Work Hardening Arbeitsbezogene Rehabilitation ABR Work Hardening n

Work Hardening Arbeitsbezogene Rehabilitation (ABR)

Work Hardening n The focus of this treatment is to build capacities for quick and safe return to work.

Milestones in the development of Work Hardening n L. Matheson (Ende 70 er-Jahre) n n Work Hardening-Programm = Work oriented program that has an outcome which is measured in terms of improvement in the client’s productivity T. Mayer und R. Gatchel (1988) n Functional Restoration for Spinal Disorders. The Sport Medicine Approach

Milestones. . . n S. Isernhagen 1991 n n L. Darphin (1995) n n Functional Capacity Evaluation and Work Hardening Perspectives Work-Hardening and Work-Conditioning Perspectives M. Nordin (Campello et al 1998) n Approaches to improve the outcome of patients with delayed recovery

In Switzerland n Ergonomie-Trainingsprograms since 1995 Rehaklinik Bellikon n Unispital Zürich n Klinik Valens n Growing need for new clinics…

Guidelines, Accreditation n n Commission for Accreditation of Rehabilitation Facilities CARF (1988) American Physical Therapy Association APTA (1991)

Work Hardening OT/PT ("work conditioning") Requires a specific return to work goal. No specific return to work goal is required. Recognized as a specific treatment program by Labor and Industries — program standards have been established. Not recognized as a specific treatment program by Labor and Industries — specific standards have not been established. Reimbursed according to the work hardening fee schedule. Reimbursed according to the physical and occupational therapy WAC in the medical aid rules and fee schedule. Addresses physical, functional, behavioral and vocational needs of the worker. Addresses physical and functional needs of the worker. Multi-disciplinary. May be provided by one discipline. Utilizes real or simulated work activities with some physical conditioning. Utilizes physical conditioning and functional activities related to work. May or may not include education. Includes education (e. g. , body mechanics, work pacing, safety and injury prevention). May or may not include an educational component. Begins at 4 hours/day and builds to 8 hours/day over the course of 4 to 8 weeks. 4 hours or less per day. Note: reimbursement limits for outpatient occupational and physical therapy do not typically cover four hours per day.

Guidelines APTA: Definition n Work Hardening is a highly structured goaloriented, individualized treatment program designed to return a person to work. Work Hardening programs, which are interdisciplinary in nature, use real or simulated work activities designed to restore physical, behavioral, and vocational functions. Work hardening addresses the issues of productivity, safety, physical tolerances, and worker behaviors. "

Guidelines APTA: Treatment Work Conditioning n Undisciplinary Work Hardening n interdisciplinary

Guidelines APTA: Treatment Work Conditioning n n n Work Conditioning Assessment Physical Conditioning Work related functional Aktivities Work Hardening n n Work Hardening Assessment Work related physical Conditioning Real or simulated workability Psychosocial Interventions

Guidelines APTA: Triage for Work Conditioning and Work Hardening

Criteria for admission to a work hardening program: n n The worker is able to participate in a progressive rehabilitation program for a minimum of 4 hours a day, three to five days a week. A specific return to work goal is identified. Ability to benefit from the program based on a screening process. The worker has still a Job (= not unemployed)

Basic elements for Work Hardening 1. Zielorientierung n n n Goaling process: functional and work related goalsetting Work with weekly goals “Self Efficacy” Global goals for Rehab

Basic elements. . . 2. Painmanagement and coping with pain n Information and practical teaching about pain coping strategies

Basic elements. . . 3. Work related Assessment n n The Base: Evaluation der funktionellen Leistungsfähigkeit EFL Important: Evaluation of symptom magnification

Baseline Tests n n n n Complete patient history related to current diagnosis and any past medical history important to the FCE evaluation. Cardiovascular response to activity Pain intensity and PACT-questionnaire pre and postrehab Assessment of fine motor skills Assessment for balance Positional tolerance testing Material handling test Musculoskeletal evaluation if there is evidence of symptom magnification or submaximal effort Functional Capacity Evaluations are performed by Occupational Therapists and Physical Therapists who have had specific training in performing Functional Capacity Evaluations.

Individualized programs include: n n n Simulated job activities with body mechanics instruction to prevent re-injury Aerobic conditioning Flexibility and strengthening exercises Learning about pain coping strategies Relaxationtechniques Sports and leisure time activities

Some actual job simulations include: n n n n n Material Handling Janitorial Services Delivery Jobs Construction Tasks Clerical Task Packaging Operations Electrical Wiring Climbing Ladders Packaging Jobs n n n n Simulated Truck Cab Stocking of Shelves Wallboard Installation Brick/Block Building Electronic Assembly Use of Shovels & Rakes Use of Drills & Saws Use of Hammers & Screwdrivers