Originally posted by Brent Mack, DPT and Chris E. Stout, PsyD, on Advance for Occupational Therapy Practitioners, August 6, 2012
While worksite programs have a positive impact on the reduction of employee injuries, physical therapists and other rehab professionals are challenged to get those workers who do suffer an injury back to work as soon as possible. This becomes even more important for patients in these currently uncertain economic times.
The recessionary era we all now deal with has demonstrated that workers’ compensation is a tumultuous arena for policymakers and elected officials. Battle lines get drawn between political parties as well as among health care practitioners, attorney groups and organized labor opposing organized business associations. Most of the feuding concerns cost and utilization containment. However, what seems surprisingly conspicuous by its absence is that when most politicians and business leaders speak of outcomes, they are almost exclusively and uniformly referring to fiscal outcomes, not clinical.
No Patient is an Island
Economic as well as humane concerns arise as well, and it becomes incumbent on physical therapists to provide proper care vis-à-vis the injury and its sequelae. However, in this process, other aspects of the patient/person also undergo a healing process. While the focus of care is on the injury, physical therapists know that patients are not a collection of symptoms, but rather a complex and dynamic system.
While we obviously understand this biomechanically, those treating injured workers also come to understand this system to include the psychological (e.g., self-esteem, self-efficacy, depression, anxiety), familial (e.g., sexuality, activities with children, caretaking of aged parents), social (physical activities with friends, role-identity to a physically demanding profession, loss of status), economic (diminution of income while simultaneously having an increase in medical expenses), and many other aspects.
All of these issues can conspire to create poor outcomes by any measure-economic, personal or professional-for both employee and employer. They are literally life changing for the injured worker.
Thus, in our practice, we feel it is important for health care to be integrative. Far too often, health care specialties become insular and siloed, resulting in care that is likewise narrow or limited. Being empirically oriented, we wanted to conduct an investigational study to probe and thus better understand the impact that our rehabilitative services may concomitantly influence other aspects of health status as well as perceptions concerning returning to work, such as being fearful to return to the site where they were injured.
While multiple studies have shown that patients with a high level of fear avoidance do much better in a supervised physical therapy exercise program, we found that no one has investigated the impact of an evidence-based, sports performance-based work conditioning/hardening (SPWC/H) program on fear avoidance beliefs and general health perceptions of injured workers. Thus, we set out to examine the outcomes and impact rehab has not only on healing the injury and expediently returning the injured worker to work, but also how participation in such a program may impact fear-avoidance beliefs as well as other health and well-being perceptions.