Functional Capacity Evaluation using the Matheson System Alison Biggs, Healthywork Ltd www.healthywork.org.uk

Matheson System Dr Leonard Matheson, Psychologist researcher. Roy Matheson, training programmes. 4 - 5 day course – then Accreditation system. Retrain after 7 years. Therapist chooses suitable tests for questions to be answered and the client’s diagnosis.

Matheson Evaluation Philosophy Purpose of FCE – to collect reliable information about current vocational status & estimate potential vocational status. Hierarchical Professional Value System: respect for client: Safety (Highest) - minimize re-injury Reliability – dependable test scores and test effort to ensure reliable results Validity - measure intended target task Practicality – reasonable direct/indirect costs of test procedures Utility – maximise case resolution Skilled clinical judgement to balance safety and utility issues. Change tests to get the answer rather than compromising safety

Feasibility. Acceptability of the worker generally. Internal threats to reliability. Tell then to give full safe effort. Stopping points determined by: Biomechanical. Psychophysical. (should be the most limiting factor, they say when they want to stop) Cardiovascular-metabolic. Allow modifications. Extra instruction. Yes, if this is not focus of test. Allow Trials. Correction of body mechanics if at risk. Psychophysical approach. Increased function + improved method = further improvement. Pain should be treated as a tool and factual. Questionable pain behaviour – distraction and effort testing, incl HR. Replace pain behaviour with productive behaviour. Activity linked to control of symptoms.

Physical demand characteristics of work (1993 Leonard Matheson & Ministry of Labor) Physical Demand Level Occasional 0-33% work day Frequent 34-66% of workday Constant 67-100% of workday Typical Energy Required Sedentary 10 lbs Negligible 1.5 -2.1 METS Light 20 lbs 2.2 – 3.5 METS Medium 20-50 lbs 10-25 lbs 3.6 – 6.3 METS Heavy 50-100 lbs 25-50 lbs 10-20 lbs 6.4 – 7.5 METS Very Heavy Over 100 lbs Over 50 lbs Over 20 lbs Over 7.5 METS

Matheson FCE Content Client info & job info. Pain scales & standardised questionnaires. MSE assessment. Spinal Sort/Hand Sort. Loma Linda, West tool sort. Jamar. Dexterity. Handling. Fitness and Cardiovascular. Mobility. Lifting, carrying, pushing & pulling. Review.

Pain reporting Pain scales: Functional Pain Scale and Visual Analogue Scale. Standardised questionnaires.

MSE and Sorts MSE: upper, lower, cervical, thoracic, lumbar. Posture, tests (ROM, mmt /5), special tests, measurement (circum, volumetric, pre and post), palpation. Sorts: West tool Sort, Loma Linda, PACT (Performance Assessment & Capability Testing) Spinal Function Sort and EPIC Hand Function Sort.

Hand Dynamometer Jamar grip test Grip Effort

Dexterity and upper limb tests Purdue Pegboard Several different tests. Timed Distraction testing

Minnesota Test Pinch gauge Several tests. Valpar 4 and 8 (assembly tests). Crawford small parts test.

Whole body Range of Motion Valpar 9 Whole body Range of Motion 4 panels of shape transfer positions.

Handling Bennett Hand tool dexterity test (Norm). Valpar 202 (MTM).

Fitness & Cardiovascular Intake questions for safety. CSTF - Canadian Standardised Test of Fitness (push ups, curls, trunk flexion, aerobic). NBFT - National Back Fitness Test (back flex, lower abdo strength, hip flexor flexib, L, R, lateral trunk muscle strength, L, R. Aerobic – walking, jogging, jumping. Cardiac – Bruce, Balke, Bench step test, Rockport walking test. Bench step test. Walking/treadmill test. Jogging. Jumping.

Mobility Balance. Crouching/squatting. Kneeling/floor mobility. Repetitive movement screening. Trunk flexibility. Crawling. Stairs. Ladder mobility. West bus bench. Work simulation.

Lifting Tests Eg Pile (frequent), Snook or West or EPIC (Employment Potential Improvement Corporation) Lift Capacity Tests occasional and frequent lifting. Standardised shelf heights. How much does this weigh? List of possible responses

Carrying, Pushing, Pulling Push/pull sled Handle heights. Increase weights on platform. Measure with Force gauge.

Matheson Review Job match table. Physical effort. Reliability of client reports. Conclusions.

Job Match Table Job Demand Demonstrated Ability Match? Mobility Sitting Occasional. 1-17% Admin tasks Sitting on the floor whilst performing low level tasks Breaks No limits reported or observed Yes Static Standing Performed over 50% of day. Varies depending on task. Can be lengthy periods of time. Demonstrated short periods of standing, Heel pain reported after 7 minutes and then increased to heel and base of foot pain. Maximum standing duration demonstrated 22 minutes before requesting to sit. Mr Stone reported that the pain in his leg when standing on it to assess his standing tolerance was 3/10 on the Functional Pain Scale (2003), where 3 = ‘Pain starting to visibly disable you, cause difficulty moving or applying strength through the painful area, affecting your productivity or performance. Causes you to take small breaks to rest or stretch’. He reported that at home he would elevate the leg to relieve the pain symptoms. If he can vary static standing with dynamic standing and walking then this tolerance could be increased, but it is likely that tolerances will need to be broken up with sitting in order to manage the pain in the right foot. A padded in sole may ease the discomfort. Carry a small folding metal stool; possibly use this during some jobs?

Points of view on Matheson Instruments whose reliability and validity has been determined through peer reviewed research, available in the public domain. Equipment available from a range of vendors. Work simulation. Weights. Jamar. Workday tolerances.

Assessment length. Answering case-resolution relevant questions while adhering to the Practice Hierarchy. Training certification/accreditation and retraining requirements. Support.

Assessment requirements Choose a practitioner who has attended suitable training to use standardised tests/system. Ensure client is ready for the assessment – needs to be work ready, able to participate fully in assessment, at end of rehab not too early. Can give info more quickly in a case. Ensure client and job is appropriate for this assessment. Good for physical jobs. Analyse effort, reliability of client reports and techniques for Manual Handling etc. Be clear what you want to find out from Assessment. Specific information required and questions. Reason for this assessment is... Also to defend its use to the payer.

Assessment requirements cont Tell the assessor what information you need to know. RTW yet? Unsafe to RTW? Look at alternatives. FCE shows they can RTW, even if they don’t think they can? GRTW hours? Which job tasks can they do? Frequency and kg of lifting/carrying? Other issues preventing RTW (social/psychological)?

Hierarchy of RTW Hierarchy of objectives: Same work and same employer Same work (modified) and same employer Different work and same employer Similar work with different employer Different work with different employer Retrain and/or re-educate the worker (Workers Compensation Board of Manitoba www.wcb.mb.ca )

Other considerations Client travelling to assessment. Gather detailed job info prior to the assessment, so that the testing can more accurately reflect the job demands. Ask for a Job Demands Analysis if req. Consents and access to medical records. Cardiac Arrest – defib requirements? Approp assessment/job? Follow ups, next day? Other standardized assessments can be used, eg. Numeracy tests, The Cognitive Test of Minnesota.

Occupational Questionnaire 1%-17% 18%-33% 34%-50% 51%-66% 67%- 84% 85%- 100% Additional information Lifting Carrying Pushing Pulling Driving vehicle type: Sitting (not driving) Walking Standing - static Standing - moving Bending/stooping Twisting/spinal rotation Crouching/squatting Crawling/kneeling Climbing stairs Is a lift available? Climbing ladders etc Reaching/stretching Eg overhead or hip height: Above shoulder work

Links www.roymatheson.com www.epicrehab.com www.khavalpar.co.uk