Welcome to the Wellness Business

For today’s industrial specialist, making a difference is often a matter of perception

Vol. 27 • Issue 9 • Page 20

Workplace Rehabilitation

Part 1 of a 2-part series.

When I teach courses on functional capacity evaluations or employment testing, I often hear occupational and physical therapists claim that they are “industrial rehab providers.” They perform FCEs, work hardening or job analyses as individual services, yet rarely as a comprehensive package.

To challenge their thinking, I often tell them that they aren’t rehab providers per se, but really are “industrial specialists in the wellness business.”

Many providers don’t realize that they can engage in direct-pay relationships with employers and assist them in preventing injuries and containing workers’ compensation claims. Instead, these providers hope for physician or case manager referrals, provide single services or a couple of disjointed services, and rely on insurance companies to pay them an increasingly smaller reimbursement rate for their valuable professional time.

At the same time, providers see injured workers as patients who are poorly matched or prepared for the work they are doing, or doing work they shouldn’t. Providers see fraud, waste, and abuse in the workers’ compensation system, knowing that they can assist employers in managing difficult claims.

As a result, providers often wonder whether they are making a difference or are just applying a bandage to the same problems over and over again. Providers hold it in their power to transform their work into something more substantive. But they have to think bigger — it’s a matter of perception.

Influencing Behavior

Think back to what a “therapist” does. A therapist, or “helping agent,” provides media that enable patients or clients to employ an adaptive method to cope with a physical or mental dysfunction.

“Industrial specialists” influence behavior by constructively confronting workers utilizing maladaptive behaviors that put them at risk or contribute to their pain or dysfunction. Thus, industrial specialists teach adaptive strategies and reinforce adaptive behaviors.

This is a bio-psycho-social process.1 Clients can decide to get well and stay well despite physical limitations or negative behavioral influences. The goal is sustained, gainful employment. Otherwise the results are poor health, dysfunction, and disability that are encouraged by plaintiffs’ attorneys, enablers, and negative peers.

Industrial specialists influence behavior. And they should look at employers in much the same way they do employees. Industrial specialists must often teach employers how to replace a culture of reactive, maladaptive strategies focused on containment with a new, proactive culture of adaptive strategies emphasizing prevention. It’s about behavior — employee and employer behavior — beginning at the top.

Wellness and Total Worker Health

Do I have your attention? You are in the wellness business! “Wellness is a conscious decision made by the patient/client to adopt adaptive coping mechanisms to maximize their potential and maintain this potential through their own deliberate effort.”2

“Wellness” is an adaptive strategy behavior. Not surprisingly, government is realizing the importance of wellness behaviors in preventing and containing work-related injuries with initiatives such as Total Worker Health.3

Total Worker Health understands the importance of interventions that can be incorporated throughout the entire employment cycle. Wellness is good for employees and employers — healthy and fit employees are more productive and cost less money to maintain.

Elevated Expectations

Some employers need help to see the big picture. But others are becoming increasingly interested in the concept of Total Worker Health.

When OTs or PTs identify themselves as industrial specialists, employers expect them to understand the workplace, speak their language, and have a basic understanding of employment law and workers’ compensation. They expect therapists working in industry to not only treat patients but provide “upstream” services for selection and maintenance of healthy and fit employees who will have a reduced chance of requiring “downstream” interventions.

If an employee does claim an injury at some point, they want OTs and PTs to administer functional, objective, time-sensitive and goal-oriented (downstream) procedures focused on achieving maximum medical improvement (MMI). In an employer’s eye, MMI is case closure.

With this realization, rehabilitation providers should practice as industrial specialists and business partners to industry by providing synergistic interventions that sup the employment cycle from time-of-hire to end-of-employment.

An important step in developing this business relationship is an understanding of the changing nature of workers in America. First, the number of employed U.S. workers is at its lowest since 1978, and the workforce is aging, with one in four American workers soon to be over 55.4

Second, workers are less healthy. As measured by body mass index, blood pressure, cholesterol, blood glucose, and tobacco and alcohol use, decline in population health is contributing to rising healthcare costs for employers.5

This is consistent with an earlier Duke University study, which found a correlation between a worker’s BMI and related diseases and the amount of money spent on workers’ compensation claims for that worker — $51,000 for obese workers vs. $7,500 for workers with normal or average weight.6

Because of this, elevated expectations demand industrial specialists to understand the issues in today’s workplace. They demand a keen awareness of workers, workplaces, and work processes. Expectations demand results.

A Continuum of Services

An integrative, comprehensive injury prevention and injury containment program should form a continuum that incorporates both upstream and downstream interventions. The continuum should be dynamic and ongoing, and should contain an objective method to assess its effect — either good or bad.

An employer-client relationship should begin with an interactive needs assessment. Where are the employer’s “pain points” — what problems are they having?

For example, are they seeing employees injured before they complete their first year of employment? Are they having problems with nagging upper-back, shoulder and upper-extremity discomfort, or with lifting injuries?

Are they having problems reliably returning employees to work after an injury? Do they see existing employees perform their work with unsafe techniques? Do they have an aging workforce?

This assessment will help you set goals that will be assessed later in a return-on-investment study. Goals are achieved through the implementation of an upstream-downstream continuum of services.

A Matter of Perception

To summarize, I propose that OTs and PTs who treat injured workers begin to see themselves as industrial specialists. They should realize the challenges of employers who staff smaller, less-healthy, and aging workforces. They should realize that the Total Worker Health Model is an invitation to do business.

Educated employers cognizant of this model are telling us what they want. Other employers need us to increase their understanding of what’s available — programs and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. Welcome to the wellness business!

In next month’s issue, I will describe detailed upstream services for injury prevention, and downstream services for injury containment.


  1. Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977;196:129-136; Engel GL: The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137:535-544.
  2. Random House Dictionary, © Random House, Inc. 2016
  3. NIOSH [2012]. Research Compendium: The NIOSH Total Worker HealthTM Program: Seminal Research Papers 2012. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2012-146, 2012 May:1-214.
  4. U.S. Bureau of Labor Statistics (2015): Job Status Report.
  5. Miller S (2011): Declining Health of U.S. Workers is Driving Up Employer Costs. Society for Human Resource Management. Available at: https://www.shrm.org/hrdisciplines/benefits/articles/pages/declininghealth.aspx#sthash.6sk0BYdj.dpuf.
  6. Østbye T, Dement JM, Krause KM. Obesity and Workers’ Compensation: Results From the Duke Health and Safety Surveillance System. Arch Intern Med. 2007;167(8):766-773. doi:10.1001/archinte.167.8.766.

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