Industrial medicine and acute musculoskeletal rehabilitation. 5. Effective medical management of industrial injuries: From causality to case closure

This self-directed learning module highlights the physician's role in treating industrial injuries, from the initial causality determination to the eventual case closure. It is part of the chapter on industrial medicine and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The article reviews important factors in determining whether an injury is work-related, particularly in the presence of preexisting, underlying conditions. The article addresses the roles of functional capacity examinations and work-hardening programs in facilitating successful return to work. Interactions are outlined between work return and nonwork activities of daily living, as well as financial and psychologic barriers that may impede work return. Legal issues regarding independent medical examinations and depositions are reviewed. Guidance is offered for identifying those relatively few injured workers who may require referral for surgical or other consultations. Overall Article Objectives: (a) To review the important medical, administrative, and legal challenges involved in treating injured workers and to describe strategies that physiatrists use to overcome effectively these challenges.