As a health care provider, we depend on you to assess a worker's functional abilities. The treatments you provide and the recommendations you make for return-to-work activities support a worker's safe recovery. Your expertise helps workers and employers when they create a recovery-at-work plan or, if the worker has to take time off, your recommendations are an important part of return-to-work planning.

Functional testing — Assessing a worker’s current abilities

Functional testing is an important element of a worker’s rehabilitation journey. The results can provide vital information for the worker, employer, and health care provider about the worker’s abilities and the appropriate next steps in their recovery journey.

Functional testing should always be worker-centred and, if the worker has their pre-injury job to return to, it should typically target the physical and/or cognitive requirements of their job. For example, if a worker’s employment typically requires them to lift a maximum of 20 kg on an occasional basis, testing should not exceed 20 kg on an occasional basis.

While functional testing often utilizes standardized protocols, you’re encouraged to think outside of the box and include more meaningful activities, i.e., elements of a work simulation, in your assessment toolkit. If a worker is required to carry ladders up and down stairs as a part of their job, incorporate that, if and when it is safe to do so. Including these types of tasks in a functional assessment will increase the reliability and validity of the outcomes, and most importantly, be meaningful to the worker.

Determining essential job demands

Whenever possible, visit a worker’s workplace to learn about their job duties. A jobsite visit allows you to see the environment and work duties, measure and weigh materials, and assess the pace of work. Completing a jobsite visit generally creates a more comprehensive understanding of the workplace and the requirements of the job and allows the worker to ensure that their specific job is understood.

If a jobsite visit isn’t feasible, be sure to ask these questions:

• What does a typical work shift look like?
• What are typical materials or tools used in the workplace?
• For heavier or more physically demanding tasks, how often are they completed? Can such duties be spread out over a longer period of time?
• Are work duties self-paced? Do productivity demands exist?
• Are any duties completed by the worker considered safety sensitive?
• Is the worker exposed to environmental factors such as weather or wet, slippery, or uneven terrain?

As a health care provider, you’re responsible for ensuring that you have appropriate safety equipment before a jobsite visit. Common personal protective equipment includes steel-toe boots, a high-visibility vest, hard hat, and gloves.

Conducting quality work simulations

We know that the most effective rehabilitation a worker can do following a workplace injury is individualized and specific in nature. What rehabilitation looks like as someone recovers from an injury will vary from person to person, and no two injuries are exactly alike and neither are the type of rehabilitation exercises that a worker will complete. Other factors that could influence rehabilitation and return to function could include a worker’s social or family support, relationships and support from co-workers, or the nature of the job. Returning to a job that is highly repetitive and fast paced will require a different rehabilitation plan than a job that is sedentary in nature, or self-paced.

Physical injuries

For many workers who are recovering from a physical injury, rehabilitation includes work or job simulation activities. While two workers may have the same job titles, the nature of their job demands can vary, so carefully consider the specific work when developing worker-specific work simulation activities.

Example: A carpenter is building a framing wall. To do this, the carpenter would be required to plan, measure, and assemble a finished product. They would use tools such as a table saw or chop saw, a measuring tape, a drill and clamps, and materials such as 2 x 4s and framing screws. Based on the physical demands of this activity, the work simulation activities would include crouching, kneeling, stooping, lifting, carrying, reaching, gripping, fingering, and full-body coordination.

Participating in this type of exercise gives the worker a meaningful activity, which is often more enjoyable and engaging than standard exercises.

Setting up work simulation exercises can provide you and the worker an opportunity to work on ergonomic and symptom management strategies and proper body mechanics before the worker returns to the jobsite. Work simulation activities can also be graded over time to align with return-to-work planning. Practicing strategies in the clinic first can provide substantial insight as to where to begin a graduated return-to-work plan and can boost a worker’s confidence and readiness to return to work.

Injuries that impact cognition

Workers who are recovering from injuries that impact their cognition can also benefit from work simulation exercises as a part of their rehabilitation journey.

Example: A work simulation for a medical office assistant could include a combination of pen and paper tasks, computer activities, and responding to interruptions at regular intervals, representing patients coming into an office. At regular intervals the worker could be required to walk down the hallway in the clinic to deliver a file, and then return to their desk to complete computer work and paperwork. This activity could be progressed over a period of sessions to be longer in duration and require more complex computer work where precision is required, or with more external distraction (e.g., music in background).

This activity allows you and worker to better assess their tolerance for work demands, and accuracy for computer-based work. It would also allow for time to implement mitigating strategies, where suitable, for cognitive factors such as memory functions or attentional challenges.

Understanding a worker’s job duties

To create high quality, meaningful, and relevant work simulation activities you need to understand a worker’s job duties. Speaking with the worker, looking at pictures, reviewing a job demands analysis from the employer, or reviewing YouTube videos and online resources are a great places to start. However, the best option is to complete a jobsite visit whenever possible.

Next, gather materials that would typically be used at the worksite, and brainstorm with the worker ways to simulate several components of their job in a clinical setting. If possible, take the work simulation outdoors for things such as shoveling, sweeping, or moving over uneven terrain or if exposure to environmental conditions is a factor in the work. Lastly, if elements of the exercise aren’t working, revise and reimagine different ways to simulate the job.

How to develop a high quality and worker-specific work simulation

1. Fully understand the worker’s job duties.
2. Gather materials and tools that the worker typically uses in the course of their work; remember the worker or employer may be able to lend materials to use in rehabilitation.
3. Brainstorm, think creatively (have fun with it), and involve the worker.
4. Trial it, then revise and modify as needed.
5. Progress the exercises and expectations.

Communicating with employers

As a health care provider treating an injured worker, your role includes communicating with the worker, the employer, and other relevant stakeholders when organizing and monitoring safe and timely return-to-work plans for the worker. To ensure you protect a worker’s right to privacy, please review our page on Privacy concerns when communicating with employers.

Communicating with WorkSafeBC

You have an important role in setting appropriate expectations for both the worker and the WorkSafeBC claim owner, which is crucial for a successful outcome. While return to work is a key objective in the rehabilitation process, it is important to recognize that this may not always be imminent and expectations may need to be adjusted.

To ensure a positive and successful rehabilitation outcome, please contact us when you’re making recommendations for further treatment, equipment, or if the treatment plan is changing. It is important to discuss your recommendations with the claim owner at WorkSafeBC as soon as possible.