On-Site Physical Therapy for Workplace Pain Relief

With Chris Adamson, SPT

Background

While working as a physical therapy tech prior to entering PT school, I noticed how common it was for patients to have difficulty getting to appointments consistently due to work. Another trend I noticed was how often patients stated that work either made symptoms worse, or that the opposite effect was happening and symptoms were making work tasks more difficult. This is unsurprising, and I continued to see this trend in each of my outpatient clinical rotations with working-age patients, regardless of their reason for coming to PT. Because of this, I have been interested in how physical therapy practices can find unique ways to overcome these barriers to treatment.

Another aspect that has always captured my interest is the efficacy of interventions that we have as tools for pain relief. Many of the patients I saw as a tech or at my first orthopedic clinical rotation had high pain levels, and I struggled to find interventions that made immediate impacts on this impairment. While I did have success in seeing pain levels lower over longer time-frames, which is very important, I struggled to make as much of an immediate impact on a consistent basis. For many patients, I wanted to improve my ability to get them feeling less pain as they return to work that day so that they may tolerate their daily activities better.

Based on these two considerations, I decided to examine two different, but related, topics for my capstone project, along with the help of Chris Adamson, SPT. First, I reviewed the literature on the different modalities and similar treatments we have available and their impact on pain in the immediate and short-term timeframes. Secondly, I, together with Chris, examined more information on the relationship between pain and work productivity and some ideas for how business interventions can impact this issue.

 

Statement of Need

As every person is aware, pain is a part of the human existence. In America, over 100 million Americans experience pain each year that will interfere with leisure or work activities.¹ In addition, the prevalence of pain increases as we age, starting around age 20 and increasing in prevalence until 60 years old, impacting the entire span of the average adult’s working life.¹ The interference of pain on work is a major component of the idea of presenteeism, which is the concept that employees do not miss time from work due to pain, but rather continue to attend work with reduced job performance.^2-3 In fact, presenteeism has been found to be the biggest cause of reduced workplace productivity as a result of pain, more so than missed time from work.² For physical therapists, this is important to focus on, as reducing pain is an important job function, especially as we move towards the goal further becoming front-line specialists that intervene on these issues.⁴ This also highlights the potential impact of physical therapists on workplace pain, and this capstone project served as an opportunity to investigate a different business model concept that could intervene on this issue.

As we move towards the goal of treating pain effectively, it is important to understand our best tools to do so. Even among physical therapists, there is a wide variety of interventions utilized for pain, such as with low back pain treatment.⁵ Through review of the literature and development of an evidence table, I hope to use this project to provide summary information on the efficacy of different modalities and treatments when it comes to treating pain.

 

Overview & Purpose

After revieing literature and considering physical therapy business models, mobile physical therapy clinics offer potential as an innovative method to address the earlier described workplace pain problems. While healthcare that is integrated into workplace environments is not a new idea, most of these clinics treat in large businesses and many do not include physical therapy.⁶ In the same manner, mobile health clinics are not a novel concept, but the overwhelming majority of these clinics are not concerned with physical therapy and treat specific populations that do not include workplace environments.^7-8 As such, a mobile clinic provides an unique opportunity to intervene earlier on pain in workplace populations, remove barriers to treatment for employees, and save employers money in the long-term through less traditional payment structures. As evidence shows, there are many tools that physical therapists have at their disposal that can reduce pain levels quickly and for varying durations, including dry needling, dry cupping, pain neuroscience education, laser therapy, and transcutaneous electrical neurostimulation. Specific to these interventions, however, the quality of studies varies, as well as the magnitude of effect on pain or other outcomes. I chose studies that I judged to provide the most clinically useful investigations for physical therapists in the United States and the most generalizable results to typical patient populations.

 

Products

The products created as a result of this project are designed to supplement each other. The first product that I created is an evidence table of treatment options for pain, which provides information regarding use of trigger point dry needling, dry cupping, low-level laser therapy (LLLT), transcutaneous electrical neurostimulation (TENS), and pain neuroscience education (PNE). The second product is created together with my partner, Chris Adamson, and is a business feasibility study. This product gives information on mobile health clinics, workplace pain and presenteeism, and a potential business that could use the previously described pain interventions for workplace intervention. My contributions to this business feasibility study include a market need analysis, mobile physical therapy analysis, and competitor analysis. My partner’s contributions to the project can be found at his site, and the entire study is included as one product below.

Pain Interventions Evidence Table

Business Feasibility Study Introduction

Market Need

Mobile Health Clinic Analysis

Competitor Analysis

Business Feasibility Study

 

Evaluation

Our Capstone advisor, Jon Hacke, provided helpful feedback on the products to improve their content and effectiveness. His feedback was vital in improving the final products and improving the messaging being delivered to the intended audience of clinicians, faculty, and students. Evaluation components were created and included in the business feasibility study to be sent to both employers and employees, but were not sent out as the business plan would need to be more comprehensive prior to contacting businesses. In order to gather feedback on the products, a feedback form was created, which a link to is included below.

On-Site Mobile Physical Therapy Feedback Form

 

Acknowledgements

I would like to thank my capstone advisor, Jon Hacke, DPT, PT, MA, first and foremost. Thank you for accepting the challenge of working on this project with both Chris and I concurrently and guiding us in direction and execution. Thank you for your flexibility in working with us and understanding of our goals and challenges.

In addition, I would like to thank our committee members, Ellen Roeber, DPT, PT, MDT Certified, and Justin Wilhelm, DPT, PT, OCS, for volunteering time from their busy schedules to review this project and offer feedback. During this especially challenging year, I want to reinforce that the willingness to use valuable free time to help current students and improve our product does not go unappreciated.

I would like to thank my partner on this project, Chris Adamson, for your cooperation, teamwork, and approach to this project. Your accessibility and creativity went a long way in helping this project see its final stages.

Lastly, I would like to extend thanks to my classmates and the faculty in the UNC DPT program, for their flexibility in trying to manage this difficult year and Capstone project amidst the COVID-19 pandemic.

 

References

1. Case A, Deaton A, Stone AA. Decoding the mystery of American pain reveals a warning for the future. Proc Natl Acad Sci U S A. 2020;117(40):24785-24789. doi:10.1073/pnas.2012350117
2. Mitchell RJ, Bates P. Measuring health-related productivity loss. Pop Health Mgmt. 2011 April 13. 14(2): 93-98. https://doi-org.libproxy.lib.unc.edu/10.1089/pop.2010.0014
3. Cancelliere C, Donovan J, Stochkendahl MJ, et al. Factors affecting return to work after injury or illness: best evidence synthesis of systematic reviews. Chiropr Man Therap. 2016;24(1):32. Published 2016 Sep 8. doi:10.1186/s12998-016-0113-z
4. American Physical Therapy Association. Workers’ Comp Research Group: Early Physical Therapy for LBP Is a Win-Win. APTA. Sept. 21, 2020. https://www.apta.org/news/2020/09/21/workers-comp-lbp-report
5. Poitras S, Blais R, Swaine B, Rossignol M. Practice patterns of physiotherapists in the treatment of work-related back pain. J Eval Clin Pract. 2007;13(3):412-421. doi:10.1111/j.1365-2753.2006.00725.x
6. Lord DJ, Wright JR, Fung R, et al. Integrated Physical Medicine at Employer-Sponsored Health Clinics Improves Quality of Care at Reduced Cost. J Occup Environ Med. 2019;61(5):382-390. doi:10.1097/JOM.0000000000001536
7. Yu SWY, Hill C, Ricks ML, Bennet J, Oriol NE. The scope and impact of mobile health clinics in the United States: a literature review. Int J Equity Health. 2017;16(1):178. Published 2017 Oct 5. doi:10.1186/s12939-017-0671-2
8. Mobile Health Map. Impact Report. Harvard Medical School. https://www.mobilehealthmap.org/impact-report