Physical Therapy: The First Line of Defense Against Delayed Return to Work

9 months ago

Physical Therapy: The First Line of Defense Against Delayed Return to Work

By Michelle Despres, PT, CEAS II, REAS, CETS, Vice President of Physical Therapy, One Call

When someone gets hurt on the job due to a musculoskeletal injury or cumulative trauma, a physical therapist can play a crucial role in setting the stage for success and is an ideal first healthcare provider to engage with them. In fact, the physical therapist may serve as the primary provider for up to eight weeks post-injury with the initial consultation occurring within the first seven days following an injury. This initial period is crucial, hugely impacting whether an injured worker goes on to successfully return to work or experiences delays.

Diving in deeper, it’s important to recognize the extent to which workplace injuries that rely upon physical therapy (PT) for recovery occur every year nationwide. In 2018, there were more than 2.8 million non-fatal workplace injuries and illnesses, with sprains, strains and tears being the leading type of injury. These injuries cost $170.8 billion to treat and resulted in 105 million days of lost work. And while those numbers cannot be ignored, they also cannot be addressed by a single group. They need to be tackled by a unified front of physical therapists, physicians, insurers, and employers.

Knowing this, a group of physical therapists (myself included) belonging to the American Physical Therapy Association (APTA) came together five years ago to create a solution. We set off to review research in the field of PT – and lots of it. With our heads down, we reviewed 20 years of research, compiling the very best of what we reviewed.

In August 2021, we published a 102-page compilation of our work – Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists – in the Journal of Orthopaedic & Sports Physical Therapy, the journal of the largest academy of the APTA, the Academy of Orthopaedic Physical Therapy (AOPT).

These clinical guidelines bring together the highest quality research in one place, available for reference by anyone, at any time. The guidelines outline delayed return-to-work risk factors and ways to mitigate them, thus enabling all stakeholders involved in an injured worker’s recovery to play an active role.

Return-to-Work Risk Factors

There are many factors that can result in an injured worker’s delayed return to work, as noted in the guidelines, including:

  • Ongoing physical demands of the job
  • Relationships with co-workers
  • Job satisfaction
  • Prior injury, with and without extended absences
  • High levels of reported pain
  • Disabilities
  • Fear avoidance
  • Low expectations

While it’s important to recognize these factors, it’s even more important to understand how to prevent or mitigate them.

Prevention and Mitigation

Engage Early
Identify any risk factors from the onset of injury so they can be addressed in the recovery plan. The longer risk factors are left unaddressed, the greater the chance of delayed return to work.

Biopsychosocial Factors
Treat the whole person. Addressing both the physical and psychosocial factors can positively influence an injured worker’s pain perception, behaviors, and response to pain.

Injured Worker Buy-In
Actively involve an injured worker in their recovery. In doing so, they are likely to be more engaged, determined, and on-board with the established treatment plan.

Progressive Activity
Slowly increase an injured worker’s activity throughout the recovery plan. This could possibly include intense, work-related activities to build up strength needed for the job.

Ongoing, proactive communication amongst the physical therapy, employer and injured worker is key. This keeps everyone feeling informed and moving in the same direction.

Transitional Work
Help an injured worker feel valued and engaged by creating transitional work opportunities that get them back into a work routine. This also decreases lost work days.

Ergonomic assessments and functional capacity evaluations (FCEs) help prevent reinjury. Both “tests” help employers understand what changes would need to be made for someone to be successful in a particular job role upon their return.

Job Descriptions
It’s important to truly understand the ongoing physical demands of each job. Employers can evaluate demands by creating job descriptions for each role. From there, they can intelligently modify processes, policies, and equipment to relieve physical stressors.

Evaluate the Job Site
Employers should consider inviting the physical therapist to review the job site. The physical therapist will more clearly be able to pinpoint risk factors for the injured worker.

The above points just scratch the surface in terms of how the clinical guidelines can influence and drive your return-to-work efforts moving forward. It’s safe to say I speak for the entire group involved in this initiative when I tell you it was a labor of love. As physical therapists, we value and appreciate our vital role in successful return-to-work journeys.

It’s our pleasure to pass along this knowledge to you, so we can collectively prevent delays. I encourage you to spend some time with the document, as well as regularly check the APTA’s website for information regarding their February 2022 CSM conference where this topic will be discussed further by two of the lead authors, Dee Daley, PT, DPT and Lorena Payne, PT, MPA, OCS.

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This article originally appeared in WorkCompWire.

Physical Therapy: The First Line of Defense Against Delayed Return to Work

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