GARY L. JARVIS : Seeking an Orthopedic Edge : Irvine Medical Center Zeros In on Physical Rehabilitation

Times staff writer

When the Irvine Medical Center, Irvine's first hospital, opened its doors last month, it faced the challenge of trying to distinguish itself in the county's highly competitive hospital market.

One way it has tried to do that is with the development of the Physical Assessment and Reactivation (PAR) Center in the 12-story medical tower next door to the hospital.

The PAR center, containing about $500,000 worth of diagnostic and exercise equipment used for physical rehabilitation, was developed by American Medical International, the Dallas company that also owns the new hospital.

After operating for a year in Costa Mesa, the PAR center last March moved to the newly constructed medical building, where its staff is treating an average of 80 patients a day.

One of the PAR center's major purposes is to help the hospital achieve its goal of becoming a leader in the field of orthopedics.

The center's clinical director is Gary L. Jarvis. Trained in physical and occupational therapy, Jarvis for 14 years has been working as a private consultant to develop rehabilitation centers nationwide. He has helped to establish 20 such centers. He is a former executive vice president of the Texas Back Institute, a Plano, Tex., rehabilitation center.

Jarvis said that he and Dr. Vert Mooney, a Long Beach orthopedic surgeon who serves on the faculty of the UC Irvine College of Medicine and is an adviser at the PAR Center, were recruited to Irvine by AMI to establish a rehabilitation program that offers state-of-the-art technology and treatment techniques.

In an interview with Times staff writer Leslie Berkman, Jarvis talked about the center and significant trends in the rehabilitation of injured workers.

Q. What is the major difference between how you treat workplace injuries now and a decade ago?

A. Ten years ago, therapists were immobilizing most injuries for a lengthy period of time. The traditional treatment was to have someone lie on a table, apply deep heat and give him a massage.

But this center and many others in the country don't use that philosophy anymore. We do a very comprehensive muscle and skeletal evaluation of the patient's total body, focusing on the injured part. Then we start the patient on a stretching and strengthening program, moving him into a conditioning program using larger resistive exercise equipment.

Also, we want to start working with patients quickly, preferably the day after an injury, whereas in the past patients were sent home for bed rest.

Q. Why is exercise important in rehabilitation?

A. Therapists found that immobilization caused muscle atrophy and joint stiffness. Once with a sprained ankle you would be in a cast for two to three weeks. Now you get a tape support and you walk on it, exercising on an underwater treadmill.

Q. Does exercise get a patient back to work faster?

A. Definitely. Generally a patient with a back injury takes several months to get over it with passive therapy like heat applications and massage. With a more active program the patient usually can go back to his work or daily activities in six weeks or less.

Getting a person back to work quicker reduces medical and insurance costs for an employer. It also reduces production loss associated with hiring part-time people while an employee is off work.

Q. Are the injuries that people sustain in the workplace the same as a decade ago?

A. There are more injuries caused by repetitive motion because of the widespread use of computer terminals in business offices and greater pressure on American workers, from secretaries and carpenters to assembly workers, to increase their speed of production.

For instance, there has always been carpal tunnel syndrome (a repetitive motion injury to the wrist), but with the advent of more word processors, secretaries get it more often because they type faster and longer hours.

The key to preventing repetitive injury is to have people vary their jobs and do different motions during the day.

Q. It seems that industry is paying a lot more attention to these problems now.

A. Yes. That is because of the rising cost of workers' compensation insurance. Over the past 10 years, and especially in the last five, more large companies have been hiring safety engineers and risk managers. When a company moves to a new space or buys new equipment, someone is actually looking at the ergonomic issues now.

Q. Do you do any consulting to companies about what they can do to prevent injuries?

A. Yes. Here in the Irvine Spectrum, we have consulted with several companies. We were just at a computer software company where we were looking for ways to reduce repetitive motion injury among warehouse workers.

Everyone wants to develop the safest work space for their employees, but the Catch-22 is that it is sometimes prohibitively expensive to make changes to facilities and machinery.

Q. If a company cannot afford to remodel its facilities, is there anything else that can be done to reduce injury?

A. We suggest alternatives. Perhaps the company could build platforms so a worker is closer to his task or add grips to levers to make them better fit a worker's grasp. It may be something as simple as suggesting that someone who answers the telephone a lot get earphones rather than balance the receiver on his or her neck.

Q. I understand that you are working with local industries to develop simulated workplaces that can be used to determine if patients are ready to return to their jobs.

A. The PAR Center has a 10,000-square-foot facility that includes a variety of spaces designed like typical work environments.

There is a framed house that can be used by workers in construction trades, a loading dock, a gravel pit, an automotive work area, a woodworking area and a simulated office equipped with computerized business machines.

We treat a lot of flight attendants who are prone to getting back and shoulder injuries from pushing beverage carts and assisting passengers in putting luggage into overhead compartments and from opening large exit doors that can weigh up to 90 pounds. So we have a section that looks like the inside of an airplane. The airlines invited us to Los Angeles International Airport to take measurements of the bodies of airplanes.

Q. Is it a new concept to have patients go through the motions of their occupations before they actually return to work?

A. This concept is sometimes called job hardening and actually dates back to 1914. It was used to rehabilitate injured World War I soldiers to get them back on the battlefields. But later that concept got lost and more recently it has emerged as the most appropriate way to rehabilitate injured workers.

Q. What are the advantages of such job simulation?

A. Doing an activity that is germane to your work is a lot different from just lifting a barbell. It documents that workers can do the minimum job requirement so they are not released back to work before they are ready, in which case they could reinjure themselves.

Q. Does information from the testing help in selecting new occupations for disabled workers who cannot return to their former jobs?

A. We quantify what physical functions they can perform by, for example, measuring their sitting and standing tolerance and lifting capacity. The vocational evaluators take that information and use it along with the results of aptitude and psychological testing to make a more rational decision about what occupation someone should get retrained in.

Q. Do as many women as men injure themselves at work?

A. Yes, the workers' compensation statistics reported around the country show the ratio is about 50-50.

Q. Is it mostly heavy work that causes problems?

A. No. It is more the moderate to lightweight work that causes injury because it involves repetition over time.

Q. Is the treatment you provide at the PAR Center very costly?

A. Our average cost per patient is $1,100 for six weeks of 21 treatments.

Our rates for workers' compensation cases are the same as anybody else's because the state has set specific prices for each kind of treatment that is done.

Q. Is the PAR Center a marketing tool for the hospital?

A. It is a marketing vehicle for the hospital's orthopedic service and other services based at the hospital that have physicians that treat musculoskeletal injury and disease.

We run advertisements about the center in newspapers and business and sports journals, and we send mailings to homes and businesses. We advise the public that if you have pain, call us. When people call we refer them to appropriate physicians. We get calls from individuals with injuries as well as from corporate risk managers and occupational nurses, insurance companies and schools.

Q. Does the center do any research?

A. We have a nonprofit research foundation to study the causes of worker injuries and pinpoint the best therapies. Also, as orthopedic specialists move into the hospital's medical building, we will help them with their clinical research by evaluating the outcome of various surgical techniques.

Q. What is the state of the rehabilitation industry today? Is it growing?

A. Yes. There is a proliferation of outpatient physical and occupational rehabilitation centers. More physical therapists are leaving the employment of hospitals and going into private practice because it is more lucrative and because there is demand. There is also a trend for large companies like Baxter Corp. to establish rehabilitation centers in joint ventures with physicians.

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