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Occupational Therapy Services at the Workplace: Transitional Return-to-Work Programs

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Occupational Therapy Services at the Workplace: Transitional Return-to-Work Programs
Occupational therapy practitioners help individuals with illness and/or injury resume work duties on a gradual basis through transitional work. Transitional work uses the actual work tasks and environments as a form of rehabilitation. After becoming familiar with the individual’s job requirements and measuring his or her functional abilities, the occupational therapist determines tasks that the individual can safely and dependably perform at work. The occupational therapist works with the employer to identify environmental and task modifications that will support work performance. The occupational therapist makes detailed recommendations to the treating physician, who releases the individual to modified work within the parameters outlined by the occupational therapist. Work performance is closely monitored and discussed among the occupational therapist, employer, and individual. As tolerance increases, work tasks are advanced to match the individual’s abilities until maximum recovery is achieved. Full duty work is the ultimate goal; however, this may not be achievable.

Occupational Therapists Are Uniquely Qualified To Design and Oversee Transitional Work Programs
Work performance is within the domain of services that all occupational therapy professionals are trained to assess. Occupational therapists have the unique combination of knowledge, skills, and abilities to address the wide range of physiological, biomechanical, cognitive, and psychosocial functions of an individual. As health care professionals, occupational therapists understand the effect of a wide range of health conditions on the body systems. Occupational therapists are trained to evaluate the individual’s motor, physical, psychological, and cognitive body functions and to compare the individual’s functional abilities to those required by the job. In addition, occupational therapists have the observational skills, training, and expertise to perform complex task analysis and assessment of the environmental factors affecting work performance.

Where Are Transitional Work Programs Provided?
Transition-to-work services are performed at the workplace; however, evaluation in a clinical setting is usually done prior to the individual returning to work. The occupational therapist performing the transitional work program interventions may be employed by a medical clinic, hospital, or company, or may be a consultant to the employer or industry. The occupational therapist collaborates closely with the individual, employer, and treating physician throughout the return-to-work transitional program.

Who Can Benefit From Transitional Work Services?
Individuals with injuries, illnesses, and chronic health conditions who have recuperated to the point that workplace participation is not contraindicated can benefit from these services. The individual must be capable of resuming some form of modified work and must be able to tolerate the environmental demands of the workplace. The individual must be capable of self-regulating and negotiating the environment with his or her symptoms in order to safely return to work.

What Are the Benefits of Transitional Work?
Transitional work can provide many benefits to the individual. The individual begins to envision him- or herself as a competent worker able to resume meaningful work roles and responsibilities. Normal routines and habits can be maintained. Damaged body structures have time to heal while still allowing for activity that prevents deconditioning due to disuse. The functional abilities necessary to perform a job, such as strength, endurance, mobility, manipulation, emotional tolerance, and cognition can improve due to participation in work activities. When the individual is able to perform modified work tasks successfully, confidence in his or her ability to work increases. The individual can learn how to compensate for limited functional abilities through environmental and task modifications. Return to work can decrease long-term residual functional limitations and disability. Improved abilities can carry over to other meaningful occupations performed at home and in the community, including activities of daily living, rest and sleep, leisure, home management, and community participation.

The employer can also benefit because the individual returns to work and/or the regular job duties more quickly and safely. Expenses due to training new workers and decreased productivity are minimized. If the injury or illness is work related, temporary total disability payments for lost work time can be reduced. Residual functional limitations may be lower, resulting in decreased permanent partial disability settlements if the condition is work related. The employer is assured that the individual has the required performance skills and is able to safely meet the essential functions of the job. Long-term related health conditions may also be minimized, preventing future problems. The worker remains active in the workplace, which can prevent loss of the worker role and maintain adaptive work habits and routines necessary for employment.

Who Pays For Transitional Work Services?
Workers’ compensation insurance plans, employers, individual health insurance plans, and state and/or local agencies can pay for transitional work services.

What Does the Future Hold?
Changes in the workforce will continue to affect how injured workers are treated and return to work. Decreasing numbers of skilled workers and the increasing use of temporary workers, the aging workforce, and a labor market shift to include equal proportions of males and females affect work-based rehabilitation. The challenge for administrators of future transitional work programs and work rehabilitation in general will be to devise new strategies to address the changes and emerging trends in the workforce.

Conclusions
Transitional work services can be a win-win situation for the individual and employer. The occupational therapist oversees transitional return-to-work services with a close collaboration among the individual, employer, and medical treatment team.

Developed by Vicki Kaskutas, OTD, MHS, OT/L; Michael Gerg, MS, OTR/L, CHT, CEES, CWCE; Faye Fick, MS, OTR/L; and Julie Dorsey, MS, OTR/L, CEAS, for the American Occupational Therapy Association. Copyright © 2012 by the American Occupational Therapy Association. This material may be copied and distributed for personal or educational uses without written consent. For all other uses, contact copyright@aota.org.