Multidisciplinary Intervention in the Prevention of Disability

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Multidisciplinary Intervention in the Prevention
of Disability
Marco Campello, PT, PhD Associate
Director Occupational and Industrial Orthopaedic
Center NYU Hospital for Joint Diseases New York
University Langone Medical Center
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Objective

• To describe our multidisciplinary intervention
  protocol

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Our Program

• Start with PT only
• Clear goal
• Active approach
• Assess for red flags and yellow flags
• No improvement 2 weeks discuss alternatives

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Our Program

• Add CBT
• Assess barriers for recovery

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Our Program

• Combination treatment
• Assess progress after week 2
• If no improvement refer to work conditioning (RTW
  program)

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OIOC Work Conditioning Program

• RTW Program
• Multidisciplinary PhysicianPsychologistPhysica
  l TherapistErgonomist

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RTW Program Structure

• 4 Hours/day5 Days/weekup to 4 Weeks
• Maximum 80 hours

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RTW Program Content

• Education
• Physical Fitness
• Cognitive/Behavioral Pain Management

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Education

• 1 hour sessions 3 X per week
• multidisciplinary team
• includes handouts
• encourages active participation

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Fitness Treatment

• Aerobic Training
• Strengthening Program
• Stretching Program
• Body Mechanics Instruction
• Self Care

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Cognitive and Behavioral Pain Management

• Relaxation techniques
• Coping strategies techniques
• Problem solving

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RTW Program

• WEEKLY MEETING
• Patient progress
• Problem solving
• Company contact and feedback
• Reinforcement of goal
• Recommendation of return to work
• Feedback to patients

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Additional

• Participation of consultants
• Ergonomist worksite visit if needed and when
  possible

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Team Building

• Use a Biopsychosocial Model framework for
  intervention
• Provide evidence-based care
• Be willing to participate in a multidisciplinary
  team approach

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Program Results

• 100 individuals completed the program
• 3/1 ratio male to female
• mean age 41 years (range 21 - 57 years)
• mean duration of work disability was 8 months
  (range 3 -24 months)

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Return to Work Status at Program End
Duration of disability prior to program 8
months, n100

• Individuals returned to regular duty
• Individuals returned to modified duty
• Employable, lost job
• Sub-total
• Retired, disability, or no information
  available or other reason
  

• 69
• 11
• 5
• 85
• 15

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Work Retention 2 Year Follow Up

• Follow up n71
• 75 retained regular duty
• 25 remained at work for an average of 362 days

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Take Home Message

• Multidisciplinary programs are currently the most
  effective approach to prevent disability
• Best results within 4-12 weeks into work
  absenteeism
• Workplace regulations influence return to work
  (involve all stakeholders)

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THANK YOU

• marco.campello_at_nyumc.org