Approaches to worker rehabilitation by occupational and physical therapists in the United States: factors impacting practice

Work-related rehabilitation services have changed in nature and scope since their inception in the late 1970s. A review of the literature reveals a large body of published data concerning the various approaches used by therapists in this practice area, but a limited number of comparison studies documenting the value of one approach over the other. This national survey of physical and occupational therapists in the US was conducted in 2002, and examined the prevailing trends in service provision, and factors that determine the nature of services provided to clients. Results indicate that services continue the move to onsite service provision and an emphasis on prevention, but that select services, such as onsite job analysis and comprehensive, inter-disciplinary programs are being used to a limited degree. Research that examines the relative contributions of selected work-related services to successful and efficient return to work outcomes is necessary to identify best practice approaches. Therapists and insurance providers should work more closely in exchange of data that will ensure optimal program design and funding.     

Work rehabilitation programs: a 1997 survey

By adapting to the changing health care environment, legislative reforms, and consumer needs, work rehabilitation programs have experienced a metamorphosis. This study surveyed occupational therapists currently employed in work programs to ascertain a current demographic profile of work rehabilitation programs. Respondents indicated the delivery of services in the areas of prevention, assessment and rehabilitation. The majority of work rehabilitation programs in this study provide services in the form of ergonomics, education and training, and job analyses at the worksite. The area of work injury prevention services is forecasted for increased growth among work rehabilitation programs.     

Features of occupational rehabilitation systems in Australia: a map through the maze

This review contributes to the limited literature on systems of occupational rehabilitation in Australia. Occupational rehabilitation is defined and features of occupational rehabilitation systems within the workers' compensation framework are described. Common features include: (a) the trend to workplace management, (b) preferred rehabilitation program settings and (c) widespread acceptance of some identified principles of occupational rehabilitation. Other features such as roles of stakeholders and participants, relationship of rehabilitation providers and employers, and the services provided have a number of variations in the Australian systems. Similarities and differences between features of Australian and North American systems are noted. Implications for occupational rehabilitation providers are discussed, and recommendations for practice and future research are made.     

A survey of occupational therapy in Australian work practice

While the prevention and management of work-related injuries are major areas of practice for Australian occupational therapists, there has been little research on occupational therapy's contribution in these areas. This study examined the characteristics of current Australian occupational therapy practice in the work arena. A postal questionnaire was sent to 355 occupational therapists employed in work practice from six of the eight state or territory Occupational Therapy Associations. The questionnaire enquired about demographic details, service provision in the prevention, assessment and rehabilitation areas and further education needs in these areas. The responses of 125 (35%) therapists were analysed and show the services commonly offered in prevention, assessment and rehabilitation. The most commonly offered services included job analyses, workplace assessment and suitable duties programs. The results also indicate high levels of service provision in the workplace. In presenting the findings of the survey, current trends in international and Australian occupational therapy work practice are discussed along with suggestions for directions in future education, practice and research.     

Will Australian workers' compensation insurance management get better soon?

A study of Australian experience in the state of New South Wales (NSW) suggests that private sector underwriting of workers' compensation insurance risk plus insurer competition on premium price may put downward pressure on benefits for injured workers, inhibit rehabilitation, and cause related cost increases for taxpayers and employers. Insurer underwriting also increases workers' compensation administrative costs and means an unnecessary loss of investment income for government and industry. An emerging and better alternative for the Australian community is for government and industry to underwrite a national workers' compensation scheme and to fix premium and benefit requirements which are competitively administered by insurers. In such a regulatory environment insurer inability to compete on premium price should promote competition to provide effective services to help employers prevent injury, assist rehabilitation and contain cost. National standards are necessary to enable widespread dissemination of comparable, reliable information on the outcome of health, rehabilitation, dispute resolution and return to work services. This is required to assess the competitive performance of service providers in order to ensure effective operation of the market to achieve scheme objectives. Holistic, multi-skilled and objective rehabilitation professionals are needed who can clearly demonstrate the effectiveness of their actions in assisting injury prevention, worker rehabilitation, and safe return to work across a range of industry contexts.     

Workers' compensation for psychological injury: demographic and work-related correlates

This study aimed to determine the demographic and work-related factors that contributed to the filing of a workers' compensation claim for psychological injury. Four groups of employees were compared: those who filed a workers' compensation claim, those who sought psychological treatment for occupational stress but did not file a workers' compensation claim, those who experienced elevated stress levels but did not seek help or lodge a claim, and those who experienced stressful events at work but did not develop symptomatology. The results indicated few variables that could adequately explain why some stressed employees opted for a workers' compensation claim. The implications of these results are discussed.     

A return to work program for injured workers: a reassignment model

The current workers' compensation system does not encourage permanently restricted workers who are disabled due to work related injuries to return to work. Workers are often labeled permanently disabled and are released from their positions with their employers. However, according to the Americans with Disabilities Act of 1990, these individuals may be qualified to return to productive employment. This paper will describe a Reassignment Model for occupational therapy supported by the rehabilitation frame of reference. This Model presents reassignment to a vacant position as a reasonable accommodation to return injured workers to productive employment. A case study will illustrate the successful implementation of the model. The potential benefits of using this Model will be described for clients, society, employers, and the occupational therapy profession.     

A unique collaboration of female medical providers within the United States Armed Forces: rehabilitation of a marine with post-concussive vestibulopathy

Uncle Sam's loyal nieces have come a long way from the days of World War I. The development of occupational and physical therapy was heavily influenced by an early relationship with medical specialists during the First World War. This relationship can be considered largely responsible for the eventual acceptance (by the Armed Forces) of women working in this area. Over the past decade active duty women have seen many changes in opportunities to serve and are now stationed aboard aircraft carriers, performing roles previously considered for male personnel. We report a case study of the medical care provided by both military and civilian women working for the United States Armed Forces. Initial assessment was conducted in a battalion aid station of a United States Marine Corp base and the subject was then referred to a military medical center with highly technical vestibular assessment and rehabilitation services. The subject's case represents a unique collaboration of women therapists, enabling a Marines' access to timely and accurate assessment, treatment and ultimately, successful return to active duty. This case study is one of many examples of the acceptance and successful integration of women as providers of medical care within the Military's medical framework.     

Work injury rehabilitation in Guangzhou: 380 case cohort study

Work injury rehabilitation is a new concept in Mainland China. In 2001, the first work injury rehabilitation centre was established in Guangzhou under the management of the Guanghzhou Bureau of Labour and Security. This paper reviews the profile of a cohort of workers with injuries who received rehabilitation services at this centre. The changes in the physical capacity, daily function, and quality of life of the workers with injuries before and after the treatment services were also reviewed. A total of 380 were extracted from the database which occupied 79% of the total patient population admitted to the centre between 2003 to 2004. The assessment results suggested that workers with injuries showed increases in physical capacity in terms of the range of motion, muscle strength and walking tolerance. The daily functioning by using Barthel Index was also improved. Quality of life assessed with the WHOQOL also demonstrated an increase in the physical and psychological domains. Work injury rehabilitation in Guangzhou is at its infancy stage. The cooperation between the rehabilitation centre, employers and workers is of the utmost importance for a successful return to work outcome. The workers' compensation and rehabilitation policy also dictates the future of success of the rehabilitation services.     

Construct validity of the instrument DOA: a dialogue about ability related to work

This study examined the construct validity of the newly developed instrument A Dialogue About Ability Related To Work (DOA). DOA [18] was developed using concepts from the Model of Human Occupation [20] as theoretical framework. The instrument assumes the assessment of work ability by both the client and the occupational therapist, and is followed by a dialogue which is expected to distinguish possible goal-setting for further rehabilitation [18,19]. Twenty-one professionals and 126 clients from three clinics in Sweden participated in the study. All clients were involved as outpatients in psychiatric work rehabilitation in county councils or community services. Results of a Rasch analysis test indicated that items are well separated and generally work together in five unidimensional continuums to measure work ability. Twenty-nine of 34 items showed goodness-of-fit statistics, which means acceptable infit MnSq values from > or = 0.6 to < or = 1.4 in association with Z values from -2 to 2. The five misfit items have to be revised. The study has indicated that DOA is a valid instrument in psychiatric work rehabilitation and ought to be useful in the dialogue between occupational therapists and clients about goalsetting and treatment planning.     

The functional IME: A linkage of expertise across the disability continuum

Disability assessment remains a significant challenge especially in welfare systems like workers' compensation and disability insurance. Many of today's managed care strategies do not impact on the seminal issue of return to gainful employment. Employers, insurers, attorneys and case managers routinely request independent medical examinations (IMEs) as a means of determining degree of disability, functional limitations, work restrictions and "estimated" physical capacities. However, this approach is limited because physicians are not trained in the functional model of disability assessment. IMEs address pathology and impairments which represent a portion of the disability continuum described by the World Health Organization, Nagi, Guccione and others [e.g. pathology-impairment-disability-handicap]. Functional capacity evaluations or FCEs are often performed by physical and occupational therapists who are trained in a function-based model of disability assessment. Unlike an IME physician who completes "Estimated Physical Capacities", therapists measure actual physical functioning. The value of both IMEs and FCEs can be enhanced through a "functional IME" that combines both models; medical-based examination and a function-based disability evaluation. This combination enhances the assessment of the relationship of pathology to impairment and impairment to disability status especially, in musculoskeletal disorders which tend to drive costs in workers' compensation.     

Demographic study on Occupational Therapy Work Rehabilitation Programs in Hong Kong Hospital Authority

A survey was implemented to collect demographic data of Occupational Therapy Work Rehabilitation Programs in the Hong Kong Hospital Authority in order to reflect the patterns of services delivery within the largest health care organization in Hong Kong. The questionnaire covered types of settings, services provided, instruments/equipment used, sources and aims of referrals, types of patient, training programs attended by occupational therapists, staffing and research. The results of this survey demonstrated that there has been a significant development of the Occupational Therapy Work Rehabilitation Programs in Hong Kong Hospital Authority in the last decade. Future directions for further development are also identified.     

Case report: a work simulation program for a manual worker with a fracture injury

Work rehabilitation programs targeting different client groups are available in nearly all major hospital occupational therapy departments in Hong Kong. Clients receiving work rehabilitation are referred from various out-patient clinics and other occupational therapists. Those clients experience limitation in work after their injuries or diseases and plan to return to work after rehabilitation. Program objectives are 1) to assist clients to reach maximum work capacity as rapidly as possible 2) to ensure clients return to work safely 3) to improve clients' work readiness. This case report describes an individualized work simulation program at a general hospital in Hong Kong provided for a typical client who is preparing to return to his worker role. Specific job analysis, goals and program rationale for the client are discussed.     

Workers' compensation for psychological injury: personal and environmental correlates

The aim of this study was to determine the personal and environmental factors that contribute to the lodging of a workers' compensation claim for psychological injury. Four groups were compared: individuals who had lodged a workers' compensation claim, people who had sought psychological assistance for the management of work-related stress reactions but who had not lodged a workers' compensation claim; people who had experienced stress symptoms but who had not lodged a claim or sought help; and people who experienced stressful work events but who had not developed symptoms. Examination was made of cognitive distortion, irrational beliefs and coping resources as individual factors, and stressful life events, daily hassles and work environment factors as environmental variables. The Compensation group was distinguished from other groups only on the basis of work environmental factors. The implications of these results in the understanding of the decision to lodge a workers' compensation claim are considered.     

I'm going back to work: back injured clients' perceptions and experiences of their worker roles

This study aimed to elicit perceptions and experiences of facilitators and barriers that affected individuals who received back rehabilitation and their ability to resume their worker roles. Qualitative research methods were used in order to explore the research question. Participants were selected by means of simple random sampling and the data were collected by means of semi-structured focus groups. Some factors that were seen as facilitatory in maintaining the worker role of an individual who received back rehabilitation included injury management strategies, a positive work culture and having meaningful/satisfactory work experiences. Factors or barriers that prevented individuals from resuming their worker roles included physical and psychosocial stressors of the job, a lack of education by the employer and inadequate workplace policy. The results indicated that occupational therapists need to reassess their role within the wider context of the helping professions where they should become more involved in on-the-job evaluations, work placements and training of individuals who received back rehabilitation.     

Assistive technology outcomes in work settings

Successfully documenting the outcomes of assistive technology (AT) interventions in the workplace benefits people with disabilities, service providers and agencies. However, no work related system currently exists that comprehensively collects the data needed to analyze such outcomes. Part of the reason for this absence of an outcome system is that, while the concept is simple, the process is complex and depends on the acquisition of data that represent many outcomes related variables. This article describes the exploratory work of the NIDRR (National Institute on Disability and Rehabilitation Research) funded ATOMS Project (Assistive Technology Outcomes Measurement System) and its efforts to identify existing data that might be used as the basis for an outcomes measurement system. Sample records from four assistive technology service programs were acquired and evaluated for the data they housed. This study discovered that AT service programs fail to collect consistent or sufficient data for outcomes analysis. However, discussions with AT programs that provided services to State vocational rehabilitation agencies revealed an interesting potential. Assistive technology service data in combination with data collected by State vocational rehabilitation departments might coalesce the needed data. The Federal Rehabilitation Services Administration (RSA) 911 Report aggregates many variables of outcomes related information including employment status and the success of the vocational rehabilitation investment. This combined database could answer a range of assistive technology outcomes related questions of interest to service providers, people with disabilities, and vocational rehabilitation State agencies. This paper describes the data needed in an outcomes system, reviews the data that appear to be available today related to AT outcomes, and projects how data from two diverse programs might be used together to create a significant outcomes database.     

Policy and practice of occupational rehabilitation in Hong Kong and Guangzhou--a comparative study

The objective of this paper is to compare social policy on occupational rehabilitation services in two mega industrial cities in southern China: Hong Kong and Guangzhou. Comparative policy study was employed as the research and analytical method in this paper. Aim, finance, target, coverage, organization and administration, service delivery and provision of the occupational rehabilitation policy and its linkages with industrial injury compensation system and re-employment policy in the two cities were critically reviewed and compared. The results of the study reflect that the Guangzhou policy is more aggressive and more tailor-made to the specific needs of occupational rehabilitation compared to the Hong Kong policy, whereas occupational rehabilitation in Hong Kong has long been developed and knowledge and skills in the occupational rehabilitation service are more mature and fruitful. Based on the research findings, it is concluded that through experience sharing and exchange, there will be more mutual understanding regarding the system, practice, success, faults and limitations in the two cities, as well as awareness of alternative courses of action. These will help in the better development of occupational rehabilitation services with the aims to safeguard the rights and wellbeing of workers in both cities.     

Proprietary rehabilitation: Challenges and opportunities in the new millennium

Proprietary rehabilitation has developed into a distinct professional sector with procedures, practices, and philosophy that differ from those in the public rehabilitation program. As the new millennium commences, proprietary rehabilitation will face a variety of challenges and opportunities that could affect the future of this sector of the rehabilitation profession. Among these issues are changes in occupational information upon which many proprietary rehabilitation practices are based; increased opportunities for early intervention and establishment of disability management programs within industry; adjustment to the movement to a managed health care system; and the necessity to demonstrate fiscal efficacy of rehabilitation services to workers with compensable injuries. This article discusses these issues and suggests some ways in which those involved in proprietary rehabilitation can properly position themselves to address and benefit from these challenges and opportunities.     

Fish harvesters with injuries' accounts of their experiences with the workers' compensation system

The workers' compensation system was established to provide fair access to compensation for workers who have experienced occupational injury and can no longer work. It was expected that such a system would reduce individual legal claims. Evidence indicates that many injured workers proceed with a variety of appeals indicating dissatisfaction with the current system. The fishing industry is extremely dangerous. The aim of this research was to explore the experience of injured fish harvesters who were making use of a compensation system. Interviews were held with a sample of injured in-shore and deep-sea fish harvesters. In general, they identified themselves strongly as hard-working people who did not deserve their injury. They also reported substantial frustration with the staff of the compensation system who they believed treated them with suspicion and disrespect. The deep-sea fish harvesters were more concerned with the amount of compensation. This dissatisfaction with the system contributed to the fish harvesters' use of the appeals procedure. The fish harvesters' complaints are discussed with reference to the concepts of distributive and procedural justice.