Work hardening for a client with low back pain.

The rehabilitation of this client with chronic back pain was successful secondary to the efforts of her entire medical team. As demonstrated by the termination letter written by the employer when the client's medical leave exceeded 1 year, this client could not have returned to her former position without work hardening. With implementation of the Americans With Disabilities Act, changes in such employer policies might be forthcoming. The occupational therapy principles of activity analysis (Trombly & Scott, 1977) and the therapeutic acceptance of gradual gains in functional abilities contributed to her resumption of both work and nonwork tasks. Although enrolled in a work program, this client was not viewed as simply a worker. The examination and treatment of her life tasks as a parent and homemaker outside her worker role was a crucial aspect of her program (Kielhofner, 1985). It was obvious to her treatment team that the largest gains occurred when the client realized she was capable of performance despite back discomfort. The foundation for return to work was laid when the client set her own goal of working the third shift. The client did not acquiesce to a therapist's goal; she actively formulated her own. Typically, a client with chronic low back pain, a history of knee problems, and an absence from work of more than 1 year has a low probability of successful rehabilitation and return to work (Isernhagen, 1988). Yet this woman was able to overcome those obstacles to return to both work and a more active life-style.(ABSTRACT TRUNCATED AT 250 WORDS)