By Kelly Marie Hale
Those who suffer work-related injuries may require some type of therapeutic intervention to aid in the healing process. When physical therapy has been completed, a second step in rehabilitation may come in the form of work conditioning. Depending on the patient’s occupation, the program is tailored to the affected area and is specific with the demands that the patient would perform on the job. This two step process begins as a hands-on treatment that eventually puts the patient in charge of an independent strengthening and conditioning program. Cardiovascular exercises, weight training/strengthening, stretching exercises, and job simulation are some examples of what would be involved in a work conditioning program. Much of the focus in the work conditioning program is not only to treat the affected/injured area, but to improve the overall performance of the patient.
When you are referred to Industrial Rehabilitation, an initial evaluation or functional capacity evaluation (FCE) must take place to determine the patient’s current physical demand level and compare that to the actual physical demands of the job. An initial evaluation identifies areas that would be hindrances for returning to work, and helps in setting goals for the rehabilitation program. The Blankenship FCE Method was adopted by Guilford Orthopaedic in 2001 because of its successful track record and the abundance of literature supporting it. The Blankenship Method has solid testing techniques that resemble the actions of what an employee is required to do on the job, and has been used to eliminate any discrepancies in the Industrial Rehabilitation setting.
Research shows that problem-oriented rehabilitation can significantly reduce long-term sick leave (Streibelt, Blume, Thren, Reneman, & Meuller-Fahrnow, 2009). Consistent with that research, work conditioning programs are problem-oriented programs with the intent to return the individual to normal work functioning as soon as possible. Streibelt, et. al (2009) conducted a study to evaluate an FCE rehabilitation with musculoskeletal ailments that put patients at risk for extended absences from work or work-related disabilities (429). The study involved using a method of the Functional Capacity Evaluation that added gradual weight to test overall musculoskeletal strength and ability. One year following the study, 62% of patients had fully reintegrated into work environments. The most interesting inference comes from patient’s preconceived notions of the rehabilitation program and the healing of injuries. Over half of the participants in the study who reported that they had a “heavy disability” did not achieve adequate results and did not successfully integrate back into the system as opposed to those who predicted success (431). This demonstrates a relationship between attitude and success rate of the Industrial Rehabilitation program. If patients do not come into Industrial Rehabilitation with the mindset of receiving care and returning to work as soon as possible, they are more likely to fail in attempts to complete a work conditioning program and return to full active duties.
At Guilford Orthopaedic, an advantage of the work conditioning program is the atmosphere that is provided for patients to excel. It is a friendly environment that encourages full recovery by performing each exercise correctly and with full effort. Those who work in Industrial Rehabilitation are focused on providing a comfortable working environment concentrated on individual-specific treatment. Those who complete a program in Industrial Rehabilitation will be prepared to do their specific on-the-job duties and feel competent in their overall level of fitness.
There is always much debate comparing the successes of Industrial Rehabilitation programs and which would be best suited for certain patients. A 2005 study evaluating the effect of function-centered rehabilitation discusses this same premise (Kool, Oesch, Bachmann, Knuesel, Dierkes, Russo, de Bie, van den Brandt). This study examined chronic lower back pain, a common injury seen in Industrial Rehabilitation facilities and the use of function-related exercises along with the biopsychosocial model as opposed to other pain management therapies. Most functional restoration programs in physical therapy are developed with the intent to incorporate social intervention to overcome physical barriers (857). Function-centered treatment involved work simulation combined with cardiovascular workouts and strengthening exercises. Pain-centered treatment involved stretching combined with passive and active mobilization (857). The study concluded that function-centered rehabilitation is recommended more than pain-centered treatment. FCT decreased work-related disability and were part of the larger return to work group (862).
At Guilford Orthopaedic we are committed to using the components of Industrial Rehabilitation as part of a continuing therapeutic process. While clinical care is provided, patients are urged to take what they have learned from our staff with them when they go. Overall achievement of optimum health is not an overnight process – It involves gaining knowledge about techniques and strategies to continue the program in a gym or at home. Continuation of work-related conditioning programs can increase strength and reduce risk of being injured on the job. It will allow patient to successfully reintegrate into full duties, and will reduce time taken off because of chronic pain. The patient can also feel more confident in performing work-related activities and less apprehensive that an injury will occur. Guilford Orthopaedic is committed to serving our community with the highest levels of integrity and professionalism. We desire to provide efficient care to our patients and equip them with the knowledge necessary to maintain proper mental and physical well-being.
Kool, J. P., Oesch, P. R., Bachmann, S., Knuesel, O., Dierkes, J. G., Russo, M., de Bie, R., & van den Brandt, P. A. (2005). “Increasing Days at Work Using Function- Centered Rehabilitation in Nonacute Nonspecific Low Back Pain: A Randomized Controlled Trial.” American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation, 86, 857-864.
Kool, J., Bachmann, S., Oesch, P., Knuesel, O., Ambergen, T., de Bie, R., & van den Brandt, P. (2007). “Function-Centered Rehabilitation Increases Work Days in Patients with Nonacute Nonspecific Low Back Pain: 1-year Results from a Randomized Controlled Trial.” American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation, 88, 1089- 1094.
Streibelt, M., Blume, C., Thren, K., Reneman, M. F., & Mueller-Fahrnow, W. (2009). “Value of Functional Capacity Evaluation Information in a Clinical Setting for Predicting Return to Work.” American Congress of Rehabilitation Medicine, 90, 429-434