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Work rehabilitation is a broad term that encompasses many aspects of intervention, all geared toward facilitating participation in work and 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
- Assist individuals in retaining or resuming their worker role, which can contribute to self-confidence and a view of self as a productive member in society, and prevent the negative psychosocial consequences of unemployment.
Who Can Benefit From Work Rehabilitation?
Anyone who is 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, have the skills to evaluate worker capacities, task performance, and the work environment, and to provide interventions related to these areas.
Using a client-centered perspective, occupational therapists evaluate the impact of wellness, cognition, physical disabilities, psychosocial factors, and medical conditions on work performance. In particular, occupational therapists possess the distinct ability to evaluate the intersection of an individual’s work demands and the work environment through evidence-based task analysis. The occupational therapy evaluation can identify supports and barriers to success in the work environment, including work culture, that can be addressed in the intervention plan to enhance work performance. The occupational therapist also considers other contexts and environments that may support or hinder the ability to fulfill the worker role, such as access to transportation and the ability to dress oneself in a timely manner for the work day. These specialized evaluation skills allow the occupational therapist to understand and deliver results in the complex psychosocial and physical work environment (American Occupational Therapy Association, 2011).
Occupational Therapy Roles in Various Aspects of Work Rehabilitation
Occupational therapists work with employers, workers, and other health care professionals or team members to create and implement feasible and individualized intervention plans in the following broad areas. They also evaluate the outcomes of these interventions and make any necessary adjustments.
Acute Injury and Illness Management: The occupational therapist works with the client to determine any gaps between the demands of the job 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, consider any potential change in the condition over time, develop a comprehensive and individualized intervention plan to address problem areas, help to implement the plan, and evaluate its effectiveness.
Work Conditioning: The occupational therapist uses a systematic approach to restore the 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 tasks. This is typically achieved through work simulation and individualized interventions to improve physical capacity that occur 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-plus hours per day. Clients in work-hardening programs may progress to transitional work programming by actually performing job duties at their place of employment. If necessary, final adaptations and/or reasonable accommodations can be determined 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 include raising or lowering 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, and modifications change as the worker develops more skills.
Where and How Are Occupational Therapy Services Provided?
Possible Location of Services: Outpatient rehabilitation centers, hospitals, private industry (e.g., on-site clinics), private practices, community-based centers
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 therapy practitioners are distinctly 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 physical, social, and cognitive supports and barriers to performance. Evaluation and intervention are tailored to the holistic needs of the client and take into account all aspects of the work environment and work demands to facilitate successful performance.
Reference
American Occupational Therapy Association. (2017). Occupational therapy services in facilitating work participation and performance. American Journal of Occupational Therapy, 71(Suppl. 2).
Revised by Julie Dorsey, OTD, OTR/L, CEAS; Denise Finch, OTD, OTR/L, CHT; Holly Ehrenfried, OTD, OTR/L, CHT; and Lisa Jaegers, PhD, OTR/L. Copyright © 2017 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.