Work and Functional Conditioning Industry (NSW)
Standard of Practice

The following standard of practice for work and functional conditioning service providers was developed in consultation with a wide variety of professions and organisations. These included the Australian Physiotherapy Association, Australian Association for Exercise and Sports Science, Australian Association of Occupational Therapists, Association of Rehabilitation Providers in the Private Sector, Comcare, Motor Accidents Authority, WorkCover Authority, Insurers and service providers, with the specific aims of developing:

1. Consistent definitions of Work Conditioning and Functional Conditioning

2. Standard of practice to be used in a self regulatory way by service providers

The consultation was driven by a four-person working party meeting on a bi-weekly basis that reported directly to industry advisors for ongoing guidance and direction. The following standard were developed in consultation with all these parties and are to be considered as a self regulatory guide for both providers and purchasers of work and functional conditioning services.

Given the large number of such service providers in existence and entering the market it was envisioned that those operators would adopt a self-assessment and regulatory stance and those purchasers would be able to set their services against a minimum standard.

It is important to note that this standard is not for accreditation purposes and it is considered that this standard will be used on an industry basis and adopted accordingly. It is also not a vehicle whereby people who are willing to practice such programmes are precluded from the market but is more a tool for those who wish to enter and/or are currently providing these services to achieve a minimum service standard.

Models of delivery
CENTRALISED - clinic/centre (client commutes to a central point for work conditioning or functional conditioning
DECENTRALISED - branch/clinic onsite (client commutes to a local point for work conditioning or functional conditioning
MOBILE - (service provider commutes to the client to provide work conditioning or functional conditioning

Mode of delivery
Individual "one on one" programs.
Group programs.

Settings of service delivery
Clinic, Gymnasium, Workplace, Hospital, Home, Other.

Note:
The Work and Functional Conditioning Industry Working Party acknowledge that various other forms of physical conditioning programs such areas as recreational and sporting pursuits exist.
It is not the intention of the Work and Functional Conditioning Industry Working Party to attempt to define these

STANDARD OF PRACTICE

For the provision of work conditioning and functional conditioning programmes.

The service provider should be knowledgeable of ethical and legal implications related to the provision of work conditioning and functional conditioning programmes. The service provider should:

1.1. Recognise the implications of any national and state political and industrial workers compensation regulations and CTP injury compensation systems

1.2. Perform according to acts, regulations, codes of practice and organisational requirements for manual handling and occupational health and safety legislation

1.3. Act within health regulations

1.4. Abide by the Information Privacy Principles ¹ which includes maintaining client confidentiality, the manner in which personal information is collected, informed consent, limited disclosures

1.5. Be cognisant of legal liability

1.6. Maintain professional accountability to all involved parties

1.7. Retain appropriate professional indemnity and public liability insurance

The service provider should be able to demonstrate an appropriate level of professionalism, skills and competencies for all clinical staff.

2.1. Clinical staff must have qualifications as recognised by participating professional bodies. Professional bodies are: Australian Physiotherapy Association, Australian Association of Exercise and Sports Scientists, Occupational Therapy Australia, Australian Medical Association.

2.2. All staff to demonstrate background knowledge, skills and competencies relevant to their role

2.3. Demonstrate related experience pertaining to musculoskeletal assessment, exercise prescription, programme management, programme evaluation and legislation within the industry context.

2.4. Maintains association/professional memberships

2.5. All staff participate in ongoing training and professional development

The service provider is able to supply documentation on organisation structure and administrative procedures to referring organisations. This documentation includes:

3.1. A mission statement

3.2. Policies and procedures

3.3. Programme structure and delivery roles

3.4. Clearly stated criteria used for outcome measurement

3.5. Record keeping procedures

3.6. Record of ongoing verbal and/or written communication to all relevant parties

3.7. A complaints procedure

The service provider should be able to demonstrate that the facilities and equipment utilised in the provision of work conditioning and functional conditioning programmes are safe and appropriate for that activity. The service provider should:

4.1. ensure that venue is suitable in size, space, safety and access

4.2. provide frequent, regular maintenance and calibration of equipment as recommended by the manufacturer.

4.3. comply with relevant health regulations.

4.4. Appropriate range of equipment to simulate work and functional tasks

The service provider should be able to demonstrate knowledge of appropriate risk stratification and emergency procedures as applicable to the provision of work conditioning and functional conditioning programmes. As it applies to:

5.1. client assessment procedures in determination of function, rehabilitation programming and supervision

5.2. safe equipment use

5.3. managing cardiopulmonary and other types of emergencies that may be encountered with clients undergoing exercise programmes

5.4. The service provider and staff must retain appropriate qualifications/certification in this regard (CPR/First Aid I certificate).

The service provider should provide a structured programme encompassing the following components:

6.1. Written inclusion and exclusion criteria

6.2. Acquisition of past treatment/medical records

6.3. Musculoskeletal assessment findings indicating symptom irritability and anticipated tolerance to physical conditioning

6.4. Pre & post programme evaluations that are objective and reproducible

6.5. Stated duration

6.6. Determination of client appropriateness for programme

6.7. Determination of client appropriateness for continuing the programme

6.8. Mechanism for reporting to referrer if client deemed inappropriate for programme

6.9. Mechanism for reporting to all relevant parties on client needs and recommendations for programme management

6.10. Determination of achievable goals and objectives for

6.10.1. the programme

6.10.2. the client within the programme

6.10.3. the cessation of the programme

6.11. Ongoing client supervision

6.11.1. element of individual or group supervision

6.11.2. encouragement toward exercise autonomy when appropriate

6.11.3. defined process of transition to independent exercise

6.12. Educational component specific to workplace and/or functional demands, including:

6.12.1. manual handling procedures

6.12.2. injury prevention

6.12.3. activities of daily living

6.12.4. basic ergonomics

6.13. Integration of programme delivery and work place rehabilitation goals

The service provider should maintain an appropriate level of professional communication with all relevant parties involved in the rehabilitation process. Relevant parties involved may include the following:

client
referrer
rehabilitation provider
insurer
treating physician
specialist rehabilitation provider
other associated professionals
workplace

The service provider should maintain and store appropriate records documenting provision of work conditioning and functional conditioning programmes and delivery of care to clients. Documents should include:

8.1. Medical clearance for participation in the programme

8.2. Programme information and expected outcomes

8.3. Informed consent to participate in programme

8.4. Information release consent

8.5. All assessment information

8.6. Clinical findings requiring further referral

8.7. Ongoing client’s response to rehabilitation programme

8.8. Documents recording assessment of level of adherence to programme

8.9. Record of communication to all parties e.g. file notes

8.10. Written information about the programme and expected outcomes be provided to the insurer

8.11. Progress reports

The service provider should be able to demonstrate a commitment to ongoing professional development and the industry. The service provider should:

9.1. Support professional industry bodies

9.2. Support industry initiatives

9.3. Demonstrate a commitment to evidence based practice by:

9.3.1. keeping abreast with current research

9.3.2. having a willingness to participate in clinical research

Fees charged by the service provider for the provision of work conditioning and functional conditioning programmes should be in accordance with the type of service provided and associated professional involvement. Fees should:

10.1. be clearly stated and approved prior to service delivery

10.2. be cost effective

10.3. reflect the service provided

10.4. reflect the degree of supervision

10.5. reflect the level of reporting

Service providers to have an understanding and commitment to the principles of best practice ² at all times. Service providers should:

11.1. seek client feedback

11.2. objectively evaluate results of programme

11.3. improve services as identified by results of evaluation

11.4. adopt evidence based practice

1. a. "Plain English Guidelines to the Information Privacy Principles"
can be purchased direct from the Office of the Privacy Commissioner.

    b. Information Privacy: Code of Practice (May, 1996)
Available from the NSW Department of Health or can be downloaded from www.health.nsw.gov.au

2. Advisory note on best practice:

Best practice is not a platform that one simply reaches, but a dynamic process of continuous improvement.

To achieve best practice, there should be evidence of a cyclical process involving

1. Monitoring
2. Evaluating
3. Planning
4. Implementing improved systems, procedures and practices

3. Reference:

NSW Fitness Industry Code of Practice available at:
Fitness NSW 139 Alexander Street, Crows Nest NSW 2065 Australia