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Journal of Occupational Rehabilitation

Erschienen in:

01.12.2006 | Original Paper

Incorporating Injured Employee Outcomes into Physical and Occupational Therapists’ Practice: A Controlled Trial of the Worker-Based Outcomes Assessment System

verfasst von: Robert H. Ross, Peter W. Callas, Jesse Q. Sargent, Benjamin C. Amick, Ted Rooney

Erschienen in: Journal of Occupational Rehabilitation | Ausgabe 4/2006

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Abstract

Background: Work related musculoskeletal disorders (WRMSDs) remain costly. The Worker-Based Outcomes Assessment System (WBOAS) is an injury treatment improvement tool. Its purpose is to increase treatment effectiveness and decrease the cost of care delivered in Occupational Health Service clinics. Methods: The study used a non-randomized (parallel cohort) control trial design to test the effects on injured employee outcomes of augmenting the standard care delivered by physical and occupational therapists (PT/OTs) with the WBOAS. The WBOAS works by putting patient-reported functional health status, pain symptom, and work role performance outcomes data into the hands of PT/OTs and their patients. Test clinic therapists were trained to incorporate WBOAS trends data into standard practice. Control clinic therapists delivered standard care alone. Results: WBOAS-augmented PT/OT care did improve (p≤.05) physical functioning and new injury/re-injury avoidance and, on these same dimensions, cost-adjusted outcome. It did not improve (p>.05) mental health or pain symptoms or return-to-work or stay-at-work success nor, on these same dimensions, cost-adjusted outcome. Conclusion: Training PT/OTs to incorporate patient-reported health status, pain symptom, and work role performance outcomes trends data into standard practice does appear to improve treatment effectiveness and cost on some (e.g. physical functioning) but not other (e.g. mental health, pain symptoms) outcomes.

Subjects were scored 1 to 4, a score produced by averaging raters across four components of injury recovery at discharge relative to pre-injury—Pain status, Return to work, Functionality/ADLs, and Strength/range of motion at discharge–each component itself scored 1 to 4 (complete recovery, near complete recovery, partial recovery, little or no recovery). For Pain status, for example, ratings were 1. Complete recovery = Pain resolved, 2. Near complete recovery = Pain not interfering with ADLs or work tasks, 3. Partial recovery = Pain partially interfering with ADLs or work tasks, 4. Little or no recovery = Pain severely interfering with ADLs or work tasks.

Subjects were scored 1 to 4, a score produced by averaging raters across four components of return-to-work success at discharge relative to pre-injury–Work status, Maximum medical improvement/impairment status, Injury treatment post-discharge, and patient’s Subjective health status–each component itself scored 1 to 4 (complete success, near complete success, partial success, little or no success). For work status, for example, ratings were 1. Complete success = patient at pre-injury work status: full duty (same or equivalent job, unrestricted), 2. Near complete success = patient at near pre-injury work status: modified duty (same or equivalent job, restricted, ex. lower performance requirements and/or hours worked), 3. Partial success = patient is discharged with improvement but measurably short of pre-injury work status: modified duty (lesser job, i.e. lower performance requirements and/or hours worked), 4. Little or no RTW success = patient is discharged with little or no improvement and far short of pre-injury work status: total disability (out of work, injury related).

The PCAS is a validated, patient-reported provider performance evaluation instrument composed of eleven sub-scales pertaining to care—accessibility (organizational, financial), continuity (longitudinal, visit-based), comprehensiveness (knowledge of patient, preventive counseling), integration of care, clinical interaction (clinician-patient communication, thoroughness of physical examinations), interpersonal treatment, and trust—which taken altogether comprehend the entire clinician-patient primary care relationship. Because study PT/OTs had no responsibility for accessibility, preventive counseling, or integration of care, the measure was modified for use in the study to include only the remaining eight scales.

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Titel: Incorporating Injured Employee Outcomes into Physical and Occupational Therapists’ Practice: A Controlled Trial of the Worker-Based Outcomes Assessment System
verfasst von: Robert H. Ross
Peter W. Callas
Jesse Q. Sargent
Benjamin C. Amick
Ted Rooney
Publikationsdatum: 01.12.2006
Verlag: Kluwer Academic Publishers-Plenum Publishers
Erschienen in: Journal of Occupational Rehabilitation / Ausgabe 4/2006
Print ISSN: 1053-0487
Elektronische ISSN: 1573-3688
DOI: https://doi.org/10.1007/s10926-006-9060-1

Springer Medizin

Abstract

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