Screening, intervention and restorative therapy services for injured workers

Oct. 23, 2018

The U.S. Bureau of Labor Statistics estimates that there were approximately 2.9 million nonfatal workplace injuries and illnesses reported by private industry employers in 2016. This translates to about 2.9 cases per 100 full-time equivalent workers. Workplace injuries and illnesses have a major impact on an employer's bottom line. The Occupational Safety and Health Administration (OSHA) estimates that employers pay almost $1 billion a week for direct workers' compensation costs alone.

Recognizing the significant social and financial impact associated with workplace injuries and disabilities, Mayo Clinic's Work Rehabilitation Program cares for employees who have experienced slower than expected recovery from traumatic or overuse injuries on or off the job. According to Russell Gelfman, M.D., a physiatrist at Mayo Clinic's campus in Rochester, Minnesota, who is involved in this program, medical providers encounter multiple challenges in treating patients with work disabilities. These include:

  • Administrative and clinical failure to address biopsychosocial factors
  • Limited administrative and clinical focus on compensable conditions
  • Administrative and clinical iatrogenesis
  • Addressing medically unexplained symptoms

Dr. Gelfman notes that given these challenges, providing these patients with multidisciplinary early intervention makes sense. "When we give high-risk individuals early access to screening, intervention and restorative therapy services, we see a rate of return to work that is superior to and more cost-effective than usual care."

Mayo Clinic began offering its Restorative Therapy Early Intervention Outpatient Program (EIOP) in 2006. The primary goal of this program is to maintain the injured employee at work or return the employee to work in a timely, cost effective manner. A team of physiatrists, occupational therapists and physical therapists who specialize in work injury management provide consultations for referring physicians. The team blends outpatient occupational therapy and physical therapy interventions with a work hardening-conditioning approach.

Each team member plays a unique role in this program:

  • Physicians supervise medical and psychosocial treatment of the patient, order diagnostic testing and interventional procedures, perform medication assessment and management, and write and support recommended work restrictions.
  • Physical therapists educate patients about spine and muscle anatomy, emphasize the benefits of exercise, and design, implement and monitor a functional exercise program.
  • Occupational therapists employ a behavioral modification approach during one-on-one education and therapy sessions that can include video, written and verbal presentations and hands-on practice of techniques related to adaption to and self-management of persistent pain during activities of daily living and physical work-related tasks.

According to Dr. Gelfman, the EIOP program typically begins as the patient transitions from the acute phase to the subacute phase (ideally from one to three months after injury). Early screening to identify the multiple variables related to the patient's specific situation can help individualize a restorative therapy program. At minimum, providers use the screening to document the following:

  • Injury severity and type
  • Pain intensity — need for opiates
  • Self-reported functional limitation
  • Work absence preceding medical evaluation
  • Psychological issues
  • Prior treatment or surgery
  • Fear of re-injury
  • Expectation for early return to work
  • Workplace issues

How does this program help return people with disabling pain back to work? By identifying physical and nonphysical barriers to recovery, physicians and therapists can effectively address and mitigate the effects of pain-limiting injuries.

As the patient progresses along the work injury management continuum, the program provides:

  • Functional capacity assessments, to observe and identify an employee's actual physical abilities at any given time during recovery
  • Return to work rehabilitation, using aerobic conditioning, endurance, strengthening exercises and job simulation tasks
  • Job site analysis and job modification (as needed)
  • Adaption to and self-management of persistent pain
  • Wellness instruction to encourage a healthy lifestyle and reduce recurrences of work disability

"One of the distinguishing features of this program is that it provides worker-centered treatment," explains Dr. Gelfman. "By that I mean that the treatment and interventions must be meaningful and relevant to the individual. Our therapists use the results of the functional capacity testing and job-specific assessments to tailor individualized function-based therapies."

Another principle that guides Mayo's EIOP is an understanding that pain and function are not the same. "Our therapists consistently teach our patients that hurt does not equal harm," says Dr. Gelfman. "We emphasize how the connections between physical and psychosocial variables can influence perception. And we stress that work is an important part of patient rehabilitation."

All of the above requires consistent communication between the patient, employer, insurer and team members. "This communication comes naturally to our staff because the team approach is ingrained in our organization's culture and model of care," notes Dr. Gelfman.

For more information

For more information about Mayo Clinic's EIOP, call 507-284-4933.