1. Peoples Injury Network NW (PINN)
PINN is an Industrial Rehabilitation therapy provider
We have been in business for over 12 years
Each PINN Clinic specializes in treating the Injured Worker through a multidiscipline approach with both Physical & Occupational Therapy
PINN has a thorough understanding of the industrial rehabilitation needs of the Injured Worker
Our PINN Clinics are at least 5,000 square feet in size

2. Peoples Injury Network NW (PINN)
What services do we provide? Physical Therapy Work Conditioning Work Hardening Physical Capacity Evaluations (PCE’s) Ergonomic Assessments On-Site Services for Job Analysis & Job Modification Extended Evaluations Vibrasym Driving Evaluation (PINN Kent) Post-Operative Testing

3. PBPCE – Performance Based Physical Capacity Evaluation
FCE
Functional Capacity Evaluation
Presented by:
Peoples Injury Network Northwest, (PINN)

4. Physical Capacity Evaluation
Is “a process of measuring an individual’s ability to dependably sustain performance in response to broadly defined physical work demands over time”

5. A Physical Capacity Evaluation can…
Evaluate current work tolerances and potential work capacity
Provide information to help determine if an individual can return to the usual occupation or perform the work demands of a new job being considered
If no vocational goals are established provide guidelines related to the individual’s physical capacities to assist with the vocational exploration process
Assist the Medical Professional in completing the Attending Physician Form (APF)

6. PCE’s should be performed with the following practice hierarchy:
Safety
Reliability
Validity
Practicality
Utility
Respect
Safety: when used properly the test must not be expected to lead to injury
Reliability: Test scores must be dependable across evaluators, evaluees, and the time of test administration. Effort testing is vital to ensure reliable results.
Validity: The test must measure what it intended to be measured and must predict or reflect performance of a target task.
Practicality: Requires reasonable direct and indirect costs of test procedures
Utility: Testing procedures must meet the needs of the referrer, payer and evaluee
Respect for the person being evaluated

7. Who can request a PCE? Doctors Chiropractors Claims Managers Attorneys
Vocational Rehabilitation Counselors
Nurse Case Managers

8. Initial Contact with the Client
Explain the purpose of the evaluation
Collect reliable information
Current physical and functional abilities as that relates to vocational considerations
Inform the client that they need to participate with:
High level of effort
Reliability of Pain and Disability Report
Do not perform any activity that they perceive to be unsafe
Explain the purpose of the evaluation
Is to collect reliable information about current physical and functional abilities as that relates to vocational considerations
Inform the client that they need to participate with 1. High level of effort, 2. Reliability of Pain and Disability Report and 3. But to not perform any activity that they perceive to be unsafe

9. Physical Capacity Evaluation’s
Usually 1-2 days
Determine level of physical effort and reliability of pain and disability report.
Evaluator must be objective
Should answer the referral sources questions

10. Oregon PCE Levels First Level PCE-
Limited evaluation primarily to measure musculoskeletal components of a specific body part
Active range of motion
Motor Power Using the 5/5 scale
Sensation
No less than 45 minutes of actual patient contact
OAR (4)(a)

11. Oregon PCE Levels continued
Second Level PCE
This evaluation is to measure general residual function capacity to perform work or provide other general information.
Musculoskeletal evaluation
To establish Residual Functional Capacities for claim closure
No less than two hours of patient contact
OAR (4)(b)

12. Oregon PCE Levels continued
Third Level PCE (WCE)-
This is a Residual Functional Capacities evaluation.
Musculoskeletal evaluation for a single body part
Endurance
Assess ability to perform essential physical functions of the job based on a specific job analysis as related to the accepted condition
Assess ability to sustain activity over time
Assess reliability of the evaluation findings
No less than 4 hours of patient contact
OAR (4)(c)
When providing a PCE for a WA State WC Claim, our clinics always provide the Level 3 PCE which typically results in a 6 hour evaluation.

13. Interviewing Strategies
Give brief explanation of what to expect in the evaluation
Privacy
Communicate Respect
Establish Rapport
Have tissues and extra pens available
Other areas considered:
Sit with client having an escape route
Sit “open” to the client to their side
Avoid phone calls and interruptions
Reinforce client’s sense of control
Focus on function
Listen to the client’s reported symptoms and dysfunction but redirect when appropriate

14. Interview Process Mechanism of Injury DOI/Onset & Diagnosis
Physician/ Physician restrictions
Diagnostic Testing
Medications
Age
Other Items reviewed:
Claim #
Rehabilitation Specialists
Mechanism of Injury
Physician restrictions
Diagnosis
Previous medical treatment
Physician Insurance
Diagnostic Testing
Referral Source
Medications
Attorney
Pain Clinics
Age
Assistive Devices
DOI/Onset
Hand Dominance
Occupation
Surgery
Employer
Treatment
Vocational Counselor
Other medical conditions
Claims manager
Present complaints (what makes sx worse or better)

15. Interview continued Assistive Devices
Previous medical treatment & Other medical conditions
Current sleep duration
ADL’s
Subjective Tolerance Levels
Examples of ADL’s:
Self Care
Household Chores
Yard Work
Car Maintenance
Shopping
Recreation/Hobbies
Exercise
Rest Periods
Subjective Tolerance Level Examples:
Sitting
Standing
Walking
Full Time Tolerance
Lifting/Carrying/Push/Pull/Squat/Crouch/Bend/Stoop/Kneel/Crawl/Climb/Balance/Twist/Reach and Hand use/Foot Controls

16. Objective Data Height Weight Blood Pressure Pulse Smoker Alcohol Usage
Medication Usage

17. A PCE Summary should include
Sitting, Standing, Walking Tolerance
Total hours alternating sit/stand/walk at one time
Total hours alternating stand/walk (being on feet)
Lifting capability frequency and levels
Carry capability frequency and levels
Push/Pull capability frequency and levels
Sitting, Standing, Walking Tolerance at a time and total hours in an 8 hour day
Total hours alternating sit/stand/walk at one time and total hours in an 8 hour day
Total hours alternating stand/walk (being on feet) hours at a time and total hours in an 8 hour day
Lifting capability frequency and levels
Carry capability frequency and levels
Push/Pull capability frequency and levels

18. PCE summary continued Reaching Fine Manipulation, pinching
Grasping, gripping, forceful grasp
Operate foot controls
Operate hand controls
Twisting
Squatting
Kneeling
Bend/Stoop
Crouch
Climb Stairs
Climb Ladders
Crawling

19. Job Analysis Definition
A Job Site Analysis is a detailed description of the essential and non-essential job tasks/functions and the relevant physical demands to perform the essential and non- essential job tasks.
PCE should address the client’s demonstrated physical and functional tolerances in relation to essential job tasks and required physical demands.

20. THE PHYSICAL DEMAND LEVELS OF WORK
PHYSCIAL DEMAND LEVEL
OCCASIONAL*
0 – 33% OF TIME
FREQUENT*
34 – 66% OF TIME
CONSTANT*
67 – 100% OF TIME
SEDENTARY
10 lbs.
Negligible
LIGHT
20 lbs.
(walk/stand and/or push/pull of arm-leg controls)
Negligible (push/pull of arm-leg controls while sitting)
MEDIUM
50 lbs.
HEAVY
100 lbs.
VERY HEAVY
Over 100 lbs.
Over 50 lbs.
Over 20 lbs.
*Occasional, Frequent, and Constant are terms defined by the Dictionary of Occupational Titles that refer to the frequency of “exerting a force,” including lifting, carrying, pushing, pulling, or any other physical activity.

21. Physical Effort
“Physical Effort Testing concerns to an individuals levels of physical exertion during encountered testing procedures. This type of testing is best evaluated via a multi-facted approach under distraction based clinical conditions. Results of such testing are not intended to imply intent” (Kyi, )

22. Three categories of physical effort testing
Isometric – Jamar Grip
Cardiovascular – EPIC and NIOSH heart rate guidelines
Behavioral

23. Jamar Grip Strength Rapid Exchange Bell Curve & SD
Jamar Dynamometer Evaluates:
Strength Consistency of effort
Rapid Exchange
Bell Curve & SD
Coefficient variation cut points

24. Cardiovascular NIOSH 65-70% of age predicted maximum
EPIC - >150% of Standing Resting Heart Rate

25. Behavioral (Competitive Test Performance)
“The musculoskeletal and/or behavioral tendency to maximize one’s test score and performance under evaluation conditions. CTP is best evaluated in a distraction-based testing environment (Kyi, RMA)

26. Musculoskeletal Evaluation
Posture and Alignment
Flexibility/mobility
Strength
Neurological Examination
Gait
Special Tests Waddell and Placebo Tests
Movement patterns, quality of movement, comparison of movement and pain
Palpation

27. Special Tests Finklestein’s Test Phalen’s Test Tinel’s Sign
Femoral Nerve Test
Straight-Leg Raise Test
Patrick’s test (FABERE)
Thomas Test
Cubital Tunnel Syndrome
Yergasson’s Test
Waddell’s Non-Organic Physical Signs and Placebo test
Finklestein’s Test – DeQuervain’s tenosynovitis
Phalen’s Test – CTS
Tinel’s Sign – CTS
Femoral Nerve Test – presence of femoral nerve root compression
Straight-Leg Raise Test – sciatic nerve root tension or compression
Patrick’s test (FABERE) – arthritis in the hip joint
Thomas Test – flexion contracture of the hip joint
Cubital Tunnel Syndrome –
Yergasson’s Test – determine integrity of the transverse humeral ligament
Waddell’s Non-Organic Physical Signs and Placebo test– To determine Reliability of Pain and Disability Report

28. Objective Data Posture Range of Motion Gait
PCE should determine if these objective findings are or are not reliable and consistent as the client did/did not self limit secondary to reported pain

29. When to stop/terminate testing
Biomechanical
Cardiovascular – Metabolic
Psychophysical
Blood Pressure exceeds 160/100
Heart rate exceeds the target zone of 85% of MAAHR
Client develops chest pain, nausea, vomiting, dizziness, blurred vision, pale
Client is unsafe or is unable to perform activity or movement patterns
Request to stop

30. Types of Testing MET/Endurance Testing Risk Factors
Single Stage Treadmill Protocol
Modified Bruce Treadmill Test
Balke Substandard Treadmill Test
Bench Step Test
Circuit Testing (Material Handling or non-material handling)
MET/Endurance Testing
Risk Factors
Have you had a heart attack?
Have you ever had heart surgery?
Have you had an abnormal electrocardiogram
Do you have heart disease?
Have you been told by a physician you have had angina?
Have you been told by a physician you have had palpitations?
Have you had a stroke?
Is the blood pressure 160/100 or higher
Are you pregnant?

31. Lifting Purpose is to assess safe maximum occasional lifting capacity
Instructions for specific test protocol and safety
Termination of the Tests:
1. biomechanical failure
2. heart rate
3. client request

32. Dynamic Lifting, Carrying, Pushing or Pulling
Isoinertial Lifting
PILE test, Lumbar PILE and the Cervical PILE
WEST II Lifting Evaluation
EPIC
Normative data for maximum acceptable weights and forces
Stover H.Snook and V.M.Ciriello
Ergonomics,1991 vol. 34, No.9,
Isoinertial Lifting – floor to knuckle, knuckle to shoulder, shoulder to overhead, carry task 30’, push, pull
PILE test – standardized lifting test, Lumbar PILE and the Cervical PILE
WEST II Lifting Evaluation
EPIC – researched based lifting protocol

33. Repetitive or sustained material handling or work postures
Endurance circuit to determine Frequent Material Handling or Frequent tolerances for work postures
Work simulation to determine Frequent or Constant tolerances for work postures
Performed in minute increments

34. Standardized Testing Method-Time Measurement
“is a procedure which analyzes any manual operation or method into the basic motions required to perform it and assigns to each motion a predetermined time standard which is determined by the nature of the motion and the conditions under which the motion is made”
In practice, 100% MTM refers to an objectively-derived entry-level production standard on a given work sample to which the evaluees’ performance can be compared

35. MTM vs. Normative
MTM - Based on Industry standards which are more reliable in determining suitability to a job
Normative - Based on a sample population may be biased by race, gender
Percentile scores do not necessarily predict whether or not someone meets industry standards

36. Introduction to Standardized Tests
Reliability and Validity
Assess the various diagnoses of the clients to be seen
Can used assess the type of industry near the clinic and the type of work performed
Can be used for evaluation or work simulation

37. Valpar 9 (Whole Body ROM) and West 7 Bus Bench
Evaluates physical tolerances for prolonged standing, repetitive and sustained horizontal reaching, stooping , prolonged light strength work, hand and finger dexterity

38. Mobility Valpar 9 (Whole Body ROM) WEST 7 Bus Bench Balancing Crawling
Stairs
Ladder
Flexibility
Squatting
Crouching

39. Purdue Pegboard
Used to evaluate a person’s ability to manipulate very fine objects.

40. Minnesota Rate of Manipulation
Evaluates a person’s ability to manipulate small objects

41. Valpar 202
Four tests that require proper selection, placement and use of hand tools.

42. Bennett Hand Tool Dexterity Test
Evaluates manipulative skill independent of intellectual factors such as understanding of mechanical principles or the ability to plan a task or follow directions

43. Crawford Small Parts Dexterity Test
Measures dexterity or hand function

44. Pinch Grip Measures strength and dexterity 3 point or palmer pinch
Tip pinch or finger pinch
Lateral pinch

45. Jamar Grip Strength Evaluates: Strength Consistency of effort
Jamar Dynamometer
Evaluates: Strength Consistency of effort
Rapid Exchange
Bell Curve & SD
Coefficient variation cut points

46. Reliability of Pain and Disability Reports
RPDR “involves completion of a battery of tests designed to asses the dependability and accuracy of a client’s subjective reports of pain and associated disability. The battery includes test which evaluate the presence or absence of non-organic findings as well as tests which compare a client’s subjective report to their demonstrate ability through distraction- based clinical observations.”

47. SORTS
Use to obtain a subjective rating of perceived ability to perform various household, work and daily activities
Use for evaluation of client’s with a wide variety of physical limitations
Evaluates “work function themes”
Evaluates “ unrealistic self-perception of ability”

48. SORT Tools WEST Tool Sort/Loma Linda Activities Sort
PACT Spinal Function Sort
EPIC Hand Function Sort

49. Functional Pain Scale 0 = no pain
1-2 = pain is present but not limiting
3-4 = pain is starting to affect your ability to perform current activity
5 = pain causes you to be unable to complete current activity
7 = you cannot use or move the painful area, can’t talk, are tearful, need to lie down
10 = requires immediate hospitalization

50. Waddell and Placebo test
Performed during assessment of range of motion, strength and movement patterns

51. Repetitive Movement Testing
Performed Pre and Post testing
Look for change in movement patterns in comparison to reported pain and disability
Look for change in performance time in comparison to reported pain and disability

52. Feasibility
“The acceptability of the worker in the general sense i.e. worker traits and behaviors” The person being evaluated perceives themselves in the “worker role” and not in the “patient” role.

53. Red Flags for Feasibility
Lack of attention to the evaluator
Resistance to testing - voiced refusal or fearful of testing
Signs of Anger
Descriptions are too explicit or vague
No future goals or goals are simple with no detail
Want a better doctor to “fix them”
Lack of active control of symptoms

54. Red Flags continued
Regional symptoms that do not make anatomical sense
Inactive lifestyle or “couch potato”
Has others perform ADL’s/chores
Reinforcement of behaviors by others
Noncompliance
Length of time off work is extensive

55. Resolving Feasibility
Evaluate Physical effort and RPDR
Intervene and confront the evaluee in a respectful manner to attempt to foster physical effort and RPDR
Document the PCE to provide functional validity.
It is the skilled evaluators job to evaluate the client in regards to 1. Physical effort and 2. RPDR
It is the skilled evaluators job to intervene and confront the client in a respectful manner to attempt to foster physical effort and RPDR
It is the skill evaluators job to document the PCE to provide functional validity.

56. Questions?

57. Bibliography
U.S. Department of Labor Dictionary of Occupational Titles, fourth Edition
Washington State Labor and Industries
Roy Matheson and Associates
Department of Consumer and Business Services Workers Compensation Division

58. The End

59. Peoples Injury Network Northwest, (PINN)
Thank you
Peoples Injury Network Northwest, (PINN)

60. Peoples Injury Network NW
PINN Kent
th Ave S
Kent, WA 98032
PINN Olympia
2120 Mottman Rd
Tumwater, WA 98512
PINN Tacoma
6704 Tacoma Mall Blvd Tacoma, WA 98409
PINN Vancouver
2501 SE Columbia Way Suite 120
Vancouver, WA 98661