Job descriptions like this that use terms such as “average-weight objects” and moderate physical activity are difficult for treating physicians and physical therapists when helping to return an injured employee to work.
Vague job descriptions impact treatment and return to work testing (a Functional Capacity Evaluation works best when there are objective minimum essential demands available for comparing the employee’s ability to push, pull, lift, carry, etc.). It is much more helpful for a physical therapist to understand the physical and postural demands when planning rehab activities and understanding goals.
But, in NJ, these vague descriptions may play out well past the end of treatment. Governor Murphy signed A2617/S-2998 which amends the Workers Compensation laws to provide a hiring “preference” to those who have reached MMI but were not returned to their job position. While the mechanics of this “preference” have not been defined, it does include language that the individual must meet the essential functions of the position:
“Following a work-related injury, an employer shall provide a hiring preference to an employee who has reached maximum medical improvement (MMI) and is unable to return to the position at which the employee was previously employed for any existing, unfilled position offered by the employer for which the employee can perform the essential functions of the position.”
Take a look at your job descriptions to see if the essential functions have been defined to include essential minimum physical and postural demands.
If you are not sure, we can help review your job descriptions. If you haven’t defined the essential physical and postural demands within your job descriptions, we can help measure those demands.
Recently**, a physical therapist who I’ve known for years reached out to me for some advice. She had two patients that were being sent for “work conditioning” to her. The problem was that job descriptions weren’t provided for either of the two patients. She knew that the “I only have to do this…..I never have to do that” wasn’t the whole story. She also knew that I had been involved in writing job descriptions for those positions for some of our clients. Having performed Functional Capacity Evaluations with us in the past, she also knew that having a solid job description is key in matching up demonstrated performance to essential physical and postural demands.
Work conditioning is defined by the American Physical Therapy Association as “work related, intensive, goal-oriented treatment program specifically designed to restore an individual’s systemic, neuromusculoskeletal and cardiopulmonary functions. The objective is to restore the injured employee’s physical capacity and function for return to work.”
Without understanding what the functional demand is for a specific position, it is difficult to define the goals of a work conditioning program. One of the patients that she had inquired about was a school bus driver. He had told my friend that he “really didn’t have to do much beyond sit in the driver’s seat and drive. Maybe, open the door every so often to let the kids on in the morning or off in the afternoon.” He was returning to work from a lower extremity injury that resulted in a joint replacement. Having performed FCEs for school bus personnel before, she knew that the demands were more but was unsure of the other tasks.
School bus drivers are tasked with performing pre- and post- inspections of their vehicles. This involves checking in and around the vehicle, checking storage compartments (if the bus has one), ensuring that all emergency exits (including the roof exits) are operational, and being able to check under the seats for both children and their belongings. Also, in some districts, bus drivers may be switched to different routes based on employer needs. Switching routes may require drivers to pick up students who may be in wheelchairs. When the wheelchair lift malfunctions, drivers use a manual, hydraulic pump to elevate and lower the lift as needed. This task requires the driver to be able to squat or kneel to a level to operate the manual pump. Drivers, if an aide is not present, may have to secure wheelchairs to floor mounted devices, which requires the ability to kneel while reaching. With demands such as those listed, she needed to work with this patient on being able to step up/down to get into and out of the bus, to be able to kneel to perform tasks, and make sure that the driver demonstrated the ability to perform the overhead tasks of checking the emergency exits. The ability to perform these demands are even more important as a result of the NTSB school bus driver recommendations that I mentioned in a January blog post.
Based on the APTA definition, work conditioning covers a larger swath than when the patient was being treated solely for the injury that brought them to physical therapy. During that initial portion of the treatment, therapy focused on the needs of healing for the specific body part along with improving range of motion and strength as appropriate based on the healing process. Work conditioning helps to pick up to make sure that the other aspects of the injured worker such as their cardiovascular endurance, strength, power, and muscular endurance are not impaired when they are returned back to work. As a result, work conditioning includes activities to improve physical capacity in all of these areas. When an individual begins a work conditioning program, their initial status in these components should be documented – both as a baseline as well as for comparison to the essential postural and physical demands. This will help the therapist communicate to the patient, the case manager, the physician, and the employer as to where the patient is in regard to return to duty.
When quarantine/shelter in place orders begin to be lifted, work conditioning is going to play an important role in returning workers that had been out on workers comp prior to the pandemic to their previous roles. For many of these patients, they may have been shifted over to telerehab as clinics closed for safety issues. Telerehab and “virtual physical therapy” are great for keeping in contact with the worker and moving them along in their rehab journey as best as can be done in these circumstances. However, they may not have access to the resources or guidance to recondition themselves for work prior to returning to their job. Correcting this deconditioning is going to be vital to their success upon return to work as well as for reducing their risks for suffering another injury after return to work.
** – I had started writing this several weeks before all of the “shelter in place” orders started to come down from the different states and it sat in a draft folder for a while. As I revisited the draft after a little over 3 weeks in quarantine, it made me think about the fact that some injured workers currently in PT may be deconditioned if not by now, but definitely by the time the shelter in place orders are lifted. Getting these workers into a work conditioning program at the soonest appropriate time point may be the best chance for a successful return to work process.
In the past, I have covered different incidents that point out how things could be done differently under the guise of “What Not To Do Wednesday” blog posts. This morning, I read an article that was written after the safe resolution of a training flight that included a mechanical failure. In “Elevator Failure at 4,500 Feet”, instructor pilot Rich Wyeroski recounts a flight in which the elevator on the horizontal stabilizer had a malfunction while the plane was in flight. Wyeroski provides a solid recounting of the steps that he took to safely bring the plane down after the student pilot reported difficulty with the controls. In the article, he states that his reason for writing the article is a concern that this incident, particular to Cessna 150 airplanes built between 1959 and 1970, could occur again without a hardware modification to upgrade the elevator hardware to the same standard as Cessna 152 planes as well as some Cessna 150 planes that were later. He also discusses the importance of training to deal with potential emergencies such as this to ensure that pilots:
“Always try and stay calm during an emergency. Don’t do anything until you assess the situation and then react slowly. (The only time I would deviate from the above recommendation is if the aircraft is on fire!)”
Wyeroski, who is not only an experienced pilot, instructor pilot, and instructor for A&P mechanics, gave a great breakdown on how the flight was handled and possible solutions. But, my reason for bringing up this aviation article was the comments section. Some of the comments argued that a pre-flight inspection should have caught this and that a request for planes to have the attachment system for the elevators in the older Cessna 150 models is a little too much for something that happens rarely.
The thought process of those who stated that it should have been caught in the pre-flight inspection really stuck with me when I was reading the article. Several people did note that it would be easy to miss (either by a lack of a thorough pre-flight inspection or by seeming ok during the pre-flight but loosening in flight). The author noted in a comment that no issues were noted during pre-flight or during a recent annual inspection.
Without Wyeroski’s recount, this near fatal flight would not be a learning experience except for those who dig through NTSB case files.
One of the problems in safety and workers compensation is that all too often, only the incidents that cause injuries are reported/recorded and potentially used to effect some level of change within a worksite. Sometimes, it is because only the people involved know about the incident because of not being required to report/record or even check in with occupational health. But these “near misses” are important to take the time and look into more deeply. Many times, the lessons learned from a “near miss incident” can provide the information necessary to change either policies/procedures and or change/adjust equipment to prevent future incidents. Wyeroski even notes in the comments that one lesson that he learned from this incident was to contact Air Traffic Control rather than the local Unicom operator to make sure that the Fire Department was ready and at the runway when he landed (apparently, the Unicom operator was unable to get the fire department to understand the urgency of the request and the risk of a fatal crash).
This is a slightly different Friday Five. I’m not going to post a check of what is new in the research in the areas of ergonomics and safety. This week will be a quick recap of what I think were five important takeaways from the conference that I attended yesterday – “Everything You Wanted To Know About New Jersey Workers Compensation” which was hosted by John Geaney from Capehart Scatchard and Millenium Seminars. If you aren’t following John’s blog on workers compensation, you should be.
“Recovery on the job” – Trudy Mandia from AtlantiCare
I tweeted about this yesterday. I hate the term “light duty”. So many people get wrapped up with the word light with a lot getting it confused with the term “light work” which is considered to be a job with an occasional lift, push, pull, carry demand of 20 pounds. Everyone tends to get wrapped up on the restrictions on an individual when they hear “light duty”. Over the years, I have been on a mission to reframe the term as modified duty which is not so wrapped up in the restrictions on demands. But, I love the term that Trudy talked about from AtlantiCare’s standpoint. They no longer use the term light duty and have replaced it with “Recovery on the job” with the focus being on an individual’s current abilities and not focusing on what they can not currently do.
“Make sure that it isn’t boxes just being clicked”
Dr. Dwyer from Premier Orthopedics mentioned the reminder that with so many medical records being generated by different EMR packages, sometimes practitioners can end up clicking through. Make sure that the physicians and therapists are being accurate when they are completing medical records in an EMR system and that they are also indicating both active and passive range of motion of the injured body part at all visits.
“Make sure that your employees know how long light duty will last”
This topic came up across multiple discussions through out the day because it is that important. This is something that we tell clients that we meet with when we are talking about both regular job descriptions and tasks that might be available for modified duty. Leaving an employee in a modified duty position for an indeterminate length makes some employees want to remain in that position for the remainder of their employment and also makes it easy to argue that the “modified duty position” is essential if an employee is left in that position for a prolonged duration of time.
Another topic that was mentioned several times because as John said yesterday, good job descriptions are the building block for creating a workers compensation program. I’ve written about customized job descriptions multiple times on this blog, but members of yesterday’s panels provided reminders that good, solid, accurate job descriptions allow:
The physicians and physical therapists do their jobs to get the injured employee back to the essential demands of the position.
Allow physicians, employers, and case managers to possibly get an injured employee on modified duty when it becomes appropriate and helps to allow for progression of modified duty over the treatment timeline
Is necessary for having an effective interactive dialogue when the issues of accommodations comes up.
Need to accurately reflect current essential postural and physical tasks that are performed.
The issue of communication came up in several panel discussions during the day. Communication between the employer, the case manager, the physician, the physical therapist, and the employee is key in moving towards a successful end state for an injury claim.
I was glad to hear that having a bilingual staff member to help with the communications process with injured workers at the Tropicana has made a big improvement in their program. I know that in the provision of FCEs, we have been grateful when a translator has been provided if a claimant does not speak English but provision of a translator is not a common occurence. Having a translator can make things go much easier and quicker when everyone is on the same page.
Make sure that you communicate your modified duty program guidelines to your injured employee when it is offered and put it in writing. This helps to make sure that everyone is on the same page.
This is just a small sampling of some of the important topics that were discussed during the course of the day. These one day conferences are a great opportunity to learn from the speakers, the attendees as they ask questions/make comments, and during the breaks to learn from the vendors and the attendees.
(A photo I took during a previous conference in Atlantic City but yesterday’s weather conditions were similar)