Assessing duties and capability

The most important treatment modality for musculoskeletal injuries is returning to as much of the worker’s usual activity as soon as possible ^{[1, 2]}. This is not limited to work but includes the usual activities the worker undertakes in sport, in recreation and at home.

Discuss with the worker what they can do in their workplace rather than what they cannot do. This will assist them to remain positive and give them the best chance of recovery.

Generic work capabilities 0 to 6 weeks

Table 1 shows work capabilities which are common after musculoskeletal injuries to specific body areas ^[3]. Obviously each injury needs to be assessed and restrictions such as these modified for individual circumstances.

Obtain information about the worker’s job role and work demands

Obtaining information about the worker’s role and work demands will assist the treating medical practitioner to provide an opinion regarding whether the worker is fit to return to pre-injury workplace duties, fit to return to modified/other duties, or make recommendations about restrictions that need to be observed. This can be achieved by asking the worker about their job and exploring the requirements of their role, giving consideration to the following:

• Physical demands such as mobility, postural requirements, manual handling
• Frequency and duration that tasks are performed
• Hours of work, including over-time, shift work, provision of rest breaks

Further information can be obtained from the worker themselves, or the rehabilitation and return to work coordinator (or the employer, if they do not have a coordinator). The employer or rehabilitation and return to work coordinator can provide information about the workplace, work practices and the job requirements of the injured worker.

Worksite assessments by a qualified occupational therapist or physiotherapist can be helpful if obvious solutions are not available.

Options for graduated return to work

Remain mindful that an injured worker does not have to be fully recovered or free from pain before returning to safe and suitable work. Work is part of the functional recovery from injury.

There are three types of suitable duties that may be considered when returning the worker to the workplace.

• Pre-injury duties – reduced hours of the pre-injury duties that the injured worker has the capability to perform
• Modified duties – components or some of the pre-injury duties that have been included or removed to match the injured worker’s capability
• Alternative duties – duties that are different from the pre-injury duties but allow the injured worker to remain at work or return to work

To be successful, suitable duties must be matched to the injured worker’s capabilities. They should only continue for a limited time. Ideally these duties should be productive, assist the worker to increase their physical capabilities, allow continued workplace social supports and be within the worker's psychological capabilities as they recover from injury.

Increasing capacity to work

Increasing capacity to work may be undertaken in a number of ways:

• Increase in work hours – The total work hours per day and/or the total number of working days per week should be increased. This should occur rapidly to return the worker to pre-injury hours within a period of several weeks. This prevents physical deconditioning and psychological sequelae thus minimising the chance of chronicity.
• Increase in physical demands of duties – As the worker recovers, the physical demands of duties performed should be increased, for example, increasing tolerance for lifting; postures that may be more demanding, such as repetitive stooping, crouching or overhead reaching. How rapidly this is increased is dependent on the injury healing, any reconditioning required, and the availability of appropriate duties.
• Frequency and duration of tasks – The work pace and the duration that tasks are performed throughout the working day are gradually increased.
• Rest breaks – Avoid the use of regular rest breaks (which denote inactivity and may lead to deconditioning) beyond the normal allocated work rest breaks. Instead, focus on restorative breaks in which there are regular rotations of tasks to allow for changes in physical demands. Some examples are:
  • changes in posture from sitting to standing/walking
  • tasks involving non-repetitive upper limb movements
  • tasks requiring no or minimal lifting.

Return to work utilising any of these alternatives should be regularly reviewed with the express aim of recognising the increasing capability of the worker which occurs as the injury heals, and reflecting this in increased hours and duties.

References

© 2010 WorkCover Corporation of South Australia | Accessibility
Updated: 12.06.2008 | Privacy | Conditions of use | Email the Web Administrator