Work Hardening, Rehab Therapy, Work Hardening Occupational Theapy

What is Work Hardening Therapy?

Work hardening therapy utilizes multiple therapy approaches to rehabilitate a worker who has been injured or experienced illness long-term. Since the only real measure of success with work rehabilitation therapy is the worker’s capacity to perform their job duties, work hardening simulates the worker’s job environment as closely as possible, using specific tools, machines and movements to ensure that the patient can return to work safely. It is typically much more of an aggressive approach than work conditioning, as the patient will need to attend sessions of at least four hours in length, five days a week, with subsequent hours added as the patient improves. The goal is to attend work hardening therapy for 40 hours a week, just as the patient would at their job.

The multidisciplinary approach of work hardening generally involves a team of healthcare professionals such as occupational therapists, vocational therapists, physical therapists, psychologists, ergonomics evaluators, job coaches and orthotic/prosthetic services. Sometimes, patients may progress to transitional work programming at their actual place of employment. While work conditioning involves an OT helping a patient to restore musculoskeletal and cardiovascular systems in order to be more prepared to return to work, this therapy generally occurs just 3 days a week for 2 hours per session.

While work conditioning alone can be sufficient enough therapy for many individuals to be able to return to work, some illnesses and injuries might be much better rehabilitated with the application of work hardening. This much more comprehensive approach addresses not only physical rehabilitation, but also psychosocial and behavioral issues, such as fears of reinjury, vocational potential and difficult employer-employee relationships. Reproducing real work conditions in a controlled setting encourages a much easier and safer transition when the individual returns to their real work environment.

What are the Benefits of Work Hardening Therapy?

As a subset of work rehabilitation, work hardening therapy facilitates safety and independence at work, while it also fosters satisfactory fulfillment of the worker’s job role. While it is most often employed after an individual has had a long-term illness or injury, work hardening is also used for those who are experiencing occupational performance problems for any reason, helping these individuals to enhance their work performance for safety, financial or social reasons.

The specific goals of work rehabilitation include the facilitation of the safe and timely return to work following extended illness or injury, maximizing levels of function following injury/illness in order to maintain the individual’s desired quality of life, and the relearning or learning of ways to prevent future illness and injury. One of the most important psychological goals of work hardening is to aid individuals in the resumption of their roles as workers as this greatly contributes to self-confidence, self-esteem and a self-view as a productive member of society. Work hardening prevents deconditioning along with the negative social and economic consequences of unemployment.

Suggestions for a Work Hardening Therapy Practice

If you are a professional therapist who is interested in, or are already engaged in offering work hardening therapy, here are a few professional suggestions to enhance your work rehabilitation program:

Treatment sessions should be conducted at your clinic, with the specified equipment and tools similar to the patient’s job site. A member of your work rehab team should always be in direct supervision of the patient. Because work hardening places its focus on the functional aspects of the job, sessions with your patients should include their unique work simulation tasks, along with components of strength and conditioning. This is a good place to start with anyone, but especially for those who are not able to tolerate various job demands, and who may also have poor endurance and strength.

Evaluations of the patient should include basic work conditioning requirements, along with a functional capacity evaluation (FCE). The FCE measures a patient’s job function abilities through the patient’s performance of simulated job tasks. When the initial evaluations are completed, it is generally recommended to start your patient practicing their specific work simulation tasks for the majority of their therapy time, with strength and conditioning exercises filling the rest of the time. Depending on the patient’s initial assessment, they should start with at least 2-4 hours, 4-5 days per week for this therapy. This time can be gradually increased as the patient improves, to at least 30 hours per week, with 40 hours (just like a full-time job) the goal for most patients.

As the patient makes progress, you can also take this opportunity to reinforce correct movements. Stop bad behaviors that can lead to injury, such as twisting with the legs or trunk instead of turning the whole body, or lifting with the back instead of the legs, and pulling instead of pushing. These are some of the most common bad body mechanics that lead individuals to injury, on the job or at home.

Keep in mind that the closer the task resembles the actual job demand, the safer it will be for the patient to return to work. If your patient is a construction employee who wears a tool belt and hard hat, then they should wear those same items during their work hardening therapy. The most effective simulated tasks reflect the real job, so choosing equipment, products and devices specifically intended for a broad range of work hardening therapy patients may provide invaluable help to your patients.

Here are just a few examples of some specially designed work hardening equipment for your therapy practice:

The Lift & Place Rack Station helps patients practice loading and lifting tasks, while the Lifting Boxes help test the patient’s functional capacity for material handling activities.

The Push-Pull Sled Station copies tasks that require moving and transporting various materials and equipment.

The Shovel/Levering Station highlights the reproduction of repetitive tasks, such as shoveling, lifting and levering. It offers capabilities for a wide variety of mimicked job functions, and can also be used to assess shoulder, arm, back and leg range of motion abilities.

The Electrical Assembly features the safe simulation of electrical work, combining multiple job and assembly activities to resemble real electrician work duties.

The Multi-Purpose Bolt Module utilizes an innovative bolt board that can be utilized vertically, horizontally or in a rack for a wide variety of job simulation tasks.

Rehabmart is very pleased to offer a vast assortment of work hardening rehabilitation products from superior quality manufacturers that include Hausmann Industries, Bailey Manufacturing Company, Clinton Industries and Fabrication Enterprises.

Hulet Smith, OT
Rehabmart Co-Founder & CEO

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