Physical Therapy's Role in Returning to Work During COVID-19

The process of getting employees back into the workplace – along with social distancing, sanitizing, and COVID-19 screening protocols – is filling business agendas these days. And rightly so, as return to work is more complicated than ever for all kinds of employees, especially:

• Post-surgical workers’ compensation patients who were unable or hesitant to access physical therapy
• Delayed surgical patients
• Workers who contracted serious cases of COVID-19

There’s no one-size-fits-all solution to address the challenges of returning to work during COVID-19, but physical therapy plays important roles in each of these situations.

Post-Surgical Patients

Many workers cancelled their post-operative physical therapy appointments and new post-surgical patients delayed the start of care because of virus concerns. MedRisk saw a 47.6 percent decline in new post-surgical referrals when comparing data from April 2019 and April 2020. While telerehabilitation provided continuity of care for patients who met the clinical criteria and wanted to try it, some much-needed physical therapy just did not happen.

Studies show that early physical therapy produces the best outcomes, reduces downstream medical costs and accelerates recovery. It stands to reason, then, that delaying or interrupting care can lead to longer claim durations and slower recoveries along with their associated costs.

Post-surgical patients who did not start or continue PT during the pandemic may need more treatment than their conditions would normally require.

Delayed Surgical Patients

The pandemic put many workers’ compensation surgeries on hold as hospitals geared up to treat COVID-19 patients. The Postponement of Elective Surgeries and its Impact on PT study estimates that 343,670 U.S. operations were cancelled every week during a 12-week period of peak disruptions. Patients whose conditions worsened while waiting for surgery during the past five or six months may need pre-surgery conditioning.

Very Ill COVID-19 Workers’ Comp Patients

The American Thoracic Society predicts that about 50 percent of patients who survive treatment in an intensive care unit will experience some form of post-intensive care syndrome or PICS. This includes critically ill COVID-19 patients, some of whom were on ventilators for weeks.

PICS is a combination of symptoms that the Home and Community-Based Physical Therapy Management of Adults with Post-Intensive Care Syndrome study defines it as “new or worsening impairments in physical, cognitive, or mental health status arising after critical illness that continue after acute care hospitalization.”

Most adults with PICS, even those who are young or middle aged, deal with slow-to-resolve physical problems, and being on a ventilator magnifies these symptoms. They will need an intense combination of physical and occupational therapy to address deficits in strength, mobility, endurance, functionality, and activities of daily living.

Claims Representatives

The pandemic presented new challenges to adjusters and case managers. Is this person a good candidate for telerehab or in-clinic care? How will delayed care affect reserves? What can help employees overcome their fear of returning to the workplace? Would they benefit from behavioral health services?

To guide decision-making, claims representatives may want to have a physical therapist consult with some of these injured workers before they start or resume physical therapy. Discussing their injury, their current condition and the physical demands of their job—and being heard—can help reduce a patient’s anxiety and set positive expectations for rehabilitation and recovery.

Some physical therapists can also screen for psychosocial factors, such as anger, fear, and depression, which pose barriers to recovery and return to work. Using the findings of the consultation, claims representatives and treating physicians can determine the best course of treatment.

Conclusion

There are no easy answers when it comes to bringing people back to the workplace right now. Each employee has different needs, and no single solution accommodates everyone. But with the right planning and mix of rehabilitation, employers can make the transition safer and a little less uncertain for their workers.

By Brian Peers

Brian Peers, DPT, OCS, MBA is a licensed physical therapist and serves as MedRisk’s Vice President of clinical services and provider management. He is responsible for overseeing and ensuring the quality of MedRisk’s centralized telerehabilitation services, as well as MedRisk’s platinum grade clinical review and peer-to peer provider coaching program. He is board certified as an orthopedic clinical specialist and is recognized as an expert in rehabilitation of the injured worker. Prior to joining MedRisk, Peers was the owner and operator of an interdisciplinary rehab practice and has held faculty appointments at multiple physical therapy education programs. He has also served as an injury prevention consultant for multiple large corporations and the United States Department of Defense. Peers holds Bachelor’s and Master’s degrees from St. Francis University, an additional Master’s degree from Louisiana State University and a Doctorate from the University of St. Augustine. 

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