How will a Job Dictionary (JD) assist with a client’s return to work you ask? Let me provide you with an example of one of my successful clients that not only did I assist her through her exercise rehabilitation program but also assisted the treating GP in negotiating suitable duties for the client’s return to work plan (RTWP).
A Job Dictionary is a physical demands assessment of a job role, that involves an examination and breakdown of skills and physical critical demands of a particular task, role or duties within the workplace. JD’s are a useful tool in examining exactly what core tasks are performed through evidence-based assessment and grading on duration, repetition, exertion, posture and vibrational forces on the core tasks. Job Dictionaries allow me to match the clinical exercise rehabilitation to the critical physical demands of the client’s job role. Rather than prescribing a “one size fits all” exercise program, the JD’s help me identify areas of potential risk for exacerbations as well as produce a more specific and targeted approach to improving functional capacity and getting my client back to work as safely and effectively as possible. Furthermore, it helps to ensure that both the client and the GP know exactly what functional capacity is required to perform the job role safely and efficiently.
The client is a 58-year old occupational and physiotherapy assistant at a nursing home, who sustained a left shoulder rotator cuff tear. She was referred to Absolute Balance to commence exercise rehabilitation after she had re-injured her left shoulder at her workplace. As the client re-injured her left shoulder, the challenge was to gradually build up her function and confidence in a gym setting but also identify modified or alternative duties at work that she can complete without increasing the risk of re-injury. A simple phone call to the treating GP to explain the benefits of a JD, and a request for a JD assessment was stated on the progress medical certificate. This then allowed approval for a JD assessment to be completed.
The client initially injured her left shoulder when she tripped over cables in the office and landed on her left shoulder. She later reinjured her left shoulder, assisting a resident to sit down into their wheelchair. At the initial assessment, the client had 90% of full range of movement through her left shoulder, with slight restrictions at end ranges in flexion and abduction. The client was currently completing modified duties with a 5kg lifting restriction. A JD assessment was also completed at the initial assessment at her workplace and I was able to identify the physical critical demands and high-risk tasks of her job role, which includes:
- Transferring and supporting residents weighing up to 120kg from a variety of postures/ positions – increased risk to lower back due to frequent lumbar flexion as well as upper limb due to the requirement to support residents in outreached postures.
- Push/pull style movements of residents on wheelchairs – increased risk to upper limbs/ shoulders due to working repetitively away from the midline of the body.
- The unpredictable nature of handling residents will risk to the upper limbs, shoulders and lower back.
Job Specific Programme
The exercise rehabilitation program initially focused on increasing her shoulder range of movement and mobility using a series of active and passive stretching exercises. This was combined with increasing scapulothoracic stability and correct muscular recruitment patterns for improved shoulder biomechanics during functional movements. The client progressed to strengthening her rotator cuff and supporting upper limb musculature with the focus on specific manual handling techniques and replicating work functional movements that were identified as the physical critical demands in a gym setting (controlled environment). The client was provided with all the tools to effectively self-manage her program and was educated on the importance of warming up before her shift, taking regular postural breaks with stretching and myofascial release to relieve her soreness during and after work.
Outcome of Exercise Rehabilitation
Along the way, I was able to provide regular client updates to the treating GP and was able to attend GP case conferences to assist the GP in outlining the suitable duties for the client, depending on the client’s level of functional capacity at different stages of her rehabilitation. As the client increased her functional capacity, the treating GP gradually increased her lifting restriction and that allowed the client to perform more pre-injury duties. After an intensive exercise rehabilitation program, the client obtained a final medical certificate and was able to return to her full pre-injury duties.
Daniel Nguyen (B.Sc. Exercise Physiology)
Senior Accredited Exercise Physiologist (AES, AEP) (ESSAM)