Begin With the End in Mind: Setting Your Patient Up for Success!

I like lists--my to-do list, my bucket list, my wish list--to name a few. Years ago, I committed to memory a list of The 7 Habits of Highly Effective People authored by Stephen R. Covey. Habit number 2 is probably the one that I silently repeat most frequently, “Begin with the end in mind.” This “Habit” can be applied to many projects or initiatives but let’s talk about the rehab process of a person with restricted ability to work following injury or illness.

The rehab goal, or your mission, as a physical therapist, along with all stakeholders is a safe, expeditious return to work. Beginning the rehab process with this end in mind, requires that you build the treatment plan upon an accurate description of the physical demands which are required to successfully complete a job. This is the functional job description. Begin with the end in mind by gathering information related to the frequency, duration and forces required, work heights and the work environment. Throughout the course of care, routinely test the ability of the worker to perform these functions. This helps identify the worker’s current safe level of work and allows you to make recommendations for restricted work or return to regular duty. Gather this information from the worker, from the employer, from your own job site visit. Without the use of the functional job description, there is needless delay in return to a safe level of work, increasing costs to worker, employer, and payor.

Now, for another list: The top 6 reasons to use a functional job description (FJD) (or why you must use an accurate FJD throughout the course of care).

  1. Sets realistic expectations: An accurate functional job description can help set realistic expectations for the patient and their employer about the expected outcomes of the rehabilitation process. Additionally, the awareness of specific job demands can identify potential hazards which may increase the risk of re-injury or exacerbating existing conditions.
  2. Provides a framework for communication: The use of a functional job description throughout the course of care serves as a framework for good communication between all stakeholders – the worker, employer, medical provider, case manager, payor, and the physical therapist. It allows for communication regarding patient progress, functional abilities, and areas requiring further attention before resuming their normal, unmodified job duties.
  3. Improves outcomes: An accurate functional job description allows for the development of a targeted treatment plan and provides a consistent measure of progress. It ensures that the rehabilitation process addresses the patient's unique needs and challenges, ultimately resulting in a faster return to work and decreased costs.
  4. Enhances professionalism: Acquiring a detailed job description demonstrates the physical therapist’s commitment to understanding the patient's work environment and the importance of their job. Attention to relevant work requirements throughout the course of care instills confidence in both the patient and their employer. Working together toward defined goals based upon a functional job description shows the patient that you understand the importance of their job and are invested in helping them return to work as soon as possible.
  5. Promotes accountability: Based upon a clear understanding of the patient's job requirements, you can justify your treatment choices, track progress, and make informed adjustments as needed. This transparency strengthens the trust between you, the patient, and their employer, demonstrating your commitment to the patient's well-being and successful return to work.
  6. Supports ongoing professional development: A job description helps identify areas where additional training or experience may be necessary to better serve patients with work-related injuries. By recognizing the specific knowledge and skills required for various occupations, you can identify gaps in your own expertise and pursue relevant continuing education opportunities.

The ultimate goal of rehabilitation following a work limiting injury is the expeditious and safe return to work, maximizing the worker’s ability to complete the essential functions of a job. To achieve that goal, the therapist and the worker begin with a description of the physical, cognitive, and organizational job demands. Developing this list of specific job tasks and functions in the initial visits is simply “begin with the end in mind.” For more information and guidance see the links below.

Key Words: functional job description, occupational health


The author declares no competing interests.


Author Bio: 

Lorena Pettet Payne, PT, MPA, OCS, a practicing physical therapist since 1983, is an independent contractor. She assists companies in minimizing risk and promoting healthy work habits in diverse settings including auto manufacturing, steel production, food processing, light manufacturing, ranching, construction, the service industry, and office environments. As adjunct faculty, Lorena teaches occupational safety and health at the University of Montana for the doctoral program in Physical Therapy. She has served in the American Physical Therapy Association (APTA) in various elected positions including two terms as President of the AOPT Occupational Health Special Interest Group and two terms as President of the Montana Chapter. Lorena is co-author of the Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists.


Please Share Me On