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Work Hardening 

Workability has developed a new and unique rehabilitation program aimed at assisting injured workers return to work. The Workability Work Hardening Program is a hybrid program that combines work hardening with the return to work process. This approach enables injured workers to return to work sooner and rehab back to full strength by performing actual work tasks in their regular work environment. Typically, these two activities are performed separately. In the traditional approach, the return to work process starts only once the work hardening or conditioning program has been completed. Participants of these programs use weight machines, sleds, crates and other rehab equipment to prepare for their job. Once they reach the work capacity specified for their job, they are released back to work.

In most cases a participant in the Workability work hardening program will start back to work straight away. They will perform real work in their normal work environment. A work hardening plan is developed using three sources of information: 1) Testing to identify strength, stamina and pain tolerance. 2) Work Place Evaluation to identify work tasks that can be used in the program and also to identify potential barriers to the workers rehab, such as ergonomic issues. 3) Team Meeting to obtain input from the injured worker, employer and case manager. 

The Workability Work Hardening Program will run for up to 8 weeks. It will be followed by final work capacity testing 2 weeks later. In some cases, the injured worker will not need the full 8 week program. They will be discharged once they demonstrate an ability to meet the full duty requirements of their job.

Rehabilitation at the worksite will be supplemented with a home exercise program aimed at addressing any deficits in strength or flexibility that are unable to be addressed at the work place. The therapist overseeing the work hardening program will visit the injured worker at their worksite twice a week during the first part of the program. Their visit frequency will lessen as the injured worker becomes more independent. The worksite visits will involve the therpaist observing the injured worker performing work tasks and discussing with them and their supervisor any problems, ideas or issues they may have. A new work plan is created for each new week of the program and a progress note is sent out to the treating doctor and case manager/adjuster every two weeks. If the injured worker had been attending physical therapy or chiropractic sessions prior to starting the work hardening program, they will be encouraged to continue with their provider on a one visit per week basis for the duration of the work hardening program. This provides good continuity of care and multidisciplinary input into the program.

The Workability model has several advantages over the traditional approach:

1) The injured worker returns to their job sooner. This is very important as research shows that the longer an injured worker is away from work, the less likely they will ever return. The early return to work provides important psychological and social benefits as well as the physical ones. Most people struggle mentally if they have been away from their jobs for an extended period.  

2) A significant portion of the strengthening and conditioning work is performed using the workers regular work equipment in their normal work setting to produce work that is purposeful and meaningful. For participants in a traditional work hardening program, the process is more abstract and the exercise routine can become monotonous. Participants are using weight machines and rehab equipment to perform simulated work activities to improve their strength. Participants often report difficulty seeing the connection between what they are performing in the rehab clinic with what they do at work.

3) With a program length of 8 weeks, the participant has a lot more time to develop strength, improve flexibility and increase stamina compared with the 3-4 weeks that a participant typically has in a traditional work hardening program. At the end of the 8 weeks of the Workability program the injured worker has an extra 2 weeks of work before they undergo final testing to determine their final work capacity and physicain release to full duty work and medical end point. That extra time can be a big advantage, particularly for worker's who are still experiencing ongoing pain.

4) The worker and the employer have a lot more involvement in this type of work rehab program. They have more say in the development of the program and the process once it is up and running. The therapist is there to set the framework and provide guideance on rehab and ergonomic issues, but they appreciate the fact that the worker and employer are the experts when it comes to the job. Its the combination of input from all parties that makes the program work.

5) The injured worker will have a lot more independence in this type of program. That could be a good thing or a challenge based on their personality. They will not be watched by a therapist 100% of the time as they would in a traditional program. The level of therapist support will be determined by need.

6) The Workability work hardening program is significantly less expensive than a traditional work hardening program. It is around 30% less than a typical work hardening program and 70% less than a functional restoration program. Add to that, the cost of wage replacement with the quicker return to work and you can save an additional 15-25% on the cost of a workers’ compensation injury.

7) Lastly, the program is a very efficient. Having both the rehab program and the return to work process performed together ensures that any issues that may present as the injured worker transitions back to work are identified straight away as part of the rehab program. Additionally, the employer has the advantage of having an expert in the field of work rehabilitation available to them throughout the whole process. This is a big bonus for the employer and specifically the supervisor who is not left trying to manage an employee who still may be experiencing pain on top of their regular work requirements.

STANDARD PROGRAM  (8 weeks + Follow-up Testing)
Initial Evaluation: Assess current work capacity and deficits. 
Worksite Visit: Assess job requirements, barriers to returning and available work tasks.
Team Meeting: Meet with injured worker, employer and case manager to formulate plan. 
Phase One (4 weeks): Work Hardening Program. Therapist visits worksite 1-2 x/ week to assess progress. 
Phase Two (4 weeks): Work Hardening Program. Therapist visits worksite every 1-2 weeks to assess progress. 
Final Testing Testing to identify final work capacity is performed 2 weeks after the completion of the program. 

 Note: Not everyone will need the full 8 week program. Worker's who demonstrate the ability to perform the fully duty requirements of the job will be released at that point.

ADDITIONAL SERVICES (optional)

SPECIALIST PHYSICIAN:
An Occupational Medicine physician is available to provide a second opinion, consult if the injured worker has any issues that need addressing during the rehab program and to provide a medical nnd evaluation or impairment rating.

SPECIALIST PHYSICAL THERAPIST:
A physical therapist considered an expert of certain body parts can be consulted to review existing treatment plan and the injured workers home exercise program.

WHO WOULD BE APPROPRIATE FOR THIS PROGRAM:
Any injured worker who does not meet the full duty requirements of their job. Typically, the injured worker would start the rehab program once they had undergone a course of physical therapy, however, that is not a prerequisite. Note: Participation in the Workability Work Hardening Program the injured worker must still have a job to return to.

MAKING A REFERRAL:
For physicians wanting to refer a patient for the Work Hardening program, the referral can read: “Work Hardening”, “Worksite Work Hardening” or “Occupational Therapy Evaluation.”