Ergo Myths and Truths
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Did you know that Lifting is not the main cause of Low Back Injury and Pain! Check back as we update the site and explain why this is MYTH!
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How about Repetitive Motion, does is really cause Cumulative Trauma Injuries like Carpal Tunnel and tendonitis or this and Ergo Myth!
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Ergonomics Program don't work!!! Ergo Myth or Truth.....check back for the rest of the story!
A STUDY AWAITING PUBLICATION...
(Using the Physical Therapist as the primary provider for MSD claims)
DIRECT ACCESS PT CARE OF INJURED WORKERS VS. PHYSICIAN REFERRAL TO PT: COMPARISON OF COSTS & OUTCOMES
Injured workers are traditionally referred to physical therapy by physicians, as is often dictated by law. Many states have liberalized laws to allow patients direct access to PT without being referred by a physician. The basis of these changes assumes physical therapists are adequately trained to evaluate patients to design safe and effective treatment. Another consideration is direct access may reduce health care costs and disability due to quicker access to PT care earlier in the disease process.
SmartCare enjoys an arrangement with workplaces whereby employers may refer workers complaining of musculoskeletal problems directly for PT care. The arrangement calls for early reporting of problems by employees, with SmartCare providing evaluation and intervention within 24 hours of referral by the employer. The physical therapist performs evaluation and initiates treatment, unless evaluation indicates need for physician referral. The clinic also treats injured workers referred by physicians. This presents an opportunity to compare employer referral to PT versus physician referral for treatment visits, costs, outcomes.
Both groups of workers in this study originated from a variety of workplaces and suffered similar musculoskeletal problems. Workplaces included sawmills, furniture manufacturers, wood-turning, paper manufacturers, ski resort housekeeping and maintenance departments, public works, office settings, construction, and others. Work injuries included non-fracture non-surgical sprains, strains, and cumulative trauma disorders of the extremities and spine. Workers in each group were treated by the same physical therapist utilizing the same treatment protocols. Treatment protocols included restorative exercises, manual therapy, electrotherapy modalities, risk factor education, and restricted duty work assignments.
RESULTS: Workers referred directly to PT by their employer needed 60 percent fewer treatment visits than workers who saw a physician before referral to PT. 132 physician-referred injured workers utilized 911 physical therapy visits, averaging 6.90 visits per worker at $607 cost per case. 137 workplace-referred injured workers utilized 566 physical therapy visits, averaging 4.13 visits per worker at $363 cost per case. 87% of employer-referred patients achieved successful outcome. 79% of physician-referred patients achieved successful outcome. These are high rates of outcomes success that may be attributable to early PT referral by both employers and physicians, plus workplaces that are skilled and cooperative at providing restricted duty work assignments to injured workers.
CONCLUSIONS: Injured workers referred to physical therapy directly by the employer, without first seeing a physician, underwent fewer treatment visits, expended less Worker Compensation costs and enjoyed higher outcomes success. Possible explanations for these findings are:
Direct referral to PT by employers allows injured workers earlier access to PT before deconditioning or other deteriorative effects can impair recovery. This may reduce Worker Compensation costs and disability.
Employers utilizing direct referral may be more pro-active with other injury management strategies such as early reporting of pain problems, effective use of restricted duty, attention to ergonomics, and training programs such as Back School and CTD School which may contribute to favorable outcomes.
Injured workers referred by the physicians may have been more severely affected, with their less severely affected workers having recovered prior to physical therapy referral. This could account for some of the differences between the two patient groups.
IMPLICATIONS TO PHYSICAL THERAPY: These findings may present an example of the intent and advantage of direct access, versus physician referral requirements. This further suggests an opportunity for physical therapists to market to employers early intervention treatment services on an early-intervention preferred-provider direct-access basis, with an objective of reduced Worker Compensation costs and more rapid recovery. Such arrangements would require direct access be allowed by law and-or standing orders arrangements with company physicians to comply with existing law.
OTHER STUDIES PARALLEL THIS: Our study closely resembles the findings of Mitchell, J.: "A comparison of Resource Use and Cost in Direct Access Versus Physician Referral Episodes of Physical Therapy" PHYSICAL THERAPY, Vol. 77, No. 1, Jan 1997. Mitchell found physician referrals to PT averaged 12.2 visits at $2236 per patient, while direct access to PT averaged 7.6 visits at $1004 per patient from Maryland Blue Cross data. Plus the study: Zigenfus GC, Yin J, Giang GM, Fogarty WT, "Effectiveness of early physical therapy in the treatment of acute low back musculoskeletal disorders" J Occup Environ Med. 2000;42:35-39, which says: Patients referred to physical therapy at day one or day two of back pain onset needed fewer treatment visits and had fewer lost work days than those referred later than day two. PT Magazine quoted the trade journal "Business Insurance" profile of the PT direct referral program at Tex Tech clothing mfg in Maine whereby costs averaged $4124 per case before PT direct referral, but only $908 per case the year after implementing direct referral to PT.
(Using the Physical Therapist as the primary provider for MSD claims)
DIRECT ACCESS PT CARE OF INJURED WORKERS VS. PHYSICIAN REFERRAL TO PT: COMPARISON OF COSTS & OUTCOMES
Injured workers are traditionally referred to physical therapy by physicians, as is often dictated by law. Many states have liberalized laws to allow patients direct access to PT without being referred by a physician. The basis of these changes assumes physical therapists are adequately trained to evaluate patients to design safe and effective treatment. Another consideration is direct access may reduce health care costs and disability due to quicker access to PT care earlier in the disease process.
SmartCare enjoys an arrangement with workplaces whereby employers may refer workers complaining of musculoskeletal problems directly for PT care. The arrangement calls for early reporting of problems by employees, with SmartCare providing evaluation and intervention within 24 hours of referral by the employer. The physical therapist performs evaluation and initiates treatment, unless evaluation indicates need for physician referral. The clinic also treats injured workers referred by physicians. This presents an opportunity to compare employer referral to PT versus physician referral for treatment visits, costs, outcomes.
Both groups of workers in this study originated from a variety of workplaces and suffered similar musculoskeletal problems. Workplaces included sawmills, furniture manufacturers, wood-turning, paper manufacturers, ski resort housekeeping and maintenance departments, public works, office settings, construction, and others. Work injuries included non-fracture non-surgical sprains, strains, and cumulative trauma disorders of the extremities and spine. Workers in each group were treated by the same physical therapist utilizing the same treatment protocols. Treatment protocols included restorative exercises, manual therapy, electrotherapy modalities, risk factor education, and restricted duty work assignments.
RESULTS: Workers referred directly to PT by their employer needed 60 percent fewer treatment visits than workers who saw a physician before referral to PT. 132 physician-referred injured workers utilized 911 physical therapy visits, averaging 6.90 visits per worker at $607 cost per case. 137 workplace-referred injured workers utilized 566 physical therapy visits, averaging 4.13 visits per worker at $363 cost per case. 87% of employer-referred patients achieved successful outcome. 79% of physician-referred patients achieved successful outcome. These are high rates of outcomes success that may be attributable to early PT referral by both employers and physicians, plus workplaces that are skilled and cooperative at providing restricted duty work assignments to injured workers.
CONCLUSIONS: Injured workers referred to physical therapy directly by the employer, without first seeing a physician, underwent fewer treatment visits, expended less Worker Compensation costs and enjoyed higher outcomes success. Possible explanations for these findings are:
Direct referral to PT by employers allows injured workers earlier access to PT before deconditioning or other deteriorative effects can impair recovery. This may reduce Worker Compensation costs and disability.
Employers utilizing direct referral may be more pro-active with other injury management strategies such as early reporting of pain problems, effective use of restricted duty, attention to ergonomics, and training programs such as Back School and CTD School which may contribute to favorable outcomes.
Injured workers referred by the physicians may have been more severely affected, with their less severely affected workers having recovered prior to physical therapy referral. This could account for some of the differences between the two patient groups.
IMPLICATIONS TO PHYSICAL THERAPY: These findings may present an example of the intent and advantage of direct access, versus physician referral requirements. This further suggests an opportunity for physical therapists to market to employers early intervention treatment services on an early-intervention preferred-provider direct-access basis, with an objective of reduced Worker Compensation costs and more rapid recovery. Such arrangements would require direct access be allowed by law and-or standing orders arrangements with company physicians to comply with existing law.
OTHER STUDIES PARALLEL THIS: Our study closely resembles the findings of Mitchell, J.: "A comparison of Resource Use and Cost in Direct Access Versus Physician Referral Episodes of Physical Therapy" PHYSICAL THERAPY, Vol. 77, No. 1, Jan 1997. Mitchell found physician referrals to PT averaged 12.2 visits at $2236 per patient, while direct access to PT averaged 7.6 visits at $1004 per patient from Maryland Blue Cross data. Plus the study: Zigenfus GC, Yin J, Giang GM, Fogarty WT, "Effectiveness of early physical therapy in the treatment of acute low back musculoskeletal disorders" J Occup Environ Med. 2000;42:35-39, which says: Patients referred to physical therapy at day one or day two of back pain onset needed fewer treatment visits and had fewer lost work days than those referred later than day two. PT Magazine quoted the trade journal "Business Insurance" profile of the PT direct referral program at Tex Tech clothing mfg in Maine whereby costs averaged $4124 per case before PT direct referral, but only $908 per case the year after implementing direct referral to PT.