Why Have an In-House Physiotherapy Programme?

Motivation for having an in-house physiotherapy programme will vary for each company and the problems a company is having will help to determine why this may be a viable option.

In general Worksite Health promotion programmes (Goetzel et. al. JOEM 1998) in the U.S. are motivated by a company's commitment to optimizing employee health, which they feel in turn will provide:

• Reduction in health care costs
• Reduction in accidents
• Improvements in productivity
• Greater job satisfaction

Employers guided by an interest in optimizing employee health care want employees to receive proper treatment and advice early on and in so doing help foster their recovery and focus on returning to work.

After a work site injury occurs, rapid initial contact with a health care professional is essential to remediate, educate and reassure the employee. Unfortunately companies frequently have no control over what treatment their employees will receive or when they receive it.

In situations where physiotherapy is the predominant requirement in rehabilitating a work site injury, there are two regimens that could prevail: On site physiotherapy Treatment and Off site Physiotherapy Treatment. The first visit to a health practitioner is generally the most important, but as indicated above, companies, without proper optimal worksite health programmes have little or no control over the timing when an employee would receive proper care and indeed have no impact whatsoever on their outcomes. The following will outline the benefits attributable to both On site (in-house) and Off site (out-of-house) Physiotherapy Treatment programmes and how companies by partnering with an experienced physiotherapy provider can contribute effectively and measurably to the desired post injury outcome.

First, in either programme the goal is to facilitate the employee's rapid recovery and to minimize lost productivity and control health care costs by:

• starting therapy immediately
• getting good therapy with a focus on return to work
• reassuring and communicating to the employee

Control over the "process" is where an in-house On site initiative shows considerable benefits over Off site treatment. However it is important to note that both programmes can result in the potential for prompt and effective treatment.

Based on study done in 1996, (Choi et. al. JOEM), the largest percentage of lost time injuries in Ontario are due to sprains and strains, (50.43%). Therefore if you are a typical company fully ½ of your lost time claims need Physiotherapy. We have not included the "walking wounded", those who have developed, over time and lack of appropriate treatment, chronic shoulder, neck, arm, hand, leg and foot problems. Ailments, which undoubtedly affect job performance, satisfaction and productivity.

Companies who have shown a progressive approach to intervention on worksite injury and established Off site out-of-house physiotherapy programmes have benefited substantially. However, a study conducted in 1997, (Grayzel Estherann et. al.), "The Value of In-House Physical Therapy", shows clearly the 'extra' benefits obtained by initiating In-house programmes.

The significance of this study conducted at NYNEX was that NYNEX already had an Off site out-of-house programme in operation. NYNEX decided to bring in On site the outside physiotherapy provider twice a week during regular working hours. NYNEX has limited equipment on site so chose to treat only uncomplicated cases. The programme was evaluated over a period of one year.

The outcome was a significant decrease in the mean lost days per employee from an average of 118 days for off site out-of-house treated employees to approximately 72% in mean lost days.

For NYNEX the real cost savings came in reducing disability costs. Based on a company average indemnity of $200 per day, the total savings came in at $69,800. In addition, while average off site physiotherapy claims were $1216 per employee treated, in-house on site claim costs per employee treated amounted to $995, saving NYNEX another $221 per case, (employees treated), or 22% (another $31,000).

The studies show a definite decrease in corporate health care costs when on site in-house physiotherapy is introduced, but why?

1. First and foremost, employees with injuries are seen earlier and rehabilitated sooner. Problems do not set in and therefore respond quicker to treatment.
2. On site physiotherapy health professionals are able to evaluate the employee's job and how it will affect rehabilitation. Frequently this leads to a review of the ergonomics which help to keep the problem from recurring.
3. In some case off site physiotherapy can be difficult to get to and thus would represent additional time off needed by the employee.
4. There is also the issue that some employers do not allow time off for rehab during normal working hours which may lead to the employee becoming more chronic.

5. Should an employee require time off due to worksite injury, an in-house, on site team can better manage the employees return to work by:

   • Keeping them closer to work
   • Helping them manage modified duties
   • Helping both the employee and the employer understand the modified work structure based on any medical restrictions provided.
   • Help the company to 'match employee abilities' to job demands and negotiate a schedule for return to full duties.

The in-house on site physiotherapy programme results in a 'Win-Win' situation for both the employee and the employer through reduced health care costs and rapid access to high quality therapy.

The Orthopaedic Therapy Clinic Inc. has been providing both Off site and On site Physiotherapy Services to business for several years. When considering an On site programme our statistics suggest that companies with a workforce of approximately 500 employees and larger, benefit most from On site physiotherapy programmes. We have found that the most benefit is obtained with a therapist on site a minimum of twice weekly for 3 1/2 to 4 hours each day.

Since The Orthopaedic Therapy Clinic Inc. services both On site and Off site business we have been able to maintain statistical comparisons of treatment cost over the years. In order to access these statistics please contact us directly.

For further information on Physiotherapy Rehab programmes for your business, please contact:

Maureen Dwight, B.Sc.P.T., Clinic Director
The Orthopaedic Therapy Clinic Inc.
1235 Bay Street, Suite 802
Toronto, Ontario  M5R 3K4

Phone: (416) 925-4687
Fax: (416) 925-6823
Email: mdwight@orthophysio.com

References

1. Choi, Bernard et al, Patterns and Risk Factors for Sprains and Strains in Ontario, Canada 1990. An Analysis of the Workplace Health and Safety Agency Data Base JOEM: 38:4, pp. 379, 1996
2. Goetzel, Ron et al, Health Care Costs of Worksite Health Promotion Participants and Non-Participants, JOEM: 40:4, pp. 341
3. Grayzel, Estherann et al, The Value of In-House Physical Therapy, JOEM: 39:4, pp. 344, 1997