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Bringing Prevention into the Workplace with On-Site Therapy
(Part 2 of 2)

Who Are On-Site Therapists?

Successful on-site therapists are trained to make the advantages of the workplace outweigh its limitations. The workplace is a different kind of “clinic” than the one in which most therapists were trained. It is a realistic workshop into which the on-site therapist brings his or her equipment and uses specialized modalities to assist workers to function in the real world of work. On-site therapists utilize functional methods of treatment, often applicable to a particular business or industry. They are usually members of groups of therapists who work interchangeably in workplace environments where their teams have been familiarized with the special needs of the individual workplaces.

Successful on-site therapists have to be innovative, flexible, and creative, and, in some ways, more adventurous than traditional therapists. Often they will have practiced in traditional clinical facilities for years and they may have switched because they were looking for something different.

They have to be tuned into the work environment and be willing to adjust to the encumbrances of the workplace that may be significantly different from traditional clinical facilities. The adjustments that they have to make are a product of the environment in which they work. In the workplace, a worker can be shown what he or she may have done wrong to cause an injury.

Nurses and Therapists

Some of the most effective on-site arrangements have registered occupational health nurses and therapists working side by side. The nurse, accountable to a physician, who frequently will have left standing orders and prescriptions, serves as a liaison into the health-care system of the particular workplace. He or she also may develop sensitivity to the therapeutic modalities used by the therapist and learn how to use them as well. Working together, the two can serve as a prevention-oriented team. Workers, on return visits, can be seen by experienced and knowledgeable nurses, who can communicate symptoms to the therapist. They can decide together who should see the worker — or whether the time has come to have such person consult with a physician.

Very large companies, of course, may have the luxury of elaborate health-care facilities where one or more on-site therapists can work alongside nurses on a full-time basis. That is an ideal situation where the therapist can serve in a more holistic capacity and even function in a more prevention-oriented fashion.

Prevention Orientation

The use of on-site therapy for early intervention is a classic example of secondary prevention in action. Those who want to see “aggressive” prevention practices in their workplaces should understand that prevention that produces visible (and quick) results is the best way to get started. On-site therapy, which is often early intervention at its best, relieves pain and muscle spasm and makes people feel well. It can lead to both primary and tertiary preventive practices.

The best time to encourage primary prevention practices is when people know that they need it. If they are suffering from back pain, that is the time they will listen to someone who can teach them how to avoid future painful episodes — by lifting properly; by avoiding deconditioning; and by checking out their back pain with, and having a complete physical examination by, a qualified physician, to rule out medical causes. And tertiary prevention can be practiced by having a returning worker check through the on-site therapy facility to be evaluated and treated by the therapist until the worker is ready for full duty.

The treatment data collected in on-site units can be used to develop priority protocols for primary prevention programming; and of no minor consequence, therapists and nurses, practicing side by side, can detect comorbid conditions that might otherwise have gone unnoticed.

Early Detection of Comorbidities

The aging of the work force raises the specter of comorbid conditions, and physiological changes that accompany aging, increasing the severity of musculoskeletal problems. Employers should encourage therapists and nurses to look for comorbid conditions, an important issue under the category of secondary prevention. It then becomes the therapist’s secondary responsibility to use clinical judgment to determine if patients, especially the older ones, have hypertension, diabetes, arthritis, morbid obesity, or any of a number of other comorbid conditions. Once suspicions of such conditions are identified depending upon predetermined protocols, the therapist can at a minimum notify the worker of these findings. The minimum requirement for this detection process would be taking blood pressure readings of selected patients, along with at least a cursory history and physical evaluation.

Another subtle possibility in the use of therapists (and nurses, for that matter) would be for them to record unidentifiable data relating to smoking and other factors, which would provide an employer with information that it could use in setting up health-education programs (e.g., smoking cessation). A therapist could be in a unique position to make observations about the health characteristics of a workforce. Such a role would be particularly important when there is no on-site nurse present.

Wellness and Fitness Centers

One of the most extraordinary wellness programs in the country exists at Sears Roebuck’s headquarters in Hoffman Estates, Illinois, where Johnson & Johnson has set up a Wellness Center within which all medical and therapeutic functions take place at this multi-thousand-employee location. Argosy manages the on-site therapy program and there is a separate fitness center nearby.

Fitness centers can be utilized by therapists as part of their primary prevention program and serve as a means of encouraging physical activity of the workforce. Rehabilitation and fitness are natural cousins in the recovery and post-recovery process.

After an employee experiences symptoms or suffers from a musculoskeletal injury, it becomes the therapist’s responsibility to:

• address the symptoms while the employee continues working, doing everything possible to avoid reinjury;
• after injury, aim for a rapid, safe return to preinjury status; and
• mitigate the risk of reinjury through safe and conservative work training, making every effort to encourage employee commitment to continued, consistent use of fitness and wellness resources.

Managing Chronic Cases

An on-site therapist would be uniquely positioned to help manage a chronic case, starting with an early and objective assessment of the case prognosis. Functioning within the workplace, the therapist can evaluate the employee’s demonstrated abilities, compliance and attitude, actual job demands, and alternative job opportunities and recommend strategic work accommodation strategies.

This is where a case manager, working with the therapist, the provider, and the claims examiner, can be assisted to make an earlier, more informed decision on how to resolve the case (i.e. settlement, vocational counseling, or litigation).

Other Uses and Roles

On-site therapists could be uniquely qualified to set up and prepare injury prevention and first-aid programs, important areas that are well within the professional competence of physical and occupational therapists.

One of the more important roles an on-site therapist can perform is functional capacity evaluations (FCEs), combining standard objective analysis with an actual work circuit observation, eliminating guesswork and coming up with meaningful information about an employee’s true functional abilities.

Work transition, an ArgosyHealth trademark, is a functionally based program that utilizes real-work tasks to strengthen and condition an injured employee. Argosy describes this as a particularly important part of “a goal-oriented reintegration through light duty and parts of the preinjury job to full return-to-work.”

Work Risk Analysis is another Argosy trademark, used under different names by other companies, for “pre- or post-claim evaluation and consultation to address injury prevention or to assist with return-to-work issues.” Argosy makes a one-time visit to the job site immediately following an initial report of symptoms to fulfill this commitment, a process clearly related to the proximity of the therapist to the worker’s place of work.

Job analyses and ergonomic assessments are two other prevention-oriented activities that an on-site therapist could be trained to handle.

Finally, the claims examiner, who is always hovering behind the scene, and managing the return-to-work process, has everything to gain from the cooperative presence of an on-site therapist. They can confer on a regular basis. The therapist is in a unique position to advise the examiner (or adjuster) about the worker’s prognosis, often better than a physician or nurse.

Sedgwick Claims Management Services (Sedgwick CMS), through its educational arm, Sedgwick University, is presently developing a prototype program in which the various members of the on-site team are training, along with selected claims examiners, to facilitate a more effective working relationship.

Observations and Conclusions

Aside from the relevance of on-site physical and occupational therapy to such routine issues as keeping workers on the job and facilitating return to work, this article has attempted to show how it can be the center of a hub around which a prevention wheel can rotate. Sedgwick CMS has developed the following conceptual goals for such a program:

• To provide physical and occupational therapeutic services directly in the workplace to improve the quality of care and reduce the time and expense of employees going to and from therapy clinics. Managed correctly, on-site therapeutic services can go well beyond traditional pain management to more prevention-oriented services. Expected outcomes include reducing the number and lengths of absences from work; palliating musculoskeletal disorders; assisting workers who have returned to work, after illnesses or injuries, to remain at meaningful work; and improving productivity.
• The ultimate goal is to reduce the direct and indirect costs associated with workplace injuries, and to provide employers and employees with appropriate resources for promoting a safe, healthy, and productive workplace environment.

Read Bringing Prevention into the Workplace with On-Site Therapy (Part 1)

ABOUT THE AUTHOR

The Journal of Workers Compensation is a quarterly review of risk management and cost containment strategies published by Standard Publishing in Boston, Massachusetts. For more information, please visit our web site, www.standardpublishingcorp.com, or contact the editor at 800-682-5759, extension 222, or subscription services at extension 228.

riskVue | The webzine for risk management profesionals
December 2001