Work adjustment, transitional employment, and work hardening

Work Adjustment Related Terms

Work Adjustment: The use of real or simulated work activity under close supervision at a rehabilitation facility or other work setting to develop appropriate work behaviors, attitudes, or personal characteristics.

Work Adjustment Training: A program for persons whose disabilities limit them from obtaining competitive employment. It typically includes a system of goal directed services focusing on improving problem areas such as attendance, work stamina, punctuality, dress and hygiene and interpersonal relationships with co-workers and supervisors. Services can continue until objectives are met or until there has been noted progress. It may include practical work experience or extended employment.

Work Hardening: A highly structured, goal-oriented, and individualized intervention program that provides clients with a transition between the acute injury stage and a safe, productive return to work. Treatment is designed to maximize each individual’s ability to return to work safely with less likelihood of repeat injury. Work hardening programs are multidisciplinary in nature and use real or simulated work activities designed to restore physical, behavioral, and vocational functions. They address the issues of productivity, safety, physical tolerances, and worker behaviors.

Work Conditioning: An intensive, work-related, goal-oriented conditioning program designed specifically to restore systemic neuromusculoskeletal functions (e.g., joint integrity and mobility, muscle performance (including strength, power, and endurance), motor function (motor control and motor learning), range of motion (including muscle length), and cardiovascular/pulmonary functions (e.g., aerobic capacity/endurance, circulation, and ventilation and respiration/gas exchange). The objective of the work conditioning program is to restore physical capacity and function to enable the patient/client to return to work.

Vocational Rehabilitation: Cost effective case management by a skilled professional who understands the implications of the medical and vocational services necessary to facilitate an injured worker’s expedient return to suitable gainful employment with a minimal degree of disability.

Work Rehabilitation: A structured program of graded physical conditioning/strengthening exercises and functional tasks in conjunction with real or simulated job activities. Treatment is designed to improve the individual’s cardiopulmonary, neuromusculoskeletal (strength, endurance, movement, flexibility, stability, and motor control) functions, biomechanical/human performance levels, and psychosocial aspects as they relate to the demands of work. Work rehabilitation provides a transition between acute care and return to work while addressing the issues of safety, physical tolerances, work behaviors, and functional abilities.

Work Adjustment, Transitional Employment and Work Hardening

After a work injury, the employee may need some assistance before they are able to return to the job duties they had prior. If they are able to work, but not at the same capacity as prior to injury, they may be a candidate for Transitional Work Duty (TWD). This would be appropriate for a janitor who slipped on a wet floor and broke his leg. He would be able to work, but not in his normal job function. He could be given a temporary desk job until he is able to return to to his janitorial duties. An employee with a traumatic brain injury may have some behavioral issues and need a work adjustment program. And other employees may have recovered from their injury, but need  the assistance of work conditioning or work hardening to be able to return to their pre-injury duties.

The goal of work conditioning is to restore function so that the client can return to work. It is done under the direction of a Physical Therapist in a therapy setting 2-4 times a week. This is different than work hardening in that the focus is not on the specific task the client needs to perform, lifting a 20 lb box and placing it on the shelf, but rather on building the strength required to lift the box with strength training.

Work Hardening is much more intense than work conditioning. It is done 5 days a week in a real or simulated work setting under the direction of a multidisciplinary team. Real or simulated work tasks are combined with conditioning activities in order to achieve goals related to improvement in the injured workers biomechanical, neuromuscular, cardiovascular-metabolic, and psychosocial functioning. This ensures that muscles are conditioned specifically for the job-related tasks undertaken by the worker. The issues of productivity, safety, physical tolerance and work behaviors are also addressed. The program is individualized to the client based on their injury or impairment and job description; which states the amount of lifting, bending, stretching, etc required to perform the job duties, and an on-site observation of the workers job.  The goal is to maximize for the employees ability to return to work safely, with less likelihood of reinjury.

The focus of work adjustment is on attitude, behavioral and social skills. This is for clients with behavioral health issues. Real or simulated work activity is performed under close supervision at a rehabilitation facility or work setting. The goal is to improve problems that are preventing the client from obtaining employment, such as attendance, hygiene and interpersonal relationship skills.

Transitional work duty (TWD) allows an injured employee to return to productive work with their employer. The employer will create a value added temporary position based on the knowledge and skills of the employee. The work must conform to the restrictions put in place by the employee’s treating physician. Only employees with temporary injuries, that will be able to return to their normal full time duties are eligible for TWD.


Work Conditioning

Work Hardening

Work Adjustment

  • 2-4 days per week
  • Done in therapy setting
  • Goal to restore function
  • 5 days per week
  • In real or simulated work setting
  • Goal-return to work
  • More intense than work conditioning
  • individualized
  • Rehabilitation facility or work setting
  • Goal to improve problems preventing employment
  • For people with behavioral health issues
  • Focuses on attitude, behavioral and social skills