Work Conditioning Natural Progressions By Nancy Botting, Judy Braun, Charlene Couture and Liz Scott How a non-traditional, geared-to-work treatment is returning injured workers to full duties quickly, effectively and at a significantly lower cost. Like many employers, Lear Corporation, a major multinational supplier of automotive parts, was finding that musculoskeletal conditions were accounting for more than 40 per cent of its occupational illnesses and 70 per cent of its workers compensation costs. More important, repetitive strain injuries were adversely affecting employees, who were experiencing substantial pain and functional impairment. To help alleviate these problems, job rotation and modified work procedures were put in place. But by mid-1995, 70 of approximately 550 employees were doing modified work; some for more than six months. Lear also found employees who had to stay in the difficult jobs were experiencing more injuries. The modified work cycle seemed never ending. Identifying the problem was easy; formulating solutions was more of a challenge. In many instances, traditional physician management of disability cases was not returning employees to their jobs. The company also tried following conservative management protocols for claim submissions, follow-up with adjudicators, and vocational rehabilitation and return-to-work plans developed in collaboration with the Ontario Workers Compensation Board (WCB). But the system was cumbersome, slow and inconsistent for both the employee and the employer. And the number of employees receiving workers compensation benefits or on modified work continued to escalate with little resolution of the underlying disabilities. Based on studies of multidisciplinary approaches to treating injured workers and its own experience, Lear decided to take a non-traditional, work-conditioning approach to getting employees back on the job. Work conditioning involves an individualized treatment program designed to increase a worker s ability to return to work. Tasks are graded progressively to improve the biomechanical, neuromuscular, cardiovascular and psychosocial functions with real or simulated work activities. Specific components usually include exercise and aerobic training; education to teach injured workers a safer, more productive way to work; and work simulation. To collaborate in developing a cost effective, work - conditioning program, Lear hired Columbia Rehabilitation
Centre (Oakville location), a private, multidisciplinary health care company that takes an active approach to workplace injuries. Putting work conditioning into action Each company has a unique work process that employees need to be physically conditioned to perform. In order to understand the needs of Lear s employees, Columbia thoroughly assessed the plant by performing a job-site analysis, reviewing the physical demands of each job (done by an ergonomist) and rating job difficulty. It was quickly identified that the jobs at the worksite needed to be rated to ensure that injured employees were performing tasks that matched their current functional abilities. The jobs were rated according to injury type and level of difficulty specific to each injury. This allowed an ergonomist/kinesiologist to understand clearly the different aspects of each job and to classify injured employees into specific categories. During the evaluation, it was found that in the past, some employees had been placed in jobs that were beyond their physical abilities, while others were being left in less physically challenging jobs for too long. The company s job rotation program was refined to incorporate job ratings and reduce the potential of injury and reinjury. Once the stressors placed on an individual, the potential for progressive reintegration into the work force and the goals of the rehabilitation program were understood, the work conditioning program design began. Evaluation of the most prevalent injuries identified problems similar to other manufacturing industries. Repetitive strain of the upper extremity and back injuries were most common and produced the greatest number of lost days. Each employee was thoroughly evaluated by a physiotherapist to determine the severity of injury, and an ergonomist/kinesiologist conducted a functional abilities screen. Then, the current capabilities were matched with job demands were matched with job demands and collaborative plans were formulated. The company provided the rehabilitation centre with actual tools from the production lines where the employees would return to work. These tools, such as seats, risers and frames, helped make work hardening job specific. Developing the program From the information collected in the work site evaluation and the physical assessment of injured employees, a specialized work conditioning program was designed. The program is six weeks long with a possible two-week extension if the centre feels that employees need additional time to fully recover. Employees start with minimal physically tasking jobs, such as inspection, and gradually progress through jobs that are more physically demanding, such as seat track assembly. Weekly progressions to more difficult tasks are suggested by the ergonomist and co-ordinated by the company s on-
site occupational health nurse. Pre-and post-program physical abilities analyses are done and, at the end, employees are cleared for full duties. The important components of the work-conditioning program include: Exercise to strengthen specific muscle groups identified as being weak; Aerobic training to improve overall cardiovascular fitness; Education to teach employees safer and more productive ways to work; Job specific, work simulated activities to prepare workers for full duties; On site job evaluations to determine weighting by injury type and job difficulty; Functional assessment of each employee to guarantee the program fits the individual; and Weekly communication with the company to ensure appropriate job progressions. Promising results So far, the program has been a great success. In four months, the number of workers doing modified work has dropped from 70 to 15 and, more important, employees are getting better. Prior to program implementation, the average duration of modified work was more than six months. Now workers are back to regular work within six to eight weeks. The rehabilitation team was able to successfully return 100 per cent of chronic modified workers that entered the work conditioning program to full duties over a short period of time: 78 per cent returned after six weeks and the remaining 22 per cent returned after eight weeks. Three months following the completion of the program, no injury recurrence has happened to anyone involved in the program. (The 15 employees on modified work are new injuries who now enter the program immediately.) This lack of reinjury is likely due to the preventive education employees received during the work conditioning program and its ongoing reinforcement. In order to remind employees of correct stretching techniques, for instance, a stretching poster has been developed and posted in the workplace. But the program has not been without hurdles. The first employee to attend had concerns about the difficulty of the functional assessment. In order to prove the process was not going to hurt workers, union members were assessed at the centre. This improved overall receptiveness to the program. At the production level, some resistance to workers gradually progressing through jobs occurred. But employees who progressed through the program as scheduled coped dramatically better than those who were placed directly back into difficult jobs after a period of light work. Job progression now goes smoothly because supervisors have seen the importance of following the reintegration process.
In addition, a few employees discovered they did not have the physical capabilities to work in the industry. These individuals were retrained and report great satisfaction in their pursuit of alternate careers. It s still too early to see any monetary improvements in workers compensation costs, however, from an individual claim perspective, the cost savings have been significant. For example, a recent back injury cost $4,500 for treatment plus WCB costs, compared to $78,000 for WCB costs in an earlier similar case. Employee perspective Upon completion of the work conditioning program, employees filled out a survey to provide feedback regarding the program s usefulness. In general, they felt good about work conditioning. On a scale of poor to excellent, 11 per cent of the respondents rated the program as average; 55 per cent as good and 33 per cent as excellent. (For additional program results, see the chart at the end of the article). One typical example is an employee who was performing modified duties for a period of eight months and still had right shoulder and neck pain. Initial assessment revealed chronic rotator cuff tendonitis as well as tight back muscles. Functional assessments found the employee was able to lift 11.2 kilograms from floor to waist height, and 6.7 kg from waist to shoulder height. Significant pain was reported in the right shoulder while performing these tasks. The employee was right handed and could not complete tasks that involved repetitive hand movements. The employee completed an individualized six-week program that emphasized strengthening exercises, aerobic conditioning, posture re-education, biomechanical training and correct lifting techniques. Strength improved to a point where the employee is not able to lift 31.5 kg from floor to waist height, and grip strength in both hands has increased. The employee has returned to full duties, reports no discomfort and, in three months, has had no recurrence of the injury. The work conditioning program has resulted in employees getting professional, geared to work treatment. In addition, the burden modified workers put on other employees and the WCB system have greatly decreased. The difference between this approach and traditional work conditioning programs is that it has a progressive treatment program that links on site and off site evaluations.
This multidisciplinary team approach has proven to be bringing workers back on the job effectively. PARTICIPANTS FEEDBACK ON PROGRAM RESULTS Below are some subjective results from a questionnaire administered to all employees who completed the work conditioning program. Overall strength 100% Improvement Arm and grip strength 100% Improvement Leg strength 89% Improvement 11% No Flexibility 89% Improvement 11% No Cardiovascular fitness 89% Improvement 11% No Lifting ability 78% Improvement 22% No Program helped 78% Yes 22% No return to work Without program, would you have returned to full duties? 89% No 11% Yes For additional information about this topic, please contact Sibley.