1. FUNCTIONAL TESTING 101… The Role of Function in Injury Prevention and Loss Control Programming Larry Feeler, PT, CEAS CEO, WorkSTEPS

2. Jack’s Picture

3. DEFINITION : System of ADA compliant employment tests designed to prevent injuries, control injury related costs and combat fraudulent claims.

4. Testing Customized to Look At: Job specific strengthJob specific strength Baseline full body functionBaseline full body function “Significant” medical risks“Significant” medical risks Common cumulative traumasCommon cumulative traumas

5. “Significant” Cumulative Traumas : Torn Rotator Cuff (Shoulder)Torn Rotator Cuff (Shoulder) Bad Backs (Neurologic)Bad Backs (Neurologic) Torn knee ligamentTorn knee ligament Carpal TunnelCarpal Tunnel Operated PartsOperated Parts ETC !!!ETC !!!

7. DELIVERY MODEL 650+ Medical Clinic Providers in 46 States “certified” in process Over 1,000,000 workers tested !!

8. Companies Utilizing Testing: Leggett and PlattLeggett and Platt William Charles Const.William Charles Const. Knight TransportationKnight Transportation Hon FurnitureHon Furniture Nabors DrillingNabors Drilling Frontier AirlinesFrontier Airlines Waste ManagementWaste Management HalliburtonHalliburton DOW ChemicalDOW Chemical MoDOTMoDOT General MillsGeneral Mills Jeanie Overhead DoorJeanie Overhead Door ComairComair Loma Linda/Purdue UniLoma Linda/Purdue Uni Hundreds of Cities and CountiesHundreds of Cities and Counties University of Texas Dana Corporation Schenectety Heinz Ketchup Cox Communication Berg Electric Rubbermaid Austin Commercial MV Transit Fleetwood Madera ISD (CAL) Thousands More !!!

9. Employer Nightmares: New-hires Hiring EE’s w/o measuring job related strengthHiring EE’s w/o measuring job related strength Hiring EE’s w/ significant medical conditionHiring EE’s w/ significant medical condition Existing EE’s Not measuring continued job capability (physical and medical) Not proving the legitimacy of any injury

10. Another Problem: Worker’s Comp Assumes Worker’s are perfect when hiredWorker’s are perfect when hired Worker’s never grow oldWorker’s never grow old Whatever happens to the worker, the employer causedWhatever happens to the worker, the employer caused

11. Changes in Economy DownturnsDownturns –Cut safety programs –Expand physical responsibilities –Downsizing –More qualified applicants in poorer physical shape –More protracted injuries and false claims UPTURNS You HIRE ANYYONE !! High salaries cause everyone to apply—even those who have not done physical labor in years Rejected EEs go to YOUR Co.

13. New-Hire Tests…ADA Post offer (Basic or Comp)–Most leeway May select hardest physical positions or ones with highest injuries Must test ALL applicants applying for that position

14. Post offer – Most leeway ER may perform background checks: driving, criminal, etcER may perform background checks: driving, criminal, etc May ask applicant if they can perform specific job tasksMay ask applicant if they can perform specific job tasks May interview and pick the most qualified applicantMay interview and pick the most qualified applicant Will hire contingent upon passing the post offer physical (just like a drug test)Will hire contingent upon passing the post offer physical (just like a drug test)

15. Pretty….does it have an engine ?

17. Standardized Process for Each Part of Test Development… Job Analysis Highest Injury JOBS

19. CHANGES IN PROCEDURES

21. LIFTING SIDEWAYS… WRONGWRONG EducationEducationClasses

22. LIFTING SIDEWAYS… RIGHTRIGHT

25. VIBRATION

26. Static Postures

27. Carpal Tunnel… 1/3 occur in first year of employment1/3 occur in first year of employment 15% occur in first 3 months15% occur in first 3 months $30,000 ave cost$30,000 ave cost 34 lost days per claim34 lost days per claim $50-300,00 with surgery$50-300,00 with surgery 90 lost days with surgery90 lost days with surgery CTD News 2004 CTD News 2004

31. Accurate Essential Function Descriptions: 18.5” Step up 5x18.5” Step up 5x Lift and carry 75 lb tool box 30 feet on uneven terrain, kneel …Lift and carry 75 lb tool box 30 feet on uneven terrain, kneel … Lift from ground and place or throw 48” skids to a height of 60 inches. Must accomplish up to 25 reps under 80% MPHRLift from ground and place or throw 48” skids to a height of 60 inches. Must accomplish up to 25 reps under 80% MPHR NIOSH force: Floor lift--100 lbs. To overhead-55lbs, Push 100 lbsNIOSH force: Floor lift--100 lbs. To overhead-55lbs, Push 100 lbs

32. STRENGTH Standard NIOSH boxes 4 Postures4 Postures Body mechanics trainingBody mechanics training Must lift enough to attempt job related testsMust lift enough to attempt job related tests

33. Shoulder to Overhead Instruct in proper body mechanicsInstruct in proper body mechanics Avoid twist while liftingAvoid twist while lifting Give max safe limitsGive max safe limits

34. KNOW YOUR LIMITS and GET HELP !!!

35. JOB SPECIFIC TESTS Posture Repetition Force Aerobic Demand “Virtual” Testing

40. Cardiovascular Tests…

44. “Baseline” Full Body Musculoskeletal Eval: Evidence Based !!!! PosturePosture Range of Motion (IMP measures)Range of Motion (IMP measures) Joint Flexibility/ Wear and TearJoint Flexibility/ Wear and Tear StrengthStrength PalpationPalpation Investigation of Damaged PartsInvestigation of Damaged Parts Medical evidence to support “not capable” for medical riskMedical evidence to support “not capable” for medical risk

45. POSTURE

47. Medical Tests

48. PALPATION

50. Centinela’s / Empty Can Rotator Cuff Test

53. RANGE OF MOTION MEASURES: According to AMA Guides According to AMA Guides

54. Legs Wrapped 3x?

55. Apportionment Any “individualized assessment” leading to quantified medical documentation of a pre-existing conditionAny “individualized assessment” leading to quantified medical documentation of a pre-existing condition “…ordering impairment and supplemental benefits reduced by 40%”“…ordering impairment and supplemental benefits reduced by 40%” Chief Appeals Judge, Case #950268, Texas Chief Appeals Judge, Case #950268, Texas

56. Measured Return to Pre- injury Status….. STOPS BENEFITS !!!STOPS BENEFITS !!! Is facilitated by knowing baseline strength and deficitsIs facilitated by knowing baseline strength and deficits Leads to faster RTWLeads to faster RTW ALWAYS supersedes speculation or UNMEASURED OPINIONS (Porter v. Alumoweld)ALWAYS supersedes speculation or UNMEASURED OPINIONS (Porter v. Alumoweld)

57. Reasons to Withdraw Offer Lie on Medical HX TAM IX-7Lie on Medical HX TAM IX-7 Bad AttitudeBad Attitude Have Significant Medical RiskHave Significant Medical Risk Can’t Lift Enough WeightCan’t Lift Enough Weight Fail a Part of Job Specific TestFail a Part of Job Specific Test Fail Drug TestFail Drug Test

59. 1,000,000 Workers! 2008

61. Return on Investment !!! Stop one carpal tunnel, one back injury, and one fraudulent claim. Pays for individualized test on: 2500 EMPLOYEES 2500 EMPLOYEES

62. $$$ SAVINGS $$$… 50% AVE REDUCTION50% AVE REDUCTION 1 ST YEAR !!! 1 ST YEAR !!! 79% Soft Tissue Injury REDUCTION79% Soft Tissue Injury REDUCTION 1 st year testing 1 st year testing 7,000 workers 7,000 workers

63. WORK INJURY MANAGEMENT

64. Fit For Duty (Existing) TAM VI-12 “The need for the exam may be triggered by some evidence of problems related to job performance of safety, or… “to determine whether individuals in physically demanding jobs continue to be fit for duty.”

67. PARAMEDIC 2 Reclassify:

68. “Reasonable Accommodation”

69. Fit for Duty—Post Injury “Under ADA, medical information or medical exams may be required when an employee suffers an injury on the job.“Under ADA, medical information or medical exams may be required when an employee suffers an injury on the job. Such an exam may be required when an employee wishes to return to work after an injury or illness, if it is job related and consistent with business necessity.” TAM VI-13Such an exam may be required when an employee wishes to return to work after an injury or illness, if it is job related and consistent with business necessity.” TAM VI-13

70. Policy 1-1 “Fit for Duty” Post Injury Effective date, EEs who suffer WR or NWR injury exceeding 5 lost days will be subject to FFD…Effective date, EEs who suffer WR or NWR injury exceeding 5 lost days will be subject to FFD… …to determine extent of disability…to determine extent of disability …to determine job capability…to determine job capability …to determine reasonable accommodation…to determine reasonable accommodation

71. PREVENTRECORDABLES

73. MAY HAVE TO MAY HAVE TO FIND BEST WAY TO PERFORM JOB SAFELYMEASUREDCAPABILITY EFFECTIVE RTW VALID EE

78. Simultaneous Bilateral Position Peer review Published2004

80. Functional Testing PAYS for ITSELF: Significant $$avings Ability to test high risk newhires – Paid for by not hiring your next claimant / by matching strength to job.Ability to test high risk newhires – Paid for by not hiring your next claimant / by matching strength to job. Ability to test existing EE’s—Paid for by reclassifying, accommodating, conditioning, medical retirement, detecting symptoms early, job matchAbility to test existing EE’s—Paid for by reclassifying, accommodating, conditioning, medical retirement, detecting symptoms early, job match Ability to ALWAYS test injured EE’s— Paid for by immediate accountability re symptoms, sincerity of effort, realistic goals (baseline) and ability to RTW in a measured capacityAbility to ALWAYS test injured EE’s— Paid for by immediate accountability re symptoms, sincerity of effort, realistic goals (baseline) and ability to RTW in a measured capacity

81. Dear Robert:October 11, 2007 I wanted to take a moment to thank you and your staff for the work you have done since the beginning of our post offer work simulation physicals for MODOT. After studying our most physically demanding job title, maintenance worker, we worked with your facility to design and implement work simulation tasks that would be performed by our applicants who had been given conditional offers of employment. We began our statewide program in January of 2006. After our first year of using your program, we reduced our lost time incidents by 61% and our lost workdays by 69%. We were so thrilled with our results we began studying other physically demanding job titles and have just begun testing those applicants. In addition to the reduction in both lost time incidents and lost workdays, we are proud to say we saved the tax payers of Missouri $7,000,000.00 by reducing our workers' compensation costs! Another bit of good news is that during the first two quarters of 2007, we have reduced our lost workdays another 55% and our lost time incidents by an additional 36%. As you can tell, we are very pleased with the results of our program. We look forward to our continued partnership in the future. Sincerely, Jean Endsley, M.S. Employee Safety and Health Manager Dear Robert:October 11, 2007 I wanted to take a moment to thank you and your staff for the work you have done since the beginning of our post offer work simulation physicals for MODOT. After studying our most physically demanding job title, maintenance worker, we worked with your facility to design and implement work simulation tasks that would be performed by our applicants who had been given conditional offers of employment. We began our statewide program in January of 2006. After our first year of using your program, we reduced our lost time incidents by 61% and our lost workdays by 69%. We were so thrilled with our results we began studying other physically demanding job titles and have just begun testing those applicants. In addition to the reduction in both lost time incidents and lost workdays, we are proud to say we saved the tax payers of Missouri $7,000,000.00 by reducing our workers' compensation costs! Another bit of good news is that during the first two quarters of 2007, we have reduced our lost workdays another 55% and our lost time incidents by an additional 36%. As you can tell, we are very pleased with the results of our program. We look forward to our continued partnership in the future. Sincerely, Jean Endsley, M.S. Employee Safety and Health Manager

82. DATA IS POWER..… No Matter How You Use IT ! ! ! BE ABLE TO PUT THE SCALES IN YOUR FAVOR … IF YOU NEED TO !!BE ABLE TO PUT THE SCALES IN YOUR FAVOR … IF YOU NEED TO !!

83. Why Wouldn’t YOU Test? Thank you! THE END