concepts in work hardening

8/3/2019 Concepts in Work Hardening

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Concepts inWork

Hardening

Dr. Shyam Krishnan K (MPT OHPT

& CBR)

Dr. Tapan S (MPT Geriatrics)



Work hardening is a highly structured,

goal oriented, individualized treatment

program designed to maximize theperson's ability to return to work. Work

hardening programs are multidisciplinary

in nature with the capability of

addressing the functional, physical,behavioral, and vocational needs of the

person served.



Work hardening provides a transition

between the initial injury management

and return to work, while addressing theissues of productivity, safety, physical

tolerance, and work behavior

Work hardening programs use real or

simulated work conditions in a relevant

work environment in conjunction with

physical conditioning tasks if necessary.



The activities are used to progressivelyimprove

biomechanical, neuromuscular,

cardiovascular-metabolic,

behavioral,

attitudinal and

vocational functions of the personserved.



The origins of work hardening are foundin the United States in the early 1900's.The program as part of Industrialrehabilitation began in response to the

large number of World War I disabledveterans.

In the 1940's the first ´work evaluationµprogram was established at theRochester Rehabilitation Center in NewYork



´Work Hardeningµ was introduced as anew occupational rehabilitation

program model in 1976 . Developed atRancho Los Amigos in California, thismodel utilized functional capacityevaluation to identify the appropriate

level of physical challenge to bepresented to the injured worker ingraded work simulations and structuredphysical conditioning tasks



Job demand analysis

Work conditioning

Functional conditioning

Functional restoration

Pain management programs



Job demand analysis is an objective and

systemic procedure to identify the

demands of a particular jobx Physical

x Mobility requirements

x Sensory/Perceptual demands

x Vocational Demands

x Environmental conditions



The Work and Functional ConditioningIndustry (NSW) (1998) defined ¶work conditioning programs· as ¶work related·,

physical rehabilitation with the goal of

restoring the client·s physical capacity and

function so s/he can be returned to,maintained at or upgraded at work



These programs emphasis on the

physical conditioning of the worker using

exercise equipment and aerobicconditioning, with less use of work-

related tasks than work-hardeningµ.



The Work and Functional Conditioning

Industry (NSW) (1998) defined functional

conditioning as ¶function related·, inwhich the objective was ¶to restore the

client·s physical capacity and maximize

function·.



The methods employed were similar to

those employed in work conditioning

programs, especially through the use ofphysical rehabilitation, except that in this

case return to work was an indirect

rather than direct goal



Functional restoration is defined as anyintervention aimed at restoring a

reasonable functional level for daily living. These programs are usually multidisciplinary

in staffing. There is a heavy emphasis onphysical rehabilitation through the use of

muscle training addressing coordination,trunk control, lumbar flexibility, aerobiccapacity, lifting capacity and sittingtolerance



Pain management programs were primarilydeveloped in pain clinic and rehabilitation

settings with patients reporting untreatablechronic pain conditions .

Restoration of function has usually beenseen as a primary goal rather than pain

relief, although in most pain managementprograms withdrawal from unhelpfulmedication and improvement in moodhave also been common goals.



physical therapists,

occupational therapists,

psychologists

vocational specialist

Stress management specialists

Nutritionists & registered dieticians



Out of work >= 3 month

Special needs of the person

Compromised cardiovascular status

Faulty body mechanics & posture

Questionable feasibility for employment

Still experiencing pain, especially when

active Possible psychosocial dysfunction



Decreased overall body

conditioning/weight gain

Poor physical/ muscular flexibility Complicated needs including

physiological & psychological deficits



Job demand analysis

¾ Task Identification

¾ Frequency designation31012010618.jpg¾ Strength analysis31012010622.jpg

¾ Mobility requirements

¾ Sensory perceptual requirements

¾ Work environment

¾ Conditions of work



History Medical status Systems review

Selected tests to measure«.. functional work capacity musculoskeletal status behavioral and attitudinal status as it relates

to the work injury vocational status cognitive/perceptual status



Functional de-conditioning

Erosion of self-efficacy.

Abandonment of the occupational role.

Addiction to palliative measures

Development of psychological disability

Development of behavioral disability.

Mismatch between residual capacity

and job demands



Occupational Role Development(Goal

development & work simulation)

Self-Efficacy Development(SerialFunctional Testing & progressive

functional Challenge)

Symptom NegotiationDevelopment(Work Pacing and Micro-

breaks, Tool or Job Modification ).

video.mp4



Work simulation includes««

Relevant work environment

Work rules & hours

Work procedures

Work titles

Work tasks

EquipmentEasyGuide_06.wmv



Flexibility, mobility, strength and aerobic

conditioning

¾ To improve postural adaptation, selectivestrengthening of body areas, workingthrough specific areas of deficits andsupport general improvement

¾ Preparation for job simulation



Development of program goals andoutcomes in relationship to specific job

requirements Interventions to develop joint integrity

and mobility, motor function (motor control and motor learning), muscle

performance (including strength, power,and endurance), range of motion, andcardiovascular/pulmonary capacityrelated to the performance of work tasks



Practice, modification, and instruction in

simulated or real work activities

Training for safe job performance andinjury prevention

Provision of behavioral and vocational

services as determined by the respectiveWork Hardening provider

Promotion of patient/client responsibility

and self-management



The physical therapist determines that

the patient/client will no longer benefit

from physical therapy services

The patient/client declines to continue

intervention



The patient/client fails to comply with the

requirements of participation

The patient/client is unable to continueto progress toward goals and outcomes

because of medical or psychosocialcomplications or because

financial/insurance resources have been

expended



Fulfillment of established program goals

can be used as an indicator of

effectiveness of the work hardeningprogram

The most prized measure is return towork(RTW)

Efficiency reflects total cost and time

utilized to achieve established goals andoutcomes



PHYSICAL

CAPABILITIES

SUPPORT STRUCTURES

SELF-MANAGEMENT SKILLS



There are 3 categories«

Clinical measures- RTW and % of

reinjuary Satisfaction surveys ² client & referral

source

Follow-up client reports- 6 & 12monthspost RTW



Length of time b/w start of work

retraining & RTW

Length of time b/w injury & start of work retraining

Program components administered

Re-injury rates RTW status



Attendance record

Days in the program

Having reached or not reached goal

Reason for discharge

Date of injury to date of admission into

program Having completed or not completed

program



Symptom magnification syndrome

Pacing problems ² affects feasibility

Family issues

Financial difficulties

Lack of education

Clients· unknown fears



Age, gender, health status

Extended sick leave

Strongest negative predictors of RTW are

o Individual·s expectations,

o Days of sick leave,

o Somatic disorders,

o High-level of life satisfaction,

o Sense of coherence



Need

Evaluation and program structure

Termination guidelines

Outcome



Abenhaim L, Rossignol M, Valat J-P, Nordin M,

et al. The role of activity in the therapeutic

management of back pain: Report of the

International Paris Task Force on Back Pain.Spine 2000; 25: 15-335

Carter, Birrell (2000). Occupational healthguidelines for the management of low back

pain at work: Evidence review and

recommendations. Faculty of occupational

Medicine, London.



Coe G. Report on Work Conditioning

Programs for Disabling Chronic Low Back

Pain: its application to S22 clients.

Commonwealth Rehabilitation Service,1995

Cohen M, Nicholas M, Blanch A. Medical

assessment and management of work-related low back or neck/arm pain. J

Occupational Health & Safety-Aust, NZ 2000;

16: 307-317.



Compensable Injuries and Health Outcomes.

Health Policy Unit, The Australasian Faculty of

Occupational Medicine, The Royal

Australasian College of Physicians (2001).

Gatchel RJ, Mayer TG, Hazard RG, Rainville J,

Mooney V. Functional restoration. Pitfalls inevaluating efficacy (editorial). Spine 1992; 17:

988-995.



Haldorsen EM, Grasdal AL, Skouen JS, Risa AE,

Kronholm K, Ursin H. Is there a right treatment

for a particular patient group? Comparison of

ordinary treatment, light multidisciplinarytreatment, and extensive multidisciplinary

treatment for long-term sick-listed employees

with musculoskeletal pain. Pain 2002; 95: 49-63.

Hansson, T.H. and Hansson, E.K. (2000) The

effects of common medical interventions on

pain, back function, and work resumption in

patients with chronic low back pain. Spine 25,

3055-3064.



Key GL, editor. Industrial Therapy. 3rd ed. USA;

Mosby: 1996



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