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Work Rehabilitation

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Work rehabilitation is a broad term that encompasses many aspects of intervention, all geared toward facilitating independence at work as well as satisfactory fulfillment of the worker role.

The goals of work rehabilitation are to:

  • maximize levels of function following injury and/or illness to maintain a desired quality of life for the worker;
  • facilitate the safe and timely return of individuals to work following injury and/or illness;
  • remediate and/or prevent future injury or illness; and
  • assist individuals in resuming their role as a worker, which can contribute to self-confidence and a view of self as a productive member in society, and prevent deconditioning as well as the negative psychosocial consequences of unemployment.

Who Can Benefit From Work Rehabilitation?
Anyone who is experiencing an occupational performance problem (i.e., having difficulty fulfilling the worker role) due to an illness or injury, and who desires to return to work or enhance work performance, can benefit from work rehabilitation.

Occupational Therapy’s Role
Occupational therapy practitioners, through their education and training, possess the unique ability to evaluate individuals’ interactions with their work demands and the work environment through detailed and scientifically based task analysis. Using a holistic perspective, occupational therapists evaluate and understand the impact of wellness, cognition, physical disabilities, psychosocial factors, and medical conditions on work performance. The occupational therapy evaluation can identify supports and barriers to success in the work environment that, if indicated, can be addressed in the intervention plan in order to facilitate work performance. These specialized evaluation skills allow the occupational therapist to understand and deliver results in the complex psychosocial and physical work environment (Ellexson, 2000).

Occupational Therapy Roles in Various Aspects of Work Rehabilitation
Acute Injury and Illness Management: The occupational therapy practitioner works with the client to determine gaps between the job demands and the individual’s existing performance abilities, and remediates or compensates for the differences in a timely manner. The occupational therapist will determine the history of the current condition or injury. The occupational therapist will then develop a comprehensive and individualized intervention plan to address problem areas.
Work Conditioning: The occupational therapist uses a systematic approach to restore the work performance skills of workers recovering from long-term injury or illness. There is a focus on restoring musculoskeletal and cardiovascular systems as well as safely performing work demands. This is typically achieved through circuit training and work simulation that occurs 3 to 5 days per week for 2 to 4 hours per session.

Work Hardening: This approach is similar to work conditioning; however it is multidisciplinary and can involve psychomedical counseling, ergonomic evaluation, job coaching, and/or transitional work services. Treatment is typically provided 5 days per week for 2 to 4+ hours per day. Work-hardening clients may progress to transitional work programming with actual performance of job duties at their site of employment. If necessary, final determination of adaptations and/or reasonable accommodations can be made during this period of transition.

Functional Capacity Evaluation (FCE): The occupational therapist uses standardized and validated advanced testing in order to: (a) determine safe job matches for return to work; (b) determine the level of reasonable accommodations necessary for reinstating an injured worker; and (c) make recommendations regarding future interventions. The results of the FCE may be used by the physician to make a disability rating for insurance purposes.

Environmental Modification: The occupational therapist, together with the worker and the employer, makes recommendations for modifications to the workplace environment to facilitate successful employment  performance. Examples of environmental modifications to meet the needs of a returning worker can include changing the lighting, creating a new layout of the workspace, modifying work-related tools and devices, and minimizing distractions.

Transitional Work Programs: 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 the individual’s 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, and makes detailed recommendations to the treating physician, who releases the individual to modified work within these parameters. Work performance is closely monitored and discussed among the occupational therapist, employer, and individual.

Where and How Are Services Provided?
Possible Location of Services: Outpatient rehabilitation centers, hospitals, private industry (e.g., on-site clinics), private practices
Referral Sources: Medical providers, insurance case managers and adjusters, attorneys, state agencies, rehabilitation team members
Payer Sources: Workers’ compensation carriers, state and local agencies (e.g., Bureaus of Vocational Rehabilitation), legal settlements, private insurance, private pay

Conclusion
Occupational therapists are uniquely qualified to provide work rehabilitation services due to their understanding of the complex and dynamic relationship between the person, the environment, and the occupation, and their ability to address barriers to performance. Evaluation and intervention are tailored to the holistic needs of the client and take into account the work environment and work demands to facilitate successful performance.

Reference
Ellexson, M. (2000). Blueprint for ergonomics. Work, 15(2), 107–112. Retrieved January 14, 2008, from http://www.ncbi.nlm.nih.gov/pubmed/12441496

For More Information: American Occupational Therapy Association. (2011). Occupational therapy services in facilitating work performance. American Journal of Occupational Therapy, 65, S55–S64. doi: 10.5014/ajot.2011.65S55

Revised by Julie Dorsey, MS, OTR/L, CEAS; Faye Fick, MS, OTR/L; Michael Gerg, MS, OTR/L, CHT, CEES, CWCE; and Vicki Kaskutas, BS, MHS, OTD, OT/L, 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.