What are the most important components for the rehabilitation of an Orthopedic WC injury? Quick, Complete and Job Specific Rehabilitation which has historically been provided through Work Conditioning, a program that focuses on functional strengthening, aerobic conditioning and job related endurance training. However, over the past several years, Work Conditioning has declined in utilization with many carriers/physicians attempting to use Light Duty as advanced rehabilitation . Depending on the employee’s current level of physical ability, this may be an appropriate substitute. But, it may also lead to returning an unprepared employee to full duty, resulting in re-injury. To ensure the best possible outcome, it is critical for all parties responsible for an employees’ course of rehabilitation to be adequately informed on the strengths, limitations and outcome goals for both programs.
Light duty can be used in conjunction with acute rehabilitation, and as a bridge from acute rehab to full duty. A well-designed light duty program must:
- Be productive
- Be progressive in physical requirements
- Adhere to physical restrictions
- Include components that will promote ongoing strengthening of the region of dysfunction
- Allow the injured worker to incorporate stretching and strengthening while working
Light duty alone may be appropriate if: the patient is returning to a Sedentary to Medium level job class as defined by the Dictionary of Occupational Titles (DOT), has been off work for less than 1 month and has a job that does not require sustained or repetitive functional activities.
Work Conditioning is a job related, highly structured program, typically involving a daily program for 3-5 hours. The program is designed to focus on regaining the injured workers necessary strength and endurance for risk free, full return to work. Through job simulation, muscles that are responsible for maintaining posture and core stability (stabilizers) are strengthened. The program is appropriate for injured workers who:
- Are returning to a job categorized by the DOT as Medium to Very Heavy
- Work in job that does require repetitive material handling, sustained posturing or functional activities
- Have been off of work for > than 1 month and therefore are aerobically deconditioned, and present with poor core stabilization
Through Advanced Physical Therapy, program duration averages 8 visits for non-surgical participants and 15 for surgical participants.
While it is easy to see how an injured worker that is returning to a job such as a carpet installer or heavy construction may be appropriate for Work Conditioning; this program is also beneficial for individuals returning to highly repetitive jobs such as assembly line work.
Statistics have found that injured workers that participate in a Work Conditioning Program are 14 times less likely to experience a re-injury after full return to work than individuals that do not receive appropriate rehabilitation. Another study has found that individuals needing an FCE who first participate in a short course of Work Conditioning perform at a higher functional level during the FCE
As with all segments of case management, it is clear that selecting the correct components of rehabilitation is critical to a successful outcome.