Work Comp

Question 1

about 1/2 work comp injuries are:

Answer 1

-MSK and may require PT

Question 2

most dangerous profession:

Answer 2

• healthcare

- 590,000 injuries in healthcare

Question 3

Work comp is ______ but ______

Answer 3

• federally mandated but state regulated

- employers must care for employees but states can make regulations

Question 4

Communication with:

Answer 4

• employee
• employer
• physician
• case manager
• insurance adjuster
• specialist physician
• attorney

Question 5

Competing Agendas

Answer 5

• employee (fear of injury, loss of job)
• Employer (cost, ID fraud)
• Provider (defensible/reimbursable rec, retain clients)
• Insurance carrier (cost)
• Case Manager (cost, outcomes, customer service)
• Attorneys ($, legal issues)

Question 6

Business Culture

Answer 6

• quick response
• time is money
• make quick decisions
• expect precise and numerically driven info to make decisions
• not like healthcare’s tendency towards “institutional” culture

Question 7

Documentation

Answer 7

• FUNCTIONAL=work specific functional goals
• objective measurements
• timelines for completion (not WNL)
• make sense to all readers/stakeholders
• pn goals/HEP goals not relevant

Question 8

Treatment Planning

Answer 8

• focus to return to work (Not pain resolution)
• able to work activities
• must use job description to guide treatment planning and goal setting

Question 9

Behavioral Differences to Document

Answer 9

• inconsistent effort
• pain behaviors
• non-compliance
• reported pain/difficulty inconsistent with physiological observations
• “observed” performance vs “unobserved” performance

Question 10

Occupational health Management Model

Answer 10

• SPICE
• simplicity
• proximity
• immediacy
• centrality
• expectancy

Question 11

Simplicity

Answer 11

• Tx focused on injury itself
• straightforward treatment planning
• don’t chase subjective symptoms
• understand MOI
• Deal with symptom magnification early

Question 12

Proximity

Answer 12

• keep pt emotional and physically engaged in work place
• help foster at least modified duty work
• PT work to liberalize work restrictions

Question 13

Immediacy

Answer 13

• timely interventions

- time based outcomes

Question 14

Centrality

Answer 14

• lots of agendas
• communication & coordination is key
• limit the # of stakeholders as much as possible

Question 15

Expectancy

Answer 15

• pt involved in goal planning
• review job description w/ pt
• establish expectation of compliance with appointments, ex’s programs and safety recommendations

Question 16

Job Specificity

Answer 16

• functional performance requirements
• -physical demands analysis
• job description
• dictionary of occupational titles
• verbal information gathered from employer

Question 17

Objective reporting

Answer 17

• specific functional descriptors
• qualified objective measurements
• specific time frames
• objective report of compliance, effort (COV)

Question 18

Types of physical performance tests

Answer 18

• post offer physical performance tests
• return to duty or fit for duty tests
• annual performance tests
• FCE’s

Question 19

FCE

Answer 19

-functional capacity exam

Question 20

FCE Componenets

Answer 20

• subj pn questionnaires
• MSK eval
• machine to quantify strength/ROM
• work stimulation
• aerobic performance
• positional tolerance
• fine motor performance

Question 21

Recommendations from FCE

Answer 21

• temp/perm restrictions
• ID Sx magnification
• case closure
• disability status
• impairment ratings
• placement to different job
• case settlement