Return to Work

Question 1

This service involves preparing adolescents and young adults with special needs for work.

Answer 1

Transition services. OT considers what the client wants or needs to do after leaving school and identifies the client’s occupational performance strengths and challenges using academic performance and functional skills as indicators

Question 2

T/F: Industrial work rehab and return-to-work programming only involve the client and employer

Answer 2

False. Industrial work rehab and return-to work programming involve the client, employer, human resources department, safety personnel, and case managers

Question 3

What administration is part of the U.S. Department of Labor and was created to ensure "safe and healthful working conditions...by setting and enforcing standards and by providing training, outreach, education, and assistance?"
A. ADA
B. OSHA
C. NIOSH
D. O*NET

Answer 3

B. The Occupational Safety and Health Administration (OSHA) provides info about general workplace safety and health, including lifting ergonomic guidelines, ergonomics to reduce workplace injuries

Question 4

What agency is part of the Centers for Disease Control and Prevention and is "the federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness" 
A. ADA
B. OSHA
C. NIOSH
D. O*NET

Answer 4

C. The National Institute for Occupational Safety and Health (NIOSH) provides info about workplace safety and health topics including injury, hazards, prevention, and ergonomics for various types of industry

Question 5

What source can be helpful when documenting job demands
A. ADA
B. OSHA
C. NIOSH
D. O*NET

Answer 5

D. O*NET. It is a database of requirements, worker attributes, and other info about thousands of occupations that can be helpful when documenting job demands

Question 6

What are the guidelines that are in place to ensure fair employee selection process are in place?

Answer 6

Uniform Guidelines on Employee Selection Procedures from the equal Employment Opportunities Commission. These guidelines apply to new employees, workers returning to work after injury or illness, and those with disabilities.

Question 7

Defined as a class of soft tissue injuries affecting the muscles, tendons, and nerves. Typically characterized by a slow and insidious onset and are thought to be the result of microtrauma.

Answer 7

Work-related musculoskeletal disorders (WSMDs). They account for one-third of all occupational injuries and illnesses in the U.S. Common types and examples include back injuries, carpal tunnel, deQuervain’s tenosynovitis, and lateral epicondylitis.

Question 8

Risks for developing Work-related musculoskeletal disorders (WSMDs)

Answer 8

Heavier levels of material handling, poor work station design, poor work process design

Question 9

All of the following EXCEPT are considered Work-related musculoskeletal disorders (WSMDs)
A. Some back injuries
B. Carpal tunnel syndrome
C. An injury sustained from fall 
D. DeQuervain's tenosynovitis
E. Lateral epicondylitis

Answer 9

C. An injury sustained from a fall is NOT considered a musculoskeletal disorder

Question 10

T/F: Checklists and body mechanic instruments are usually not useful in determining the client’s actual body movements and issues resulting from work injuries

Answer 10

True. Checklists may be used to assess a client’s body mechanics but are not useful in determining the client’s actual body movements. Most body mechanic instruments don’t have established reliability and validity and are not sensitive to change in task performance

Question 11

Positive reinforcement, progressive relaxation, biofeedback are appropriate to use with clients when considering their psychosocial needs and physical deficits during ergonomic assistance. They are examples of what kind of frame of reference?

Answer 11

Cognitive-behavior strategies

Question 12

Non-adaptive, static approach to manipulating society with display of symptoms

Answer 12

Symptom magnification. Other terms used: consistency of effort, sincerity of effort, maximum voluntary effort

Question 13

Type of symptom magnification; deliberate or conscious faking of symptoms and disability to avoid work or responsibility to achieve personal gain

Answer 13

Malingering.

Question 14

Four types of unconscious symptom magnification

Answer 14

1. Refugee: uses symptoms to escape an unresolvable conflict
2. Symptom misinterpreter: responds to the physical changes in the body in an extreme manner because of difficulty processing sensory and kinesthetic input or unrealistic belief systems about the manner in which the body works
3. The game player: consciously attempts to convince those working with him/her of the reality of symptoms for positive gain
4. The identified patient: assumes the patient role as a lifestyle

Question 15

A client who keeps symptoms hidden so he/she can return to normal activity or avoid appearing weak

Answer 15

Symptom minimizer

Question 16

A common assessment used to assist the clinician in determining max. effort

Answer 16

The five-level grip test. Using the Jamar dynamometer, the client is instructed to grasp the dynamometer at each setting handle on the dynamometer. The strongest grip is expected on the second and third settings. When graphed, the results are expected to fall in a ball-shaped curve

Question 17

Identification of symptom _______ is required as part of FCE.

Answer 17

Symptom magnification. Clinicians should screen for behaviors, symptoms, and signs that are inconsistent with the client’s medical history. Pain associated with a true pathological condition appears in the anatomical areas associated with the pathological condition.

Question 18

Primary prevention goal for an Injury prevention program
A. Early identification of symptom-related risk factors; ultimately, to minimize or reduce the duration, severity, and cost of work-related injuries
B. To identify and reduce risk factors early before injuries occur and to promote healthy work habits and lifestyle
C. Occurs after an injury or illness has been diagnosed; interventions focus on medically treating the work-related injury and restoring the work goal

Answer 18

B. To identify and reduce risk factors early before injuries occur and to promote healthy work habits and lifestyle

Question 19

Secondary prevention goal for an Injury prevention program
A. Early identification of symptom-related risk factors; ultimately, to minimize or reduce the duration, severity, and cost of work-related injuries
B. To identify and reduce risk factors early before injuries occur and to promote healthy work habits and lifestyle
C. Occurs after an injury or illness has been diagnosed; interventions focus on medically treating the work-related injury and restoring the work goal

Answer 19

A. Early identification of symptom-related risk factors; ultimately, to minimize or reduce the duration, severity, and cost of work-related injuries

Question 20

Tertiary prevention goal for an injury prevention program
A. Early identification of symptom-related risk factors; ultimately, to minimize or reduce the duration, severity, and cost of work-related injuries
B. To identify and reduce risk factors early before injuries occur and to promote healthy work habits and lifestyle
C. Occurs after an injury or illness has been diagnosed; interventions focus on medically treating the work-related injury and restoring the work goal

Answer 20

C. Occurs after an injury or illness has been diagnosed; interventions focus on medically treating the work-related injury and restoring the work goal

Question 21

Process that is often included in an FCE and looks to define the actual demands of the job and involves use of questionnaires, interviews, observations, and formal assessments completed in the real work environment

Answer 21

Job demands analysis. Use of employer-provided job descriptions assists clinicians in identifying essential job functions. Many FCEs include a job demand analysis. During the course of a job demands analysis, it is important to distinguish between tasks that are essential and those that are not.

Question 22

Defines the physical demands of work using a standardized classification system and defines the occupations in the U.S.

Answer 22

The DOT, developed by U.S. Department of Labor. It defines overall level of work and strength demands for and frequencies of physical demands of work. The O*Net is a newer format for classifying occupations, also developed by U.S. DOL. Clinicians are recommended to refer to both formats when obtaining occupational information

Question 23

Assessment guidelines for a Job demands analysis

Answer 23

Interview supervisors, workers, or both to gather info on number of job tasks for the job; may or may not obtain a job description to confirm the nature and requirement of the job tasks; determine essential versus marginal functions of the job tasks; observe workers performing each of the job tasks; measure the physical environment (such as table height), physical requirements (such as weight to be lifted or carried, sitting vs. standing), and frequency of the physical demands

Question 24

According to DOT, what qualifies as Sedentary work?

Answer 24

Exerting as much as 10 lb of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time, but may involve walking or standing for brief periods of times. Jobs are sedentary if walking or standing are only required occasionally and all other sedentary criteria are met

Question 25

According to DOT, what qualifies as Light work?

Answer 25

Exerting as much as 20 lb of force occasionally, as much as 10 lbs of force frequently, or a negligible amount of force constantly to move objects. Physical demands are in excess of those for sedentary work. Even though the weight lifted may only be a negligible amount, a job should be rated as light when:

• it requires walking or standing to a significant degree
• Sitting most of the time but entails pushing or pulling of arm or leg controls
• Working at a production rate pace entailing constant pushing/pulling of materials even though the weight of those materials is negligible
• Note: the constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding for a worker, even though the amount of force exerted is negligible

Question 26

Even though the weight lifted may only be a negligible amount, a job should be rated as ________ when:

• it requires walking or standing to a significant degree
• Sitting most of the time but entails pushing or pulling of arm or leg controls
• Working at a production rate pace entailing constant pushing/pulling of materials even though the weight of those materials is negligible

Answer 26

Light work
*Note: the constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding for a worker, even though the amount of force exerted is negligible

Question 27

According to DOT, what qualifies as Medium work?

Answer 27

Requires exerting 20-50 lbs of force occasionally, 10-25 lb of force frequently, or more than negligible to as much as 10 lb of force constantly to move objects. Physical demand requirements are in excess of those for light work

Question 28

According to DOT, what qualifies as Heavy work?

Answer 28

Exerting 50-100 lb of force occasionally, 25-50 lb of force frequently, or 10-20 lb of force constantly to move objects. Physical demand requirements are in excess of those for medium work

Question 29

According to DOT, what qualifies as Very heavy work?

Answer 29

Requires exerting force in excess of 100 lb occasionally, in excess of 50 lbs frequently, or in excess of 20 lb of force constantly to move objects. Physical demand requirements in excess of those for heavy work

Question 30

Dot definition for physical demand frequency for “never,” “occasionally,” “frequently,” and “constantly”

Answer 30

never: activity/condition doesn’t exist
Occasionally: activity/condition occurs as much as 1/3 of day
Frequently: Activity or condition occurs 1/3 to 2/3 of day
Constantly: Activity/condition occurs 2/3 of the day to a full day

Question 31

Used to assess a client’s physical and cognitive abilities to meet the general or specific demands of the essential functions of the job.

Answer 31

Work tolerance screening. A useful screening is based on an accurate job description

Question 32

When is a work tolerance screening generally done?

Answer 32

After the client has received an offer of employment, and the client is hired for the position only after passing the screening. If the client doesn’t pass, he is evaluated for a disability, and the employer then determines whether reasonable accommodations will allow the client to carry out the duties of the job. The employer may allow client to take a job in another area while regaining skills or strengths identified at screening as needing attention. The employer may also release client from job offer if client unable to pass screen. EEOC provides guidelines to ensure fair employee selection processes

Question 33

Documentation of a work tolerance screening should include…

Answer 33

• Weight limits
• Activity tolerance in time
• Restrictions within the environment
• The client’s report of pain
• The occupational therapist’s observations of the client
• Should be directed to the identified payer e.g., vocational rehab program, workers’ comp, long-term disability insurer

Question 34

T/F: In a work tolerance screening, general strength testing is an accurate predictor of potential for injury

Answer 34

False. The focus is on whether an applicant can perform the tasks required to do the job

Question 35

What happens if a client does not pass a work tolerance screening?

Answer 35

After the client has received an offer of employment, and the client is hired for the position only after passing the screening. If the client doesn’t pass, he is evaluated for a disability, and the employer then determines whether reasonable accommodations will allow the client to carry out the duties of the job. The employer may allow client to take a job in another area while regaining skills or strengths identified at screening as needing attention. The employer may also release client from job offer if client unable to pass screen. EEOC provides guidelines to ensure fair employee selection processes

Question 36

What is work therapy? When does it occur?

Answer 36

Work therapy involves work tasks to improve function. It can occur at any point in the healing of injured tissues, and is typically part of the acute phase of the rehab program

Question 37

Programs which provide individuals with a process to help them identify goals for work and identify a plan for returning to work

Answer 37

Work readiness programs. They prepare people for return to work

Question 38

An outcomes-focused, individualized, interdisciplinary program that addresses the medical, physical, psychological, behavioral, physical, functional, and vocational components of employability and return to work. Relies heavily on actual task replication

Answer 38

Work hardening. A person may only participate in a work hardening program once high levels of stress will no longer pose a threat to tissue hemostasis

Question 39

For a person whose general physical status has deteriorated, how long may work hardening take?

Answer 39

Total body reconditioning requires a minimum of 1 month to a max of 3 months. Not a prescribed number of days per week or hours per day a worker is to participate in a work hardening program. Very individualized.

Question 40

Explain the hierarchy of functional return according to the work hardening program?

Answer 40

A gradation from gross to fine motor, from less to more resistive, from skill to speed focused, and from simple to complex

Question 41

Program designed to restore the client’s systematic, neuromuscular-skeletal function and typically involves only one discipline. Focus is on limited work tasks with more emphasis on exercise, aerobic conditioning, eduction

Answer 41

Work conditioning

Question 42

On-the-job assessments used to determine whether an individual can return to work after onset of disability or whether a person can benefit from reasonable accommodations to maintain employment.

Answer 42

Worksite evals. Occur AFTER job site analysis is completed. Assesses: essential job functions, functional assets and limitations of worker, physical environment of the workplace

Question 43

Program that allows a worker to temporarily perform job duties with less physical demand

Answer 43

Light or modified duty programming. Worker’s regular duties are gradually added as she improves in skill and strength. OT helps employer understand that early return to work improves worker’s long-term success. OT always considers employer’s capacity to provide modifications, particularly in small organizations

Question 44

Objective assessment of a person’s ability to perform work-related tasks and is the core of all return-to-work programs.

Answer 44

Functional Capacity Evaluation (FCE). Can be performed by a multitude of disciplines and a wide variety of FCEs are currently used in practice. Typically includes review of medical records, interview, musculoskeletal screening, eval of physical performance, formation of recommendations, and report generation. Includes all physical demands of work as defined by DOT.

Question 45

Type of FCE, performed after a worker receives a job offer to determine whether work demands match the person’s work capacity

Answer 45

Post-offer screening

Question 46

Type of FCE performed by occupational medicine physicians to determine whether the worker can return to work after injury

Answer 46

Fit-for-duty tests

Question 47

T/F: FCE should not be used with the intent to prove worker fraud

Answer 47

True dat

Question 48

The FCE helps generate an __________. This is defined as the percentage of whole-body function and often translates into a final monetary settlement for an injured worker. It focuses on the permanent quantifiable physical loss related to injury when the worker is at the max medical endpoint

Answer 48

Impairment rating.

Question 49

The FCE helps generate __________. It combines the worker’s impairment and the impact of that impairment on the ability to perform the preinjury job or any job

Answer 49

Disability rating

Question 50

Who performs FCE?

Answer 50

Clinicians who have several years of experience in the field. It is NOT recommended for the novice clinician.

Question 51

What kind of evaluation is the core of an FCE?

Answer 51

Musculoskeletal eval. It includes ROM strength, sensation, volume, and soft tissue status

Question 52

T/F: An FCE eval typically begins with the most physically demanding components, which should gradually increase in resistance and complexity

Answer 52

True.

Question 53

T/F: A FCE eval includes both objective and subjective components

Answer 53

True. Typically includes review of medical records, interview, musculoskeletal screening, eval of physical performance, formation of recommendations, and report generation. The subjective evaluation focuses on the client’s subjective experience of the injury or illness with a primary focus on pain, impact on ADLs, and cosmesis. Should also document appearance of client and extremity/ies.

Question 54

A comprehensive FCE should be well designed. What does this mean?

Answer 54

Standardized, practical, objective, reliable, and valid assessments; and include all the physical demands of work as defined by DOT. Clients should not be pushed beyond their max level of performance

Question 55

T/F: Physical demand testing includes both standardized and nonstandardized components.

Answer 55

True. Nonstandardized assessments or structured activities allow evaluator to grade and tailor the FCE to individual worker

Question 56

This tx approach requires the client to perform tasks similar to the actual job.

Answer 56

Work simulation

Question 57

This assessment requires an exact duplication of all physical demands of the target occupation

Answer 57

Situational assessment

Question 58

T/F: Computerized variable resistance tests are a necessary component of FCE

Answer 58

False. They are not necessary.

Question 59

Final component of the FCE and are completed a day or more after the eval

Answer 59

Reevaluation and postevaluation. They are used to determine activity performance and to monitor edema, discoloration, and pain levels postassessment

Question 60

Order of operations/components in FCE

Answer 60

• Intake/initial interview
• Subjective eval e.g., pain, impact on ADLs, cosmesis
• Musculoskeletal eval (core of FCE): ROM, strength, sensation, volume, soft tissue statu
• Physical demand testing
• Situational assessment (requires exact duplication of all physical demands)
• Computerized variable (not necessary)
• Manual material handling eval
• Onsite evaluation
• Reeval and posteval (completed a day or more after eval)
• Report with summary, conclusions, recommendations

Question 61

Best resources to assist employers and disabled workers with reasonable accommodations

Answer 61

Job Accommodations Network

Question 62

Program that should focus on maintaining the employee in a productive capacity while facilitating progressive recovery, have designated staff appointed to monitor a worker’s adjustment and tolerance of work tasks, and ensure that the demands of the assignment are within the stated restrictions of the employees abilities

Answer 62

Productive modified-duty program

Question 63

Provides info about a person’s capacities and interests for work in situations when he/she has not worked before or is looking for a new job after injury or illness.

Answer 63

Vocational evaluation. May also generally examine individual interests and abilities to explore work opportunities . Uses actual or simulated work for vocational assessment and help clients in their vocational development. Includes either general vocational eval (evaluates person’s potential to do any type of work) or specific vocational eval (assesses readiness to return to particular occupation)

Question 64

Programs that are offered during a transition period when the client is able to complete some but not all job tasks and may encompass job coaching, education, instruction, and monitoring of the company’s return to work programs

Answer 64

Transitional programs. Provide clients opportunity to use environmentally focused intervention to facilitate return to work.

Question 65

Transition evals typically completed by…

Answer 65

OTs!

Question 66

What analysis is clinically indicated with and is a component of transition services

Answer 66

Job site analysis

Question 67

Provides an appropriate level of support on the basis of individual needs in the work environment; may include job training or assistance for job task completion

Answer 67

Job coaching

Question 68

When is job coaching necessary?

Answer 68

When a client is unable to return to work because injury or illness prevents him/her from fulfilling job requirements. Clients with developmental delays or other childhood conditions may need this during the transition from school to work

Question 69

What is involved in job coaching?

Answer 69

• Evaluation with a job analysis to identify activity demands
• Intervention (may include training client to visualize what he wants to be, ensuring small successes along the way, facilitating identification of work that has intrinsic value for client)
• Reevaluation
• Nonstandardized interviews, observation of task performance or simulation, and activity analysis
• Typically occurs in workplace setting while individual is performing assigned work duties
• Optimal psychosocial and sociocultural functioning is critical to successful work entry or return to work

Question 70

OTs role in supported employment settings

Answer 70

Identify the amount and type of support to be provided and to develop clients’ work skills to enable them to complete job tasks. Natural supports are a primary component of supported employment. Support for modifications to job tasks may include task adaptation, job specific training for the individual, or coworker support in specific task completion

Question 71

T/F: Work programs require more documentation than acute therapy

Answer 71

True. The use of progress notes, daily schedule and circuit sheets, and progress summaries is recommended to complement initial and discharge evals

Question 72

The use of daily schedule sheets in return to work programs

Answer 72

Provide client with a list of activities and promote the client’s responsibility for his/her own rehab program