Value-Adds of Concentra Physical Therapy Include Clear Communication

If you had to name a type of work injury that is responsible for about one-third of all days away from work and an equal proportion of total workers’ compensation costs, what would you guess?^1,2 If you answered “musculoskeletal injuries,” you’re right. Injuries to bones, muscles, and soft tissues invoke an image of highly physical jobs involving heavy lifting, pushing, and pulling. Vigorous activity is not the only cause of musculoskeletal injuries. Extended sitting or standing, the effects of chemicals and heat, vibration, poor lighting and other non-ergonomic conditions can take a toll.^3,4,5 Regardless of how a musculoskeletal injury occurs, it may require time and skilled therapy for the injured employee’s functional recovery and return to work. Concentra® therapists work hard to achieve quality therapy outcomes while keeping case duration and costs as low as possible. In this article, we’ll look at the important role communication plays in physical therapy outcomes but first, let’s review the big picture.

Five tips for maximum therapy value

In 2018, Concentra therapy directors shared five tips with employers on “How to Maximize the Value of Physical and Occupational Therapy.” These are hallmarks of Concentra physical therapy:

1. Get the employee into therapy early. Concentra’s early intervention model of care was validated once again in 2020 – this time, by studies conducted by the Workers’ Compensation Insurance Rating Bureau (WCIRB) of California^.6,7 Among the WCIRB’s significant conclusions:
   A. Delaying appropriate physical therapy for soft-tissue injuries results in significantly higher indemnity and medical costs and longer case duration than similar claims with no undue delay.
   B. With early intervention, soft tissue workers’ compensation claims are less likely to involve opioid use, surgical intervention, and lost work time, compared to cases when physical therapy is delayed.
   
   
2. Ask the treating clinician why therapy is part of the treatment plan. At Concentra, the treating clinician examines the injured employee for several critical factors before making a physical therapy referral. Concentra uses evidence-based referral triggers that have been developed to help ensure that only the employees whose recovery will be enhanced and expedited by physical therapy are referred for physical therapy.
   
   
3. Seek therapists with interpersonal skills. Concentra therapists are people-oriented and understand the importance of biopsychosocial impacts on patient outcomes. Strong interpersonal skills help create a positive experience and promote patient engagement for adherence to the treatment plan and faster recovery. At Concentra, employers can talk to or visit their local physical therapist at the center to understand how the therapist uses this connection to form a therapeutic alliance with each patient.
   
   
4. Ask how the clinician and therapist deal with pain. Clinicians who gauge perceptions of pain at every visit and/or routinely prescribe opioid medications can delay recovery, as the California WCIRB study showed, and create more problems, given the national opioid epidemic that already exists. Concentra focuses on functional recovery, not perceptions of pain. 
   
   Asking injured employees to think about and rate their pain can actually make the perception of pain worse. Focusing on function is more effective in helping people renormalize their lives. This is particularly important when subjective complaints of pain exceed objective findings, indicating that pain is not a sign of ongoing tissue injury^.8 For this reason and to use objective measures of recovery, Concentra has developed an alternative to the traditional pain scale, called Functional Restoration/Status of Healing, or FReSH. This scale uses function-based outcome measures and shifts the focus onto the patient’s abilities in achieving return-to-work goals.
   
   
5. Inquire if, and how, the treating clinician and therapist collaborate on care. At Concentra, the treating clinician and physical therapist are under the same roof, enabling them to communicate in real time, have access to each other’s notes, and make treatment plan adjustments, as needed. This facilitates quality therapy (and medical) outcomes and helps case managers, adjustors, and company safety managers have the best clinical documentation available to make case decisions.

Clear communication is implicit in each of these value-adds. Even so, the noteworthy – and sometimes unrecognized – contribution of clear communication to quality physical therapy outcomes, shorter case durations, and lower costs justify considering it separately on its own merits – first, with employers and then, with injured employees.

Clear physical therapy communication with employers

Communicating clearly with employers at regular intervals is a necessity. It’s a key differentiator that demonstrates an important Concentra priority:

Building the Employer-Therapist Relationship to Foster:

• Quality clinical outcomes
• Lowest possible case duration and costs
• Ease in discussing return-to-work concerns and questions
• Collaboration, enhanced by mutual understanding and expectations
• Delivery of the care the injured employee needs while being appropriately mindful of Occupational Safety and Health Administration recordable injury rates
• Clear understanding of the role of therapy and its relationship to return to work

At Concentra, our goal is to have the medical clinician contact the employer after the injured employee’s first visit. As physical therapy treatment progresses, a physical therapist will contact the employer at various points, for example, when case progression or patient compliance with therapy visits is not what we expect or when there is a significant change in status.

Employers like to hear from the physical therapist, and they know they have an open invitation to call or email with any questions they have. This communication builds a level of trust and understanding, which helps achieve quality outcomes by making each therapy visit as productive as possible. Concentra physical therapists and employers have the same goal: getting the employee back to work and avoiding re-injury.

Clear physical therapy communication with employees

Clear communication between the therapist and the employee receiving physical therapy also helps build rapport with a purpose.

Building the Therapist-Employee Relationship to Motivate:

• Compliance with therapy visits and home exercise
• Attention to measures of functional recovery with a focus on capabilities, not disabilities
• A shift from a mindset of fear to positive engagement
• Education on body mechanics to help prevent re-injury
• Ability to see ‘the little victories’ in every session to keep the recovering employee moving forward

Concentra physical therapy emphasizes a therapeutic alliance for all these reasons and because injured employees have unique opinions and concerns regarding their injury management. Some arrive at their first therapy session filled with ideas about their injury or how to treat that they’ve gathered from friends, relatives, internet searches, and social media. Unsurprisingly, most of these perceptions are not correct; however, the therapist can provide tailored, evidence-based advice and education to help employees navigate their injury and understand what will aid their recovery.

Why use Concentra for work-related physical therapy?

Concentra physical therapy is prudent, using only the visits that are truly needed to restore function, even if more visits have been authorized. We have case studies that support this conclusion and show that Concentra uses 25 to 30 percent fewer physical therapy visits, based on tens of thousands of individual workers’ compensation cases. Concentra’s model of early intervention physical therapy is unmatched in the workers’ compensation industry.

You can request our case study summary, “Concentra Achieves Optimal Outcomes in 25% Fewer Physical Therapy Visits” to learn more about Concentra Physical Therapy. Better yet, download the case study summary, and contact us.

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Jennifer Klose, DPT, PT, is the director of therapy operations in eastern Ohio and western Pennsylvania. Since joining Concentra in 2001, Jen has been involved in all aspects of occupational health from injury care management to workplace safety and prevention. She received her master’s degree in physical therapy from D’Youville College and completed her transitional doctor of physical therapy at Temple University. She has achieved an advanced training certificate in manual therapy through the Manual Therapy Institute and a Business Excellence in Healthcare certificate from Cornell University. Jen is actively involved in the Occupational Health Special Interest Group of the American Physical Therapy Association (APTA). She is working with the group to provide evidence-based research and best practices to the field to promote positive therapy outcomes.

Kurt Hookstra, DPT, PT, first joined Concentra in the Michigan market in 1999 as a center therapy director. He has been in a leadership role in the Midwest – supporting Kansas City, St. Louis, Nebraska and Iowa since 2007.  He received his bachelor’s degree  from Nebraska Wesleyan University and his master’s degree in physical therapy from Washington University in St. Louis. Kurt completed the Manual Therapy Institute certificate program and completed the transitional doctor of physical therapy  program at the College of St. Scholastica in Duluth, Minnesota. Kurt is a member of the American Physical Therapy Association (APTA) and is the Kansas liaison for the Occupational Health Special Interest Group.

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NOTES [SAMPLE]

1. Fact Sheet. Occupational Illnesses and Injuries Resulting in Musculoskeletal Disorders. U.S. Bureau of Labor Statistics. May 2020.
2. Industry Injury and Illness Data. U.S. Bureau of Labor Statistics.
3. Pauley, SM. Lighting for the human circadian clock: recent research indicates that lighting has become a public health issue,” Medical Hypotheses. 2004; 66(4): 588–596.
4. Charles LE, Ma CC, Burchfiel CM, and Dong RG. Vibration and Ergonomic Exposures Associated with Musculoskeletal Disorders of the Shoulder and Neck. Safety and Health at Work. June 2018; 9(2):125-132.
5. Ross JA, Shipp EM, Trueblood AB. Ergonomics and Beyond: Understanding How Chemical and Heat Exposures and Physical Exertions at Work Affect Functional Ability, Injury, and Long-term Health. Human Factors. August 2016; 58(5): 777-795.
6. Cost Impacts of Medical Care Delays in the California Workers’ Compensation System. WCIRB California. October 2020.
7. WCIRB Releases Study on Impact of Physical Medicine Treatments on Opioid Use and Lost Time in California Workers’ Compensation. WCIRB Wire. January 16, 2020.
8. Shifting Focus from Pain to Function, a Concentra webinar presented by Dr. Maja Jurisic, vice president and medical director of strategic accounts. February 13, 2020.