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July 2004


Getting Comfortable

By Jeff E. Snodgrass, MPH, OTR/L, CEES, CWCE
Whether you are an OT or PT, the field of industrial rehabilitation presents many opportunities and rewards for the motivated clinician. Industrial rehabilitation is a catch-all term used to describe various work injury management and prevention programs including postoffer/preemployment screening, functional capacity evaluation, job analysis, injury prevention, and ergonomics.

Ergonomics is perhaps the most popular subspecialty practice area for clinicians to enter within the field of industrial rehabilitation. Arguably, ergonomics is considered the foundation upon which all other industrial program components are built. Many clinicians are finding ergonomics to be an excellent avenue for expanding or developing a clinical specialty area for several reasons. Some clinicians simply want a new challenge due to boredom or frustration with existing practice areas, while other entrepreneurial clinicians view ergonomics as an excellent opportunity for practice expansion to increase referrals and revenue.

However, there is no clear-cut path a clinician must take to become specialized in the practice of ergonomics or even how to tap into the market. Therefore, many excellent opportunities for the right clinician are overlooked, ignored, or even dismissed.


STEPPING INTO ERGONOMICS
In order to succeed in the field of ergonomics, clinicians must learn how to acquire the requisite knowledge, understand the distinction between an ergonomist versus a clinician specializing in ergonomics, and consider opportunities for practicing ergonomics by tapping into the local market segment. Ergonomics is an emerging and burgeoning specialty practice for clinicians. The challenge for educators is trying to determine the best strategies for meeting the growing demand for ergonomic-related services by incorporating ergonomics into existing graduate-level curriculums. However, the majority of entry-level graduate OT and PT curriculums cannot handle additional coursework. Therefore, the onus is placed on the practicing clinician to seek out additional education and training to adequately prepare for practice in the field of ergonomics. The path clinicians take to specialize in ergonomics is highly variable.

Occupational therapists are often perceived as the experts with functional task analysis. On the other hand, physical therapists are frequently viewed as the experts with assessment of musculoskeletal dysfunction. The practice of ergonomics requires a thorough understanding of both. However, without the proper education and experience beyond entry-level practice, neither OTs nor PTs are adequately prepared to jump directly into the practice of ergonomics.

Opportunities abound for clinicians to pursue additional education and training within the field of ergonomics. Many higher education institutions offer graduate certificate programs in ergonomics, such as Texas Woman’s University, Cleveland State University, University of Central Florida, University of Wisconsin, and University of Massachusetts. These graduate-level curriculums typically require four to five courses for a total of 12 to 16 credit hours.

Continuing education companies provide 1-, 2-, and 5-day courses for clinicians interested in developing basic ergonomic evaluation and interventions skills. Through completion of these courses, clinicians are eligible for specialty ergonomics certifications such as the Certified Ergonomic Evaluation Specialist1 and the Certified Ergonomic Assessment Specialist.2

PROFESSIONAL WORK
Neither a graduate certificate nor a clinical specialty certification entitles a clinician to be referred to as an ergonomist; however, continuing education can serve as a precursor to becoming an ergonomist. Ergonomists are professionals from varying backgrounds who have demonstrated the highest level of commitment and expertise in the field of human factors and ergonomics. Through the Board of Certification in Professional Ergonomics (BCPE), qualified individuals can become a Certified Professional Ergonomist, which is considered the highest level of certification in the field of ergonomics.3 Other certifications available through the BCPE include Certified Human Factors Professional, Associate Ergonomics Professional, Associate Human Factors Professional, and Certified Ergonomics Associate. Additionally, the Oxford Research Institute offers three advanced level certifications including Certified Industrial Ergonomist, Certified Associate Ergonomist, and Certified Human Factors Engineering Professional.4

With sufficient hands-on experience and continuing education, clinicians can consider a multitude of opportunities for ergonomic practice. One of the easiest strategies for developing the specialty is by tapping into your existing referral base or place of employment.

Do you currently provide evaluation and treatment services for work-related musculoskeletal disorders (WRMSDs) such as low back strains and sprains, wrist tendonitis, carpal tunnel syndrome, or de Quervain’s disease? If you routinely evaluate and treat any of these WRMSDs, you already have an excellent opportunity right at your doorstep. By working closely with the patient, doctor, case manager, and employer, you can offer on-site ergonomic assessment and return-to-work management services for existing patients covered by workers’ compensation insurance. Once you get your foot in the door, you may convince the employer, case manager, or doctor that this is a valuable and necessary service to reduce workers’ compensation cost and increase patient satisfaction with faster return-to-work rates.

Do you work for a hospital, a skilled nursing facility, or a large health care system? If so, you are probably surrounded by numerous opportunities. The nursing industry has the highest rate of days away from work due to WRMSDs with nursing staff in skilled nursing facilities suffering from the highest injury rates.5 Appropriate ergonomic programs within a hospital environment include proper patient handling and lifting, correct body mechanics, introducing and training staff with lifting equipment, and forming lifting teams. These are all examples of opportunities for motivated clinicians to develop or expand their specialty practice in ergonomics.

Office-based ergonomics is perhaps the easiest and least threatening area of practice. This is an excellent place to launch your ergonomic practice. Do you work in a facility or for a company with office workers? If so, you may have an excellent opportunity to provide office-based ergonomic evaluations and interventions. The service industry is also fertile ground for marketing office-based ergonomic consulting.

REIMBURSEMENT ISSUES
Reimbursement for ergonomic programs is different from traditional OT/PT evaluation and treatment services. Providing ergonomic-related services for a client with a compensable work-related injury may be covered by the individual’s workers’ compensation insurance with the appropriate justification provided. However, ergonomics is not usually covered by private insurance for non-work-related injuries. As part of an injury prevention program, ergonomics is not routinely covered by workers’ compensation insurance or private insurance, though some workers’ compensation insurance companies recognize the value of injury prevention services and are therefore willing to pay for services designed to prevent future injuries. Additionally, employers are often willing to pay out-of-pocket for prevention services as long as they understand the cost-savings of preventing future injuries that could potentially generate large compensation claims and lawsuits. For instance, the cost of one workers’ compensation claim for a WRMSD can be as little as $100 to as high as $100,000 or more.6

The key selling point for interested parties such as employers and workers’ compensation insurance carriers is that research has found aggressive work-management programs including ergonomics prevent WRMSD, significantly reduce workers’ compensation costs, decrease utilization of services, yield higher return-to-work rates, and increase patient satisfaction.7-10

CONCLUSION
Developing a clinical specialty in ergonomics will expand your horizons while providing you with a new set of skills with opportunities and challenges yet to be faced. As with any area of clinical practice, you will encounter frustrations and difficulties, but you will find the rewards to be substantial.

Jeff E. Snodgrass, MPH, OTR/L, CEES, CWCE, is assistant professor of occupational therapy at Milligan College, Kingsport, Tenn.

REFERENCES
  1. Roy Matheson and Associates Inc. The Ergonomic Evaluation Certification Program. Available at: Ergonomic Program. Accessed April 29, 2004.
  2. Back School of Atlanta. Musculoskeletal disorders and ergonomics certification. Available at: Back School of Atlanta. Accessed April 29, 2004.
  3. Board Certification in Professional Ergonomics. Available at: Board Certification. Accessed April 29, 2004.
  4. Oxford Research Institute. Available at: Oxford Research Institute. Accessed April 29, 2004.
  5. Bureau of Labor Statistics. Number and median days of nonfatal occupational illnesses and injuries with days away from work involving musculoskeletal disorders by selected occupations, 2002. Available at: Bureau of Labor Statistics. Accessed May 4, 2004.
  6. National Institute of Occupational Safety and Health. Musculoskeletal disorders (MSDs) and workplace factors. Available at: NIOSH. Accessed November 25, 2003.
  7. Bernacki EJ, Guidera JA. The effect of managed care on surgical rates among individuals filing for workers’ compensation. J Occup Environ Med. 1998;40:623-631.
  8. Lyall JM, Gliner J, Hubbell MK. Treatment of workers’ compensation cases of carpal tunnel syndrome: an outcome study. J Hand Ther. 2002;15:251-259.
  9. Feurerstein M, Huang GD, Ortiz JM, Shaw WS, Miller VI, Wood PM. Integrated case management for work-related upper-extremity disorders: impact of patient satisfaction on health and work status. J Occup Environ Med. 2003;45:803-812.
  10. Bernacki EJ, Tsai SP. Ten years’ experience using an integrated workers’ compensation management system to control workers’ compensation costs. J Occup Environ Med. 2003;45:508-516.

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