Presentation on theme: "Peoples Injury Network NW (PINN)"— Presentation transcript:
1Peoples Injury Network NW (PINN) PINN is an Industrial Rehabilitation therapy providerWe have been in business for over 12 yearsEach PINN Clinic specializes in treating the Injured Worker through a multidiscipline approach with both Physical & Occupational TherapyPINN has a thorough understanding of the industrial rehabilitation needs of the Injured WorkerOur PINN Clinics are at least 5,000 square feet in size
2Peoples 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
4Physical 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”
5A Physical Capacity Evaluation can… Evaluate current work tolerances and potential work capacityProvide information to help determine if an individual can return to the usual occupation or perform the work demands of a new job being consideredIf no vocational goals are established provide guidelines related to the individual’s physical capacities to assist with the vocational exploration processAssist the Medical Professional in completing the Attending Physician Form (APF)
6PCE’s should be performed with the following practice hierarchy: SafetyReliabilityValidityPracticalityUtilityRespectSafety: when used properly the test must not be expected to lead to injuryReliability: 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 proceduresUtility: Testing procedures must meet the needs of the referrer, payer and evalueeRespect for the person being evaluated
7Who can request a PCE? Doctors Chiropractors Claims Managers Attorneys Vocational Rehabilitation CounselorsNurse Case Managers
8Initial Contact with the Client Explain the purpose of the evaluationCollect reliable informationCurrent physical and functional abilities as that relates to vocational considerationsInform the client that they need to participate with:High level of effortReliability of Pain and Disability ReportDo not perform any activity that they perceive to be unsafeExplain the purpose of the evaluationIs to collect reliable information about current physical and functional abilities as that relates to vocational considerationsInform 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
9Physical Capacity Evaluation’s Usually 1-2 daysDetermine level of physical effort and reliability of pain and disability report.Evaluator must be objectiveShould answer the referral sources questions
10Oregon PCE Levels First Level PCE- Limited evaluation primarily to measure musculoskeletal components of a specific body partActive range of motionMotor Power Using the 5/5 scaleSensationNo less than 45 minutes of actual patient contactOAR (4)(a)
11Oregon PCE Levels continued Second Level PCEThis evaluation is to measure general residual function capacity to perform work or provide other general information.Musculoskeletal evaluationTo establish Residual Functional Capacities for claim closureNo less than two hours of patient contactOAR (4)(b)
12Oregon PCE Levels continued Third Level PCE (WCE)-This is a Residual Functional Capacities evaluation.Musculoskeletal evaluation for a single body partEnduranceAssess ability to perform essential physical functions of the job based on a specific job analysis as related to the accepted conditionAssess ability to sustain activity over timeAssess reliability of the evaluation findingsNo less than 4 hours of patient contactOAR (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.
13Interviewing Strategies Give brief explanation of what to expect in the evaluationPrivacyCommunicate RespectEstablish RapportHave tissues and extra pens availableOther areas considered:Sit with client having an escape routeSit “open” to the client to their sideAvoid phone calls and interruptionsReinforce client’s sense of controlFocus on functionListen to the client’s reported symptoms and dysfunction but redirect when appropriate
14Interview Process Mechanism of Injury DOI/Onset & Diagnosis Physician/ Physician restrictionsDiagnostic TestingMedicationsAgeOther Items reviewed:Claim #Rehabilitation SpecialistsMechanism of InjuryPhysician restrictionsDiagnosisPrevious medical treatmentPhysician InsuranceDiagnostic TestingReferral SourceMedicationsAttorneyPain ClinicsAgeAssistive DevicesDOI/OnsetHand DominanceOccupationSurgeryEmployerTreatmentVocational CounselorOther medical conditionsClaims managerPresent complaints (what makes sx worse or better)
15Interview continued Assistive Devices Previous medical treatment & Other medical conditionsCurrent sleep durationADL’sSubjective Tolerance LevelsExamples of ADL’s:Self CareHousehold ChoresYard WorkCar MaintenanceShoppingRecreation/HobbiesExerciseRest PeriodsSubjective Tolerance Level Examples:SittingStandingWalkingFull Time ToleranceLifting/Carrying/Push/Pull/Squat/Crouch/Bend/Stoop/Kneel/Crawl/Climb/Balance/Twist/Reach and Hand use/Foot Controls
17A PCE Summary should include Sitting, Standing, Walking ToleranceTotal hours alternating sit/stand/walk at one timeTotal hours alternating stand/walk (being on feet)Lifting capability frequency and levelsCarry capability frequency and levelsPush/Pull capability frequency and levelsSitting, Standing, Walking Tolerance at a time and total hours in an 8 hour dayTotal hours alternating sit/stand/walk at one time and total hours in an 8 hour dayTotal hours alternating stand/walk (being on feet) hours at a time and total hours in an 8 hour dayLifting capability frequency and levelsCarry capability frequency and levelsPush/Pull capability frequency and levels
18PCE summary continued Reaching Fine Manipulation, pinching Grasping, gripping, forceful graspOperate foot controlsOperate hand controlsTwistingSquattingKneelingBend/StoopCrouchClimb StairsClimb LaddersCrawling
19Job 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.
20THE PHYSICAL DEMAND LEVELS OF WORK PHYSCIAL DEMAND LEVELOCCASIONAL*0 – 33% OF TIMEFREQUENT*34 – 66% OF TIMECONSTANT*67 – 100% OF TIMESEDENTARY10 lbs.NegligibleLIGHT20 lbs.(walk/stand and/or push/pull of arm-leg controls)Negligible (push/pull of arm-leg controls while sitting)MEDIUM50 lbs.HEAVY100 lbs.VERY HEAVYOver 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.
21Physical 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, )
22Three categories of physical effort testing Isometric – Jamar GripCardiovascular – EPIC and NIOSH heart rate guidelinesBehavioral
24Cardiovascular NIOSH 65-70% of age predicted maximum EPIC - >150% of Standing Resting Heart Rate
25Behavioral (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)
26Musculoskeletal Evaluation Posture and AlignmentFlexibility/mobilityStrengthNeurological ExaminationGaitSpecial Tests Waddell and Placebo TestsMovement patterns, quality of movement, comparison of movement and painPalpation
27Special Tests Finklestein’s Test Phalen’s Test Tinel’s Sign Femoral Nerve TestStraight-Leg Raise TestPatrick’s test (FABERE)Thomas TestCubital Tunnel SyndromeYergasson’s TestWaddell’s Non-Organic Physical Signs and Placebo testFinklestein’s Test – DeQuervain’s tenosynovitisPhalen’s Test – CTSTinel’s Sign – CTSFemoral Nerve Test – presence of femoral nerve root compressionStraight-Leg Raise Test – sciatic nerve root tension or compressionPatrick’s test (FABERE) – arthritis in the hip jointThomas Test – flexion contracture of the hip jointCubital Tunnel Syndrome –Yergasson’s Test – determine integrity of the transverse humeral ligamentWaddell’s Non-Organic Physical Signs and Placebo test– To determine Reliability of Pain and Disability Report
28Objective 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
29When to stop/terminate testing BiomechanicalCardiovascular – MetabolicPsychophysicalBlood Pressure exceeds 160/100Heart rate exceeds the target zone of 85% of MAAHRClient develops chest pain, nausea, vomiting, dizziness, blurred vision, paleClient is unsafe or is unable to perform activity or movement patternsRequest to stop
30Types of Testing MET/Endurance Testing Risk Factors Single Stage Treadmill ProtocolModified Bruce Treadmill TestBalke Substandard Treadmill TestBench Step TestCircuit Testing (Material Handling or non-material handling)MET/Endurance TestingRisk FactorsHave you had a heart attack?Have you ever had heart surgery?Have you had an abnormal electrocardiogramDo 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 higherAre you pregnant?
31Lifting Purpose is to assess safe maximum occasional lifting capacity Instructions for specific test protocol and safetyTermination of the Tests:1. biomechanical failure2. heart rate3. client request
32Dynamic Lifting, Carrying, Pushing or Pulling Isoinertial LiftingPILE test, Lumbar PILE and the Cervical PILEWEST II Lifting EvaluationEPICNormative data for maximum acceptable weights and forcesStover H.Snook and V.M.CirielloErgonomics,1991 vol. 34, No.9,Isoinertial Lifting – floor to knuckle, knuckle to shoulder, shoulder to overhead, carry task 30’, push, pullPILE test – standardized lifting test, Lumbar PILE and the Cervical PILEWEST II Lifting EvaluationEPIC – researched based lifting protocol
33Repetitive or sustained material handling or work postures Endurance circuit to determine Frequent Material Handling or Frequent tolerances for work posturesWork simulation to determine Frequent or Constant tolerances for work posturesPerformed in minute increments
34Standardized 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
35MTM vs. NormativeMTM - Based on Industry standards which are more reliable in determining suitability to a jobNormative - Based on a sample population may be biased by race, genderPercentile scores do not necessarily predict whether or not someone meets industry standards
36Introduction to Standardized Tests Reliability and ValidityAssess the various diagnoses of the clients to be seenCan used assess the type of industry near the clinic and the type of work performedCan be used for evaluation or work simulation
37Valpar 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
38Mobility Valpar 9 (Whole Body ROM) WEST 7 Bus Bench Balancing Crawling StairsLadderFlexibilitySquattingCrouching
39Purdue PegboardUsed to evaluate a person’s ability to manipulate very fine objects.
40Minnesota Rate of Manipulation Evaluates a person’s ability to manipulate small objects
41Valpar 202Four tests that require proper selection, placement and use of hand tools.
42Bennett 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
43Crawford Small Parts Dexterity Test Measures dexterity or hand function
44Pinch Grip Measures strength and dexterity 3 point or palmer pinch Tip pinch or finger pinchLateral pinch
46Reliability 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.”
47SORTSUse to obtain a subjective rating of perceived ability to perform various household, work and daily activitiesUse for evaluation of client’s with a wide variety of physical limitationsEvaluates “work function themes”Evaluates “ unrealistic self-perception of ability”
48SORT Tools WEST Tool Sort/Loma Linda Activities Sort PACT Spinal Function SortEPIC Hand Function Sort
49Functional Pain Scale 0 = no pain 1-2 = pain is present but not limiting3-4 = pain is starting to affect your ability to perform current activity5 = pain causes you to be unable to complete current activity7 = you cannot use or move the painful area, can’t talk, are tearful, need to lie down10 = requires immediate hospitalization
50Waddell and Placebo test Performed during assessment of range of motion, strength and movement patterns
51Repetitive Movement Testing Performed Pre and Post testingLook for change in movement patterns in comparison to reported pain and disabilityLook for change in performance time in comparison to reported pain and disability
52Feasibility“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.
53Red Flags for Feasibility Lack of attention to the evaluatorResistance to testing - voiced refusal or fearful of testingSigns of AngerDescriptions are too explicit or vagueNo future goals or goals are simple with no detailWant a better doctor to “fix them”Lack of active control of symptoms
54Red Flags continuedRegional symptoms that do not make anatomical senseInactive lifestyle or “couch potato”Has others perform ADL’s/choresReinforcement of behaviors by othersNoncomplianceLength of time off work is extensive
55Resolving Feasibility Evaluate Physical effort and RPDRIntervene and confront the evaluee in a respectful manner to attempt to foster physical effort and RPDRDocument the PCE to provide functional validity.It is the skilled evaluators job to evaluate the client in regards to 1. Physical effort and 2. RPDRIt is the skilled evaluators job to intervene and confront the client in a respectful manner to attempt to foster physical effort and RPDRIt is the skill evaluators job to document the PCE to provide functional validity.
57BibliographyU.S. Department of Labor Dictionary of Occupational Titles, fourth EditionWashington State Labor and IndustriesRoy Matheson and AssociatesDepartment of Consumer and Business Services Workers Compensation Division
60Peoples Injury Network NW PINN Kentth Ave SKent, WA 98032PINN Olympia2120 Mottman RdTumwater, WA 98512PINN Tacoma6704 Tacoma Mall Blvd Tacoma, WA 98409PINN Vancouver2501 SE Columbia Way Suite 120Vancouver, WA 98661