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National Research and Training Center 3921 30th Ave – Suite A – Kenosha, WI 53144 P: 866-470-4440 ▪ F: 866-520-5557 ▪ www.occupro.net

OCCUPRO, LLC © 2014 www.occupro.net

Comprehensive Industrial Rehabilitation Training Online Assessment Application

Functional Capacity Evaluation

Functional Progress Note™

Functional Discharge Summary™

Work Hardening/Conditioning

Job Demands Analysis

Training Compendium

Developer Jim Mecham, MSIE, OTR/L, CPE

Industrial Rehab Continuing Education Comprehensive Industrial Rehabilitation Training


Instructor: Jim Mecham, MSIE, OTR/L, CPE Carmelo Tenuta, PT

Day One - Industrial Rehabilitation Philosophy and Job Demands Analysis

TIME SUBJECT CONTENT METHOD OF INSTRUCTION

7:45 – 8:15 Registration Receive your course materials and check into course Course Materials 8:15 – 8:30 Introduction Clinic tour, instructor/attendee intro, overview of course Lecture, Tour, Power Point

8:30 – 9:30 THE INNOVATIVE

APPROACH

Learn OccuPro’s innovative approach to treating the injured worker and increase your industrial rehab revenue

by 400% Lecture, Power Point

9:30 – 10:00 The OccuPro Evaluation

Philosophy

Discuss the foundation of performing industrial rehab and how to intertwine Functional Capacity Evaluations, Functional Progress Notes, Functional Discharge

Summaries and Work Hardening

Lecture, Power Point

Break 10:00 – 10:15 10:15 – 10:45

Specializing in the Return-to-Work of the injured worker

Discuss being considered a specialist in the treatment of the injured worker and grow your work comp referrals


10:45 – 11:15 Principles of Industrial

Rehabilitation Discuss industrial rehab definitions/foundation and gain a

general knowledge of this specialized field Lecture, Power Point

11:15 – 12:00 Industrial Rehabilitation

Documentation Discuss and practice proper industrial rehab documentation

Lecture, Power Point, Handouts

Lunch 12:00 – 1:00 1:00 – 1:30

Job Demands Analysis and Industrial Rehab

JDA overview and how this fits in your industrial rehab program

Lecture, Power Point, Handouts, Video

1:30 – 2:00 Job Demands Analysis

Documentation

Learn to write job descriptions, essential function statements, gather physical demands and other pertinent

JDA data

Lecture, Power Point, Handouts, Video

2:00 – 2:30 Performing Job Demands

Analysis Procedures for going on-site to gather the physical

demands and how to gather them Lecture, Power Point,

Handouts, Video Break 2:30 – 2:45

2:45 – 4:30 JDA Case Study/Practicum Go to a local company or analyze a job from a pre-

recorded video and perform a JDA Handouts, On-Site Analysis

4:30 – 4:45 Job Site Analysis Presentation Present your Job Demands Analysis to the class with

feedback from participants and instructors Classmate Lecture

4:45 -5:00 Day 1 Wrap Up Summarize day and discuss Day 2 Lecture



Day 2 – Performing Functional Capacity Evaluation


8:00 – 9:00 Functional Capacity Evaluations General overview of FCE performance, types of FCE’s,

reasons for performing and answering the referrals question Lecture, Power Point, Video

9:00 – 9:15 Evaluation Sitting and Standing

tolerance How to calculate sitting/standing tolerance for eight hours and using this data to determine RTW recommendations

Lecture, Power Point, Video

9:15 – 9:45 Intake Process FCE preparation, client entering the clinic, intake forms,

consent to treat, performing your interview Lecture, Power Point, Video

Break 9:450 – 10:00 10:00 – 10:45 Job Demands Analysis

Using data from an On-Site Job Demands Analysis, Dictionary of Occupational Titles or from an interview

Lecture, Power Point, Video

10:45 – 11:15 Consistency of Effort Evidence based practice for determining if you client put

forth full and consistent effort during testing Lecture, Power Point, Video

11:15 – 11:45 Reliability of Pain Ratings Determining if the subjective pain is reliable using RPE,

functional pain scale, McGill, Oswestry, Ransford Lecture, Power Point, Handouts, Hands-on

11:45 – 12:00 Musculoskeletal Screening Gathering basic information such as pain levels, edema,

sensation, Orthotics, heart rate, BP, respiratory rate Lecture, Power Point, Video

Lunch 12:00 – 1:00 1:00 – 1:30 Musculoskeletal Testing

Goniometric and Inclinometric joint evaluation and its importance in FCE testing

Lecture, Power Point, Video, Hands-on

1:30 – 2:30 Upper Extremity Testing Performing Grip and Pinch, evidence based consistency of

effort and determining physical demand level Lecture, Power Point, Video,

Hands-on

2:30 – 3:00 Coordination Gross Motor and Fine Motor Coordination and determining

physical demand level Lecture, Power Point, Video,

Hands-on Break 3:00 – 3:15

3:15 – 4:45 Repetitive Functional Activities Walking, Forward/Overhead Reach, Bending, Squatting,

Kneeling and determining the physical demand level Lecture, Power Point, Video,

Hands-on 4:45 -5:00 Day 2 Wrap Up Summarize day and discuss Day 3 Lecture



Day 3 - Performing Functional Capacity Evaluation


8:00 – 8:30 Balance Dynamic and Static Balance and determining the physical

demand level Lecture, Power Point, Video,

Hands-on

8:30 – 9:300 Occasional Material Handling Evaluate, determine and calculate maximal/safe occasional

lifting abilities during various required lifts Lecture, Power Point, Video,

Hands-on

9:30 – 10:00 Job Simulation Learn to evaluate and implement various job simulation

testing to increase your tests overall validity Lecture, Power Point

Break 10:00 – 10:15 10:15 – 11:00 Frequent Material Handling

Evaluate, determine and calculate maximal/safe frequent lifting abilities as well as RPE vs. Heart Rate

Lecture, Power Point, Video, Hands-on

11:00 – 11:30 Sitting, Standing and Climbing Evaluate, calculate and determine sitting, standing, crawling

and climbing abilities Lecture, Power Point, Hands-

On

11:30 – 12:00 FCE Completion Final documentation, determine overall PDL, summarize

Consistency of Effort and Pain, and RTW recommendationsLecture, Power Point

Lunch 12:00 – 1:00 During Lunch here about the OccuPro Advantage: OccuPro’s Return-to-Work Software

Ashley Rhode, National Sales Consultant 1:00 – 4:15 FCE Case Study Perform a full FCE Lecture, Handouts, Hands-on 4:15 -4:45 FCE Presentations Present your FCE to the class Lecture, Software 4:45 – 5:00 Day 3 Wrap Up Summarize day 3 and discuss Day 4 Lecture



Day 4 - Performing Functional Progress Notes, Functional Discharge Summaries, Work Hardening/Conditioning


8:00 – 9:00 The OccuPro Advantage Hear from a Physical Therapist, Business Owner,

Entrepreneur on how he implemented this innovative approach and grew his workers’ compensation footprint


9:00 – 10:00 Introduction to FPN and FDS How to use and implement FPN’s and FDS’s into your

practice. Lecture, Power Point

Handouts Break 10:00 – 10:15

10:15 – 10:45 Performing FPN and FDS Performing injury/job specific evaluations on all your work

comp patients. Lecture, Power Point

10:45 – 12:00 FPN – FDS Case Study Perform an FPN based on a patient case study Hands-on Lunch 12:00 – 1:00

1:00 – 1:30 Introduction to Work

Hardening/Work Conditioning Implementing, running and growing profitable work

conditioning/hardening programs in your practice Lecture, Power Point,

Handouts

1:30 – 1:45 Performing WH/WC Evaluation What and how to perform work hardening/conditioning

evaluations Lecture, Power Point

1:45 – 2:00 WH/WC Treatment Planning Establishing goals, setting up treatment, progressing treatment, difficult patients and your treatment area

Lecture, Power Point, Handouts

2:00 – 2:30 WH/WC Case Study’s Set up a treatment plan, establish goals, and progress a

patient based on a case study Handouts, Hands-On,

2:30 – 3:00 Certification and Wrap up Certification, course evaluations, CEU presentation Lecture

Comprehensive Industrial Rehab Training Testing Decision Tree

Test All Functional Testing ►

Disability Functional Capacity

Evaluation

Test only the physical ►

·····················································································································

Return To Work FCE WH/WC Evaluation WH/WC FPN WH/WC FDSdemands required for full duty return to

work

►

······················································································································

Outpatient FDSOutpatient FPN

Test only the physical demands

directly related to the injured

j i t/b d t

►joint/body part

Document the physical d d ►

······················································································································

JDAdemands required for

full duty return to work

►

1

Comprehensive Industrial Rehab Training

OCCUPRO3921 30th Ave, Suite AKenosha, WI 53144

Introduction


Introductions

Instructors

Attendees


Who We Are

A three tiered organization which provides

1. Industrial rehab/Functional Capacity Evaluation and Ergonomic continuing education courses

2. The industry’s most comprehensive suite of web based Return to Work software

3. We consult an provide prevention, assessment, and injury cost reduction services for employers throughout North America.

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What you will learn Implement or improve your industrial rehab practice Become a specialist in the treatment of the injured worker

Become a medical professional that treats from initial eval to full duty return to work

Learn how to use the industries most comprehensive suite of Return-toWork assessments Job Demands Analysis Functional Capacity Evaluation Functional Progress NotesTM Functional Discharge Summaries TM Work Hardening/Conditioning

First steps towards Certified Industrial Rehab Specialist Certified Functional Capacity Evaluator


Return to Work Software Six separate testing options which produce eight

different reports in OccuPro’s Return-to-Work Software Functional Capacity EvaluationWork Hardening/Work Conditioning Evaluation Job Demands Analysis Functional Progress Note TM

Functional Discharge Summary TM

Pre-Placement Post-Offer Assessment One Page Return to work Recommendation Sheet Patient Progress Note/Re-evaluation


Return-to-Work Software Easy to read reports

Post-test documentation takes 2-15 minutes to complete

Reports are generated immediately

Standardized data gathering mechanisms

Reliability, validity and evidence based

Software users get unlimited testing support, technical support and program development support

Part of OccuPro’s North American referral network

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Following the completion of this course

Contact OccuPro with any question you may have OccuPro never teaches you how to use the service and then

sends you on your own Your practice is recognized as a specialist in the rehabilitation

of the injured worker You have the opportunity to build relationships with area employers,

workers’ compensation insurance carriers and physicians with the potential for an on-site clinic


THE INNOVATIVE APPROACH


North American results of the approach 10% increase in worker’s compensation revenue 100% increase in work hardening or work

conditioning revenue 20% of your worker’s compensation patients will be

self referred into your work hardening/ conditioning program

275% increase in productivity secondary to the speed of the software

400% increase in industrial rehab revenue

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How does it work Five services that are intertwined into your program

Functional Capacity Evaluation Functional Progress Note TM Functional Discharge Summary TM Job Demands Analysis Work Hardening/Conditioning

Instead of industrial rehab being an end of treatment specialty program you incorporate the same philosophies from the first patient visit for all work comp patients.

Instead of sending your Dr’s musculoskeletal based progress notes you send them functional based progress notes




An effective return to work FCE determines whether there is a match between the client's functional capabilities, and the physical demands of an occupation.

An effective disability based FCE determines a persons ability to perform functional tasks as outlined by the US Department of Labor and associated with gainful employment

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Functional Progress Note™ Functional progress note (FPN) is an objective/functional re-

assessment performed during outpatient therapy or during work hardening/conditioning that provides functional improvement documentation to the physician, insurance, case manager and employer

The test is focused on the injured joint and what that injured joint needs to do for full duty return to work

Greatly assists in the plan of care with the primary goal being full duty return to work.


Functional Discharge Summary™

Functional Discharge Summary (FDS) is an objective/functional discharge assessment performed at the end of outpatient therapy or at the end of work hardening/ conditioning which provides functional improvement documentation to the physician, insurance, case manager and employer

The test is focused on the injured joint and what that injured joint needs to do for full duty return to work



Job Demands Analysis (JDA) is the analysis of your patients full duty return to work job to determine the exact physical demands of the client’s job.

Can be performed as an actual on-site evaluation

Can be performed via a job description, gathered from the Dictionary of Occupational Titles, a verbal discussion with the employer or from an interview of your client

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Work Hardening/Conditioning Evaluation

Similar to an FCE but performed in a psychophysical approach

Comprehensive baseline assessment of an injured workers functional abilities prior to beginning a comprehensive return to work program.


Pre-Placement Post-Offer Testing

This test is not part of the innovative approach and this course but is an aspect of the OccuPro’s Return-to-Work Software

Post-Offer testing may be conducted in house or for various employers as cash based services. It consists of performing a very thorough JDA- or gathering all of the

essential physical demands of the job Organizing the information gathered and testing for only the job

specific tasks This will determine if the client is capable of performing the essential

physical demands prior to hire. Benefits are to decrease the amount of workers’ compensation claims.


OCCUPRO Evaluation Philosophy

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OccuPro Evaluation Framework 1. Safety

Performing testing in a manner that keeps the patient and the evaluator safe

2. Reliability Inter Rater and Intra Rater reliability Standardized tests to make sure your tests are reliable OccuPro’s research shows a high level of test reliability

3. Validity Does your test match what a persons job is FCE testing globally has a low level of validity

4. Practical test Making some test changes to match what the job requires Performing some job simulated testing

5. Objective Your documentation needs to be objective at all times!


Psychophysical vs. Kinesiophysical

Who determines the stopping point of a test?Patient?

Tester?

How hard should I push the client?Patients comfortable end point

Mechanical changes

Mechanical deficits.


Psychophysical

The client being tested reports that they are unable to continue a test secondary to psycophysical reasons

They feel from a psychophysical standpoint that they are unable to go on May be pain related, fear of re-injury, fear of more pain,

and/or anxiety

As evaluators we need to substantiate these psychophysical reports and agree or disagree Some tests use a rating of perceived exertion

Our agreement or disagreement with this would be based off of mechanics

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Kinesiophysical

Based on our medical knowledge of biomechanics, physiology, anatomy, cardiovascular endurance, and the diagnosis we decide whether a client has performed at their maximum effort Mechanical changes vs. Mechanical deficits A mechanical change would suggest a client can perform an

activity on an occasional basis i.e. lumbar extension during lifting testing

A mechanical deficit would be a mechanical breakdown or kinesiophysical endpoint in which the client demonstrates mechanics which would be considered to be unsafe and the client would be unable to perform at that level in a competitive work environment


The innovative approach Both approaches need to be intertwined in this overall industrial

rehab approach and used to come to the best overall decision Safety remains an important aspect FCE is a always a 100% kinesiophysical approach Work Hardening/Conditioning Eval is a 50% kinesiophysical / 50%

psychophysical approach Work Hardening/Conditioning Functional Progress Note is a 75%

kinesiophysical / 25% psychophysical approach Work Hardening/Conditioning Functional Discharge Summary is a

100% kinesiophysical approach An outpatient Functional Progress Note or Functional Discharge

Summary is a 25% kinesiophysical / 75% psychophysical approach


Consistency of Effort When performing industrial testing the question will always arise

whether the client put forth full and consistent effort to come to the most accurate functional results

It should be the assumption of the evaluator that each an every client is putting forth full effort during testing and this opinion should not change until objective data gathered during the test would suggest otherwise.

Throughout this course consistency of effort testing will be discussed OccuPro’s Return-to-Work software has 33 baked in consistency of

effort tests As an evaluator you may see other things that are inconsistent during

testing and can be classified as observational inconsistencies If your FCE patient demonstrates inconsistent effort during testing you

will need to document that the results could be considered their minimal functional level secondary to the self limiting behavior or submaximal effort.

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Consistency of Effort

If a client puts forth consistent effort during testingSuggests the client put forth full effort during

your test

If the clients effort is incosnistent during testingSuggests self limiting behaviors or

submaximal effort


Pain Pain may be a warning and should be respected

???? Is the clients pain at a level that affects their functional abilities???

???? Is the pain level being told to the evaluator an accurate level of pain or is the client exaggerating their pain level????

Pain can be very subjective both from the evaluator and the patient


0-10 OccuPro Functional Pain Intensity Scale

Developed as a functional pain scale

Correlates a clients pain to a defined level of function

Improves the pain report to a more objective level of pain

Allows the therapist to question the reported pain level secondary to the pain behaviors in the definitions

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Reliability of Pain Is the level of pain being reported a reliable level

of pain i.e. “I am a 10 out of 10 today”

i.e. “I am a 12 out of 10 today” LOL

Questionable Pain Are the reports of pain levels reliable?

If they are reliable then pain may be a limiting factor

If the pain level being reported is not a reliable level of pain need to focus on your kinesiophysical approach and the demonstrated mechanics


Reliability of Pain

58 baked in tests in OccuPro’s Return-to-Work software system determining the patients reliability of pain reports

Pain related psychometric tests will also help to determine the reliability of pain

During this course various tests will be outlined that are reliability of pain tests


Distraction Based Testing A clinical testing situation in which the client

being tested is unaware of all information being gathered.

For instanceObserving someone putting on their jacket with full

shoulder flexion but not being able to achieve full shoulder flexion during musculoskeletal testing

Changing a standardized test to evaluate a persons ability in a non-standardized test i.e. doing a fine motor test but making a test up because you are not

evaluation the fine motor ability but maybe cervical and/or lumbar flexion

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Specializing in the Return to work of the Injured Worker


Becoming a Specialist in the Treatment of the Injured Worker

The innovative approachTreat from initial eval to discharge???? Why

Change this to a therapist that treats from initial eval to full duty return to work

Incorporate industrial rehab philosophies starting at the acute outpatient eval


Outpatient TherapyThere are two specific areas where as a clinician,

director, and/or owner you receive payment fromMajor Medical Insurance

Group Health

Medicare

Medicaid

Worker’s Compensation Insurance The best paying insurance in 95% of the US

The only insurance that from year to year increases in 95% of the US

If you are a clinic/clinician that specializes in the treatment of the injured worker whether you perform industrial testing or not you can reap the benefits of this higher paying insurance

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Outpatient Therapy

Medicare requires us to document functionally! No matter what patient we are treating the insurance

requires us to return that client to “their previous level of function”

If we do not focus on the previous level of function for Medicare patients we will not get paid for our service

For the worker’s compensation patient it is just as important to return the client to previous level of vocational function


Outpatient therapy

While in school rehabilitation professionals are not taught how to return an injured worker back to work

We are taught how to return our patients to their activities of daily living.

We focus on skills required to manage activities outside of work

Our goals are very focused on daily living skills and improved musculoskeletal abilities


Outpatient Therapy- Goals Therapists/clinicians in general write their goals in relation to:

Muscle Strength

Active/Passive range of motion

ADL’s

Research suggests that Range of Motion correlates to function mildly

Research suggests that Manual Muscle testing correlates to function poorly

If a work comp patient is 5/5 strength and full ROM it does not mean they can do their job

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What about return to work Functional Goals? Concentra Approach

100% return to work goals at initial evaluation

OccuPro Approach 75% of your goals at initial outpatient evaluation should be return to

work goals Worker to demonstrate 180 degrees of right shoulder flexion for

stocking shelves, continuously, at Sentry Foods within 8 weeks. Worker to demonstrate the ability to lift 80 pounds to shoulder level on

an occasional basis for return to work within 6 weeks. Worker to demonstrate the ability to perform 90% of the physical

demands of the job noted in the JDA within 3 weeks. Worker to return to modified duty work/full time within 2 weeks.

Writing return to work goals for every WC client will separate you as a clinic, clinician, owner whom specializes in treatment for the injured worker.


How do you know what the client is required to do at work?

Job Demands AnalysisThe JDA is the most accurate tool for you to gather

the exact physical demands of the job

Use the demands gathered for setting goals and for your functional re-assessments

May not be feasible from a staff standpoint or a revenue standpoint

Stay tuned for the benefits of the JDA though



Job Description Obtained from the employer

Job Descriptions are rarely “good enough” to use Usually cognitively based

Education and skill based

Rarely do they get into detail of the physical demands of the job Weights, frequencies, and levels of objects/items

Most employers do not know all the physical demands of the job or frequency of the tasks

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Functional Job Demands FormOccuPro developed form outlining some

basic physical demands of the job to assist in writing return to work functional goals


Functional Job Demands Form


Initial Evaluation Questions When performing the initial evaluation the following items

will help direct return to work functional therapy Is the client off of work Was surgery performed Does the client need to perform- greater than 20 pounds? Is the client on modified duty/part time Is the client a returning new client?

If any of these questions are yes the clinician should begin to think that this patient may need work conditioning.

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First Visit Client fills out the Functional Job Demands

Form while filling out normal paper work Therapist reviews this form with the client Perform traditional initial evaluation While completing initial evaluation

documentation use the Functional Job Demands Form to establish return to work goals


Being a Specialist in the Treatment of the Injured Worker

Now that you are writing long term goals that are full duty return to work goals you have to functionally test your patients to determine if they have met these goals?Functional Progress Note

Functional Discharge Summary

Work Hardening/Work Conditioning



Principles of Industrial Rehab

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Industrial Rehab Testing Foundation

Can your client return to work? Light Duty?

Full Duty?

Transitional Duty?

Functional Testing Need to compare the client’s abilities to the physical

demands of the job Overall comparison in a percentage format

Individual task comparison

US Department of Labor Physical Demands comparison


US Dept of Labor Physical Demand Levels

Industrial Rehab programming must always include this primary physical demand level.

This primary tool is used to compare patient’s physical demand level to their job’s demand level using the United States Department of Labor, Employment and Training Administrations, Dictionary of Occupational Titles Physical Demand Levels.

This tool is widely used by occupational analysts who perform job site analysis, ergonomics and functional capacity evaluations.


PHYSICAL DEMANDS LEVEL-STRENGTH RATING

Expressed by one of five terms: Sedentary 0-10#Light 11-20#Medium 21-50#Heavy 51-100#Very Heavy 101# or greater

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S-Sedentary Work

Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.


L-Light Work

Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.


M-Medium Work

Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Light Work.

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H-Heavy Work

Exerting 50 to 100 pounds of force occasionally, and/or 25 to 50 pounds of force frequently, and/or 10 to 20 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Medium Work.


V-Very Heavy Work

Exerting in excess of 100 pounds of force occasionally, and/or in excess of 50 pounds of force frequently, and/or in excess of 20 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Heavy Work.


Classifications of Frequency and Duration

Occasional 1-1/3 of the work day 1-33% of the work day 1 -20 minutes per hour

Frequent 1/3-2/3 of the work day 34-66% of the work day 21-40 minutes per hour

Continuous 2/3-3/3 of the work day 67% -100% of the work day 41-60 minutes per hour

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Repetitive Functional Activities Physical Demands

associated with work are classified asNever

Occasional

Frequent

Constant

The clients abilities during functional testing will be classified as Avoid

Occasional

Frequent

Constant


Repetitive Functional Activities

Upper Extremity Testing Grasping Pinching Fine Motor Coordination Gross Motor Coordination

Walking Reaching

Forward reaching Above shoulder reaching

Bending Squatting

Sustained Repetitive

Kneeling Sustained Repetitive

Crawling

Climbing

Stair Climbing

Ladder/Other Climbing

Balance

Static

Dynamic


Sit – Stand

Sitting calculated in hours

Could be classified as Occasional, Frequent or Constant

Standing calculated in hours

Could be classified as Occasional, Frequent or Constant

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Material Handling Abilities Can be Occasional, Frequent or Constant Lifting

Job Specific/Bend Lift Squat lifting Power lifting Shoulder lifting Overhead lifting Unilateral lifting

Carrying Bilateral Carrying Unilateral Carrying

Pushing/Pulling


Industrial Rehabilitation Documentation


Documentation

Similar documentation occurs in all testing methodologies

Final/Summary Documentation is most important Individual test documentation is also important Software is created in a sense that if the client

passes a test without deficit then your pre-population documentation is taken care of for you If there were deficits then extra documentation must

be performed to outline these deficits

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Purpose of the Evaluation State the purpose of the your evaluation in work related

terms The purpose of this functional capacity evaluation is to determine this

client’s functional abilities as it relates to the physical demands of their job as a police officer

The purpose of this baseline FCE is to determine this client’s overall return to work functional abilities

The purpose of the outpatient functional progress note is to determine the client’s injured joints ability to perform what this injured joint needs to do for full duty return to work

The purpose of the outpatient functional discharge summary is to determine this client’s injured joint’s ability to return to full duty work.

The purpose of this work hardening evaluation is to establish baseline functional abilities to establish return to work goals and a comprehensive work hardening treatment plan


Individual Test Documentation Functional abilities a client is able to perform Mechanics

Mechanical Changes and/or Mechanical Deficits

Pain Pain Level Pain Location Pain Behaviors Reliability of Pain Reports

Physiological Responses Heart Rate

Limiting factors Inconsistency or Consistency noted during tests Normative Data comparison


Results / Recommendations Lift, Carry, Push, Pull Functional Abilities to Job Demands Match

What percentage of the physical demands can the client tolerate

Return to Work Recommendation if appropriate OccuPro Predictive Validity Research would suggest that if a

client can perform 80% or more of the physical demands than an Return to Work Recommendation is warranted

Consistency of Effort/Reliability of Pain What percentage of the test is consistent/reliable

Client/Occupation Physical Demand Level What physical demand level can the client tolerate What physical demand level is the job

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Results / Recommendations

Limiting FactorsWhat were the limiting factors during testing

RecommendationsGeneral overall recommendations in regards to the

clients functional abilities Rehab Recommendations

If appropriate make a rehabilitation recommendation FCE Rehab Recommendation is very questionable FPN and FDS should always have a Rehab

Recommendation


Objective Data

All documentation should be objective

NEVER PUT YOUR OPINION INTO A REPORT

Objective data protects you from an attorney questioning your FCE if you are deposed in a deposition and/or court of law


Standardized testing

There may be times that you perform a standardized test in a non-standardized fashion.Make sure you document why you performed

the test in this way and what your results were

May be done as a job simulated test?

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Consistency of Effort vs. Reliability of Pain Reports OccuPro’s Return to Work Software calculates separate

consistency of effort and reliability of pain percentages

If someone is consistent/reliable make sure the documentation reflects this

If a client is inconsistent or unreliable make sure you outline whether this was related to consistency of effort or reliability of pain reports Requires documentation suggesting the results may not be a

true representation of the clients actual function

Requires significant objective documentation


Final thoughts An FCE report should tell a story and the reader

should be able to start at the beginning and know what your client can and can’t do by the end of the story. FCE story is from date of injury up to the date of FCE

testing

All other reports need to tell and easy to read, short and concise outline of the clients abilities

Need to refrain from to many acronyms

Complete sentences and spell checked.



Functional Job Demands Form Patient Use Only Please complete all of the following information. We pride ourselves in offering the best care possible and this information is extremely important in providing you with the best possible care.

Name: Referring Dr.: Phone Number: Date of Injury: DOB: Employer: Diagnosis: Employer Contact: Job Title: Employer #: Work activities that are a problem? What percentage of your day is spent performing the following tasks:

Task Frequency: 0% Nothing

1-33% Occasional

34-66% Frequent

67-100% Continuous

Standing Sitting Lift 20 to 50lbs. Lift 50+ lbs. Carry 20 to 50lbs. Carry 50+ lbs. Push/Pull Bend/Squat/Kneel Grasping/Pinching Below Shoulder Reaching Above Shoulder Reaching Balance Climbing

THERAPIST USE ONLY

Present Work Status: (circle two) Part Time Full Time Regular Duty Modified/Light Duty Off of Work? Y N Why: Surgery? Y N JDA needed?(presently) Y N Ergo consult needed? Y N FCE needed?(end of treatment) Y N Work Hardening needed? Y N FPN needed?(during treatment) Y N FDS needed?(at end of treatment) Y N Does this job require balancing? Y N Therapist Name:

Clinic (Please Circle): Comments:

Who is the treating company?

Insurance Carrier:

Claims Adjuster:

DOB: DOI:

Job Title: Case Manager:

Referral:

Diagnosis:

Contact:

Treating Therapist:

Date:

OCCUPRO ©2011

Clinic Based Industrial Rehabilitation

Communication Notes:

Client Name:

Phone Number:

Phone Number:

Phone Number:

Clinic:

Phone Number:

Employer:

Initiating Therapist:

What is the Industrial Rehab service to be provided?

SERVICE INFORMATION FORM

CODE DESCRIPTION CODE DESCRIPTION

97750 Functional Capacity Evaluation 97537

97750 Functional Progress Note 97537 Ergonomic Consultation

97750 Functional Discharge Summary WORK REINTEGRATION TRAINING:

TRAVEL TIME:

97750

WH/WC Functional Progress Note 99056

97750

WH/WC Functional Discharge Summary

99050

97001 PT EVALUATION 99052

97003 OT EVALUATION 99054

For walk in work hardening evals

97002 PT RE-EVAL PHONE CONSULTATION:

Services between 7:00 PM - 10:00 PM.


FCE, FPN, FDS:

Services between 10:00PM - 8:00 AM.

Services on Sundays and Holidays.

97750

WORK HARDENING:

TIME:


Services provided in a location other than a physicians office. (Non-timed)

DATE:

EMPLOYER:

JDA/ERGONOMIC CONSULTATION:

STATE:

Industrial Rehabilitation Service Provided

Direct one on one contact by provider for training in daily activities / work environment modification, task analysis.

OccuPro Industrial Rehabilitation Charge Ticketlit

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DIAGNOSIS:

THERAPIST:

CLINIC:

PATIENT NAME:

97002 PT RE EVAL PHONE CONSULTATION:

97004 OT RE-EVAL 9937197750 15 Min. TEST/MEASUREMENT

For patients already in your clinic

97545 2 hr. WORK HARDENING

97546 1 hr. ADDITIONAL HOURS 99372

97110 15 Min. THER EXERCISE(Strength, End., ROM, Flex)

97112 15 Min. THER EXERCISE(posture, balance, pnf, coordin., kin, sense, prop)

99373

97530 15 Min. THER ACT/ FUNC/ PERF(Dynamic act., Funct. Performance)

97124 15 Min. MASSAGE

97116 15 Min. GAIT TRN/CLIM CASE CONFERENCE:

97535 15 Min. ADL/SELF CARE/ADAPTIVE EQ. 99361

97032 15 Min. TENS/INFERENTIAL 99363

97033 15 Min. IONTOPHORESIS

97034 15 Min. CONTRAST BATH97035 15 Min. ULTRASOUND

97035 15 Min. PHONOPHORESIS

97010 HOT/COLD PACK Service:

97022 WHIRLPOOL Company

97012 MECHANICAL TRACTION Address

95831 MAN. MUSC. TEST Amount to be billed:


COMPREHENSIVE

Phone call to patient or physician for coordination of medical care. Simple, brief for purpose of clarifying previous instruction, adjusting therapy plan, or report results of a test.

Intermediate phone call to provide advise to an established patient, coordinate care of a new condition that may arise, initiate a new plan of care, or discuss new information.

BRIEF

INTERMEDIATE

Medical conference with a physician for the purpose of coordinating the activities and care of patient.

Complex call for lengthy consultation, discussion with distraught patient / family member, coordination of complex services with several health care providers working on same patient.

30 MINUTES

60 MINUTES

ON-SITE OR INVOICE BILLING

Occ

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Ind

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Job Demands Match Worksheet

Physical Demand Client Abilities

Calculation Physical Demands of

Job

Job Demands Match %

Material Handling Pounds Pounds Percentage Occasional Squat Lift (Floor to Waist) ÷ Frequent Squat Lift (Floor to Waist) ÷ Continuous Squat Lift (Floor to Waist) ÷ Occasional Power Lift (Shin to Waist) ÷ Frequent Power Lift (Shin to Waist) ÷ Continuous Power Lift (Shin to Waist) ÷ Occasional Shoulder Lift ÷ Frequent Shoulder Lift ÷ Continuous Shoulder Lift ÷ Occasional Overhead Lift ÷ Frequent Overhead Lift ÷ Continuous Overhead Lift ÷ Occasional Bilateral Carry ÷ Frequent Bilateral Carry ÷


Calculation Physical Demands in a percentage

Job Demands Match %

Positional Tolerances Percentage Percentage Percentage Simple Grasping ÷ Firm Grasping ÷ Pinching ÷ Fine Motor Coordination ÷ Gross Motor Coordination ÷ Walking ÷ Forward Reaching ÷ Above Shoulder Reaching ÷ Bending ÷ Squatting ÷ Sustained Squatting ÷ Repetitive Kneeling ÷ Sustained Kneeling ÷ Stair Climbing ÷ Ladder Climbing ÷ Static Balance ÷ Dynamic Balance ÷ Crawling ÷

Continuous Bilateral Carry ÷ Occasional Unilateral Lift ÷ Frequent Unilateral Lift ÷ Continuous Unilateral Lift ÷ Occasional Unilateral Carry ÷ Frequent Unilateral Carry ÷ Continuous Unilateral Carry ÷ Occasional Push ÷ Frequent Push ÷ Continuous Push ÷ Occasional Pull ÷ Frequent Pull ÷ Continuous Pull ÷


Calculation Physical Demands in a percentage

Job Demands Match %

Sit-Stand Hours Hours Hours Total Sitting Requirements ÷ Sitting at one time Requirements ÷ Total Standing Requirements ÷ Standing at one time Requirements ÷

Physical Demand Client

Abilities Calculation Physical

Demands in a percentage

Job Demands Match %

Job Simulated Activities Percentage Percentage Percentage 1. ÷ 2. 3. 4. 5. 6. 7. 8. 9. 10.

Add up the Job Demands Match % Column = How many Client Abilities and Job Physical Demands did you test? Divide the number of tests into the job demands match total for Percent of Job Client can tolerate

1


Job Demands AnalysisJob Demands Analysis

INNOVATIVE APPROACH TO IR

Understanding that all jobs require certain physical abilities for full duty return to work

Need to be able to gather this information for your worker’s compensation clients

May be gathered from an actual on-site Job


May be gathered from an actual on site Job Demands Analysis

If an actual on-site analysis is not an option need to understand, scientifically what jobs require so when gathering this information from an interview of the client the information is as accurate as possible

TYPES OF JOB SITE ANALYSIS

Job Safety Analysis Analyzing a job to determine that it has minimal

to no safety risk factors i.e. lock out tag out, slips-trips-falls, appropriate fire

escape routes


Ergonomic Analysis Analyzing a job determine musculoskeletal risk

factors and providing controls to minimize/eliminate these risk factors


2

JOB DEMANDS ANALYSIS

Job Demands Analysis (JDA) is the on-site analysis of a particular job to determine the exact physical and positional demands of the job. Helps to establish the three items that need to be evaluated

in regards to a clients ability to return to work


in regards to a clients ability to return to work Pounds (Material Handling)

Frequency (Repetitive Functional Activities)

Hours (Sit and Stand)

JOB DEMANDS ANALYSIS

Used to establish long term goals in outpatient rehab May not be financially responsible?

Used in conjunction with all industrial rehab testing methodologies


testing methodologiesUsed to determine the essential functions and the

physical demands associated with the essential functions for Pre-Placement Post-Offer Testing

Should be done on 100% of your work hardening/conditioning patients

OUTPATIENT REHAB LONG TERMGOALS

Clinics that go above and beyond the norm are clinics that perform Job Demands Analysis on their outpatient work comp patients

Focus on return to work abilities early on in the


patients care

Revenue generated however does not justify the time it takes to complete at this stage of therapy

Make a top ten list of companies you want to build cash based relationships with

3

INDUSTRIAL REHAB AND JDA’S

All industrial rehab tests need to compare the clients ability to the physical demands of the job

Need to know what the job requires

Use knowledge gained in regards to job demands analysis to also interview the client so you can establish


analysis to also interview the client so you can establish the physical demands of the job

OBTAINING JOB INFORMATION

On-Site job analysis: The best way to understand physical demands of a job.

Job Description: obtained from the employer.

Dictionary of Occupational Titles: using the


c o y o Occup o es: us g t ereference of the DOT for weight range.

Employer: Discussing the job with the supervisor

Client: asking the client about physical and positional demands essential to perform their job.

JOB DESCRIPTIONS

Rarely good Focus on educational and vocational aptitudes Sometimes have physical demands Never outlines positional tolerances/repetitive

f i l i i i


functional activities

4

DICTIONARY OF OCCUPATIONAL TITLES

A resource that allows any occupation or job description to be classified. You have an electronic copy of the DOT on your

OccuPro supplied CD

This will list every job/occupation


This will list every job/occupation Helps to identify the physical demand level strength

rating Will provide a reference number of the job/occupation

Nice tool if you are writing a job description it is pre-written for you in the DOT

PHYSICAL DEMANDS - STRENGTH RATING

The strength rating is expressed by one of five terms:

Sedentary

Light

M di


Medium

Heavy

Very Heavy

CLASSIFICATIONS OF FREQUENCYAND DURATION

Occasional 1-1/3 of the work day 1-33% of the work day 1 -20 minutes per hour

Frequent 1/3-2/3 of the work day 34-66% of the work day


21-40 minutes per hour Continuous

2/3-3/3 of the work day 67% -100% of the work day 41-60 minutes per hour

WHAT IS OCCASIONAL, FREQUENT AND CONTINUOUS????

5

JDA AND WORK HARDENING/ CONDITIONING

To establish a good work hardening/ conditioning program requires you to perform a Job Demands Analysis on every patient in this program

100% of your goals in this program need to be


100% of your goals in this program need to be focused on return to work and accurate

To say you are a work hardening program you need to perform Job Simulation Requires a Job Demands Analysis to establish high

quality Job Simulation treatment and testing


JOB DEMANDS ANALYSISDOCUMENTATION

DOCUMENTATION OVERVIEW

Helps to establish your expertiseShows employers that you are an expert

in the field of job analysis and may help to establish other services


Main areas requiring documentation Writing Job Descriptions Writing Essential Functions

6

SENTENCE ANALYSIS TECHNIQUE

Technique used to document all job-worker situations when writing job descriptions or essential function statements

Helps to write sentences and descriptions


Helps to write sentences and descriptions in simple, brief, and declarative sentences

Three basic questions need to be answered in each sentence you write What does the worker do? What gets done? What is the final result?


Synthesizes Serves

Feeds Cuts

What does the worker do?

Requires you to start each sentence you write with a verb and usually an action verb


Serves Analyzes Teaches Fabricates Informs Coordinates Diagnoses

Cuts Tends Saws Positions Drives Supervises Instructs


Logging Cleaning

Spinning Printing

What gets done?General overall work field


Lubricating Machining Welding Paving Fabricating Electroplating

Sewing Photographing Appraising Packing Filling Material Moving

7


What is the final result? This is within an industry and is based on

Basic materials that are processed such as fabric metal or wood

Final products created such as automobiles, field crops, or


sponges Subject matter like astronomy or journalism Services rendered like barbering, janitorial work or physical

therapy


Examples Assists patrons to locate their seats before and

during an entertainment event Teaches English courses in public secondary

h l t d t t d t


school to educate students Fabricates and repairs jewelry articles such as

rings and bracelets to customers specifications Diagnoses and treats work related

musculoskeletal diseases and injuries to return a patient to full duty work

JOB DESCRIPTION

Identify the job observed Should reflect

The significant involvement(s) of the worker

The purpose of the job

Materials used


Products created

Subject matter

Services rendered

Should be short and concise

8

JOB DESCRIPTION

The easiest way to write a job description is to list in sentence analysis technique format, in order, what the client does during the day

Optional: may use the job description right out of the DOT but should cite the reference # from the DOT


DOT but should cite the reference # from the DOT.

ESSENTIAL JOB FUNCTIONS

Identify the main essential job functions

The primary items the worker is responsible for?

What is essential for that job to be completed?

If this function was eliminated or the employee


If this function was eliminated or the employee was unable to perform it than the job as a whole could not be performed

Do not use physical demands!!!!!!!

MARGINAL FUNCTIONS

A job function is marginal when: The duty is not one of the reasons for the job’s existence

The job would still exist if the duty were not performed

A function may be marginal when: The character of the job would remain the same if the duty were


The character of the job would remain the same if the duty were not performed

The function occupies a small percentage of time

Failure to perform the function may have minor consequences

The nature of the duty is such that another employee could readily perform it

9

ESSENTIAL/MARGINAL FUNCTIONS

What are the essential functions in your job?What are the marginal functions in


your job?

PHYSICAL DEMANDS

The physical aspects of a job which need to be performed to satisfy an essential function

Three types of Physical Demands will be gathered Pounds (Material Handling)

Frequency (Occasional Frequent Continuous


Frequency (Occasional, Frequent, Continuous

Hours (Sit and Stand)


PERFORMING JOB DEMANDS

ANALYSIS

10

SETTING THE JDA UP Identify that a JDA is needed in outpatient rehab or

during work hardening/conditioning Contact the employer to gain permission onsite,

determine time/date, try to have the patient with you. The main person to contact is someone in human resources

Explain to the employer the benefits of this information-how it helps with the Plan of Care


p Ask at this time, if a video is allowed to be conducted

explain how this helps the MD and future reference Do everything you can to get the patient to come to the

analysis They cannot perform the job but will be able to explain things

and tell you what they do differently than the person being observed

Helps to break the psychosocial barrier of return to work

ONCE ON-SITE AT COMPANY

Meet with safety, human resources and/or supervisors

Spend the first ¼ of the analysis watching and asking questions

Spend the next half of the analysis gathering the data (pounds frequency hours)


(pounds, frequency, hours)

Spend the last quarter of the analysis filming if able

FILMING THE ANALYSIS

If you film the JDA, consider the filming as a verbal Job Demands Analysis and talk into the camera as you are filming to explain every thing that you see


Introduce the site and job station

Identify the weights

Describe all the equipment

Try to film the entire flow and normal speed of work

Burn video on a CD disc and distribute to rehab team

11

SUPPLIES NEEDED FOR JDA’S

Hard hat

Steel Toed Shoes

Safety Glasses

Industrial Scale

Pen/paper

Business Cards

Video Camera- charged

Ear plugs


Force Gauge

Tape Measure

Goniometer

INFORMATION TO GATHER ON JOB DEMANDSANALYSIS DOCUMENTATION TOOL

Demographics Name of client

Employer

Address or on-site location


Job title/occupation

Contact person

Phone number

Date of service

Did you take a video or not?

JOB DESCRIPTION

Typically the job description is written after the on-site analysis is completed

Notes should be taken to satisfy the job description during the first ¼ of your analysis

Make note of the exact order that things are completed


Make note of the exact order that things are completed

12

ESSENTIAL JOB FUNCTIONS

Typically the Essential Functions are identified after the analysis is complete

Notes should be taken to help identify the essential functions during the first ¼ of your analysis

If a function is questionable in regards to essential or


If a function is questionable in regards to essential or marginal, ask the employer

PHYSICAL DEMANDS

Sitting Total hours that they are sitting during their work shift Total hours they are sitting throughout 24 hours if a

24 hour shift job The number of hours they sit at one time


Standing Total hours that they are standing during their work

shift Total hours they are standing throughout 24 hours if it

is a 24 hour shift job The number of hours they stand at one time

MATERIAL HANDLING PHYSICALDEMANDS

Gathered using your scale or a force gauge Occasional, Frequent and Continuous material

handling demands


13

LIFTING PHYSICAL DEMANDS

Occasional Lift Frequent Lift Continuous Lift Occasional Shoulder lift Frequent Shoulder lift Occasional Overhead Lift


Occasional Overhead Lift Frequent Overhead Lift Occasional Unilateral Lift Frequent Unilateral Lift Continuous Unilateral Lift Occasional Bend/Job Specific Lift

CARRYING PHYSICAL DEMANDS

Occasional Bilateral Carry

Frequent Bilateral Carry

Continuous Bilateral Carry

Occasional Unilateral Carry


Frequent Unilateral Carry

PUSH AND PULL PHYSICAL DEMANDS

Occasional Push/Pull

Frequent Push/Pull

Continuous Push/Pull


14

POSITIONAL TOLERANCES – NONMATERIAL HANDLING

Percent frequency the task is performed (1 –100%) Walking

Forward bending


Squatting

Sustained Squatting

Sustained Kneeling

Repetitive Kneeling

Crawling

UPPER EXTREMITY – NON MATERIALHANDLING

Percent frequency the task is performed (1 – 100%)

Above Shoulder Reach

Below Shoulder/Forward Reach

Fi M t C di ti


Fine Motor Coordination

Gross Motor Coordination

Simple Grasping

Firm Grasping

Pinching

CLIMBING NON MATERIAL HANDLING

Percent frequency the task is performed (1 –100%) Stair Climbing

Ladder Climbing/other


Step to get up to truck, step at work station, etc.

Static Balancing

When climbing

Dynamic Balancing

When climbing

15

DISTANCES AND HEIGHTS

List the equipment and the heights of all the main equipment used

Identify: heights of lifting (floor to overhead) bilateral or unilateral Reiterate the object (size) being carried or lifted with a


specific height.

List the distances of walking, push/pull, carrying-maximum limit and frequent limit

DISTANCES AND HEIGHTS

List the distances in reaching – forward and overhead What height are they reaching to?

For what job function?

What depth is the reach span at? Does this need to be changed? Can the task be performed more

efficiently? (this may be part of ergonomic comments)


efficiently? (this may be part of ergonomic comments)

TOOLS AND EQUIPMENT USED

Identify all the tools and equipment that the client uses Hand tools (grip span?), ladders (height), machinery

type, fork lift (sit/stand), push/pull (what is it?)- does it have wheels and over what terrain?G th h h ti i t th i t


Gather how much time is spent on the equipment or how often task performed daily/weekly?

Unilateral lift weight ranges and what are they doing it for?

What are they lifting?- equipment

16


Identify the Conditions Terrain (even/uneven), grass, mud, snow, ice, rain, and wet

floor

Environment: lighting, temperature

Gear: hearing protection, eye protection, special clothes, steel


g p , y p , p ,toed shoes, hard hat, and gloves, and hair net, etc.


Be specific with this section This is where the ideas come from for the FCE and during

work hardening/conditioning for job simulated activities.

This is where the evaluator can clarify any information observed


WORKER COMMENTS

Identify if the client was present or not present If present ask the following questions

Hour/week and days/week worked full time/full dutyOvertime- mandatory or voluntaryDuties of the job- find out if the client floats to other areas- if


jso- what are the duties?

How long the client has been with the company- with the department- in the occupation?

Is the client currently on restrictions? If so- what? Are they being accommodated and for how long on the restriction? How many hours/week & days/week worked on restriction

Same shift- different shift?

17

EMPLOYER COMMENTS This is a chance to build rapport with the employer

Identify the type of worker the client is How long has the client been employed with the company? Is there overtime- Mandatory or Voluntary

Does the client work overtime How many hours/week and days/week does the client work and


How many hours/week and days/week does the client work and what shift?

EMPLOYER COMMENTS

Overall goal is to have a comprehensive view of the work environment/conditions in order to return client back to work safely and timely.

State to the employer they will receive a copy of report and video for their records/employee file Identify the particular shift the client works


Identify the particular shift the client works Ask the employer if there is a job description- may help if the

client has numerous job duties. If numerous job duties occur- ask the employer the % of time

spent in these areas.

MODIFIED/LIGHT DUTY

Identify the employers ability to accommodate modified or light duty If so what does that consist of?

Identify the types of tasks: sitting/standing, filing, answering phones, paperwork, etc.


How many hours/week can they accommodate?

18

ERGONOMIC/SAFETY RISK FACTORS

Be Careful with this section- just observations not statistical analysis.

What was observed in regards to ergonomic risk factors?


For example Small handled tool used for sustained gripping

Reaching greater than 20 inches

Working environment of poor lighting conditions

Anti-fatigue mats?

ERGONOMIC/SAFETY RISK FACTORS

What may be a safety risk factor that was observed? For example

Working in all weather conditions may be a fall risk


Working with electrical power lines

Uneven terrain and debris on floor

JOB DEMANDS ANALYSIS REPORT

Report should outline: Basic demographics

Job description

Essential functions

Physical demands

H i ht d Di t


Heights and Distances

Tools and equipment

Other important items

19

MARKETING

JDA’s up front are not profitable Excellent tool for marketing your abilities

Foot in the door Injury cost reduction services

Top 10 list of emplo ers ou ant to get into


Top 10 list of employers you want to get into

JOB DEMANDS ANALYSIS PRACTICUM

Perform a Job Demands Analysis and write up your report



Worker/Patient: Employer:

Date of Birth: Address:Gender: Job Title:Diagnosis: Contact Person:Clinic: Phone Number:Date:

Job Description:

Essential Job Functions:

Job Demands Analysis Documentation Tool

Was job videotaped?

yes No


1

5

6

7

2

3

4

yes No


Physical Demands: EnterDescriptor

▼Vocational Status:

Current Work StatusSittingSitting Throughout 24 hoursSitting at one time

StandingStanding Throughout 24 hoursStanding at one timeWalking

Material Handling:Occasional Floor to Waist Lift: Pounds

Frequent Floor to Waist Lift: PoundsContinuous Floor to Waist Lift: Pounds

Occasional Waist to Shoulder Lift PoundsFrequent Waist to Shoulder Lift Pounds

Occasional Overhead Lift PoundsFrequent Overhead Lift Pounds

Occasional Unilateral Lift PoundsFrequent Unilateral Lift Pounds

Occasional Bilateral Carry PoundsFrequent Bilateral Carry Pounds

Continuous Bilateral Carry PoundsUnilateral Carry Pounds

Frequent Unilateral Carry PoundsOccasional Push Horizontal Force PoundsFreqequent Push Horizontal Force Pounds

Hours during an average shift

(i.e. Floor to knuckle, 100yards.

Hours during an average shift

% Frequency during an average shift

Enter Distance▼


eqeque t us o o ta o ce ou dsContinuous Push Horizontal Force Pounds

Occasional Pull Horizontal Force PoundsFrequest Pull Horizontal Force Pounds

Continuous Pull Horizontal Force PoundsJob Specific/Bend Lift Pounds

Positional Tolerances:Bending % Frequency during an average shift

Squatting % Frequency during an average shiftSustained Squatting % Frequency during an average shiftSustained Kneeling % Frequency during an average shiftRepetitive Kneeling % Frequency during an average shift

Crawling % Frequency during an average shift

Climbing:Stairs % Frequency during an average shift

Ladders/Other % Frequency during an average shiftStatic Balancing % Frequency during an average shiftDyn. Balancing % Frequency during an average shift

Upper Extremity:Above Shoulder % Frequency during an average shiftBelow Shoulder % Frequency during an average shift

Fine Motor Coordination % Frequency during an average shiftGross Motor Coordination % Frequency during an average shift

Simple Grasp % Frequency during an average shiftFirm Grasp % Frequency during an average shift

Pinching % Frequency during an average shift


Distances and Heights:

Tools and Equipment Used:

Worker Comments:

Employer Comments:


Observed Safety Risk Factors:

Observed Ergonomic/Safety Risk Factors:

*Ergonomic risk factors are only observed and are not quantitatively analyzed

Modified Duty/Light Duty:


1




The Innovative Approach

Testing includes the same testing you would use for all of the following evaluationsFunctional Capacity Evaluation


Functional Progress Note TM

Functional Discharge Summary TM


Functional Capacity Evaluation Functional Capacity Evaluations (FCE’s) determine

an individual’s functional abilities and limitations, in the context of safe, productive work tasks, in order to determine whether an individual has the physical abilities required to meet the physical demands of a job.

Two types of FCE’s: Baseline FCE

Job Specific FCE

2


Baseline FCE Usually performed for disability reasons

Social Security Disability Long Term Disability Division of Vocational Rehab Medico Legal

No specific job to return to An objective assessment of the client's overall

physical abilities to perform a variety of tasks that are outlined US Department of Labor physical demands related to everyday work related function


Baseline FCE Benefits

Help to determine if a client is disabled or more importantly their abilitiesMedical professionals should be focusing on

abilities and not disabilities

Perform all reasonable functional tests in a kinesiophysical approach

Need to perform each test to its fullest level


Job Specific FCE: Client being tested has a job to return to The primary goal of performing the job specific FCE

is to know what the physical demands of the client’s job are and to test the client’s abilities to compare their abilities to those specific demands in an effort to determine return to work status. This is accomplished by gathering the physical

demands of the job in one or multiple fashions Job Demands Analysis Job Description Dictionary of Occupational Titles Interview of the client

3


Job Specific FCE Benefits Helps to establish plan of care following a clients

plateau during rehabilitation Helps to determine return to work abilities at any point

of the rehab process Unable to work - Full duty/Light duty - Part time

/Full time Transitional RTW

In conjunction with an Independent Medical Exam Helps to establish consistency of effort and reliability

of pain Helps to establish PPD ratings at end of healing


When to perform an FCE: Individual who has completed a course of therapy

and is close to return to work Initial evaluation for work hardening/conditioning To determine permanent/temporary restrictions or

disability Individual who has achieved maximum medical

improvement and is unable to return to work Individual who needs quantification of their physical

capacities for determination of disability status


OccuPro FCE testing methodology

Job Specific FCE completed in 3 to 4 hours 15 minute post test documentation time with OccuPro software Paper based template 1-2 hours after reporting mechanism is developed

Baseline FCE for disability reasons in 5-6 hours 30 minutes post test documentation with OccuPro software 2-3 hours with paper based template after reporting mechanism is

developed

100% kinesiophysical approach OccuPro Return to Work software

Easy to read format with several graphs to summarize the consistency/reliability and physical demand abilities

First page of the report summarizes what most physicians need to make a return to work decision

Immediate report generation

4


Referral Sources

The recognition by someone involved in a worker’s compensation case that a Functional Capacity Evaluation will benefit the injured worker

This can be established in different ways The referral can come directly from the physician or chiropractor. The treating therapist may feel that an FCE will benefit the entire

rehabilitation process The insurance company may directly order an FCE based on

their need of this documentation. The client’s employer, attorney, or client may ask for an FCE to

be performed and they may directly pay (invoice) for the service.


Billing/Coding

Will bill out 97750 for Physical Performance Test and Measure

Bill for the entire time you are with the patient 16-20 units. Average is 16 units

Per the AMA you cannot bill for your documentation time

Many clinicians are making sure they are doing documentation

with the patient present

This service may be invoiced directly to an employer, the client and the fee may adjust depending on the circumstances


Longer FCE’s Full day FCE

Need to implement significant amount of job simulation tasks

Could perform FCE onsite at company

2 Day FCE 2nd Day of FCE is a repeat of 1st day

May need to implement significant job simulated tasks

Compare first day results to second day and determine if an adjustment up or down needs to be made in regards to the clients functional return to work abilities

5


Preparing for Court OccuPro Software UsersContact OccuPro

Provide research to back up your findings

Provide mentoring on what to expect

Non-Software UsersStudy your methodology

Perform some research on the kinesiophysical method at your local library

Contact OccuPro for support


Heart Rates and Pain Levels Heart rates:

This will provide vital information as to: How the client is tolerating the activities? How much endurance the client has? How much effort the client is putting forth? Resting heart rate

OccuPro Functional Pain Scale May be a limiting factor if pain is reliable Need to check Reliability of Pain! Good observation skills will ensure appropriate test termination. With a resting heart rate, the evaluator will be able to see

physiological heart rate responses with physical exertion Together these will provide a glimpse of the physiological response-

graphs at the end of your test will compare these two


Pain When a client reports increased pain one,

two, and/or three evidence based things should occur.Physiological Response

Heart rate increase by 8 bpm within 8-12 seconds

Difficult to know if heart rate increase is due to pain or exertion

Mechanical changes Hold the most value in a kinesiophysical FCE

Pain Behaviors Needs to be a true pain behavior you can clinically

support

6


Borg Scale

This scale is used to assist with physiological responses and exertion by the client during frequent material handling, job simulation and climbing testing

6-20 numerical scale 6= no exertion al all 7= extremely light 9=very light (easy walking slowly at a comfortable pace) 11=light 13= somewhat hard (it’s quite an effort, you feel tired but can

continue) 15= hard (heavy) 17=very hard (very strenuous- feel very fatigued) 19= Extremely hard (you can not continue for long at this pace) 20= Maximal exertion (exhaustion)


Limiting Factors Limiting Factors Reasons “why” a specific task was terminated

or a client was unable to meet what the physical demand of the job was. Some limiting factors may be:

Increased Pain Mechanical Changes Mechanical Deficits Compensatory Techniques Substitution Patterns Maximum Effort Inadequate Strength Client Anxiety Safety Concerns


Limiting Factors

Evaluator Stopped

Client Terminated

General Fatigue

Limited Range of Motion

Poor Posture

Self Limiting behaviors

Sub Maximal Effort

Heart Rate Exceeded Aerobic Limiting Factor

Sensation

Extra ordinary muscle recruitment

7


Sitting and Standing



Needs to be evaluated from the start of the evaluation

Looks at objective observational data and compares this to the clients subjective self reported data

Is in the Sit-Stand-Climb module at the end of your evaluation


Sitting and Standing Questions you will need to answer at the

end of your test to obtain Sitting and Standing abilitiesHow long did the client sit during the FCE?

How long did the client tolerate sitting at one time during the evaluation?

How long did the client stand during the FCE?

What was the longest duration the client stood at one time?

8


Intake Process


Consent to Evaluate Prior to performing the FCE, a consent to

evaluate form must be filled out by the clientThis will explain what the test is

How long it will take

What activities will be performed

What will be expected of the client during the test

The client will sign and date at the bottom of this form prior to starting the FCE


The interview

May take 30 to 45 minutes

Is looking at sitting tolerance

Gathering the story of the client from the initial injury up through today

9


Assessment Setup Demographics

During the initial interview stages of the FCE some important information must be completed and gathered.

Clients name Employer Occupation and/or job title Referring physician/or referral source Case Manager Diagnosis Evaluator Date of birth Date of FCE Date of injury Date of surgery/Dates of surgery Time in


Assessment Setup

Demographics The dates are very important as they give the evaluator the

first glimpse at the time frame that some major events may have taken place during the injury to full rehab process.

The entire interview process is your time to build a level of rapport with the client


Basic Diagnostics

AnthropometryHeight

Weight

Hand Dominance

10


Basic Diagnostics Pre-evaluation diagnostics

Heart rate- resting Blood pressure- resting

Watch for the guidelines- Consult the MD if BP is 160/100 or higher and do not perform

the test without medical clearance first.

Respiratory Rate


Basic Diagnostics Aerobic Limiting FactorThis is the maximum heart rate level- 85%

level.

220-age x .85=?

If the client’s heart rate meets or exceeds this number then the current test should be stopped

During testing if the Aerobic Limiting Factor is exceeded multiple times this is an indication of cardiovascular endurance issues and RTW


Basic Diagnostics

Weight Limiting FactorThis is the maximum “safe” weight limit for the

client.

60% of body weight

11


Basic DiagnosticsOccuPro Functional Pain Scale

Following the presentation of OccuPro’s functional pain scale did this client report that they understood the pain scale?

0-10 functionally based scale Present Functional Pain Level Worst Functional Pain Level- within the last week Least Functional Pain Level- within the last week Average Functional Pain Level – within the last week

Following the client’s report of their present, average, worst and least pain level did they report a reliable level of pain prior to functional testing based on the OccuPro Functional Pain scale?


Assessment Setup

History of Present Condition The first section to be completed is the history of the present

condition This area should tell a story of the injury up to the date the

FCE is being performed Some of the information that needs to be gathered includes

the following: What happened on the date of injury? What were you doing at work or otherwise that caused the

injury? Was this an injury or an illness? When did you seek medical attention? When you sought medical attention what occurred?


Assessment Setup History of Present Condition

What did the medical professionals do? What medications were given? Where you removed from work? What medical recommendations were given? Was surgery performed? Who are all the physicians /specialists you saw? Has any physician returned you to work since the injury on

light /modified duty?

How was your course of treatment and was it beneficial? What diagnostic tests were performed? What type of rehabilitation programs have you participated

in? Was the rehabilitation beneficial?

12


Assessment Setup

Past Medical History The next section pertains to past medical history information

that may adversely affect this evaluation. Has the client had other surgeries, broken bones, strains or sprains that

may affect their performance in the test outside of the present diagnosis?

Also, are there any health concerns that may effect the evaluation outside of their present diagnosis?

For instance, is their history of heart problems, breathing problems, diabetes, high blood pressure or other systemic diseases?


Assessment Setup

Present Status The third section pertains to the present condition of the client

following the rehabilitation process. How do they feel they are doing today prior to going through

this evaluation The information that needs to be gathered for the present

status category includes: How does the client feel they are presently doing? What aspects of rehab have been beneficial? What daily activities have become easier or still are a challenge? What activities/strategies help any continued deficits or pain symptoms?


Assessment Setup Medications

The following questions should be asked regarding medications: Ask what type of medication they are currently

taking?

Amount of dosage and when this was last taken?

Are any other medications taken- on “prn” status?

Did they take any medications related to their diagnosis prior to coming to the test?

13


Assessment Setup

Assessment PurposeDocument the overall reason why you are

performing the FCE Is it for return to work

What position are they attempting to return to

Is it a baseline FCE Is it for SSDI

Is it for long term commercial disability


Interview


Job DemandsAnalysis

14


Job Demands Analysis Physical Demands obtained from?

Was there a job demands analysis performed?

Do you have a formal job description from the employer?

Utilizing the DOT (Dictionary of Occupational Titles)

Asking the client some of the positional/physical demands and levels of their job

What is their Current work status



Good place to document vocational status and overall job information What is their current job status How long have they been off of work? How long they have been employed with the company? Are they in a union- what Local # How long have they been in their occupation? How many hours/week & days/week? Voluntary or Mandatory Overtime? And how often? May enter brief description of the job.



Gathering the physical demands from an interview processThere three types of physical demands you

need to gather Hours

Pounds

Frequency

15



Sitting Hours?

What are the total number of hours at most you need to sit during the day

Standing Hours?

What are the total number of hours at most you need to stand during your day



Occasional Material HandlingAlways start with asking occasional questions

What is the heavy weight you lift from floor to waist?

What is the heaviest weight you lift to shoulder height?

What is the heaviest weight you carry?



Frequent Material HandlingDo you need to do lift, carry, push pull for 500

to 1,000 times during your shift?

This is asked to get to a level in which they are doing frequent lift, carry, push and/or pull.

16



Constant Material HandlingDo you need to lift, carry, push, or pull greater

than 1,000 times during your shift

This is in an effort to determine if they lift, carry, push or pull continuously



Occasional squat lift Frequent squat lift Continuous squat lift Occasional power lift Frequent power lift Continuous power lift Shoulder lift Overhead lift Unilateral lift

Occasional Carry

Frequent carry

Continuous carry

Occ. Unilateral carry

Freq. Unilateral carry

Occasional push

Frequent push

Continuous push

Occasional pull

Frequent pull

Continuous pull

Occasional, Frequent and Constant Material Handling in pounds and horizontal force pounds


Job Demands Analysis Positional Tolerances/Repetitive

Functional ActivitiesUltimately need to choose “Occasional,

Frequent, or Constant”“What percentage of your shift do you

perform____________?This will help you to determine if it is never,

occasional, frequent or continuous

17


Job Demands Analysis Positional Tolerances for Non-Material

HandlingWalkingBendingSquattingSustained SquattingSustained KneelingRepetitive KneelingCrawling


Job Demands Analysis Positional Tolerances for Non-Material

HandlingClimbing

Stair climbing

Ladder climbing

Static balancing Associated with climbing tasks

Dynamic balancing Associated with climbing tasks



Positional Tolerances for Non-Material Handling and Upper Extremity Testing Above shoulder reaching Below shoulder reaching

Above Shoulder Reach plus Below Shoulder Reach equals Gross Motor Coordination

Fine Motor Coordination Gross Motor Coordination Simple grasping Firm grasping Pinching

Pinching equals Fine Motor Coordination

18



Job Simulation Tasks There may be some things in your test in which you need to

test that require job simulated testing Tasks 1-20 option to perform based off job demands




Consistency of Effort/Reliability of Pain

19


Consistency of Effort and Reliability of Pain Overview of the testing methods used for

Consistency of Effort and Reliability of Pain testing


Consistency of Effort Observational Questions

Range of motion consistency

Muscle testing consistency

Looking through the blinds consistency

Biomechanical Two handed lifting vs. one handed lifting

Biomechanical lifting between various lifts

Occasional Handling versus Frequent Handling

Upper Extremity Coefficient of Variation (Grip and Pinch)

Five Span Grip

Rapid Grip Exchange


Reliability of Pain Ratings Follows OccuPro Functional Pain Scale

Pain and heart rate

Rating of Perceived Exertion Formula

Ransford Pain Drawing

McGill Pain Questionnaire

Oswestry Low Back Disability Questionnaire

Oswestry Neck Disability Questionnaire

20


Reliability of Pain

Rating of perceived Exertion FormulaDuring Frequent MH, Job Sim and Climbing

The formula utilized in this section is RPE*10-HR=. For instance if a client has a heart rate of 125

during testing and reports a rating of perceived exertion at 12 than this would be 12*10= 120. Then subtract the heart rate of 125 and the formula calculates out to -5. This would be considered an acceptable correlation.


Reliability of Pain Rating of perceived Exertion FormulaAcceptable Correlation (-15 to +20)

Large Negative Numbers ( <-15) Poor Cardiovascular fitness

Underestimating Difficulty

Moderate Positive Numbers (21-49) Mild Exaggeration of Difficulty of Task

Poor Musculoskeletal fitness Good CV Fit

Large Positive Numbers (≥+50) Symptom Exaggeration


Waddell Signs This is for lumbar spine client’s only

There are 5 tests that comprise this section 3 out of 5 being positive constitutes a Positive Waddell Sign

This should be performed prior to any physical activity

Superficial/non-anatomical Tenderness

Simulation test

Distraction Straight leg raising (supine vs. sitting)

Regional Disturbances

Overreaction to examination

Input “positive/negative” after each test

21


Musculoskeletal Testing



Posture

Palpation

Reflexes

Orthotics/Assistive Devices

What type are currently used and how often?

Are they using any device during the evaluation?

What may they use at home?



Need to test the entire body area or the entire extremity.

If testing an extremity need to compare it to the other extremity

Range of Motion Cervical ROM

Lumbar ROM

Thoracic ROM

Lower Extremity ROM/MMT

Upper Extremity ROM/MMT

Thumb ROM/MMT

Index Finger

Middle finger

Ring finger

Pinky Finger

22



Comment and summarize the findings Discuss any decrease in range, strength or any other

musculoskeletal findings.

Input heart rate during this part of the evaluation and pain level If numerous pain rating are given then may provide

a range in the comment section Note observed behaviors during ROM/MMT- facial

expressions, body language, and quote any comments pertinent to this section.


Musculoskeletal Screen

Circumferential/Volumetric Measurements Pre evaluation Post evaluation Document your findings May want to evaluate distal and proximal to area of injury



Two point discrimination Sharp/Dull Awareness Sensation comments Semmes Weinstein Lower Extremity Sensation

23



Abnormal Sensation Identify any abnormal sensations – numbness or tingling

Is it constant or intermittent Identify the dermatome patterns identified or

specify location Sensation

Testing for the following sensations, if appropriate-

Light touch 2 point discrimination Sharp/dull touch

Semmes Weinstein- if appropriate




Upper Extremity Testing

24


Grip Strength

Standard Three Trial Grip Testing Test bilateral hands in position II of the dynamometer Test in seated position Seated position with elbows flexed to 90 degrees and

in adduction holding against gravityDo not take the average – WHAT IS THE HIGHEST

NUMBERCompare results to normative ranges


Five Span Grip Testing Test bilateral hands, alternating, in all five positions

one time in each grip span Test in seated position This will determine a bell shape curve or a lack of

curve A non-bell shaped curve may suggest an

inconsistent response during three trial grip testing Positions 1 and 5 should be lower- numerically

than 2, 3, and 4 positions. If so this will be a bell shaped curve

Also want to know what the grip strength is in position number 2 to use so we can compare to the normative data


Rapid Exchange Grip Strength testing Test bilateral hands in position II of the dynamometer in a

rapid fashion with elbows flexed at 90 degrees, arms adducted and holding against gravity, sitting position, and forearms in neutral position A second person may be of assistance to document the numbers to

ensure proper speed is conducted. If the grip strength performed during this test are GREATER than

the three trial peak of gripping- then the client’s performance is inconsistent in regards to three trial grip

If the grip strength is LESS than the 3 trial peak – then the client’s performance is consistent in regards to three trial grip

Use position number 2 along with other position number 2 testing to compare to normative data

25


Simple Grasping Decision Chart


Firm Grasping Decision Chart


Grip Strength Documentation Abilities

CAN TOLERATE SIMPLE GRASPING WITHIN THE FOLLOWING FREQUENCY Avoid, Occasional, Frequent, Continuous

CAN TOLERATE FIRM GRASPING WITHIN THE FOLLOWING FREQUNCY Avoid, Occasional, Frequent, Continuous

Mechanics Mechanical Changes - Mechanical Deficits

Pain Pain rating - Pain location - Pain Behavior

Heart Rate Limiting Factors Normative Data Reliability of Pain Consistency of Effort

26


Grip Strength Testing


Five Span Grip Testing


Rapid Exchange Grip

27


Pinch Strength Key pinch

3 trials for each hand using the DI and the lateral aspect of DII with forearm in neutral position

Palmar pinch using the DI, DII, and DIII in a series of 3 trials

Tip pinch DI and DII in a series of three trials

Test in seated position

Will not average the results and will take the highest of each pinch bilaterally

Normative ranges for age and gender


Pinch Strength Decision Chart


Pinch Strength Documentation CAN TOLERATE PINCHING WITHIN THE FOLLOWING

FREQUNCY

Avoid, Occasional, Frequent, Continuous

Mechanics

Mechanical Changes - Mechanical Deficits

Pain

Pain rating - Pain location - Pain Behavior

Heart Rate

Limiting Factors

Normative Data

Reliability of Pain


28


Pinch Strength


Fine Motor/Gross Motor Coordination

Normative data in testing does not mean a whole lot

? Does the client have coordination or not?????

Use any fine motor or gross motor coordination test


Fine Motor Coordination Purdue PegboardTesting for coordination and speed of work

Performed with bilateral coordination simultaneously

There are 4 subtests Right hand

Left hand

Both hands

Assembly

29


Fine Motor Coordination Moberg’s Pick up Test

Only tested if other Fine Motor testing found a fine motor deficit

2 trials for each hand Eyes open

Pick up objects then place in container as fast as possible

Score= time to pick up and place all 12 objects into a box

Eyes closed Client manipulates the object in hand and names it as fast as

possible

Score= time it takes to recognize each object on each of 2 trials –up to 30 seconds


Fine Motor Decision Chart


Fine Motor Documentation CAN TOLERATE FINE MOTOR COORDINATION WITHIN THE

FOLLOWING FREQUNCY Avoid, Occasional, Frequent, Continuous



Heart Rate

Limiting Factors

Normative Data

Reliability of Pain


30


Purdue Pegboard


Moberg’s Pick Up Test



Normative Data again does not mean much

Does the client have adequate gross motor coordination abilities.

31



Box and Block Test each hand independently

This is a timed test For 1 minute in duration

Input the number for each hand


Gross Motor Decision Chart


Gross Motor Documentation CAN TOLERATE GROSS MOTOR COORDINATION WITHIN THE




Heart Rate

Limiting Factors

Normative Data

Reliability of Pain


32


Non-Material Handling


Non-Material Handling Testing aspects of function that are

considered to be repetitive. Test according to the physical demands of

the job or for baseline testing This section is a high kinesiophysical

section with biomechanics playing an important role

Identify their functional ability “avoid, occasional, frequent, or continuous” using the decision charts as a guide


Non-Material Handling Fast paced walking testTest for 100 yards at the clients fastest walking

pace

Tell the client: “This is a timed test”

Observe gait pattern: antalgic or non - antalgic

Time to complete

Performance of pivot/turn- noting any loss of balance or inability to perform

Observe equal/non-equal stride length

Compensatory patterns- holding body part?

33


Non-Material Handling Fast pace walking testPhysical behavior signs- facial grimacing,

labored breathing, holding injured area, profuse sweating, and heart rate

Input heart rate and pain levels and note the location of pain

Input findings in the comment section


Prolonged Walking

This is to determine if the client is able to tolerate walking on a continuous basis.

Test on a treadmill 15 minute walk test on the treadmill

3.0 mph +

Note the treadmill speed and duration

This may be used to simulate an activity on the client’s job.


Walking Decision Chart

34


Walking Documentation CAN TOLERATE WALKING WITHIN THE FOLLOWING

FREQUNCY Avoid, Occasional, Frequent, Continuous


Stride length, antalgic/non-antalgic gait, speed


Pain correlates to diagnosis

Heart Rate

Limiting Factors

Reliability of Pain



Walking


Forward Reaching

Bilateral upper extremity to 90 degrees of shoulder flexion.

Input % of ROM after each test Test 1 time

Input heart rate and pain level Test 10 times

Input heart rate and pain level Test 10 times fast

Input heart rate and pain level

35


Forward Reaching Decision Chart


Forward Reaching Documentation CAN TOLERATE FORWARD REACHING WITHIN THE



% shoulder reach, speed, scapulohumeral rhythm, Compensatory Techniques


Pain correlates to diagnosis?

Crepitus

Heart Rate

Limiting Factors

Reliability of Pain



Forward Reaching

36


Above Shoulder Reaching Bilateral upper extremity to full range of motion of

true shoulder flexion% of ROM after each test Test 1 time

Input heart rate and pain level Test 10 times

Input heart rate and pain level Test 10 times fast

Heart Rate and Pain after each test


Above Shoulder Reaching Decision Chart


Above Shoulder Reaching Documentation

CAN TOLERATE ABOVE SHOULDER REACHING WITHIN THE FOLLOWING FREQUNCY Avoid, Occasional, Frequent, Continuous


% shoulder reach, speed, scapulohumeral rhythm, Compensatory Techniques



Crepitus

Heart Rate

Limiting Factors

Reliability of Pain


37


Above Shoulder Reaching


Bending Lumbar flexion with legs straight and shoulder width apart

Test 1 time

% of ROM demonstrated

heart rate and pain level

Test 10 times

Heart rate pain level and ROM

Test 10 times fast

Heart rate, pain level, and ROM


Bending Decision Chart

38


Bending Documentation CAN TOLERATE BENDING WITHIN THE FOLLOWING FREQUNCY



% of full bend, movement pattern, speed, compensatory techniques, hamstring tightness



Heart Rate

Limiting Factors

Reliability of Pain



Bending


Squatting

Squatting to as close to the floor as possible in a functional manner

Document % of full squat for each test Test 1 time

Document heart rate and pain level Document % of full squat for each test

Test 10 times Input heart rate and pain level Document % of full squat for each test

39


Squatting Decision Chart


Squatting Documentation CAN TOLERATE SQUATTING WITHIN THE FOLLOWING

FREQUNCY



% of full squat, movement pattern, speed, compensatory techniques, equal weight bearing



Crepitus

Heart Rate

Limiting Factors

Reliability of Pain



Squatting

40


Sustained Squatting

Will be performed in a job simulation fashion

The only factor to determine avoid, occasional, frequent or continuous is how long the client can tolerate the activity you set up


Sustained Squatting Decision chart


Sustained KneelingTall kneel position with equal weight

distribution bilaterally Hold for up to 2 minutes in duration

Document heart rate and pain level

41


Sustained Kneeling Decision Chart


Sustained Kneeling CAN TOLERATE SUSTANINED KNEELING WITHIN THE

FOLLOWING FREQUNCY



Time tolerated, movement pattern, speed, compensatory techniques, equal weight bearing, upper extremity assistance



Crepitus

Heart Rate

Limiting Factors

Reliability of Pain



Repetitive KneelingTest 10 times


Documents % of full kneel

The sustained kneel represents the kneel 1 time

42


Repetitive Kneeling Decision Chart


Repetitive Kneeling CAN TOLERATE REPETITIVE KNEELING WITHIN THE

FOLLOWING FREQUNCY



% of full kneel, movement pattern, speed, compensatory techniques, equal weight bearing, upper extremity assistance



Crepitus

Heart Rate

Limiting Factors

Reliability of Pain



Kneeling

43


Crawling

Test both forward and backward mobilityTest for 1 to 20 minute in duration

Test for 21 to 40 minute duration

Test for 41 to 60 minute duration Input heart rate and pain level


Crawling Decision Chart


Crawling Documentation CAN TOLERATE CRAWLING WITHIN THE FOLLOWING

FREQUNCY



% of full crawl position, movement pattern, speed, compensatory techniques, equal weight bearing in all four extremities



Heart Rate

Limiting Factors

Reliability of Pain


44


Crawling


Dynamic and Static Balance

Balance testing occurs when a client has ajob that requires them to perform activities up off of the ground as in climbing


Static BalanceRomberg’s

Eyes open No eyes closed

Need to complete 30 secondsOccasional Level of Testing

45


Romberg’s eyes open


Static Balance

Sharpen Romberg’s Eyes openNeed to complete 30 seconds Occasional Level of Testing


Sharpened Romberg

46


Static BalanceFunctional Reach Assessment

Norms: Young male 18-35=17 inches

Young female 18-35=15 inches

Middle age male 35-55=15 inches

Middle age female 35-55= 14 inches

Elderly male 55+ = 13 inches

Elderly female 55+ = 10 inches

Occasional Level of Testing


Functional Reach


Static Balance

Single leg stance Eyes Open Bilaterally for 30 seconds Frequent Level of Testing

47


Single Leg Stance


Static Balance

Single Leg Stance Eyes closedBilaterally for 30 seconds

Continuous Level of Testing


Single Leg Stance Eyes Closed

48


Static Balance Decision Chart


Static Balance Documentation CAN TOLERATE STATIC BALANCE WITHIN THE FOLLOWING

FREQUNCY



movement pattern, compensatory techniques, loss of balance



Heart Rate

Limiting Factors

Reliability of Pain



Dynamic Balance Functional Gait Assessment

9 dynamic balance tests Gait level surface

Instructions: “Walk at your normal speed from here to the next mark (6 m (20 ft)).”

Pass – Walks 6 m (20 ft) in less than 5.5 seconds, no assistive devices, good speed, no evidence for imbalance, normal gait pattern, deviates no more than 15.24 cm (6 in) outside of the 30.48 – cm (12-in) walkway width.


49


Gait Level Surface


Dynamic Balance Change in gait speed

Instructions: “Begin walking at your normal pace (for 1.5 m [5 ft]). When I tell you “go,” walk as fast as you can for (1.5 m [5 ft]). When I tell you “slow,” walk as slowly as you can for (1.5 m [5 ft]).

Pass – Able to smoothly change walking speed without loss of balance or gait deviation. Shows a significant difference in walking speeds between normal, fast, and slow speeds. Deviates no more than 15.24 cm (6 in) outside of the 30.48-cm (12-in) walkway width.



Change in gait speed

50


Dynamic BalanceGait with horizontal head turns

Instructions: “Walk from here to the next mark 6 m (20 ft) away. Begin walking at your normal pace. Keep walking straight; after 3 steps, turn your head to the right and keep walking straight while looking to the right. After 3 more steps, turn your head to the left and keep walking straight while looking left. Continue alternating looking right and left every 3 steps until you have completed 2 repetitions in each direction.”

Pass – Performs head turns smoothly with no change in gait. Deviates no more than 15.24 cm (6 in) outside 30.48-cm (12-in) walkway width.



Gait with horizontal head turns


Dynamic Balance

Gait with vertical head turns Instructions: “Walk from here to the next mark (6 m

[20 ft]). Begin walking at your normal pace. Keep walking straight; after 3 steps, tip your head up and keep walking straight while looking up. After 3 more steps, tip your head down, keep walking straight while looking down. Continue alternating looking up and down every 3 steps until you have completed 2 repetitions in each direction.”

Pass – Performs head turns with no change in gait. Deviates no more than 15.24 cm (6 in) outside 30.48-cm (12-in) walkway width.


51


Gait with vertical head turns


Dynamic Balance Gait pivot & turn

Instructions: “Begin with walking at your normal pace. When I tell you, “turn & stop,” turn as quickly as you can to face the opposite direction and stop.”

Pass – Pivot turns safely within 3 seconds and stops quickly with no loss of balance

Frequent Level of Testing


Gait pivot & turn

52


Dynamic Balance

Step over obstacle Instructions: “Begin walking at your normal speed.

When you come to the shoe box, step over it, not around it, and keep walking.”

Pass – Is able to step over 2 stacked shoe boxes taped together (22.86 cm [9 in] total height) without changing gait speed; no evidence of imbalance.

Frequent Level of Testing


Step over obstacle


Dynamic Balance Gait with narrow base of support

Instructions: “Walk on the floor with arms folded across the chest, feet aligned heel to toe in tandem for a distance of 3.6 m [12 ft]. The number of steps taken, in a straight line, is counted for a maximum of 10 steps.”

Pass – Is able to ambulate for 10 steps heel to toe with not staggering.


53


Gait with narrow base of support


Dynamic Balance

Gait with eyes closed Instructions: “Walk at your normal speed from

here to the next mark (6 m [20 ft]) with your eyes closed.”

Pass – Walks 6 m (20 ft), no assistive devices, good speed, no evidence of imbalance, normal gait pattern, deviates no more than 15.24 cm (6 in) outside 30.48-cm (12-in) walkway width. Ambulates 6 m (20 ft) in less than 7 seconds.



Gait with eyes closed

54


Dynamic Balance

Ambulating backwards Instructions: “Walk backwards until I tell you to stop”.

Pass – Walks 6 m (20 ft), no assistive devices, good speed, no evidence for imbalance, normal gait pattern, deviates no more than 15.24 cm (6 in) outside 30.48-cm (12-in) walkway width.


Gait Ambulating Backwards


Dynamic Balance Decision Chart

55


Dynamic Balance Documentation CAN TOLERATE DYNAMIC BALANCE WITHIN THE FOLLOWING

FREQUNCY



movement pattern, compensatory techniques, loss of balance



Heart Rate

Limiting Factors

Reliability of Pain



Occasional Material Handling


Occasional Material Handling Most important aspect of any test

To test for the client’s ability with lifting, carrying and push/pull in a variety of positions and levels

KINESIOPHYSICAL APPROACH vs. Psychophysical approach

Mechanical Changes vs. Mechanical Deficits

Peak Weight vs. Occasional Weight

Document the pain rating prior to testing

Document the heart rate prior to testing Lifting- testing for the “MAXIMUM” SAFE abilities

56


Bend/Job Specific LiftUsing the top handles

Floor to waist level with pivot/turn Mechanical Changes vs. Mechanical Deficits Occasional weight vs. Peak Weight Identify limiting factors Document heart rate Document pain level reported

Bend Lift mechanics Need to take into account

Mechanics of this lift Prior surgery SAFETY YOU WILL ONLY PERFORM THIS LIFT IF THE JOB IS

DESIGNED IN A WAY THAT MAKES THE CLIENT LIFT IN THIS MANNER


Bend/Job Specific Lift


Squat Lift

Using the bottom handles Floor to waist level with pivot/turn


Occasional Weight vs. Peak Weight

Identify limiting factors

Document heart rate

Document pain level reported

57


Squat Lift


Power lifting

Using top handles Floor to waist level with pivot/turn


Occasional Weight vs. Peak Weight Input heart rate Document pain level reported Document limiting factors


Power Lift

58


Shoulder Lifting

Using the Bottom handles Waist level to shoulder level

Identify the limiting factors- why the test was terminated




Document the body mechanics used


Shoulder Lift


Overhead Lifting

May use handles or the bottom of the box

Functional lifting: perform from waist level to overhead level

Job lifting: may be floor to overhead or shoulder level to overhead




Document body mechanics used

59


Overhead Lift


Occasional Material Handling Documentation

One of the most important areas for documentation for all bilateral lifting tasks

Mechanics

Mechanical Changes - Mechanical Deficits

Pain



Heart Rate

Limiting Factors

Reliability of Pain



Unilateral lifting Testing affected/unaffected or dominant/non-dominant

extremity May perform at various levels dependent upon job and

occupation of task


Occasional weight vs. Peak Weight


Heart Rate

Limiting Factors

Reliability of Pain


60


Unilateral Lift


Bilateral carrying Using the bottom handles

Test for function- 50 feet total in distance

25 feet out and 25 feet in return

Test for job specific- distance will vary 3-100 feet

With pivot/turn, holding bottom handle



Pain


Heart Rate

Limiting Factors

Reliability of Pain



Bilateral Carrying

61


Unilateral Carrying Test bilaterally for 25 feet

Walk a distance of 1 feet to 300 feet- depending on job tasks

Unilateral carrying may use dumbbell or simulated tool box



Pain


Heart Rate

Limiting Factors

Reliability of Pain



Unilateral Carrying


Pushing/Pulling: Dynamically using a resistive sled – measured in Horizontal Force

Pounds (HFP) Functional testing at 25 feet May vary the distance for job specific


Observe gait pattern, BUE posture and gripping


Pain


Heart Rate

Limiting Factors

Reliability of Pain


62


Pushing/Pulling


Job Simulated Functional

Abilities


Job Simulated Functional Abilities

Testing for a specific activity and body positions in order to perform their job.

Look at job description

Look at the job demands analysis

Ask the client

Is there something that “you” think we could test-this puts some responsibility to the client and gives them some control during the evaluation

63



Description of the job simulated activity Input the title of the job simulated Describe what the task is and what it will simulate Note the type of equipment used or the set-up

position Document the task with parameters of duration,

repetition, and sets Input what the level “Occasional, Frequent, or

Continuous” that is trying to be achieved



Document the client’s ability to perform this task.

Identify the level “Occasional, Frequent, or Continuous” that they are performing within.

Input post heart rate level and pain rating

Document any observed behavior


Examples of Job Simulated Tasks

Unilaterally Carrying Test for distance 5-100 feet

May test with ladder climbing or stair climbing

Static- push/pull Feet static in position Horizontal ADD/ABD push/pull of box to

simulate “line work” a factory worker on an assembly line

Simulate height of work station

64



Performing lifting-

Specific heights and distances to the job

Carrying:

100 pounds for 5 feet with a pivot/turn

Crawling:

On stomach with fire gear on for 50 feet

Donning/doffing: fire gear under 1 minute

4 point position: with a 2x4 or using a trowel in kneeling for a cement finisher



Obstacle course- ambulating over and around objects in the floor- simulate debris or job site

Unilateral carrying while ladder climbing Washing windows/mirrors- simulate cleaning chores,

washing a car, etc. Using a Swiss ball/medicine ball rolling in forward bent

position- simulate fire hose roll/unroll


Frequent Material Handling

65



Three approaches on the market50% approach

Psychophysical approach

Kinesiophysical approach Exceeds Aerobic Limiting Factor

Mechanical Changes

Muscle Endurance Decrease in in-repetition cadence/pace


Frequent Material Handling Lifting

Testing the client’s ability to lift frequently

KINESIOPHYSICAL APPROACH

For all the lifts will enter in the “peak weight” and the “frequent weight”

These may be the same or slightly different

Before the first lift note the baseline heart rate and pain level

Identify the body mechanics used

Post each lift- note heart rate, pain level and identify Borg Rating of Perceived Exertion level CR-20 scale


Frequent Squat Lifting Performed using the bottom handles of the box from floor to waist

level with pivot/turn

Same as Occasional Squat Lift

Test weight at 5 repetitions and then increase weight until peak weight is achieved

Weight should be 50-70% of their maximum ability

Document Peak and Frequent weight performed


Pain


Heart Rate - Exertion Level

Limiting Factors

Reliability of Pain


66


Frequent Power lifting Performed using the top handles of the box from floor to waist level

with pivot/turn

Same as Occasional Power Lift





Pain



Limiting Factors

Reliability of Pain



Frequent Shoulder Lifting Performed using the bottom handles of the box from waist to

shoulder level with pivot/turn

Same as Occasional Shoulder Lift





Pain



Limiting Factors

Reliability of Pain



Frequent Two handed Carrying Performed using the bottom handles of the box and walking for 25

feet out and 25 feet back

Same as Occasional Bilateral Carry





Pain



Limiting Factors

Reliability of Pain


67


Frequent Pushing/Pulling Performed using the push pull sled for 25 feet of a push and 25 feet

of a pull

Same as Occasional Push/Pull





Pain



Limiting Factors

Reliability of Pain



Frequent Unilateral Lifting Performed using a dumbbell and/or the simulated tool box from

shin to waist level with pivot/turn

Same as Occasional Unilateral Lift





Pain



Limiting Factors

Reliability of Pain




68


Sit - Stand -Climb


Stair climbing

Can use any stairs you would likePerform 0 – 36 steps = Occasional

Perform 37 – 72 steps = Frequent

Perform 73 – 108 steps = Continuous

A step up and down equals 1 step


Stairs Decision Chart

69


Stair Climbing Documentation CAN TOLERATE STAIR CLIMBING WITHIN THE FOLLOWING

FREQUNCY



speed, movement pattern, speed, compensatory techniques, gait pattern, use of hand rails, pivot/turn



Rating of Perceived Exertion

Heart Rate

Limiting Factors

Reliability of Pain



Stair Climbing


Ladder/other climbing

Document heart rate and pain level prior to testing

Test 4 rungs for 1 repetition

Occasional 1-5 repetitions

Frequent 6-15 reps

Continuous 16-25 reps.

Avoid if unable or safety concerns.

70


Ladder/Other Decision Chart


Ladder/other Documentation CAN TOLERATE LADDER CLIMBING WITHIN THE FOLLOWING

FREQUNCY



speed, movement pattern, speed, compensatory techniques, gait pattern, pivot/turn



Rating of Perceived Exertion

Heart Rate

Limiting Factors

Reliability of Pain



Ladder Climbing

71


Sitting and Standing Questions obtain Sitting abilities In a 24 hour period, how many hours are you

lying down or sleeping

How long did it take to drive to this evaluation

How long were you sitting prior to this evaluation?

How many more hours will you be sitting today?

How long did the client sit during the FCE?


Sitting

Questions to obtain Sitting abilitiesWhat is the most you could now sit during

the course of a day?

What was the longest the client sat at one time during this evaluation

How long can the client tolerate sitting at one time?


Standing

Questions to obtain Standing abilitiesHow many hours are left today

Need to add up the sleeping or lying down with theclients demonstrated and reported sitting ability today.

Take this number form 24 hours and you will have then number of hours left in the day in which the clients self report and demonstration of standing should be close to.

72


Standing Questions to obtain Standing abilities

How long did the client stand during prior to the evaluation?

How long did the client stand during the FCE? How many more hours will the client stand after the

testWhat was the longest duration the client stood at one

time? How many hours does the client stand within a 24

hour period? How many hours can the client stand at one time?




Consistency of Effort and Reliability of Pain Profile


Reliability of Pain

73


COE/ROP Profile Answer the following questions based on the results of the

assessment

Reliability of Pain Did this clients overall movement pattern correlate with their reported

pain symptoms

Did this clients physiological responses match their reported pain symptoms

Consistency of Effort Did this client demonstrate range of motion inconsistencies during two

or more functional tasks as compared to range of motion testing

Did this client demonstrate manual muscle testing inconsistencies during two or more functional tasks as compared to manual muscle testing?

These questions will help to determine the consistency and reliability of pain based on the evaluators observations


COE/ROP Profile Occasional Material HandlingAll considered biomechanical consistency of

effort

Hand TestsAll considered biomechanical consistency of

effort


COE/ROP Profile

Frequent Material HandlingConsistency of Effort

Comparison between what the client lifted occasionally as compared to what the client lifted frequently

Reliability of Pain Borg Rating of Perceived Exertion Formula

74


COE/ROP Profile

ClimbingReliability of Pain

Borg Rating of perceived exertion formula


Results and Recommendations


Evaluation/Results Summary Assessment Purpose

Functional Abilities to Job Demands Match

What % was the client consistent and reliable? Consistency of Effort?

Reliability of Pain Ratings

Physical Demand Level of the client

Physical Demand Level of the Job

What were the limiting factors during the evaluation?

Return to Work Recommendations?

75


Recommendations

The evaluator will provide objective recommendations:

Does the client meet job demands in order to return to work?

At what overall levels did the client demonstrate in regards to return to work function

List the frequency of tasks demonstrated

List weights of all lifts performed


Rehabilitation Recommendations

List the frequency and duration

Reasons to justify continued treatment

Identify any additional treatmentWhat the client is currently able to perform

and in what levels Material Handling

Positional Tolerances

Range of Motion abilities


Evaluation Comments

Fluff and buff all the comments that have been documented in the evaluation

Make sure all documentation makes sense and is grammatically correct

76


Report Customization

The physician only wants a short report so do not send them a 15 page report

Send the longer version of the report to the insurance carrier


Charts/Graphs % of Job Matched

% Consistency of Effort

% Reliability of Pain Ratings

Heart Rate

Pain Level

Material Handling Abilities

Positional Tolerances


Functional Capacity Evaluation Consent


We would like to thank you for choosing us for your functional capacity evaluation. Your Doctor has requested your participation in this evaluation but you should be aware that this is a voluntary evaluation and we need your permission to perform it. Functional Capacity Evaluation (FCE): This is a comprehensive evaluation designed to determine your tolerance and physical abilities to perform your required job demands or to test your overall functional abilities at this time. You have the right to stop any test during this evaluation however the medical tester will be looking for your maximum effort during testing.

This evaluation requires your maximum effort during all tasks in order to determine accurate recommendations to your physician and or employer.

o There are tests that tell us if you are giving your best effort during testing. This effort is determined by the testing procedures and the objective data gathered and in no way is based on an opinion of your evaluator

This evaluation may take 3-4 hours in order to complete in the entirety. It is possible for your pain to increase during this evaluation

Some pain may be normal when you perform activities but this does not necessarily mean you have been injured.

During testing we will be using a functionally based pain scale. This is being used to specifically determine how your pain effects you from performing functionally in a competitive work environment

You must determine how much pain increase is acceptable for you. The evaluator will be monitoring your pain throughout this test.

We do not expect you to perform activities that increases your pain to a level that you feel is unsafe

There will be testing procedures that help to determine if the pain reports you provide can be considered reliable pain reports

The therapist will send the report to your doctor, case manager, employer, and insurance adjustor. This evaluation will be conducted in several stages: 1. The first is obtaining a brief history of your injury/illness, conducting a musculoskeletal

evaluation, and discussing your job duties. 2. The second will consist of demonstrating positional abilities such as: squatting, bending,

kneeling, walking, reaching, stair/ladder climbing, and balancing tasks. 3. Next will consist of lifting, carrying, and push/pull. This section will be focused on your

maximum ability to perform occasional and frequent abilities. 4. The last aspect may be performing a job simulated task that is appropriate.

At the end of the evaluation, the therapist will discuss the results with you. If at any time during the evaluation if you have any questions/concerns please let us know.

I hereby have read, reviewed, and am willing to participate in this Functional Capacity Evaluation

Patient Signature Date

Unit Price: $566.80

Qty:

Simulates lifting and loading tasks. Must be secured to wall.

Lift and Place Rack Station Item # 8901

FCE TESTING EQUIPMENT

Unit Price: $656.50

Qty:

Ergonomic grip handles at each end of sled. Simulates push pull work tasks.

Push Pull Sled Station Item # 8930

Unit Price: $201.50

Qty:

Four 2.5 lb, eight 5 lb, and four10 lb disc weights.

Set of 16 Disc Weights Item # 8952

Unit Price: $188.50

Qty:

Fixed wooden tote handle. 16 lb.

Tool Kit Weight Box Item # 8912

Unit Price: $183.30

Qty:

Stockroom Crate is 17.5 lbs.

Stockroom Crate Weight Box Item # 8913

Unit Price: $2,115.10

Qty:

Equipment of System I with 8930 Sled Station added.

Work Well System II Item # System II

Unit Price: $137.80

Qty:

Foot Stool Item # 2216

Unit Price: $1181.70

Qty:

Hand rails enclose platform. Four 6” high x 30” wide steps.

Stairs Straight Single Side Item # 1567

Unit Price: $174.20

Qty:

Fixed wooden tote handle. 12.5 lbs.

Carry All Weight Box Item # 8911

Unit Price: $201.50

Qty:

Hinged lid to coneal contents. Packing Carton is 17 lbs.

Packing Carton Weight Box Item # 8914

0910

Unit Price: $ 88.40

Qty:

Used for determining the two point threshold of touch.

Two Point Aesthesiometer Item # 16022


Unit Price: $ 69.95

Qty:

Shows heart rate on large and easy to read display.

Heart Rate Monitor Item # FT1 Black

Unit Price: $ 208.00

Qty:

6 foot ladder 300 lbs. Load Capacity

Stepladder Item # 3W141

Unit Price: $ 5.00

Qty:

Moberg pick up test.To determine sensibility of hand and finger in median nerve distribution.

Moberg’s Test Item # Moberg

1110

Unit Price: $ 22.97

Qty:

Measuring Tape with 25ft. blade length

Industrial Tape Measure Item #3TB93

Unit Price: $ 11.70

Qty:

1/100th second stopwatch

Stop Watch Item # STPW

Unit Price: $ 1.50

Qty:

OccuPro Tape Measure for basic mea-suring

OccuPro Tape Measure Item # OccuTM


Qty:

This device has been used extensively to aid in the selection of employees for jobs that require fine and gross motor dexterity and coordination.

Purdue Pegboard Item # 32020


Qty:

Acumar Single Digital Inclinometer is a compact, handheld unit that includes a large digital display for clear and easy reading.

Acumar Single Digital Inclinometer Item # ACU001


Qty:

Set of 5 Hand Monofilaments.Measure Cutaneous Sensory Perception Threshold.

Baseline® Tactile™ Semmes-Weinstein™ Monofilaments Item # 566762



Qty:

Ideal for routine screening of grip strength and initial and ongoing eval-uation of clients with hand trauma and dysfunction.

Jamar Hydraulic Hand Dynamometer Item # 5030J1


Qty:

Includes an aneroid sphygmomanometer with calibrated nylon cuff and easy to read gauge with luminescent dial.

Match Mates Littmann Combo Kit Item # 5570-30 - Black

Unit Price: $351.83

Qty:

Unique design frees the client to perform a true pinch pattern because the therapist supports the weight of the gauge.

Jamar Hydraulic Pinch Gauge Item # 749805

1110

Unit Price: $56.69

Qty:

Clearly marked numbers make measuring easy. Measures 6” (15cm) long.

Stainless Steel Deluxe Small Joint Goniometer Item # 7507

Unit Price: $23.58

Qty:

12 1/2 inch International Standard Goniometer. For observation of joint axis and motion. Linear readings inches and centimeters.

12 1/2 Inch Plastic Goniometer Item # 7514


Qty:

Portable version of the standardized test of manual dexterity. Provides a baseline for upper extremity manual dexterity and gross motor coordination.

Box and Block Item # 7531


Qty:

Inclinometer is graduated in 2 degree increments on both sides.

Baseline Accu Angle Goniometer Item # 7503


Functional Progress NoteFunctional Progress Note

Functional Discharge SummaryFunctional Discharge Summary


Becoming a specialist in the treatment of the injured worker

� Step 1

– Train staff in regards to the changes the clinic will be making to become a clinic that specializes in the treatment of the injuredworker

� Step 2– Implement the Functional Job Demands Form

� Step 3– Perform Functional Progress Notes and Functional Discharge

Summaries on all your work comp patients� Step 4

– You will see an increase in work conditioning referrals� Step 5

– FCE referrals will follow


Rehabilitation of the Injured Worker

� Part of acute outpatient rehab is to determine appropriate plan of care

� Many clinicians continue to treat injured workers the same as other types of patients

� Return to work function is the key during outpatient therapy

� What does MMT and AROM really mean?� Should they return to work?

– full duty, light duty- at part-time or full-time?


Before you discharge a work comp patient from rehab you need to determine

�Can they go back to full duty work


Outpatient Functional Progress Note

� (FPN) an objective FUNCTIONAL re-assessment that provides full duty return to work information to the physician, insurance, case manager and employer

� Test diagnosis specific and only areas that may affect return to work.

� Test may take 60-90 minutes to perform depending on the client’s current abilities and injury status.

– Test all injury specific and job specific areas

� Could be done if 15 minutes if necessary– Test only squat lift, power lift, bilateral carry push and pull


Outpatient FPN and Testing

� FPN- test only the job specific tests related to the outpatient diagnosis– If you established return to work goals this will

help to reassess the goals, identifies new goals, streamlines the POC, but focuses your treatment on return to work.

– This will help to justify the need for continued therapy or to progress therapy to more aggressive treatment techniques.

� May perform Musculoskeletal testing????


When to perform functional testing

� First third of therapy

– Musculoskeletal re-assessment

� 2nd third of therapy

– Musculoskeletal and functional re-assessment

� Last third of therapy

– Functional re-assessment


Functional Discharge Summary

� Functional Discharge Summary (FDS)- A comprehensive FUNCTIONAL discharge note that provides objective information in support of FUNCTIONAL discharge from physical therapy.

� Helps to determine full duty return to work status

� Diagnosis and job specific testing only

� May take 45-60 minutes to perform

� BEFORE DISCHARGE FROM OUTPATIENT THERAPY CAN YOUR PATIENT RETURN TO FULL DUTY WORK????????????


FDS and Testing

� FDS- test only diagnosis specific and job specific tasks.

� May perform musculoskeletal testing

� IF A CLIENT IS 5/5 STRENGTH AND FULL ROM THIS DOES NOT MEAN THEY CAN DO THEIR JOB

� Main source for referring into your work conditioning/hardening program

� IF THEY CANNOT DO 100% OF THEIR JOB THEN THEY REQUIRE A REHAB RECOMMENDATION FOR WORK HARDENING


FPN/FDS Assessment

� Same functional tests in the OAA

� Some musculoskeletal tests have been removed

� Perform in a Psychophysical approach


Evaluation Results and Summary

– Identify the physical demand level the client is currently functioning “within”

– Identify the job demands match %

– Comparative Value from prior notes to show progress or decline

– 80% or better suggests a return to work recommendation

– Less than 100% suggests more therapy or work hardening



� FPN Rehab Recommendations

– Identify continued areas of deficits

� Strength, end range of motion, balance, etc.

– Identify POC- Cont’ PT/OT (2x/wk for 3 wks)

– List functional ability and goal(s) that needs to be

achieved within the POC.

– Focus on return to work function



� FDS Rehab Recommendations

– Identify their current abilities and functional return to work levels

– Discharge from PT/OT to IHEP

– Return to work full time at (light duty, full duty)

� Ex…Trial period of light duty for 2 weeks transitioning to full duty full time within 3 weeks and follow up with MD in

4 weeks.

– Discharge from outpatinet and recommend work hardening/ conditioning


Recommendations

� May add specific work recommendations

� Specific positional tolerances or weight recommendations

� This may consist of any area needing clarification


Completed Reports

� After the report is completed get co-signature if needed

� Have your front desk person send to Dr. insurance, case manager and employer.

� Contact the MD about this new service- may need to educate them that this is “NOT an FCE”.

� May be helpful to attend the MD appt. with client.

– Human Progress Note


Case Study Documentation

� Functional abilities a client is able to perform

� Mechanics

– Mechanical Changes and/or Mechanical Deficits

� Pain

– Pain Level

– Pain Location

– Pain Behaviors

– Reliability of Pain Reports

� Physiological Responses

– Heart Rate

� Limiting factors

� Inconsistency or Consistency noted during tests

� Normative Data comparison


FPN Case Study

� What to look for?

– Pie charts (validity) and bar graphs (software only)

– Limiting factors

– Work Status (vocational status)

– Physical demand level- current level

– Job Demands Analysis


1


Work Hardening/Conditioning Program

Work Hardening◦ Multidisciplinary team◦ CARF accredited◦ Job Simulation


Work Conditioning◦ Conditioning a client in regards to the physical aspects needed for return

to work

Training consists of both work hardening and work conditioning components◦ Job Simulation is easy and important

The primary goal of the program is to return the injured worker to productive employment as soon as possible

Utilizing a team approach may be of benefit◦ the staff works closely with the injured employee, the

employee's physician the employer and the insurance


employee s physician, the employer and the insurance carrier

The clinical expertise on the team may include Occupational and Physical Therapy, Physical Therapy Assistant, Occupational Therapy Assistant, Athletic Trainer and/or a case manager

2

Case manager◦ tends to be the liaison between the patient and all parties involved in the

rehabilitation process

Physician◦ Oversees the patients care

PT/OT


PT/OT◦ Oversees the patients rehab program◦ Performs evaluation

PTA, COTA, Athletic Training◦ Monitors patient during treatment program◦ May perform parts of evaluation

The focus of the entire program is comparing the workers physical capabilities through an initial evaluation, comparing this to the physical requirements of their particular job, and the creation of a rehabilitation program to minimize the difference


p gbetween the two

In doing so, WH/WC does not focus on one joint or region of the body but rather looks at a person’s entire range of physical capabilities that are related to their job.

The basic elements of the program are:

◦Work style modification◦ Education◦ Strengthening/conditioning exercises


g g g◦ Endurance improvement◦ Job simulation◦ Life-style changes

3

After physician or Chiropractic referral authorization from insurance needs to be completed

Then a WH/WC evaluation is conducted to prescribe a tailored rehabilitation program for each individual


In the worker’s compensation arena the payer for such a service is the worker’s comp insurance carrier, sometimes the employer, or an attorney

Work related injury Client is off work due to their injury Client is working limited duty Client has been off work for an extended period of time Client has not demonstrated the ability to perform essential job functions Client must return to a physically demanding job Client has limited overall strength and/or endurance


Client has limited overall strength and/or endurance Client has reached a plateau in conventional therapy They may have been off of work for six months or more for example, they

may be well rehabbed regarding their specific injury but they may lack ◦ Flexibility◦ Endurance◦ Strength in other parts of their body

Tailored after the FCE Test job specific items Performed in a Psychophysical approach


Performed in a Psychophysical approach

4

Goals There are 3 “canned goals”◦ Lifting input weight and frequency◦ Carry – input weight and frequency◦ Push/pull- input weight and frequency

There are 7 other blank text areas to list goals.


◦ Add some short term goals and long term specific for areas of deficit noted in the evaluation.

◦ Refer to the sample hand out Make sure you note the timeline and overall frequency and

duration of the program as well as hours/session with re-evaluations

This is an integral part of WH/WC Every patient entering a WH/WC program should have

a full Job Demands Analysis performed◦ Get referral◦ Call insurance to authorize


◦ Call insurance to authorize◦ Call employer to schedule the JDA◦ Call patient to inform them of the first part of the evaluation

at the employer and schedule the evaluation in the clinic

For a program to say they are a work hardening program this aspect of evaluation and treatment is extremely important◦ Do not need to evaluate Job Simulated abilities◦ Begin Job Simulated tasks within the first week of WH/WC


◦ Begin Job Simulated tasks within the first week of WH/WC

5

Monday Through Friday 3.5 hours per day to start◦ Increase to six hours in order to return to work full

duty/full time ◦ OR

R t t difi d d t k f 4 h d k


◦ Return to modified duty work for 4 hours and work hardening for 3.5 hours

Morning Session ◦ 8:00 to 11:30

Afternoon Session◦ 1:00 to 4:30

Daily Functional Activity Sheet◦ Includes all functional based return to work activities◦ 8:00 to 9:30

Daily Conditioning Sheet◦ Focuses on strength and endurance activities


g There are exercises listed on these sheets- are only meant for

assistance. These do not have to be performed. ◦ 9:30 to 10:30

Job Simulation Sheet◦ 10:30 to 11:30

SOAP Note◦ You need to document and log the first visit in the log as

well.

WH/WC program requires daily documentation Utilize the daily forms as part of your soap note Document upgrade of IHEP, Pt. education/training

and any pertinent information from that day’s treatment


Daily Soap Note- this section focus on the assessment-continue to clarify deficits-problem areas, show progress, etc.

6

Work hardening/conditioning◦ Up to the first 2 hours- 97545- use only 1 time◦ Additional 1 hour-97546- may have 2-3 units if necessary

(for ex. 5 hours of WH).

Daily Functional Activity Sheet


◦ Document all functional activity- 97530

Daily Conditioning Sheet◦ Strength/Conditioning- 97110

Job Simulation Sheet◦ Document clearly all job simulation activities- work

reintegration code at- 97537



Work Conditioning/Hardening Program

We would like to thank you for choosing us to complete your work hardening/ conditioning program. We also would like to give you some important information about this program. Your Doctor and Worker’s Compensation Insurance Carrier has given approval for work hardening/conditioning to begin. During the program a Job Demands Analysis and work hardening evaluation may be performed. After completing the program a Functional Capacity Evaluation or Comprehensive Functional Discharge Summary is performed. These are described below: Job Demands Analysis (JDA): A therapist enters your work environment, views your specific job demands and discusses those demands with you and your employer. This information is strictly used to provide you a treatment program that assists in successful return to work. The Work Conditioning/Hardening Evaluation: This evaluation is designed to evaluate your tolerance/ability to perform specific job tasks usually determined from the Job Analysis or other means. You will be asked to use a heart rate monitor and perform tasks including but not limited to bending, lifting, walking, balancing, and carrying. This evaluation is meant to see where you are in the course of your recovery, and the level you will start your program at. Work Conditioning/Hardening Program: The program consists of a total body workout with a primary goal of returning you to full duty work. It will focus on strengthening your entire body while implementing job simulated tasks for you to perform in order to return you to work. This is a Monday through Friday treatment program and you will be asked to participate up to 3.5 hours in the beginning of the program per day. Your hours may be increased up to six hours per day or you may return to work on modified duty part time while in the program. Functional Capacity Evaluation (FCE): This is a comprehensive evaluation designed to evaluate your tolerance/ability to perform your required job demands. This evaluation is meant to see if you are able to return to full duty work. In place of a Functional Capacity Evaluation a comprehensive Functional Discharge Summary may be performed as well. Once again, we would like to thank you for choosing us and hope that you will find the work conditioning/hardening program beneficial for you.

I hereby have read, reviewed and understand the Work Conditioning/Hardening Program.



Work Hardening/Conditioning Basics

Please know that the program will range from a minimum of 3.5 hours to 4 – 6 hours to complete, and will increase as you progress.

If light duty work is available at your employer than retuning to light duty would be more beneficial and this program will remain at 3.5 hours.

It is important that you attend all of your scheduled appointments. We are required to notify your case manager of missed appointments which could ultimately jeopardize your case. If for any reason you must cancel an appointment please call prior to that time and reschedule for another day during the same week.

The therapist is in contact with your doctor and case manager on a regular basis, and functional progress notes will be written as you go.

Wear appropriate clothing and footwear. Try to dress as close to your work attire as you can, yet be comfortable.

If you have specific tools, belts or other objects you must use on a daily basis for your job, please bring them in, or describe the object so that we can simulate it as close as possible.

The therapist will take you through your program the first couple of visits, and go over the paper work required.

You should always let your therapist know if any activity causes you an increase in your symptoms.

It is important that all exercises are done, even if they do not pertain to your specific injury. You will be able to progress at a comfortable pace.

The program will start with a light weight along with repetition based on the evaluation.

Specific Job Simulated tasks will be implemented when appropriate. Functional re-assessments will be performed every two weeks and you may meet

with your overall treatment team at this time Strategies will be developed to maximize your functional ability in regards to

work without relying on physical therapy modalities (i.e. ultra sound, soft tissue massage, heat and ice).

I hereby have read, reviewed and understand the Work Hardening Basics sheet.


Unit Price: $112.32

Qty:

Encourages Cognitive and Perceptual Skills. May be used for range of motion when used with Adjustable Height Shelf #6049.

Sorting Bin Item # 6048

WORK HARDENING EQUIPMENT


Qty:

Stimulates multiple job tasks that in-volve assembly activities. Encourages upper extremities range of motion and working in confined spaces.

Elect. Assembly Center Table Top Item # 6046


Qty:

An upper extremity range of motion assembly box and work capacity box all in one.

Lifting Bolt Center Item # 6030


Qty:

48” wide x 60” long x 1 1/8” thick. Manual hydraulic adjustment from 28” to 35 ½” high.

Economy Hi-Low Work Table Item # 3405


Qty:

Table top device includes 102 parts designed for activities using bolts, washers, and nuts that require hand tightening and or a wrench.

Hand Assembly Device Item # 6044

Unit Price: $698.10

Qty:

Stimulates multiple job tasks and assembly activities. Encourages whole body range of motion and working in confined spaces.

Elect. Assembly Center Deluxe Item # 6047

Unit Price: $205.92

Qty:

A wall mount unit designed to im-prove manual dexterity. The height ad-justable feature allows the therapist to recreate a variety of working postures.

Work Station Item # 6031

Unit Price: $368.16

Qty:

A general purpose utility cart that can be used in a work hardening program.

Utility Cart Item # 776

1110

Floor Model


Qty:

Bolt Board can be used either horizon-tally, vertically, or at a 15 degree angle or in a #8901 rack

Multi Purpose Bolt Module Item # 8925



Qty:

Stimulates tasks that involve shoveling and lifting objects or materials.

Shovel Station Shovel Sand Item # 8920


Qty:

Stimulates lifting and loading tasks

Lift and Place Rack Station Item # 8901


Qty:

Stimulates Push Pull Work Tasks. Not Designed for Use on Carpet.

Push Pull Sled Station Item # 8930

1110

Unit Price: $ 2,115.10

Qty:

Equipment of System I with 8930 Sled Station added.

Work Well System II Item # System II


Qty:

Handrails enclose platform. Platform is 30” wide x 24” deep x 24” high

Straight Staircase Item # 1567


Qty:

Sets up and converts to straight or corner. 36 x 36 x 24 high platform.

Convertible Staircase Item # 1560-65-036


Qty:

Fixed wooden tote handle. Weight 12 1/2 lbs

Carry All Weight Box Item # 8911


Qty:

Weight is 17 ½ lbs

Stockroom Crate Weight Box Item # 8913

Set of 16 Disc Weights Item # 8952


Qty:

Fixed wooden tote handle. Weight 16 lbs

Tool Kit Weight Box Item #8912


Qty:

Hinged lid to conceal contents. Weight is 17 lbs

Packing Carton Weight Box Item # 8914



Qty:

Premium 1 3/4” thick Butcher Block Top.60” x 28” x 26” - 28”

Deluxe Crank Butcher Block Work Table Item # 4325


Qty:

Premium 1 3/4” thick Butcher Block Top.66” x 48” x 26” - 38”

Deluxe Crank Hi-Lo Butcher Block Work Table Item # 4326

Unit Price: $201.50

Qty:

Four 2.5 lb, eight 5 lb, and four10 lb disc weights.

Unit Price: $137.80

Qty:

Foot Stool Item # 2216

Unit Price: $ 69.95

Qty:

Shows heart rate on large and easy to read display.

Heart Rate Monitor Item # FT1 Black


Qty:

Manipulative Dexterity Test Consist-ing of 25 Holes with randomly posi-tioned slots.

Grooved Pegboard Test Item # 32025



Qty:

Requires Hand Placement of 3 pins per hole.

O’Connor Finger Dexterity Test Item # 32021


Qty:

Measures simple hand eye coordina-tion and gross motor skills.

Complete Minnesota Manual Item # 32023A


Qty:

For Dexterity and Coordination

Lafayette Pegboard Item # 32027


Qty:

Measures Proficiency in using ordi-nary mechanic’s tools.

Hand Tool Dexterity Test Item #32521


Qty:

Requires the use of tweezers in placing a single pin in each 1/16 inch diam-eter.

O’Connor Tweezer Dexterity Test Item # 32022


Qty:

Measures hand, arm, and finger dexterity and speed.

Roeder Manipulative Aptitude Test Item # 32026


Qty:

6 feet 300 lbs Capacity

Stepladder Item # 3W141

1110

Dexterity Test

Work Conditioning/Work Hardening Patient Progress Map

Worker: Diagnosis: Precautions: Physician: Eval Date: RTW Goal: FPN: MD Date: Freq/Dur: Anticipated D/C:


Functional Activity Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 RTW Goal

Squat Lift

Power Lift

Shoulder Lift

Overhead Lift

Bilateral Carry

Unilateral Carry

Unilateral Lift

Push

Pull

Sit

Stand

Simple Grasp

Firm Grasp

Fine Motor Coord.

Gross Motor Coord

Walking

Forward Reach

Above Shoulder Reach

Bending

Squatting

Kneeling

Climbing

Balance

Therapist Signature: Client Signature:

Work Conditioning/Work Hardening Functional Activities Daily Productivity Sheet


P = Planned by therapist A = Actual performed by client E = Exertion level Date

Monday Tuesday Wednesday Thursday Friday Exercises P A E P A E P A E P A E P A E


Time in/out: Hours/session:

In _______ Out_______

In _______ Out_______

In _______ Out_______

In _______ Out_______

In _______ Out_______

WARM-UP AND STRETCHES

Perform warm-up and stretches before ALL exercises

Bike or Treadmill

Min.

Min.

Min.

Min.

Min.

Stretches Warm-up

Min.

Min.

Min.

Min.

Min.

Injury Specific Stretches:

Min.

Min.

Min.

Min.

Min.

Material Handling Goal:

Weights = box + weight in box (box = approx. 15 pounds)

Squat Lift – lift from floor to waist level using bottom box handles

Power Lift - lift from floor to waist level using top box handles

Shoulder – lift from waist height to shoulder height using bottom box handles

Overhead Lift – lift from shoulder to overhead height

Two-handed Carrying – carrying box using bottom handles

Push/Pull Sled – pushing/pulling sled using two hands

Unilateral Carry – carry box/DB with one hand – perform task with right and left hands

Work Conditioning/Work Hardening Functional Activities Daily Productivity Sheet





Unilateral Lift – lift box/DB from floor to waist height with one hand with right and left hands

Sets: Box from floor to waist height, waist to shoulder, shoulder to overhead, overhead to shoulder, shoulder to waist, waist to floor

Borg CR-20 Rating of Perceived Exertion Scale

Very, Very Light Fairly Light Hard Very, Very Hard

Very Light Somewhat Hard Very Hard

6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

0-10 OCCUPRO Functional Pain Intensity Scale TM

Functionally Very Severely Worst No

Pain

Non-Limiting Pain Limiting

Pain Limiting

Pain Disabling

Pain Possible

Pain

0 1 2 3 4 5 6 7 8 9 10

Work Conditioning/Work Hardening Work Conditioning Daily Productivity Sheet





UPPER EXTREMITY EXERCISES

Perform UE exercises on a daily basis; R/L = perform with right and left UE

Shoulder Flexion

Shoulder Abduction

Internal Rotation

External Rotation

Scapular Rows/Retracts

Shoulder Extension

Lat pull downs

LOWER EXTREMITY: Calf Raises

Functional squats

Step-ups – forward/back

Step-ups – left/right

Hamstring Curls

Leg Extensions






CONDITIONING EXERCISES:

UBE Seat height____ Seat distance_____

Treadmill – squeezing Digigrip while walking % Grade:

Elliptical

Recumbent Bike L:


Very, Very Light Fairly Light Hard Very, Very Hard Very Light Somewhat Hard Very Hard

6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Work Conditioning/Work Hardening Job Simulation Daily Productivity Sheet





JOB SIMULATION

Work Conditioning/Work Hardening Job Simulation Daily Productivity Sheet






Very, Very Light Fairly Light Hard Very, Very Hard Very Light Somewhat Hard Very Hard

6 7 8 9 10 11 12 13 14 15 16 17 18 19 20