Work Conditioning/Work Hardening

Are you confused about work conditioning and work hardening? You are not alone. While there are many similarities you need to be aware of the critical distinctions. Refer your clients for the appropriate services and get what you think you are paying for!

The American Physical Therapy Association (APTA) has guidelines that describe these programs as separate and distinct. The guidelines were developed to:

1. Accurately reflect contemporary practice
   
2. Standardize terminology
   
3. Include in the delivery of these services, small or single-service providers and smaller institutions that are not appropriate for the Commission for Accreditation of Rehabilitation Facilities (CARF) accreditation standards. (CARF is practicable only for providers within large organizations.)
   

HOW APTA DEFINES EACH TERM

WORK CONDITIONING

• Injured worker must have an immediate job goal and a demonstrated willingness to participate
• Treatment focus changes to restoration of work-related function(s)
• Must commence no greater than 1 year after injury unless a multi-disciplinary evaluation has ruled out non-medical behavioral or vocational barriers
• Single discipline provider -- PT or OT
• Physical and functional activity related to work - goal oriented and intensive addressing issues of flexibility, strength, endurance, and coordination
• Multi-hour sessions up to 4 hours per day
• 5 days per week
• 6-8 weeks

Work conditioning can be terminated when:

1. Goals are met
2. The injured worker is unable to progress toward goals.
3. Injured worker declines further participation in recommended intervention.
4. Injured worker fails to comply with program requirements.

Work conditioning can assist the injured worker to obtain ergonomics services as appropriate.

The APTA guidelines for injured workers with behavioral and vocational dysfunction describe work hardening as:

• Injured worker must have a targeted job or job plan for return to work at the time of discharge and a stated willingness to participate
• Addresses behavioral and vocational dysfunction within a multi-disciplinary model
• Utilizes real or simulated work activities with functional components designed by a PT or OT
• Goal oriented and intensive as well as highly structured and individualized
• The multi-disciplinary providers shall meet on a regular basis to discuss and coordinate goals and outcomes
• Multi-hour sessions up to 8 hours per day, 5 days per week, 8 weeks total
• Work Hardening can be terminated when:
  1. Goals are met
  2. Injured worker is unable to progress toward goals
  3. Injured worker declines further participation in recommended intervention
  4. Injured worker fails to comply with program requirements

Work hardening programs also can assist the injured worker to obtain:

1. Counseling for substance abuse
2. Medical services
3. Nutrition and weight control services
4. Smoking cessation counseling
5. Ergonomic and/or rehabilitation engineering services