Practice in Occupational Health Flashcards
50% of all persons with a disability were age ___
65 and over
Across all age groups, persons with ____ were much less likely to be employed than those with ___
a disability
no disability.
___ percent of workers with a disability were employed part time, vs ___ for those with no disability.
30%
16%
Employed persons with a disability were more likely to be ___ than those with no disability.
self-employed
COST of WORK-RELATED RMDs
65% - income and HRQOL loss
33% - productivity loss and turnover
2% - GDP impact
Engaging with the ___ is key
employer
psychosocial risks (yellow flags):
high pain severity (low pain acceptance)
catastrophizing
high perceived functional disability
high fear-avoidance beliefs or kinesiophobia
low recovery expectations
low self-efficacy (low perceived control over situations)
observed pain behaviors
workplace risks (blue/black flags)
poor job satisfaction
poor relationship with supervisors or coworkers
job stress
nonavailability of RTW programs or ergonomic changes
high job demands
workplace culture and policies that discourage RTW
Self-reported outcomes
SF-36 (generic)
WORQ (function-specific)
FABQ (condition-specific)
DASH
ODI
PERFORMANCE-
BASED TESTS
trunk
15 min stand
floor-to-waist lift
1-min crouch
2-min sustained trunk flexion
5-min repetitive trunk rotation
PERFORMANCE-
BASED TESTS
UE
waist-to-overhead lift
sustained elevated work
crawling
hand grip strength
hand coordination
PERFORMANCE-
BASED TESTS
15-min stand
floor-to-waist lift
1-min crouch
2-min kneel
stepladder or stairs
GLOBAL RESIDUAL FUNCTIONAL CAPACITY (GRFC)
Patient-reported outcomes:
FABQ
RMDQ
ODI
WORQ
DASH
Performance-based outcomes:
6 minutes walk
9-hole peg test
MMT
ROM
30 STS
Handgrip
Time: A friend or a foe?
Work disability evolves over time
Predictors evolves over time
Expected recovery evolves over time
What is occupational health?
promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations
by preventing departures from health, controlling risks and the adaptation of work to people, and people to their jobs
Principles of Occupational Health
Management of lost time and minimization of disability
Facilitation of timely and appropriate referrals
Minimization of injury/reinjury incident rate
Determination of safe work activity
The design of safe, progressive rehabilitation programs that aggressively recondition the injured worker.
Principles of PT in OH:
Management of lost time and minimization of disability
Facilitation of timely and appropriate referrals
Minimization of injury/re-injury incident rate
Work rehabilitation =
multi-professional evidence-based
approach that is provided in different settings, services, and activities to working age individuals with health-related impairments, limitations, or restrictions with work functioning, and whose primary aim is to optimize work participation
Services may be delivered in:
Hospitals, homes, outpatient clinics or offices, rehabilitation facilities, subacute care facilities, corporate or industrial health centers, industrial, workplace or other occupational environments, fitness centers, and education or research centers.
Physical therapists may also participate in prevention and the promotion of health, wellness, and fitness, consultation, and education.
___ with other health care professionals, employees, employers, insurers, governmental regulatory and administrative agencies
Coordinate service
Facilitate optimum work environment:
analyze work tasks, tools and work station / workplace design
Advise employers on the
Americans with Disabilities Act (ADA) and OSHA and worker’s compensation
Work-worker match!
includes the physical, cognitive, and emotional requirements of the job
Work conditioning
objective of the work conditioning program is to restore physical capacity and function to enable the patient/client to return to work
addresses physical and functional needs
may be provided by one discipline
utilizes physical conditioning and functional activities related to work
Work hardening
Work Hardening addresses the issues of productivity, safety, physical tolerances, and worker behaviors
addresses physical, functional, behavioral, vocational needs within a multidisciplinary model
utilizes real or stimulated work activities
Work rehabilitation
addresses physical, functional, behavioral, vocational needs with a multidisciplinary model that includes medical and workplace stakeholders
utilizes various therapeutic interventions with a functional emphasis, emphasizing the role of the worker/work activities
Work conditioning:
provided in multi-hour sessions up to:
4 hours/day
5 days/week
8 weeks
Work hardening:
provided in multi-hour sessions up to:
8 hours/day
5 days/week
8 weeks
WORK REHABILITATION PROGRAM COMPONENTS
Promote patient/worker responsibility and self-management
multi-disciplinary
Weekly assessment and objective documentation
PROVIDER RESPONSIBILITIES
Familiarity with job expectations, work environments/ergonomic risk factors, skills and physical demands required of the patient/client
Principle: Minimization of Injury/Reinjury Incident Rate
Physical therapist services are provided on-site or in close proximity to the workplace.
Note of job demands: type of job, frequency of job
Acute Phase =
(Immediate Post-Trauma) -
Patient management focused on the control and reduction of inflammation, joint and soft tissue swelling, and the stabilization of the injury.
Post-Acute Phase =
Involvement of the injured worker in more active/functional activities.
Graduated therapeutic exercise to increase muscle performance, improve joint integrity and mobility, and improve motor function .
Functional training to increase ability to perform physical tasks related to community and work reintegration.
Reconditioning Phase =
More vigorous therapeutic exercise emphasizing daily functional and work activities and improved endurance
Return-to-Work Phase =
This phase is indicated for worker’s who have progressed satisfactorily through the reconditioning phase but are not yet ready to return to work because of identifiable physical, functional, behavioral or vocational deficits
A physical therapist is managing the care for a patient with referral for a work-related injury by his employer. The patient came today for a re-evaluation. The physical therapist should discharge the patient if the patient meets the following conditionsEXCEPTfor:
a) Patient had improved work capacity but no change in pain symptom
b) Patient has new injury resulting in medical complications
c) Patient’s insurance provider refused to authorize additional treatment
d) Patient failed to comply with requirements of participation in the program
a) Patient had improved work capacity but no change in pain symptom
The four major components of an FCE include:
Intake interview
Medical records review
Physical examination
Content valid functional testing
Functional Capacity =
PTs began to develop functional capacity tests for comparison to the physical demands of jobs and occupations
initially examined and evaluated the ability of a worker to perform physical job match conditions
Frequency of Work Demands
Occasional: 0 – 33% of workday
Frequent: 34 – 66% of workday
Constant: 67 – 100% of workday
S-Sedentary Work –
Exerting up to 10 pounds of force occasionally and/or a negligible force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.
L-Light Work –
Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects
M-Medium Work –
Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects.
H-Heavy Work –
Exerting 50 to 100 pounds of force occasionally, and/or 25 to 50 pounds of force frequently, and/or 10 to 20 pounds of force constantly to move objects.
V-Very Heavy Work –
Exerting in excess of 100 pounds of force occasionally, and/or in excess of 50 pounds of force frequently, and/or in excess of 20 pounds of force constantly to move objects.
An employee with a work-related injury was referred to physical therapy. The employee reported that he works in a factory where the primary task involves moving 40 lbs of boxes for up to a third of a typical working day. WhatBESTcharacterize this type of work?
Medium work
Light work
Heavy work
Very heavy work
Medium work
3 primary areas of consideration
Performance or Effort level
Effect of pain and other symptoms on test performance
Residual functional capacity including functional abilities and functional limitations.
Examiners should avoid the use of ____ tests to determine functional abilities unless a job specific static strength requirement exists.
static strength
Work disability following occupational injury is generally ___
temporary (< 1 month)
__ is positively correlated with time to RTW
Age
(older = more time to RTW).
General trends of time to RTW based on injury type:
MSK sprains, strains, tendinopathies = median 8-14 days
Upper extremity, wrist, and knee injury had greater RTW time = 17-21 days
Carpal tunnel, fractures, amputations, and repetitive motion problems = 30+ days
CLINICAL COURSE & RISK FACTORS
Timing of care
Therapeutic Alliance
Duration of care
Risk factors
Job demands and functional assessment should be used to develop a ___ and ___.
work-limiting diagnosis
treatment goals
For patients with low risk of delayed RTW:
Implement a combination of condition-specific exercise and work task replication.
For patients with high risk of delayed RTW
A behavioral approach with a combination of clinic-based, work-focused interventions and jobsite interventions.
Psychologically informed practice should include individual goal setting, motivational interviewing, activity pacing, problem solving, relaxation, and coping techniques.
