Do Your Workers Receive Opioids or Job-Specific Physical Therapy?
All too often, injured workers are over-prescribed medications for pain, rather than consulting with physical therapists who will emphasize self-management of symptoms, physical fitness, and safe work participation.
- Salt et al. compared treatments for low back pain (LBP) and found that opioids were over-utilized, compared to safer alternative therapies such as exercise and physical therapy that improve function.
- Frogner et. al. found that when LBP patients saw a physical therapist first, there was an 89.4 percent lower probability of having an opioid prescription and much lower utilization of high cost medical services such as advanced imaging, emergency department visits, and hospitalization.
- The Occupational Health SIG of the American Physical Therapy Association recommends job-specific care and early workplace intervention when work participation is limited by work-related or non-occupational musculoskeletal conditions.
For all types of healthcare providers, poor communication of job demands at the start of care contributes to lost productivity and excessive treatment. WorkerFIT has established an innovative Job Function Survey and a Worker AbilityFIT Survey to support job-specific care and accommodation when work participation is limited by health conditions. This survey feature offers a simple and inexpensive way to clarify job demands and engage the worker, supervisor, and provider in planning for safe return to productive work.
The worker is often the only source of information about job demands for an attending health provider to consider. When job demands are exaggerated by the injured worker, this results in excessive lost-time or restricted duty days. If the worker minimizes their job demands, then a worker is at high risk for ongoing chronic symptoms or new work-related injury after premature release to return to full duty. WorkerFIT’s innovative survey feature helps to expedite safe return to work in the following manner:
Job Function Survey:This is a mobile-friendly survey that prompts the manager or safety professional to describe physical or cognitive ability requirements for a given job position or modified duty assignment. Identifying expected job demands is a helpful first step when a worker reports having job performance difficulties due to health issues. Survey responses can be used to create a functional job description that communicates physical and cognitive job demands to health examiners.
Worker AbilityFIT Survey:This is a mobile-friendly survey that invites a worker with job performance issues to rate his or her ability to perform specific physical or cognitive job demands. Identifying the worker’s perception of their ability is a helpful next step for early intervention to address work performance issues. The worker is prompted to identify concerns or suggest job improvements. This better communicates full duty job demands and available modified duty options.
These WorkerFIT survey tools create a strong foundation to promote safe and cost-effective therapy and workplace interventions that include:
- early contact with worker by the employer
- work accommodation offers
- interactive work-site visits for ergonomic consultation
- contacts between healthcare provider and employer
- service coordination to promote return to work
- functional capacity evaluation measures to validate work restrictions
After a limiting injury or illness, treating providers often over-rely on subjective reports of symptoms and perceived function by injured workers. Studies indicate that physicians often under-estimate work-related abilities after performing a clinical evaluation of impairment, especially when chronic pain is a factor. This contributes to unnecessary work disability and restricted duty. Peppers et. al. recommended adding objective functional capacity evaluation measures to improve the accuracy of physical activity restrictions for workers who report chronic pain. Lambeek et. al. investigated the cost-benefit of integrated care in sick listed patients with chronic low back pain and estimated 26 to 1 return on investment for every dollar invested in integrated care. The image below presents an algorithm approach to integrated care using the WorkerFIT Platform.
- Salt E, Gokun Y, Rankin A, and Talbert J. A Description and Comparison of Treatments for Low Back Pain in the U.S. Orthop Nurs. 2016; 25(4):214—221.
- Frogner BK, Harwood KJ, Schwartz M, Pines J. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Care Utilization, and Costs. Health Serv Res. 2018 Dec;53(6):4629-4646.
- Perry T, Cheung A, Asumbrado A, McBee K. Current concepts in occupational health: managing an acute injury that limits work participation. Orthop Phys Ther Pract. 2019;31(2):101-105.
- Brokaw JP, Walker WC, Cifu DX, Gardner M. Sitting and standing tolerance in patients with chronic back pain: comparison between physician prediction and covert observation. Arch Phys Med Rehabil. 2004 May;85(5):837-9.
- Brouwer S, Dijkstra PU, Stewart RE, Göeken LN, Groothoff JW, Geertzen JH. Comparing self-report, clinical examination and functional testing in the assessment of work-related limitations in patients with chronic low back pain. Disabil Rehabil. 2005 Sep 2;27(17):999-1005.
- Peppers D, Figoni SF, Carroll BW, Chen MM, Song S, Mathiyakom W. Influence of Functional Capacity Evaluation on Physician’s Assessment of Physical Capacity of Veterans With Chronic Pain: A Retrospective Analysis. PM R. 2017 Jul;9(7):652-659.
- Lambeek LC, Bosmans JE, Van Royen BJ, Van Tulder MW, Van Mechelen W, Anema JR. Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomized controlled trial. BMJ. 2010 Nov 30;341:c6414.