What’s in a Date? The Importance of the Date of Injury to Physical Rehabilitation Success

Dorothy Riviere

As physical therapists, we understand the importance of time. Our schedules each day are comprised of blocks of time for each patient we see. We think about healing periods each time we design, advance, or re-evaluate our patient’s care plans. We track how many visits we have over a certain number of weeks to build our goals based on how far we believe the patient should progress in that time.

Our work in patient care revolves around time, yet we tend to think of time in terms of the start and finish of care. How many weeks and visits have they spent in physical rehabilitation with our organization or with us in the clinic? While that time is important to track, in workers’ compensation, the most valuable time that therapy providers need to consider above all others is how much time has passed since the date of the injury.

Why is the Date of Injury Important?

By definition, a date of injury in workers’ compensation means the first day the employee is absent from work due to that injury. (1) Because more than any other activity, work is a basic part of almost everyone’s daily routine, it is a vital component of an individual’s life. We know that maintaining that routine—keeping active by showing up to work, even if not completing the same activities—promotes physical and mental recovery from a work injury. (2) Most importantly, we know that if a person is absent from work for 20 days (about three weeks), they have a 70% chance of returning to work; if absent 45 days, (about one and a half months) the chance of returning to work drops to 50% and if absent for more than 70 days (about two and a half months), their chances of returning to work decrease to just 35%. (3)

Regardless of the body area or injury you treat with your injured worker patients, the number of days since the date of injury should be top of mind in how you construct your plan of care. Incorporating and thinking about the return to work from day one is key to your patient’s success in getting back to work with efficient timing. Measuring any activities your injured worker patient CAN perform from day one and focusing on helping your patients understand how they can safely return to some type of work, if available, is a prominent responsibility you must complete to help your patients get back to work as soon as possible.

However, how many therapy providers find that your injured worker patients start their care in under 70 days (about two and a half months) from the date of injury? In reviewing our Bardavon Network data from the last year, the average date of injury to when the injured worker is referred for physical therapy overall is 190 days (about six months). That does include surgical claims, which tend to have longer dates of injury to start of care times, but nowhere in the research does the number of days post-injury impacting return-to-work success measures change simply because surgery has been performed. If we narrow it to injured worker patients with a date of injury within the last 12 months, the average number of days for the injured worker to have a referral to get into physical therapy within the Bardavon Network remains 66 days (about two months).

Only when we narrow the date of injury to those that happened only within 2023 do we get to 44 days (about one and a half months) average from the date of injury for the worker to start of care in therapy. The above data means, in nearly every case, when therapy providers are evaluating an injured worker patient, they are working to get a person back to work who, from day one, has a 50% chance of succeeding at that task.

Yet, physical rehabilitation is best positioned to help injured workers overcome the odds and successfully get back to work. Our job is not just to improve the injured area in care but to help each worker understand their overall physical capabilities for work and measure them. When considering the seven fundamental movements of squat, lunge, push, pull, hinge, gait, and rotation (4), we are presented with the blueprint of what to measure to help our injured worker patients, their employers, and the physician managing the claim understand what they are capable of day one. It also gives us the overarching keys to return-to-work success for our care plans, even if we do not have more detailed information defining the specific job tasks required for our patient.

Three Steps to Improved Return to Work 

Beyond having a clear blueprint of what to measure, there are simple steps that any therapy provider can begin to take to improve your injured worker patient’s chance of success in returning to work. Three such examples are:

  1. From the initial evaluation, understand your injured worker patient’s work status. Set the expectation with your patient that the shared goal of care is to get them back to some form of work safely as soon as possible and explain why that is important to them as the patient.
  2. Know and communicate with the patient about their job demands, assess them, and point out areas of success with work activities as opposed to simply the limitations.
  3. Involve your injured worker patients in the conversation of return to work. Understand their concerns and help to manage them as much as you can or communicate them to the care team for your patient.

How much time and effort do you choose to devote to functional movement measurement, treatment, and education with your patients? If you do not today, you have an opportunity to do so tomorrow. Each day that passes from your injured worker’s date of injury is one more step away from the likelihood they return to work successfully. You hold important keys to helping them overcome this challenge by understanding the importance of the date of injury and focusing your care, from the beginning, on return to work.