Are they worth their weight?? Peg Hau OT/CHT Advanced Physical Therapy & Sports Medicine.

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Are they worth their weight?? Peg Hau OT/CHT Advanced Physical Therapy & Sports Medicine Slide 2 In developing diagnostic tests, we must remember that it is better to miss an insincere individual than to classify a sincere patient as insincere. Tests must be chosen carefully, and if multiple tests are used, they must be administered in a logical order. Ahmer, 2007 Slide 3 History of the FCE A functional capacity evaluation is set of tests, practices and observations that are combined to determine the ability of the evaluated to function in a variety of circumstances, most often employment, in an objective manner 1970s beginning 2001critized as not being job specific Reneman et al, 2001 Slide 4 What is an FCE Evaluates and individuals ability to perform work axs related to his/her employment Similar types of testing Consists of standardized assessments Administered with care and safety in mind (Kuijer et al., 2011; Soer, et al., 2008). Slide 5 Why are they ordered Baseline Pre employment Job Specific Medical/legal Assisting with case closure Slide 6 Who can benefit from an FCE Individual injured on the job Applying for Social Security Disability Seeking to return to work after extended leave Someone seeking vocational rehabilitation Transition from school to work setting Slide 7 FCEs are done on a one-on-one basis and may range in length from 4 to 6 hours. The FCE may take place over 2 consecutive days. Slide 8 Components of an FCE History review medical, vocational, social Screening tests musculoskeletal Physical functional testing based on DOT Job simulation when identified job is known Behavior assessment Results, data compilation, and recommendations Slide 9 Types of FCEs Matheson Ergo Science www.ergoscience.comwww.ergoscience.com ARCON FCE http://fcesoftware.com/home.htmlhttp://fcesoftware.com/home.html Isernhagen Work System Blankenship Ergos Work Simuolator and Ergo Kit Variation Hanoun Medical WEST-EPIC Key AssessAbility Slide 10 Ergo Science Developed in 1988 by Deborah Lechner PT,MS Administrators must complete 24 hours of instruction Used in 850 clinics www.ergoscience.com Slide 11 ARCON Science www.fcesoftware.com 30 years of development and refinement. 1,000 clinics nation wide Slide 12 ARCON continued The Arcon system includes: * Computerized hand and pinch gauges. * Electronic goniometer. * Dual range of motion inclinometers. * Dynamic and isometric lifting system. * Carpal tunnel testing attachment. * Computerized heart rate monitor. Testing protocols includes: * Dynamic lifting. * Isometric testing extremities & back. * Range of motion testing. * Dexterity testing. * Endurance testing. * Activities of daily living. Slide 13 Iserhagen Work System Susan J. Isernhagen PT created the first functional capacity evaluation in the mid 1980s. Redeveloped in 2004 Objectivity of results to replace the subjective estimates that were currently being used Medical base to tie the functional capacity and limitations into current diagnoses Information on level of effort, to identify those who used full effort and those who did not use full effort. Safety in functional tests so that this information could lead to safe return to work Work relatedness to determine abilities to perform specific jobs, http://dsiworksolutions.com/history.htm Slide 14 Iserhagen continued The Relevance for Nondiscrimination Compliance by Susan Iserhagen - 2010 Slide 15 Blankenship A unique FCE called the WORKEVALTM and it helps Physicians, Case Managers and Employers determine what work limitations are appropriate for the injured worker. We also provide Physicians with the objective data they need to determine the injured worker's Permanent and Partial Disability, or PPD. The name for this evaluation, which was developed and published by the American Medical Association, is a Permanent Impairment Evaluation. This evaluation process determines the percent of Permanent, Partial Impairment and that percentage is used to help Patients, Employers, Insurers and Attorneys negotiate the settlement of the Workers' Compensation Case. Slide 16 Ergos Work Simulator Slide 17 Hanoun Medical Strength & dexterity testing Protocols Fatigue analsyis software ???????????? Slide 18 Assessability http://www.assessability.net/fme-vs-fce.html Functional Medicine Evaluation (FME) vs. Functional Capacity Evaluation (FCE) Slide 19 Key Glenda Key Founder and President 1987 300 clinics & 42 states Double blind testing Slide 20 Physical Examination Heart rate and blood pressure Posture and gait Range of motion Strength Balance Other special testing as warranted Slide 21 Functional Testing continued: Sustained overhead activity Climbing ladders Crouching/squatting/ stooping Slide 22 Functional testing Floor to waist/ shoulder/overhead lift Carrying Push/pull Slide 23 Functional Testing cont: Grip strength Pinch strength FMC/9 hole peg/Purdue Stereognosis Slide 24 Less than Full Effort Performance Reasons for .. 1. Medically determined impairments 2. Malingering 3. Factitious disorder 4. Learned illness behavior 5. Conversion disorder, pain disorder Matheson, 2003 Slide 25 Continued: 6. Depressive disorder 7. Test anxiety 8. Fear of symptom exacerbation or injury 9. Fatigue 10. Medication & psychoactive substance effects 11. Lowered self-efficacy expectations 12. Need to gain recognition for symptoms Slide 26 Methods to identify inconsistancy Intra test inconsistency Absence of expected relationships among measures. Completion of tests and willingness to do more Coefficient of variation Rapid exchange grip Correlation of heart rate with reported max effort Correlation of impairment (range of motion, manual muscle tests, etc. ) to function Slide 27 Non-Organic Signs Pain Questionaire Waddell McGill Pain Questionaire Ransford Numeric pain scale Million Visual Analogue Slide 28 Slide 29 Million Visual Analogue Scale The Million visual analogue scale The Million visual analogue scale (MVAS) (Table 15) is a 15-item questionnaire about disability and pain intensity in patients with LBP. 38 The 15 questions investigate the body functions (pain, sleep, stiffness and twisting), daily activities (walking, sitting, standing and work) and social life. Information about item selection process is not available. Score is given on a 100 mm visual analogue scale(VAS). For example, if patients are asked to quantify the severity of his pain (like the first question), they mark a point on a 100-mm line in which the end points are labelled as no pain and intolerable. In each question, it is possible to obtain an index of severity of symptoms in a patient- specific fashion measuring the distance of the marked point from the origin of the line. The final score is calculated by adding up the equally weighted scores.15 38 Slide 30 Physical Demand Characteristics of Work Slide 31 References Chapman-Day, K. M., Matheson, L. N., Schimanski, D., Leicht, J., & DeVries, L. (2011). Preparing difficult clients to return to work. Work (Reading, Mass.), 40(4), 359-367. doi:10.3233/WOR-2011- 1247; 10.3233/WOR-2011-1247 Gouttebarge, V., Kuijer, P. P., Wind, H., van Duivenbooden, C., Sluiter, J. K., & Frings-Dresen, M. H. (2009). Criterion-related validity of functional capacity evaluation lifting tests on future work disability risk and return to work in the construction industry. Occupational and Environmental Medicine, 66(10), 657-663. doi:10.1136/oem.2008.042903; 10.1136/oem.2008.042903 Gouttebarge, V., Wind, H., Kuijer, P. P., Sluiter, J. K., & Frings-Dresen, M. H. (2010). How to assess physical work-ability with functional capacity evaluation methods in a more specific and efficient way? Work (Reading, Mass.), 37(1), 111-115. doi:10.3233/WOR-2010-1084; 10.3233/WOR-2010- 1084 Streibelt, M., Blume, C., Thren, K., Reneman, M. F., & Mueller-Fahrnow, W. (2009). Value of functional capacity evaluation information in a clinical setting for predicting return to work. Archives of Physical Medicine and Rehabilitation, 90(3), 429-434. doi:http://dx.doi.org.ezproxy2.library.drexel.edu/10.1016/j.apmr.2008.08.218http://dx.doi.org.ezproxy2.library.drexel.edu/10.1016/j.apmr.2008.08.218 Westbrook, A. P., Tredgett, M. W., Davis, T. R., & Oni, J. A. (2002). The rapid exchange grip strength test and the detection of submaximal grip effort. The Journal of Hand Surgery, 27(2), 329-333. Wind, H., Gouttebarge, V., Kuijer, P. P., Sluiter, J. K., & Frings-Dresen, M. H. (2009). Effect of functional capacity evaluation information on the judgment of physicians about physical work ability in the context of disability claims. International Archives of Occupational and Environmental Health, 82(9), 1087-1096. doi:10.1007/s00420-009-0423-8; 10.1007/s00420-009-0423-8