Focus on Patients’ Strengths as Injury Recovery and Prevention Strategy
Frailty increases chances of poor outcomes
Case managers working with workers’ compensation clients or managing a population of older adult patients should keep in mind that strength is important for positive health outcomes.
“Strength is so important to maintaining health,” says Michelle Despres, PT, CEAS II, vice president and national product leader at One Call Care Management in Jacksonville, FL. Despres has spoken about workplace trends at national conferences, including the 2018 Case Management Society of America (CMSA) national conference.
Don’t Waste the Muscles
Data from the U.S. Bureau of Labor Statistics show that the percentage of the U.S. workforce that is age 55 and older has increased from 12% in 1990 to 19% in 2010 and is projected to reach 25% in 2020. Older workers injured on the job are slower to heal and out of work longer than younger workers with an injury, Despres notes.
“Our muscles waste away as a byproduct of age,” she says. “Strength is a key component of our health, and it [muscle deterioration] cannot only be stopped with strengthening, but it can be reversed with strengthening.”
Strengthening is more than exercise. It involves specific actions to improve strength and muscle mass, including slow eccentric exercises and then rapid concentric exercises, she explains.
When someone is injured, case managers should be proactive and ensure patients are seen by physicians and physical therapists very quickly. This is especially true for older workers, who have double the median number of lost work days post-injury as younger workers, she says.
“The more quickly someone gets in and gets moving, the better the outcomes,” Despres says.
Another key to moving injured workers back to their jobs is to find out exactly what it was that they did in their day-to-day work. “Get their job descriptions, something that functionally describes the work,” she says.
A generalized job description, such as one that says “must be good at customer service or be timely,” does not tell a physical therapist or doctor what the expectations are for that injured worker, Despres adds.
Knowing the worker’s job also can help explain and prevent injuries. For example, Despres worked with one injured loading dock worker who hurt his knee at work. When Despres asked him how he was injured, he replied that he jumped off the loading dock four times an hour.
She checked out his workplace and discovered he was accurate about jumping off the loading dock, but that there also were stairs he could have used.
“Sometimes, it just takes common sense,” she says. “There are situations like that where people don’t understand their job requirements, and they have some choice in the way they work.”
Part of the injured worker’s return-to-work plan involved always using the stairs and protecting his knee through proper work movement.
“Case managers can provide physical therapists with the job demands at the time of the worker’s injury,” Despres says.
Changes in Vision, Functioning Are Issues
When therapists and case managers lack important information about the injured worker’s job habits and roles, someone needs to call the employer and ask for details.
“Ask how the injury occurred, and if it’s something simple like the worker jumping off the loading dock, then it helps us understand,” she says. “With our aging workers we need to be cognizant of all the other things involved, which could include arthritis that is exacerbated by work.” Medications and falls, a common injury type in older populations, also could be factors, she adds.
Despres lists the following points to consider in older workers and aging populations:
• Vision changes and aging joints. “If someone is sitting at a desk, using bifocals, the person might adjust the desk so the monitor and bifocals line up, or else the person’s head would be tipped to the ceiling,” Despres says. “Ergonomic changes can be helpful. One simple one is that if the bifocal is on the bottom, move the monitor down.”
Older workers also are at greater risk of osteoporosis, which increases their fracture risk, and of arthritis.
• Hydration. “As we get older, hydration is an issue,” she says. “People working in warm environments or warehouses that are not environmentally controlled, or when they wear respirators that can be hot, they might experience dizziness.”
As people age, their vascular system also ages, causing blood pressure to rise and creating a less effective oxygen exchange and cardiovascular system, Despres notes.
Case managers working with employers can help them anticipate and prevent this issue by making sure workers are staying hydrated during hot and humid work conditions, she adds.
• Adjust productivity. Older workers might struggle with keeping up with productivity demands, so it might be best to adjust productivity requirements to prevent injuries, she says.
“Case managers can recognize patterns of injury,” Despres notes. “They might say, ‘You know, I’m seeing people over age 50 coming in with wrist injuries, so is there some way we can adjust their jobs?’”
Aging workers have a lot of experience and a good work ethic, so they are valuable as employees, despite a possibly slower pace, Despres says.
“Older employees might have the best ideas of how to do a job, and they might know how to alter tools or use a great technique,” she adds. “You can learn a lot from aging employees.”
• Functional capacity evaluations. This test can be peformed for anyone returning to work. It also can help case managers and employers determine what functions an employee can safely perform.
It is a four- to six-hour test that matches employees to suitable work based on how well they can perform activities like kneeling, squatting, reaching, and other physical actions, Despres says.
“If someone is injured and can’t do the same job anymore, then you can match the person to another job, vocational rehab, or reassignment,” she explains.
• Work conditioning. Work conditioning programs can get injured workers back to their jobs.
For example, a worker will see the physical therapist to treat a knee injury. The therapist will help the person work on strength and motion in the muscles surrounding the knee.
“Maybe the knee improves and the strength looks good, but the person doesn’t have the ability to sustain work functions for eight to 10 hours a day,” Despres says. “So the person will go to training that is tailored to him, including aerobic conditioning, functioning proficiency, and others.”
A case manager discusses the injured worker’s treatment plan with therapists and others involved in the patient’s care. Sometimes, the case manager accompanies the patient to therapy or the doctor’s appointment.
“The case manager finds out if there’s a barrier to the person getting well and then comes up with a plan for that,” Despres says.
• Obesity. Case managers working with employee populations, as well as other populations, must be aware of how obesity can affect health and recovery.
Obese workers have more musculoskeletal injuries, more claims requiring physical therapy, and have higher rates of claims, she says.
“Body mechanics is a big issue when someone becomes obese,” Despres says. “We teach people to hold the load close, but someone who is obese has a mass in front of them and is carrying boxes 10 to 15 inches away from them.”
Case managers working with workers’ compensation clients or managing a population of older adult patients should keep in mind that strength is important for positive health outcomes.
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