rom extracting oil on the North Slope to hauling nets in Bristol Bay, the physical nature of work in the Last Frontier can be brutal and demanding. Keeping the workforce mobile is the job of occupational medicine. However, occupational health isn’t just for laborers doing the heavy lifting; desk jockeys can also suffer wear and tear after long hours at their computers—especially when they’re working from home.
Layoffs, furloughs, cut hours, and a whole slew of other environmental, social, and physical factors connected to the pandemic have led to the deconditioning of many people within Alaska’s workforce—especially those who were hospitalized by COVID-19. As the pandemic continues to grind communities down and more people look for opportunities to return to work, it’s important for future employees and employers to plan that return safely.
There are many tools and programs now that can help people meet those goals, Trivedi says. Select Physical Therapy uses a biopsychosocial approach that helps practitioners ensure that they are focusing on patient-centered goals and education. By uncovering the psychosocial factors associated with an injury, therapists can unpack the non-physical elements of injury-connected trauma that can be affecting a patient.
“It’s not that they’re faking it because they don’t want to go back to work,” Trivedi says. “It’s because they just don’t have the coping skills. There’s a lot of stress factors around their injury that they don’t understand. We as therapists can help them understand and kind of get them to gain more control and independence back.”
Trivedi says it’s not only about helping patients break perception barriers but it’s also getting employers to understand how they can be better partners in encouraging people to return to work in a safe and healthy way.
“The musculoskeletal impairments that we find are obviously going to be similar whether you’re an industrial athlete or a sports athlete playing baseball,” Trivedi says. “But all the other factors, the pressures, are different.”
Trivedi points out that the patient populations, support systems, and final goals can be significantly different between an athlete and a fisherman or office worker. An athlete might be better prepared and have a stronger support system for quickly healing than an average worker injured on the job, she says.
“You can’t really cookie cutter the same treatment plan because the diagnosis is similar. The way that you apply a treatment methodology is really going to depend on that individual’s unique characteristics plus their system issues,” Trivedi says.
Whatever the treatment, the primary goal of occupational medicine (a specialty within the field of physical therapy) is helping people get back to work, which is a daunting goal during the pandemic. Select Physical Therapy has seen a spike in the number of psychosocial factors that put patients into high risk categories, Trivedi explains.
“There’s more fear associated with getting back to work; there’s more fear associated with potentially contracting COVID, if they do go back,” Trivedi says. “There was a lot of this particularly in 2020.”
It’s not only patients wrangling with work; all forms of physical therapy, including occupational medicine services, struggled at the onset of the pandemic.
Phelps grew Advanced Physical Therapy in Alaska from four therapists in 2002 to more than eighty employees operating in Seward, Soldotna, Wasilla, Fairbanks, and Anchorage before the beginning of the pandemic.
“Half the staff thought that we were not essential, and the other half thought we were essential,” says Phelps, who was firmly on the essential side of the discussion.
Physical therapists keep people out of emergency rooms, help optimize immune systems, and support better health and wellbeing. All important services—especially during the pandemic, Phelps says.
“They stopped surgery for what, three or four months?” Phelps says. “We were working to help people survive [and] not go down a rabbit hole of drug abuse or alcohol abuse and self-medication while they were waiting for surgery.”
Like many physical therapy providers, Advanced Physical Therapy saw a huge number of practitioners in its ranks—about half—leave as stay-in-place orders were issued in Alaska. In March 2020, seeing the writing on the wall, Phelps put everyone who wasn’t in the clinic on layoff status. Those that remained took cuts to their benefits as they prepared to ride out the long storm while continuing to care for their communities.
Patient numbers also dropped by about 50 percent for Advanced Physical Therapy. Initially they dropped to 30 percent, and then trended downward over the next six months to 50 percent.
“The Advanced Physical Therapy paradigm of treatment,” according to Phelps, “is you need to restore integrity of the myofascial structures and the joints and the movement system before you ask it to move, before you do strengthening, endurance, balance coordination, that kind of thing.”
Phelps explains how her services can extend beyond what is normally thought of as physical therapy to assessing and triaging acute, recurrent, or chronic musculoskeletal injuries, helping keep people out of hospitals at a time when healthcare facilities are hitting their capacity due to surges in COVID patients.
“We tried to do some more hands-off [work], especially with the COVID-positive patients, and we collaborated with nursing and respiratory therapy to do some basic exercises to help provide some care for these patients,” says Abbey Jackson, clinical practice manager in the Physical Therapy department at Alaska Native Medical Center in Anchorage.
However, Alaska Native Medical Center also has a Level II Trauma designation, so against the trend for other physical therapy providers, the workload didn’t decline.
“The traumas did not stop. It was actually one of our biggest trauma seasons—ever,” Jackson says of the summer of 2020.
Some of the treatment for trauma, as well as COVID-19, left patients in a deconditioned state, explains Alaska Native Medical Center physical therapist Anthony Martin.
Eventually, there was a turning point as the team realized that it was becoming vital for patients to have more significant in-patient therapy work done. Physical therapy, occupational therapy, speech language pathology, and respiratory therapists at the hospital worked together to help patients.
“It’s their muscles, and they have a hard time getting up, standing. It affects their balance,” Martin says. The isolation that COVID-19 patients faced in hospitals—despite the best efforts of staff—also had an impact.
Martin explains that at times recovering COVID-19 patients were apprehensive or reluctant to participate in therapy sessions because they were fearful of losing their breath. The best tool in a therapist’s toolbox for such situations is educating patients about what they’re facing and what their road to recovery could potentially look like.
“The more care and therapy I think a person can get while they’re with us, the higher their chances are I think for success being in the outpatient setting,” Martin says.
“That way, we can continue to improve and boost our immune system and fight this virus,” Martin says. “With [patients’] deconditioned state, also with some of the anxiety that they got from contracting COVID, I think outpatient or home health will pick up.”
This is a trend Select Physical Therapy and Advanced Physical Therapy are both already seeing. Slowly, patients have been returning. Advanced Physical Therapy now has about 85 percent of its pre-pandemic caseload, Phelps explains.
“We’re slowly, slowly climbing our way back,” Phelps says.
Despite this, 20 to 30 percent cancellation rates have become the new norm. A large part of this is due to people canceling even if they have the sniffles, which Phelps says she’s grateful for.
Part of the spike in work for Advanced Physical Therapy and Select Physical Therapy has been for post-hire, pre-placement testing.
Regional Manager
Select Physical Therapy
“There’s a huge return on investment for employers, the more that they invest in injury prevention,” Trivedi says.
Rebecca Tamaki, a physical therapist that specializes in occupational medicine for Select Physical Therapy in Anchorage, says another reason for the steady increase in demand for physical therapy has been people avoiding help earlier in the pandemic.
“I think people are just saving up all their medical conditions and now they’re all going out and they’re all wanting therapy,” Tamaki says.
Phelps is inclined to agree.
“There are people that didn’t do any health care for the past year and a half,” Phelps explains. “So now they’re getting out and trying to get things taken care of.”
“They do have issues sometimes that are lingering with their ability to just get that energy, that stamina to keep up with their work demands,” Trivedi says. “So we have a recovery and reconditioning program that we’ve started that really focuses on the patient that may have had COVID at some point.”
Unfortunately, for many patients—even if they haven’t contracted COVID-19—it can be a longer road to meet their goals than it would have been eighteen months ago.
“To this day, people are healing slower,” Phelps says, pointing toward the environment of fear and anxiety that has gripped much of the nation from vaccine politics to COVID-19 itself. “There is great research out there about the stress or anxiety in an individual slowing healing times by 30 to 60 percent.“
Healthcare providers are not immune to these stressors. While the increase in business and the increase in patients accessing care are positive changes for therapists and the communities they take care of, these practitioners are under significant pressure.
Phelps points out that dealing with unvaccinated patients continues to be a source of stress and risk for providers.
“By May, 50 percent of my personal clients had not been and refused to get vaccinated, and I just felt like I was playing Russian roulette with those patients,” Phelps says.
Phelps, who is part of at least two COVID-19 at-risk groups, was eventually able to get those patients transferred to her younger, healthier colleagues.
“We have anxiety about people coming in who aren’t vaccinated,” Phelps says. “The whole thing has had a detriment on the health of everybody who’s trying to provide healthcare.”
The threat of burnout and the intensity of therapy work is particularly high for therapists.
“I myself suffered burnout this spring, just because it was becoming a lot, becoming too much,” Phelps says. “We’re suffering as providers… We’re struggling to get back on our feet.”
Nonetheless, those offering occupational medicine services are determined to help Alaskans safely return to work.
“When someone comes to me, they’re like, ‘I cannot work and feed my family or pay my rent because I injured my back at work,” Tamaki says. “This is something I feel passionate about.” 