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MSK IV > occupational medicine > Flashcards

occupational medicine Flashcards

1
Q

occupational health

OM

A

medical care and compensation for injuries and diseases which occur as a result of employment

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2
Q

occupational medicine

OM

A

branch of medicine concerning the maintenance of health in the workplace, including prevention and treatment of diseases and injuries

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3
Q

participations in occupational health

OM

A
  • employees
  • employers
  • medical providers: physicians, PT, OT, chiropractors
  • case managers
  • vocational consultants/industrial hygienists
  • insurance companies
  • governmental agencies/personnel (OSHA, legislators)
  • attorneys
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4
Q

occupational health concerns

OM

A
  • disaster plans and protocols
  • industiral/environmental hazards: dust, air, pollution, radiation
  • governmental regulation compliance: occupational health and safety administration (OSHA)
  • occupational medicine
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5
Q

OM is currently considered a _ system

OM

A
  • considered a “no fault” system
  • employer must provide workers’ compensation: medical care, indemnity (loss of earning power)
  • average medical and indemnity costs per case continue to increase
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6
Q

national averages and costs

OM

A
  • cost/claim $40,051 (2016-2017)
  • total cost of work injuries $170.8 billion (2018)
  • 2.83 million recorded work related injuries or illness
  • 5,250 workers killed on the job
  • trend: frequency down, but severity up
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7
Q

survival of companies is threatened

OM

A
  • current caps on wages: $1,022.56/week in CO (does not exceed 91% of state average weekly wage)
  • caps on settlements: total temporary disability (TTD) maximum, based on percentage of impairment
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8
Q

since the early 1990s, claim frequency of work related injuries has

OM

A
  • declined
  • improvement in work conditions
  • aging workforce - fewer accidents
  • competitive labor markets
  • global competition - outsourcing
  • technology - use of robotics, automation
  • indirect impacts of OSHA - advances in ergonomic designs, proliferation of cordless tools, employee/employer education
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9
Q

OM depends on which legislation

OM

A
  • states - each has its own legislation and system
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10
Q

designated clinical care in OM

OM

A
  • emergency care is reimbursed
  • employer must designate 4 medical providers known as designated medical provider (DMP)
  • if employer does not designate, a worker can go where they wish

Colorado is a designated state

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11
Q

worker’s compensation

OM

A
  • insurance is required by employers to carry
  • covers employees injured in the workplace
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12
Q

private health insurance vs workers’ compensation insurance

OM

A

private health insurance
* medical benefits
* copays
* deductibles
* provider makes recommendations regarding work status
* employer under no obligation to accomodate injured worker

workers’ compensation insurance
* medical benefits (100%)
* indemnity benefits (wages lost due to work injury)
* vocational rehab
* retraining for new job skills
* permanent/partial disability
* death and dependency benefits
* benefits vary from state to state
* provider assumes responsibility for return to work status
* employer must accommodate injured worker while under care

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13
Q

WC patient pathway

OM

A
  • claim
  • WC provider
  • treatment
  • physical therapy
  • case closure
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14
Q

patient pathway injury

OM

A
  • worker injured while performing job duties
  • reports injury to supervisor/employer
  • worker referred to a healthcare provider:
  • occupational medicine nurse or physician onsite
  • occupational medicine clinic offsite
  • emergency room/urgent care
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15
Q

OM physician/nurse or ER refers for treatment

OM

A
  • imaging
  • specialist (orthopedic, surgeon, neurologist, podiatrist, physiatrist)
  • PT or OT
  • possibility of additional medical eval: further testing or imaging, specialist referral
  • possibility of intensive subacute PT: work conditioning/hardening, functional capacity exam (FCE)
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16
Q

patient pathway - discharge

OM

A
  • discharge or case closure
  • return to work at full or modified duty
  • maximum medical improvement (MMI) and impairment rating
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17
Q

initial filing of claim

OM

A
  • employee completes incident report for employer
  • physician completes physician’s initial report - WC 164 form: include date of incident, statement of work-relatedness, treatment plan, work restrictions
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18
Q

when is treatment for a work-related condition covered

OM

A
  • work exposure causes a new condition
  • work experience causes the activation of a previously asymptomatic or latent medical condition
  • work exposure combines with accelerates, or aggravates a pre-existing symptomatic condition
  • “is it medically probable that the patient would need the treatment if the work exposure had not taken place?”: yes - not work related, no - work related
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19
Q

treatment WC

OM

A
  • PT
  • chiropractic
  • alternative/integrative
  • medication
  • work restrictions
  • interventional/surgical
  • medical treatment guidelines
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20
Q

PT work considerations

OM

A
  • job and requirements
  • work status
  • MOI
  • limitations at work
  • work psychological and social aspects
  • return to work (RTW) requirements
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21
Q

potential barriers for PT WC

OM

A
  • employee-employer relationship or workplace
  • disability benefits
  • pre-existing condition
  • behavioral - fear avoidance/kinesiophobia
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22
Q

division of worker’s comp approved outcome measures for PT

OM

A
  • UE: quickDASH, simple shoulder, hand/wrist symptom severity scale
  • LE: LEFS, lower limb questionnaire, Oxford
  • spine: oswestry, quebec, NDI
  • general: FABQ
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23
Q

goals of WC PT

OM

A
  • return to work
  • functional and job related
  • ICF activity and participation domains related to work: mobility, changing/maintaining body positions, lifting/carrying, fine hand/arm use, walking, moving around, driving
24
Q

rehab communcation form (WC 196)

OM

A
  • form to report a PT/OT subjective and objective findings to the referring physician
  • must include one of the approved outcome measures
  • sent to WC physician before or at patient’s follow-up appointment
25
Q

WC PT intervention for acute

OM

A
  • acute is >70% of cases
  • early progressively-graded exercise: work-oriented functional activity and strenghtening
  • manual techniques
  • psychologically informed practice: individual goal setting, MI, problem solving, relaxation and coping techniques
  • education: posture, ergonomics, body mechanics, integrate exercises into work
26
Q

WC PT intervention - education

OM

A
  • educate employees AND employers
  • cover or protect body parts
  • encourage worker input regarding equipment design and modificaiton
  • identify hazards at job site: JSA, ergonomic assessments
  • rotate worker assignments: reduce exposure to repetitive tasks, reduce boredom, promote focus
27
Q

WC PT intervention

OM

A
  • focus on function: percentage of improvement, aggravating or alleviating activities, activities you can do now that you couldn’t last week, treatment that has helped so far, how do they safely return to work
28
Q

WC PT intervention for sports med model of “industrial athlete”

OM

A
  • more intensive and personalized care
  • physically demnading jobs require a high level of physical fitness
  • frequent reassessment with progression of work capabilities in relation to full duty requirements
  • focus on progressing toward maximal functional outcomes
  • patient and provider as a team
  • maintain work relevance: encourage modified duty job to maintain employee as part of team: psych benefits of being productive, maintain income, maintain dignift, foster morale
29
Q

work restrictions

OM

A
  • RTW early, avoid punitive modified duty (desk duty)
  • appropriate work restrictions
  • occasional lifting up to 20 lbs
  • frequent lifting limited to 5 lbs
  • no over-head work
  • sitting limited to 20 mintues, change position for 10 minutes
  • unlimited walking
  • no use of tools with vibration
  • avoid exposure to temperatures < 20 degrees F
30
Q

the longer it takes a person to RTW

OM

A
  • the less likely they ever will
  • only 50% of workers who have been off work for 6 months or longer ever return to work
  • only 25% return to work after having been off work for 1 year
  • a negligible percent ever return to work after having been off for 2 years
31
Q

of all workers who file claims

OM

A
  • 70% follow expected course of natural recovery and return to work rapidly: account for only 20% of injury costs
  • the 30% that don’t recover quickly account for 80% of claim costs: problems or disabilities may last 3 months or longer
32
Q

WC PT outcome

OM

A
  • patient recovers, returns to work full duty with no restrictions OR
  • signs and symptoms plateau: intensive subacute care, intermediate care
33
Q

subacute injury management

OM

A
  • more intensive PT
  • exercise and/or manual therapy
  • work hardening or conditioning
  • functional capacity evaluation (FCE)
34
Q

work conditioning programs

OM

A
  • restores physical capcity and function: enables patient to return to work
  • team members include: physician, PT, employer
35
Q

work conditioning

OM

A

intensive work-related, goal oriented program designed to retore system neuro/MSK functions, motor function, muscle performance, ROM, CV/pulmonary functions

36
Q

work hardening programs

OM

A
  • more comprehensive multidisciplinary program performed in “real work” environment
  • team members include: patient, physician, PT, psychologist, vocational counselor
  • employer may or may not be involved depending on work status
37
Q

work hardening

OM

A
  • highly structured, goal-oriented, individualized program designed to return the patient/client to work
  • multi-disciplinary, use real or simulated work activities designed to restore physical, behavioral, and vocational functions
  • addresses issues of productivity, safety, physical tolerances, and work behaviors
38
Q

similarities of work conditioning and work hardening

OM

A
  • work oriented with specific work goals
  • initiated with evaluation and concluded with RTW oriented discharge evaluation
  • limited duration 3-8 weeks
39
Q

differences between work conditioning and work hardening

OM

A

work conditioning
* less complicated injuries or cases: severe sprain/strain, routine fractures, post surgical
* primary objectives: strength, endurance, motor control
* education: body mechanics, posture, ergonomics, posture
* limited work simulation
* cost effective
* goal is to return patient/client to full duty work without restrictions

work hardening
* complicated injuries or cases: severely deconditioned, maladaptive behaviors, psychosocial difficulties, problems cannot be solved with physical strengthening or conditioning only
* specialized work rehab using work oriented treatment - work simulation: designated treatment area for work hardening
* focus on restoring function vs obtaining perfection: increase fitness level and work tolerances, maximize work capabilities
* enhance safe work abilities with work behavior

40
Q

summary of work conditioning and work hardening

OM

A
41
Q

discharge/case closure

OM

A

return to work
* team effort between PT, physician, employer
* work status: full duty (no restrictions), modified duty, or permanent disability
* permanent work restrictions/disability: often determined with assistance of FCE, employer determines status of ongoing employment

42
Q

maximum medical improvement (MMI)

OM

A
  • when underlying condition causing disability has become stable and nothing further in the way of treatment will improve condition
  • impairment rating: % assigned for specific disorders, ROM loss, sensory loss, weakness
43
Q

americans with disabilities act (ADA)

OM

A
  • requires employer to provide positions for those with temporary impairment/disability
  • unless there is an “undue burden” that cannot be “reasonably accommodated”
  • undue burden: an action necessary to provide a reasonable accommodation that would cause the employer or owner significant difficulty or expense
  • reasonable accommodation: modifications to the job to enable a person with a disability to easily perform a specific job
44
Q

summary of patient pathway

OM

A
  • worker injured during course of work
  • worker reports injury to supervisor/employer
  • employer refers work to healthcare provider
  • healthcare provider refers to PT
  • worker undergoes acute PT
  • worker returns to full duty
  • worker placed at MMI
45
Q

additional roles of PTs in OM

OM

A
  • health and injury prevention management
  • injury prevention programs
  • work injury management - ergonomics, biomechanics
  • wellness and fitness programs
  • JSA
  • pre-employment screen - physical exams
  • fit for duty/return to work - functional eval after injury
  • FCE
  • nutrition, exercise, smoking cessation
46
Q

job site analysis

OM

A
  • shadowing, observing and capturing quantitative data about tteh essential functions of a job
  • work with employers to modify jobs to improve efficiency and minimize injury/re-injury
  • utilized to provide validity for pre-employment screens
  • essential function: basic job duties that an employee must be able to perform and performed by all workers who hold the job
47
Q

pre-employment screen

OM

A
  • objective assessment to evaluate a candidate’s ability to perform the essential functions of a job
  • hiring the right employees for the job requirements to minimize injury and risk
48
Q

worker’s comp patients in PT

OM

A
  • less likely to have established diagnosis or objective findings
  • higher prevalence of psych disturbances
  • more resistant to conservative treatment
  • greater risk for not responding to surgical intervention
  • higher treatment costs with poorer outcomes
  • less likely to return to work if out of work for more than 6 months (<50% will return)
  • involved with litigation
49
Q

risk factors for delayed RTW

OM

A

subjective complaints
* high levels of perceived or self-reported disability
* excessive pain behavior (in excess of objective findings)
* non-organic/phsyiological findings
* psychosocial or socioeconomic factors

work related factors
* poor job satisfaction (work demands, workplace politics)
* resistance to return to work
* short-term work history
* prior work injuries with prolonged recoveries

other factors:
* attorney representation

50
Q

WC PT should focus on

OM

A
  • function and ability
  • avoid reinforcement of disability
  • apply chronic illness model when appropriate
  • coordinated treatment
  • recognize provider overreliance on subjective complaints
51
Q

aging workforce

OM

A
  • 27% of US workforce is 55 and older
  • benefits of employing older worker: file fewer WC claims, more experience, low turnover, few absences, punctual
  • older more likely to fall - leading cause of non-fatal work related injuries with highest average number of days away from work
  • indemnity costs higher - make more money due to longevity
  • medical severity increases with age - increased medical costs, higher number of treatments per claim, more complex treatment with each session
  • cases take longer to close but not a risk factor in delayed RTW
52
Q

WC and gender

OM

A
  • male: more days of work disability and complicated recoveries
  • female: extended absence and poor RTW outcomes
53
Q

WC and obesity

OM

A
  • obesity has roughly same association with chornic health conditions as 20 years of aging
  • most common injuries caused by falls and lifting
  • most injuries affect LE, wrist, and back
  • much higher average WC claim
  • workers with high BMI have higher rates of WC claims
  • treatment: promote health, wellness, lifestyle changes, potential modifications to work, educate
54
Q

mental health and WC

OM

A
  • risk factors for delayed RTW or less likely RTW: A, D, panic, high perceived/self-reported disability, fear avoidance, low self-efficacy
  • treatment: psychologically informed practice, therapeutic alliance
55
Q

PTs as cost drivers

OM

A
  • ineffective treatments: passive, modalities, not EBP
  • optimistic and slow recognition of limitations: not knowing when time to refer
  • productivity demands: limited time with patient, decrease quality of care, administrative burden
  • results in increased case durations

MSK IV (8 decks)

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