Managing Injuries Effectively – What Happens When Prevention Measures Fail

Several of our prior blog posts have focused on injury prevention (ergonomics and post-offer employment testing). As the saying goes, an ounce of it is worth a pound of the cure. This rings true in study after study, as both ergonomic and POET programs have shown reductions in injuries while delivering significant return on investment to employers. While prevention should always be the priority, it is worth noting that it is impossible to prevent every workplace injury, despite even the best-implemented plans. In this blog post, we will discuss the importance of post-injury interventions, and how this can facilitate a timely return to work.

Injuries in the workplace fall into a few different categories, widely ranging from simple first aid interventions to more extreme cases of surgical interventions. Getting injured workers into the right category early is crucial, as effective triaging will ensure the most appropriate care is provided. In the next few paragraphs, we will explore a variety of “post injury” treatment options, and how these physical therapy driven interventions can improve functional return to work. These interventions will include medical screening/Early Symptom Intervention (ESI), formal physical or occupational therapy, and work conditioning.

Medical Screening/Early Symptom Intervention

Some injuries that occur on the job start out as relatively minor; an employee reports a sore back or nagging shoulder pain with performance of essential job functions. In these situations, acting quickly is crucial to nipping these minor musculoskeletal issues in the bud. This is where an Upstream Rehabilitation’s Early Symptom Intervention Program can be effective. The employee is sent to a nearby clinic, and a licensed clinician will screen the individual to determine which of three courses of action is appropriate:

1. The employee needs medical intervention, and (in employer-choice states) should be referred to one of the employer’s panel physicians for further assessment.
2. The employee’s complaint is relatively minor, and seems to have responded favorably to OHSA approved first aid interventions. The employee will return in 2-3 days for additional first aid care and assessment with the hopes that symptoms will further improve.
3. The employee’s complaint is relatively minor, and based on favorable response to OSHA-approved first aid, does not require further consultation.

By effectively triaging the employee into 1 of the 3 categories above, the clinician can ensure that the best care options are provided to the employee, and therefore limit OSHA recordability for minor musculoskeletal complaints (by implementing only first aid to manage symptoms). It is important to stress that this particular means of intervention is NOT formal physical therapy. Rather, the clinician is providing a variety of OSHA-approved first aid interventions like taping, heat/ice, soft tissue mobilization, and education to target the employee’s symptoms and improve their functional status. Some of Upstream Rehabilitation’s employer partners have seen significant reductions in their OSHA recordability rates by utilizing an ESI Program.

Formal Physical or Occupational Therapy

When an injury is significant enough to warrant formal medical care, often physical or occupational therapy is the best first line of offense. PT/OT is a proven cost saver, and is an intervention directly focused on return to function (vs. imaging, injections, surgery)1, 2. Furthermore, evidence continues to show that early access to therapy following an injury is crucial to improving outcomes and facilitating return to work2. It is important to highlight that not all PT/OT providers are the same, and that working with an organization with a proven track record of exceptional outcomes will ensure that the injured worker has the best chance of returning to their pre-morbid status as quickly, and cost effectively, as possible.

Upstream Rehabilitation uses an independent, third-party, risk-adjusted database that tracks clinical outcomes (called KEET). Upstream Rehabilitation’s clinical teams provides world-class treatments that place us above the national average for outcomes, highlighting our clinical expertise. How do we consistently provide such exceptional care? By emphasizing clinical education, providing easy access to care via our ~1,200 clinics, and implementing a biopsychosocial approach patient education. These elements, along with an emphasis on hands-on manual therapy to reduce pain and improve functional mobility, all ensure that the injured worker has the best opportunity to heal without further, more invasive, interventions.

Work Conditioning

Some jobs are very physically demanding. Returning an injured worker to a job that requires heavy lifting, carrying, climbing, or reaching can be a dangerous proposition, particularly if the worker has been off work for an extended period. While many injuries require formal physical therapy, and while the PT may have prioritized work-related functional progression of exercises/activities as part of the rehab plan, often physical therapy alone (2-3x/week for 60-75 minutes) simply is not enough to ensure a smooth transition back to work.

In these cases, work conditioning can be a very effective means to bridge the gap between therapy ending, and formal return to full duty (which may involve 50-60 hours/week of physically demanding work). Work conditioning is a program that typically lasts 2-3 weeks, 5 days/week, for 2-4 hours/day. This program focuses not only on the musculoskeletal deficits (progression of lifting, pushing/pulling, carrying, and other job specific tasks), but also on the cardiovascular deconditioning that can arise from prolonged time away from the job.

By allowing the injured worker to prepare intensively for a return to work, all while under the watchful eye of a skilled clinician in a controlled environment, the injured worker builds strength, conditioning, and confidence. Ultimately, work conditioning allows all stakeholders within the workers’ compensation realm to know with a degree of certainty that the injured worker is ready for discharge. Work conditioning should also minimize any incidence of secondary complications once the injured worker returns to full duty, since the worker has been thoroughly screened prior to discharge.

Conclusions

Prevention is the best strategy to ensuring a safe work environment. While post-offer testing, ergonomic assessments, and pre-shift exercises routines can all reduce the likelihood of injuries, work place injuries will still occur. When these happen, it is crucial for employers and insurance companies to consider conservative interventions like physical therapy as a primary line of offense. In addition to formal PT, it’s also important to highlight other effective strategies at reducing recordables (Early Symptom Interventions), as well as ensure a smooth transition back to work (Work Conditioning). By understanding and utilizing all available strategies, employers and employees will benefit from effective management of work place injuries.

1. One of the brands under Upstream Rehabilitation completed an analysis in partnership with a national commercial payer on downstream services, reviewing 15,000 PT patients in the state of Tennessee – patients had 20% fewer downstream services in the 12 months following physical therapy when compared to treatment from other PT companies.
2. Primary care referral of patients with low back pain to physical therapy: impact on future healthcare utilization and costs. Fritz et al, Spine, 2012 Dec 1;37(25):2114-21