA)
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What to do with all the Information
JOB MATCH?
If yes, return to work
If no, can the jobbe modified or adjusted?
Based on current functional ability level
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What do I do with all the Information?
ERGO and TreatmentRecommendations
Is further treatmentRecommended?
Are modifications to job or work station
recommended?
Work ReadinessProgram?
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Questions and Answers
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The Toolkit- Part 2?
• In the new year we will explore:• Physical Demands Descriptions• Ergonomic Assessments• Post Offer Pre-Placement Screening
…and more