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Are they worth their weight?? Peg Hau OT/CHT Advanced Physical Therapy & Sports Medicine.

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Presentation on theme: "Are they worth their weight?? Peg Hau OT/CHT Advanced Physical Therapy & Sports Medicine."— Presentation transcript:

1 Are they worth their weight?? Peg Hau OT/CHT Advanced Physical Therapy & Sports Medicine

2 In developing diagnostic tests, we must remember that it is better to miss an insincere individual than to classify a sincere patient as insincere. Tests must be chosen carefully, and if multiple tests are used, they must be administered in a logical order. Ahmer, 2007

3 History of the FCE A functional capacity evaluation is set of tests, practices and observations that are combined to determine the ability of the evaluated to function in a variety of circumstances, most often employment, in an objective manner 1970s beginning 2001critized as not being job specific Reneman et al, 2001

4 What is an FCE Evaluates and individuals ability to perform work axs related to his/her employment Similar types of testing Consists of standardized assessments Administered with care and safety in mind (Kuijer et al., 2011; Soer, et al., 2008).

5 Why are they ordered Baseline Pre employment Job Specific Medical/legal Assisting with case closure

6 Who can benefit from an FCE Individual injured on the job Applying for Social Security Disability Seeking to return to work after extended leave Someone seeking vocational rehabilitation Transition from school to work setting

7 FCEs are done on a one-on-one basis and may range in length from 4 to 6 hours. The FCE may take place over 2 consecutive days.

8 Components of an FCE History review – medical, vocational, social Screening tests – musculoskeletal Physical functional testing – based on DOT Job simulation – when identified job is known Behavior assessment Results, data compilation, and recommendations

9 Types of FCEs Matheson Ergo Science ARCON FCE Isernhagen Work System Blankenship Ergos Work Simuolator and Ergo Kit Variation Hanoun Medical WEST-EPIC Key AssessAbility

10 Ergo Science Developed in 1988 by Deborah Lechner PT,MS Administrators must complete 24 hours of instruction Used in 850 clinics

11 ARCON Science 30 years of development and refinement. 1,000 clinics nation wide

12 ARCON continued The Arcon system includes: * Computerized hand and pinch gauges. * Electronic goniometer. * Dual range of motion inclinometers. * Dynamic and isometric lifting system. * Carpal tunnel testing attachment. * Computerized heart rate monitor. Testing protocols includes: * Dynamic lifting. * Isometric testing extremities & back. * Range of motion testing. * Dexterity testing. * Endurance testing. * Activities of daily living.

13 Iserhagen Work System Susan J. Isernhagen PT created the first functional capacity evaluation in the mid 1980s. Redeveloped in 2004 Objectivity of results to replace the subjective estimates that were currently being used Medical base to tie the functional capacity and limitations into current diagnoses Information on level of effort, to identify those who used full effort and those who did not use full effort. Safety in functional tests so that this information could lead to safe return to work Work relatedness to determine abilities to perform specific jobs,

14 Iserhagen continued The Relevance for Nondiscrimination Compliance by Susan Iserhagen - 2010

15 Blankenship A unique FCE called the WORKEVALTM and it helps Physicians, Case Managers and Employers determine what work limitations are appropriate for the injured worker. We also provide Physicians with the objective data they need to determine the injured worker's Permanent and Partial Disability, or PPD. The name for this evaluation, which was developed and published by the American Medical Association, is a Permanent Impairment Evaluation. This evaluation process determines the percent of Permanent, Partial Impairment and that percentage is used to help Patients, Employers, Insurers and Attorneys negotiate the settlement of the Workers' Compensation Case.

16 Ergos Work Simulator

17 Hanoun Medical Strength & dexterity testing Protocols Fatigue analsyis software ????????????

18 Assessability Functional Medicine Evaluation (FME) vs. Functional Capacity Evaluation (FCE)

19 Key Glenda Key Founder and President 1987 300 clinics & 42 states Double blind testing

20 Physical Examination Heart rate and blood pressure Posture and gait Range of motion Strength Balance Other special testing as warranted

21 Functional Testing continued: Sustained overhead activity Climbing ladders Crouching/squatting/ stooping

22 Functional testing Floor to waist/ shoulder/overhead lift Carrying Push/pull

23 Functional Testing cont: Grip strength Pinch strength FMC/9 hole peg/Purdue Stereognosis

24 Less than Full Effort Performance Reasons for …….. 1. Medically determined impairments 2. Malingering 3. Factitious disorder 4. Learned illness behavior 5. Conversion disorder, pain disorder Matheson, 2003

25 Continued: 6. Depressive disorder 7. Test anxiety 8. Fear of symptom exacerbation or injury 9. Fatigue 10. Medication & psychoactive substance effects 11. Lowered self-efficacy expectations 12. Need to gain recognition for symptoms

26 Methods to identify inconsistancy Intra test inconsistency Absence of expected relationships among measures. Completion of tests and willingness to do more Coefficient of variation Rapid exchange grip Correlation of heart rate with reported max effort Correlation of impairment (range of motion, manual muscle tests, etc. ) to function

27 Non-Organic Signs Pain Questionaire Waddell McGill Pain Questionaire Ransford Numeric pain scale Million Visual Analogue


29 Million Visual Analogue Scale The Million visual analogue scale The Million visual analogue scale (MVAS) (Table 15) is a 15-item questionnaire about disability and pain intensity in patients with LBP. 38 The 15 questions investigate the body functions (pain, sleep, stiffness and twisting), daily activities (walking, sitting, standing and work) and social life. Information about item selection process is not available. Score is given on a 100 mm visual analogue scale(VAS). For example, if patients are asked to quantify the severity of his pain (like the first question), they mark a point on a 100-mm line in which the end points are labelled as no pain and intolerable. In each question, it is possible to obtain an index of severity of symptoms in a patient- specific fashion measuring the distance of the marked point from the origin of the line. The final score is calculated by adding up the equally weighted scores.15 38

30 Physical Demand Characteristics of Work

31 References Chapman-Day, K. M., Matheson, L. N., Schimanski, D., Leicht, J., & DeVries, L. (2011). Preparing difficult clients to return to work. Work (Reading, Mass.), 40(4), 359-367. doi:10.3233/WOR-2011- 1247; 10.3233/WOR-2011-1247 Gouttebarge, V., Kuijer, P. P., Wind, H., van Duivenbooden, C., Sluiter, J. K., & Frings-Dresen, M. H. (2009). Criterion-related validity of functional capacity evaluation lifting tests on future work disability risk and return to work in the construction industry. Occupational and Environmental Medicine, 66(10), 657-663. doi:10.1136/oem.2008.042903; 10.1136/oem.2008.042903 Gouttebarge, V., Wind, H., Kuijer, P. P., Sluiter, J. K., & Frings-Dresen, M. H. (2010). How to assess physical work-ability with functional capacity evaluation methods in a more specific and efficient way? Work (Reading, Mass.), 37(1), 111-115. doi:10.3233/WOR-2010-1084; 10.3233/WOR-2010- 1084 Streibelt, M., Blume, C., Thren, K., Reneman, M. F., & Mueller-Fahrnow, W. (2009). Value of functional capacity evaluation information in a clinical setting for predicting return to work. Archives of Physical Medicine and Rehabilitation, 90(3), 429-434. doi: Westbrook, A. P., Tredgett, M. W., Davis, T. R., & Oni, J. A. (2002). The rapid exchange grip strength test and the detection of submaximal grip effort. The Journal of Hand Surgery, 27(2), 329-333. Wind, H., Gouttebarge, V., Kuijer, P. P., Sluiter, J. K., & Frings-Dresen, M. H. (2009). Effect of functional capacity evaluation information on the judgment of physicians about physical work ability in the context of disability claims. International Archives of Occupational and Environmental Health, 82(9), 1087-1096. doi:10.1007/s00420-009-0423-8; 10.1007/s00420-009-0423-8

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