Code of Colorado Regulations
1100 - Department of Labor and Employment
1101 - Division of Workers' Compensation
7 CCR 1101-3 R17 Ex 08 - Rule 17, Exhibit 8 - CERVICAL SPINE INJURY MEDICAL TREATMENT GUIDELINES
Section 7 CCR 1101-3-17-08-5 - Return to Activity and Work Considerations

Section 5.a. Job History and Communication

Recommendation 27. A job history interview should be completed at the time of the initial evaluation. A thorough job history generally includes:

* duties and demands of job held at time of injury; and

* duties and demands of current job, if different; and

* stressors; and

* cognitive and social issues, with treatment incorporated into the plan of care.

Recommendation 28. A formal job description for the injured worker is recommended to identify physical demands at work and to assist in the creation of medically appropriate work restrictions. Job descriptions are helpful but should not be used as a substitute for thorough patient interview and/or direct observation.

Recommendation 29. Nurse case management is recommended in medically complex cases to facilitate communication between the primary provider, referral providers, insurer, employer, and employee. The patient may decline nurse case management services.

Section 5.b. Return to Work

Recommendation 30. It is strongly recommended that the patient return to work as soon as it is medically appropriate, even if it is in a modified capacity.

Recommendation 31. Ergonomic or adaptive equipment, therapeutic breaks, and workplace interventions are acceptable to maintain employment.

Recommendation 32. Interdisciplinary services are acceptable to assist the injured worker in return to work efforts (e.g., behavioral and/or psychological support, active therapy).

Recommendation 33. For patients with work restrictions, a graduated return to work is recommended as part of a successful medical treatment plan with a goal of return to full duty, if medically feasible (e.g., nature and frequency of activities; hours worked).

Recommendation 34. Permanent work restrictions, when needed, should be developed based on objective information available, including:

* history;

* findings on physical examination and diagnostic testing; and

* functional response to active therapy, work conditioning, and/or modified duty.

Section 5.c. Workplace Tests

Recommendation 35. A jobsite evaluation is acceptable to fully understand the physical demands of an individual's work. This information can be used when determining medical causation, the need for ergonomic changes, and/or ability to return to work. The timing and maximum allowed for jobsite evaluation are as follows:

* 1 time for initial evaluation, 1 for mid-treatment assessment, and 1 at final evaluation.

Recommendation 36. A work tolerance screening is acceptable to determine a patient's tolerance for performing a specific job activity or task from a cardiovascular, postural tolerance, ergonomic, and physical fitness perspective. The timing and maximum allowed for work tolerance screening are as follows:

* 1 time for the initial screen. May monitor improvements in physical work capacity every 3 weeks up to a total of 6 visits.

Recommendation 37. A functional capacity evaluation (FCE) is acceptable to determine an individual's capacity to work. A formal job description and jobsite evaluation, if performed, should be made available to the FCE evaluator prior to having the FCE performed. The timing and maximum allowed for FCE are as follows:

* 1 time to determine baseline status, and 1 time to determine permanent work restrictions at case closure if the provider needs additional information regarding the patient's physical work capacity.

Recommendation 38. Follow-up evaluation with the treating therapist and/or the treating physician is required within 3 days after the functional capacity evaluation (FCE) to assess the patient's status.

Recommendation 39. Functional capacity evaluations (FCEs) and computer-enhanced evaluations are not recommended as the sole tool for the development of temporary or permanent work restrictions.

Recommendation 40. Performance during functional capacity evaluations (FCEs) cannot be used as the sole criteria in diagnosing malingering.

Recommendation 41. Computer-enhanced evaluations (including computerized dynamometry) are acceptable. The timing and maximum are as follows:

* 1 time for initial evaluation, 1 for mid-treatment assessment, and 1 at final evaluation.