Transcription:
Benefits of a Quality Rehabilitation Program for Work-Related Injuries

Caitlin Whyte: Workplace injury rehabilitation is a broad term that covers many aspects of care. So in this episode, find out about the most common workplace injuries and how a quality rehabilitation program for work-related injuries benefits both the injured worker and their employer. Joining us for this conversation is Charlie Eberling, a regional outpatient rehabilitation manager at Good Shepherd.

This is Transforming Lives and Inspiring Hope, a Good Shepherd Rehabilitation Network Podcast. I'm your host, Caitlin Whyte. So Charlie, to begin here, tell us what made you choose physical therapy as your career path?

Charlie Eberling, PT, DPT, CWCE, TPI: So I was never one of those kids that knew exactly what I wanted to do with my life. I kind of was an average student early on. And, as I got older, I decided I was going to be one of those cool kids that bought a motorcycle. And that is really what set me on to the path of where I am today. About four months after I bought a motorcycle, I was stopped and a drunk driver hit me at a high rate of speed, which changed my life forever.

So at that point, I ended up with extensive injuries to my lower leg, where I had, in the next seven months, about 16 operations to put me back together. So I spent the better part of a year and a half without walking on that leg because of how much trauma was there with all the muscle grafting and skin grafting.

That gave me a different perspective on life, you know. Right away, I didn't know it, but I didn't know that I was going to get into the field right away after that. But after all the rehab, after doing everything, getting back to normal, getting stronger. And at that time I was only a 19-year-old kid, you know, so I said, "Okay, well I'm going to go out and I'm going to earn money" and then I met who turned out to be my wife and she says, "You know, you can't do manual labor the rest of your life." And at that time, I was moving furniture, I was doing construction. And, you know, I thought, "Well, I'm going to become an accountant. I'm good with numbers." And she says, "I think you should do physical therapy." And I looked into it and it turned out to be exactly what I needed. I can sympathize with the people that come into the clinic. You know, I remember those days when it was constant pain, when you had uncertainty of what was going to happen the following day of how you could even plan for the next week because you didn't know how bad things were going to get as far as your day to day life.

So it really put me into a different perspective as to what was important and what was fulfilling at the time. And then, once I actually went into physical therapy, it became the love of my life. I adore what I do. I think it's amazing thing at the end of the day to go home and feel fulfilled that I did something for someone.

The aspect of it with Workman's Comp, that kind of came from my background of manual labor where I did a bunch of different manual jobs. I was a mason for the better part of eight years and learned how the skilled trade works, how I worked with all the plumbers, with the masons, with the carpenters, and kind of figured out what they did, what their lives were like. So it made it a really easy transition for me to be able to get into the Work Comp field.

Caitlin Whyte: Gosh, Charlie, what a way to start off the show. It's an incredible story already.

Charlie Eberling, PT, DPT, CWCE, TPI: Yeah, it was a trying time, but it thought me a lot about myself.

Caitlin Whyte: Yeah. I mean, those are the things that get us to where we are, right? Well, let's dive into your work. So like you said, you worked in manual labor and now you work in workplace-related injuries. So what are some of the most common types of work-related injuries that you see now?

Charlie Eberling, PT, DPT, CWCE, TPI: So we see a wide variety. And in physical therapy in general, you see a very distinctive ebb and flow as the year goes on. So certain times of the year in regular therapy, you're going to have your knee replacement people happening. You're going to be having this slips and falls during the winter that end up with rotator cuff injuries.

The ebb and flow of Workman's Comp is much different. You know, as you get closer to now, as we're getting into the gift-giving season, we're going to end up with more overuse kind of stuff. Especially in the last year and a half, we've seen a lot of order pickers, people that are having to go and pull the orders for say Amazon or whatever company they're working for. They're working with less and less staff and they're having to work and fulfill those orders still. So you're seeing a lot more of people having the shoulder pain, the neck pain, the tennis elbow, that kind of stuff coming in from just the high repetition motions.

The injuries, really, depending on what industry you're looking at too, you know, once we get into construction season at the beginning of the construction seasons around spring time or so, you'll see a lot of people with like crush injuries. They'll end up getting fingers pinched between machinery or they'll get their hand hit if they're placing trusses on a roof or something like that. It could be a totally different thing. That's where it really comes in the need to understand what the demands of each of these places are and what these employees go through to make sure that you can really treat what's going to be coming in the clinic.

Caitlin Whyte: Well, you touched on my next question a bit. You know, COVID-19 obviously has changed everything about how we work and live. So how has the pandemic changed the types of injuries that you're seeing?

Charlie Eberling, PT, DPT, CWCE, TPI: Yeah, I think that goes right back into the last one with the order pickers. You're having a lot more of that, the overuse thing. The construction trade really didn't take too much of a downturn. So you saw a little bit of it at the beginning of the pandemic, but all the construction trades really came back and they started working really early on. So there wasn't a massive drop in those, but what you do see is that the workforces are running on skeleton crews. So you're getting that low back strain from people not having the team lift people there to help them. You're getting the overuse, the gripping type activities. Our hand therapy clinic has been very busy with the hand injuries just from the gripping and squeezing and reaching kind of thing.

And then, you know, now you'll get the Amazon people or delivery people from any kind of thing where they're getting into more time on the road means more accidents. So you're going to end up having a post-traumatic from MVAs happening as well that you have to treat.

Caitlin Whyte: So let's talk about the Good Shepherd At Work Program now. Where is that offered and what are some of the services?

Charlie Eberling, PT, DPT, CWCE, TPI: Sure. So Good Shepherd At Work is really a brain child that came out of the company back at the beginning of 2019, end of 2018. And it started out as a thing of-- you know, at the time we weren't offering too much care for Workman's Comp and it was an aspect of the injured population really that needed to be addressed. There was a void there where people just were having difficulty finding places to go. So Good Shepherd itself decided, "Okay, well, let's look into seeing what we could do here." You know, is this something that we can actually offer for people?" And that's where I come in.

My background is Workman's Comp. I've done it for the majority of my career. And we really pulled together a stellar team. We have a team for the Work Comp committee that includes physicians, our marketing people. We have PTs, OTs. We have every spectrum of it that we can to kind of look at it early on when we were first developing the paradigm of what Good Shepherd At Work was going to be. And we really sat down. We had meetings quite frequently, like, "Okay, well, what does this portion of it looked like? And what does this portion of it look like?" And we've really hammered out our core values for it as well as what is our focus, where are we at now, where do we want to be? So we pulled this team together.

And in Good Shepherd, we have 25 locations that we offer any kind of injured worker treatment for. And the range of what we treat is amazing. Even starting at the purest form is our physicians. They are doing EMGs for the people that have-- sometimes you'll deal with the overuse stuff or with any kind of crush or any kind of injury, you can end up with some nerve damage and it's hard to fix that when you're doing just therapy and you say, "Okay, well, the person has pain here, but why is that happening?" "Okay, well, if there's an injury to the nerve, we need to know that." So our physician group does EMGs. We have physicians also that do IMEs/IREs, which are like independent medical reviews. If people aren't getting better, sometimes the Workman's Comp case manager will send them into getting a review, just kind of trying to get an idea as to what is holding this up, what's making this where the patient can't get better, why aren't they getting over that hump? And then, you know, we have our PT, OT, and speech teams as well in all of our locations.

One of the big issues out there that we keep seeing is concussions. You know, people having slips and falls or just not paying attention to what they're doing. You know, they happened to stand up too fast, hit a rack or something like that. We have an unbelievable team at our main campus that works on concussion injury. And, you know, when people hear of concussion, they say, "Okay, well, you know, they hit their head. They got a little woozy, but there's so much more to it. You know, you end up having these reactionary issues with post-concussive symptoms, with like a sensitivity to fluorescent lights or getting dizzy or inability to focus correctly. And a lot of times, you'll find that where people are just, you know, "God, that person's in a daze," but it's not really them being in a daze. It's just their brain is processing information so much differently after a concussion. Sometimes they'll get cognitive delays where they just can't really focus and express what they're trying to say as they did before. So we have that entire concussion team working at things.

We have all of our clinics treat just, you know, regular aches and sprains and all that stuff that come along with Workman's Comp. But it's a different beast altogether to learn the ins and outs of the insurance. Even though the treatment is going to be similar, trying to navigate the insurance companies is much, much different than the regular insurances. So you got to be aware of, you know, who is the payer? Who is the employer? Who are you working with? And it really is a skill that our clinicians have taken to heart to really learn as much as they can in such a short period of time in the last two, two-and-a-half years. We can rely on those therapists to make sure that they go from regular treatments to-- there's something called work conditioning for the people, small portion of population that might be out of work for 6, 7, 8 months, that the injury itself isn't the only thing that's preventing them from returning to work. It might be that they're deconditioned now, and they might not have cardiovascular ability to be able to go back to do what they were doing, or they might still have lingering issues where can they go back to that same position or would they be able to go for a different position within the same company? And that's where they can use work conditioning, which is anywhere between two to seven or eight hours each day, sometimes five days a week, where the person has to come here and replicate job duties to make sure that they can safely go back to their job.

And then for a small portion of the population, we also offer FCEs, which are functional capacity evaluations. Those are more intense. They are usually anywhere between four and six hours and we put them through everything. You want to look at how they can lift, how they can push, how they can pull. Is there a dexterity there? Are they following directions? And we have right now, six people that are in our network from Good Shepherd that are actually working towards certifications. I can happily say that I am one of six people in the state that's certified through Matheson for functional capacity evals. We have two more that are on their certification route right now. They're waiting for the response so that they have their certification and then we have three more that are actually working towards a certification as well. Then that just makes sure that we have the specialty to be able to offer to the patient. Our goal is to get the patient better; to get them better, but get the better fast. You know, every minute that somebody is out of work, you got to make sure that they can get back whenever they can.

Caitlin Whyte: Well, it sounds like there are many, many people included on this program. So why is this team-based approach in your opinion the most beneficial way to attack these problems?

Charlie Eberling, PT, DPT, CWCE, TPI: So, like I said, when you have everybody working together and looking at the person as a whole. The worst thing you could do in therapy is look at somebody as a knee injury or look at somebody as a shoulder injury. You know, it's a person with a shoulder injury, a person with a knee injury. And every day that they're out at work, they're getting less compensation than they would while they're at work. Every day that they're out of work, if they're not able to drive, so say after a concussion, they're having to eat too much dizziness, vertigo, they can't drive. Now, they're being inconvenienced as well from having to contact somebody to be able to physically get them to a facility to get treatment. It just really puts a burden on the person's life and anybody that's ever had an injury that has taken them more than a couple of days to get better from. They'll notice there's an emotional aspect of every injury and you could see it in everybody that comes into clinic that they just kind of get bummed. You know, they're down-spirited. They just want to go back to normal. You know, it's a normal thing to want to just return to what you were doing.

So when we bring all these people together to focus on the patient, instead of the injury, it really is focusing on trying to get them some kind of normalcy. So for the patients, there's an aspect of it that really is beneficial for them as far as, "Okay, we're going to get you less pain. We're going to get you back to your normal function. We're going to have you throwing a ball with your kid. We're going to have you go riding a bike for long distances," stuff like that.

But then for the employer aspect of it, Workman's Comp in Pennsylvania, their insurance, their rate is really determined by how many days out of work they had for injured workers in any set timeframe. It could be six months or 12 months or whatever. So for every day that somebody is out of their business and on injury, their rates are at risk of increasing. So we're trying to save the money for them as far as getting the people back to work as fast as possible and be able to function.

There's also an aspect of every job, and everybody knows this, if you have a team of people that work really well together and everybody has their little role, if you pull one of those people out and try to stick somebody else in new, okay, well, now there's something different in that dynamic. And that happens in factories as well and it happens on production lines. It happens everywhere. Now, there's a lower production rate associated with that one person being injured, even though somebody else might be just as proficient at doing the job, but how the dynamic works changes and the productivity takes a little bit of a slip.

So for the employer, it's focused on, "Okay, can we get you back to profitable business and can we get you back to where you should be?" And for the patient it's "Can we get you back to functioning how you should be? Can we make sure that you don't have long-term injuries that you're going to have to deal with?" You know, is it something that we have to make accommodations for and teach you how to be able to do a different aspect of your job so that you can have productive income coming in? So you're not just having the accessory issues of being permanently disabled. So there's different aspects of it that actually benefit both of them. For us as therapists, we just feel good when we get people better too.

Caitlin Whyte: Yeah. Yeah, of course. And Charlie, as we wrap up here, sticking with the employer side of things, why should employers prioritize listing quality rehabilitation providers on their Workers' Compensation panels for employees?

Charlie Eberling, PT, DPT, CWCE, TPI: Sure. So I can go to the beginning of that too. So with, Work Comp injuries, a lot of times, if you look back at some of the people, not all of the populations, you know, sometimes it is just a natural accident or anything, but when we look at the data in 2018, a very large portion of it, that's when the reporting came out, is people got injured within the first year on the job. And when they look at that, they say, "Okay, is that something that the person just wasn't trained correctly? Is it that they had a pre-existing issue? Was it that they are just really trying to show their worth and they're putting themselves out there more than other people?" I don't know. They haven't really looked at that in depth enough to know yet, but there is a small percentage of those people from the first year that are injured actually in the first week of employment.

And what you look at then is okay, were they actually doing something incorrectly? Were they were they injured before they were employed? And that's where something called post-offer employment testing comes in. We shortened it to POET. But a POET, you know, might run only a couple hundred dollars for somebody to do for a new employee. But what it really does is it looks at can they do the job and is there something pre-existing that limits them from that? In Pennsylvania, how it works is if you take somebody in and you have them start working, they get injured, it doesn't matter if it was preexisting or not, you are on the hook to pay for the entire plan of care then.

So POETs are something that you can do for relatively inexpensive to make sure that you're getting the candidates that are best suited and best capable to do the job. Then once you actually have somebody employed, if they end up having an injury on the job, which does happen, you know, from simple stuff to big stuff, we have the ability in our company within 48 hours after the doctor seeing the patient to have them in the clinic.

Every research out there will show that sooner treatment after injury leads to faster recovery and faster times of getting back to work, that's just known across the board. That's why surgeons are starting to push people to therapy faster after surgery. Work Comp injuries, they want them in within 48 hours and we can accommodate that at every one of our clinics. It's just one of those things that if you actually work with providers that know the job, that know what's entailed in the recovery and know what's financially involved for the employer too, it helps to kind of be a little bit more focused. We're looking at our end of if we get on somebody's panel, you know that we're going to be available no matter what. Our therapists are going to be available to be able to speak to you about what's going on. Our focus is to get the person back as soon as possible, but also make sure that we're giving the person exactly what they need.

You know, not everybody can just jump in. You know, I can draw stick figures, but I'm never going to draw a very exquisite painting. It really takes a person that has the skill specific for the job to do it, to get the best outcome that you can. And I think that's really what we try to do here at Good Shepherd, is make sure that we are covering all the bases to give everybody involved, all the stakeholders, us, the employer, the patient, everybody involved, the best quality care that we possibly can.

Caitlin Whyte: Well, we love to hear about the great work you're doing, Charlie. Thank you so much for joining us today.

Good Shepherd is a destination for transforming lives and inspiring hope. Call 1-888-44-REHAB. That's 1-888-44-REHAB or visit us at goodshepherdrehab.org.