Work hardening, presented in this paper as a "new" service for the industrially injured, is actually well grounded in the traditional models and practices of occupational therapy. From the profession's early roots in industrial therapy to the development of a variety of programs for the industrially injured through the 1950s and 1960s, the historical and philosophical bases of occupational therapy support the use of work as an evaluative and therapeutic medium. What is actually new is the adoption of terminology, technology, and a program format that fits in with the needs of consumers in the 1980s. Recent developments that created the need for the specialized services that occupational therapists are uniquely qualified to provide include growth of private sector vocational rehabilitation, changes in workers' compensation laws, and increasing costs of vocational rehabilitation. This paper describes work hardening in its present form. A case example is given that demonstrates how work hardening can be a cost-effective and time-saving bridge which spans the gap between curative medicine and the return to work.

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Trauma and disease processes in the upper extremity frequently cause pain as well as impairment in movement, strength and in function. While perception of pain occurs normally in response to bodily insult, prolonged or severe pain may interfere with attempts to maximize physical function and the return the involved person to optimal occupational role. Whether participating as a member on a medical or vocational rehabilitation team, the occupational therapist must adequately assess the area, nature and behavior of pain prior to providing appropriate intervention and recommendations to other team members. A structured interview to assess pain furnishes the therapist with a format for evaluation that is thorough and methodical. The structure and process of the interview allows the therapist to collect subjective information which can be coupled with objective findings from standard upper extremity evaluation and/or observation of task performance. Data gathered will assist the therapist in discovering the etiology of pain, in evaluating the appropriateness of complaints as they relate to pathology and in making appropriate recommendations about the patient's future work roles.