ASSESSMENT OF MEDICAL WORK

FITNESS .Dr David Hartshorn

Occupational Medicine Specialist

Occupational Medicine

Clinical assessment and treatment of work related illness or injury.

Health surveillance within the work place. Illness and injury prevention

programmes. Rehabilitation and return to work

planning. Health risk assessment within the

workplace. Development of workplace policies and

procedures. Assessment of medical work fitness.

Medical Work Fitness- When?

In safety critical roles- transport, emergency workers.

Pre- employment and during employment.

As part of return to work or rehabilitation. As part of the insurance sector including

ACC.

In practical terms is central in Income Protection and TPD claims.

Medical Work Fitness-How?

The assessment requires detailed knowledge of;

1. The functional requirements of the job. 2. The functional level of the person.

And… An assessment of whether they match

up. Are any mis-matches important?

Job Description

Needs to be functional.

What precisely is done, where, how often, who by, and for how long.

What is the environment and what are the hazards.

Quantify if at all possible. Work site visit or assessment very useful.

Should be able to explain the job and the environment to someone else.

Function- Different Aspects.

Physical capacity. Cognitive capacity. Endurance. Consistency/lapses.

Function?

Diagnosis does not dictate function. Impairment does not reliably predict

function or disability. Neither diagnosis nor impairment, in

them- selves, accurately predict work involvement.

Functional Information.

Self report- context important. Medical assessment. Functional Capacity Evaluation- FCE. Exercise programme reports- functional. OT programme reports-functional. Work trial reports-functional. Surveillance.

Functional Information

Self report < physician < FCE in terms of estimate of level of function within the disability assessment framework.

Medical Work Fitness- Decisions

3 Questions to ask once the job and functional level are clear.

1. Can they perform the tasks required in the job? (physical/cognitive).

2. Can the job be performed safely without risk to self or others? (sudden incapacity/judgement)

3. Can the job be sustained for the duration of hours required? (fatigue/pain/stamina)

Prognosis- TPD

What is current medical work fitness?

What is the likely future medical work fitness?

This does require diagnostic information- known tissue pathology and expected course of a defined illness or injury.

More difficult in conditions of uncertain cause or variable course.

Medical Work Fitness-Goals

Desirable features of medical work fitness assessments within the insurance industry?

Reliable- in other words does the process produce consistent results across assessors and claimants?

Validity- in other words does the assessment reflect reality in terms of actual work capacity?

How Are We Doing?

Overseas studies suggest wide inter-assessor variability in assessment of work disability.

Evidence suggests some of this is due to differing patterns of information received.

The disconnect between diagnosis, function, disability, and work involvement also a likely factor.

This may be particularly true for subjective complaints such as pain and fatigue.

How Are We Doing- Validity?

There is no “gold standard” for disability assessment.

In the ACC sector many of those found to be “fit for work” move across to a sickness or invalids benefit. Fitness vs skills?

Many of those on a sickness benefit do not have illness that precludes safe work.

Difficulty is that a return to work relates to more complex processes than just medical fitness for work.

Successful and sustainable return to work is best validation but this doesn’t help to validate “unfit” findings.

Improvements?

Consistency in protocol for FFW assessments?

Seek a range of functional information sources?

Psychology assessment as part of process for pain and fatigue related cases?

Expert panel assessments?

Questions-Discussion.

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