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Industrial Rehabilitation

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Industrial Rehabilitation George T. Edelman MPT, MTC Rick Hayward MPT, OCS, OMPT – PowerPoint PPT presentation

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Title: Industrial Rehabilitation


1
Industrial Rehabilitation
  • George T. Edelman MPT, MTC
  • Rick Hayward MPT, OCS, OMPT

2
Scope of the Problem
  • 5.7 Million injuries and illnesses reported in
    private industries in 1999
  • Of those, about 2.7 million were lost workday
    cases
  • Of those 5.7 M, 5.3 million were accidents
  • Injury rates higher for those mid-sized companies
    employing 50-249 workers.

3
INJURY COSTSMedical CostsEmployee WagesBenefit
Package PaymentsSalary of Replacement
PersonnelTraining of Replacement
PersonnelOvertime Payments for Current Personnel
4
What do I need to know?
  • Acute care management of patients with
    musculoskeletal dysfunction
  • Functional Capacity Evaluation
  • Job Demands Analysis
  • Ergonomics, hazard identification and abatement
  • Pre-employment Screening
  • Information management

5
What do I need to know?
  • Work conditioning
  • Work simulation
  • Injury Prevention Education
  • Fitness
  • Governmental agencies
  • Regulatory issues
  • Reimbursement issues
  • Marketing

6
Players
  • Worker/patient
  • Employers
  • Physician
  • PTs/OTs/ Exercise physiologist
  • Vocational Rehab consultant
  • Psychologist
  • Attorney
  • Case manager

7
Scope of Practice
  • Most Common
  • Treating acutely injured workers in outpt setting
  • Return to Work Screens (mini-FCE)
  • Functional Capacity Evaluation (FCE)
  • Job Demands Analysis (JDA)
  • Post-Offer / Pre-Placement Screens
  • Worker Education
  • Ergonomics
  • Fitness/Wellness

8
Overview of Lecture
  • History, Regulations, and Agencies
  • The Continuum of Care and Services
  • Functional Capacity Evaluation The Well
    Designed Test
  • Job Demands Analysis
  • Post Offer Screening
  • Marketing Selling Your Services to Business
    Industry

9
  • History,
  • Regulations,
  • and
  • Agencies

10
History - 3 Major Areas
  • Workers Compensation
  • Social Security
  • Employment Selection

11
History Workers Compensation
  • Early 1900s - trend toward awareness of rehab of
    physically disabled
  • Prior to 1910 the only recourse to bring a suit
    against their employers in court to claim damages
    for work related injuries

12
Workers Compensation Law
  • Early 1900s increasing number of claims being
    settled in favor of plaintiff but many did not
    have resources to go to trial
  • only 6 workers received financial relief
  • employers risk of liability in isolated cases was
    astronomical - out of business in single claim

13
History - Workers Compensation
  • State Workers Compensation Law
  • 1910 New York
  • 1911 Wisconsin
  • mandated employer-financed insurance programs
  • created a no fault system where workers gave up
    right to sue and employers accepted limited
    liability
  • purpose was prevention of poverty, not disability
    prevention

14
Workers Compensation Law
  • varies from state to state
  • costs are paid by employer to state fund or
    insurer
  • each state determines specific benefits received

15
History Workers Compensation
  • By 1920, 42 out of 48 states DC had WC laws
  • has been called the most dramatic event in 20th
    century of American civil justice
  • for 25 years was the only social disability
    income program in the US
  • Darling-Hammond L, Keisner TJ The law and
    economics of workers compensation, Santa Monica
    CA, 1980, Rand Publications.

16
Understanding Workers Comp
  • Who pays and why?
  • Every employer except
  • family business, only family employees
  • self-insured
  • Point is to spread risk
  • riskier industries pay more
  • higher injury rates pay more

17
Who is Covered
  • Everyone except
  • Baby-sitters
  • Temporary agriculture
  • Religious school teaching
  • Part-time domestic help
  • Family members in family business

18
What is Covered?
  • Work-related injuries or illnesses
  • must arise out of and in the course of
    employment
  • Includes
  • organized recreational functions
  • travel
  • homework
  • unauthorized presence in workplace

19
Pre-existing Conditions Pre-disposing to Injury
  • If it occurs at work, it arises out of employment
    as far as the law is concerned
  • does not matter if the injury occurs during an
    activity that would not have been injurious but
    for the preexisting sensitivity
  • Employers must take employees as they find them

20
Pre-existing Conditions Causing Injury
  • When cause is unclear, law will not attribute it
    to work unless evidence points in that direction
  • King v. TTC Illinois Inc., Montana, 2000
  • Truck driver, smoker, HBP, high cholesterol
  • died in cab of truck after handling tarps
  • medical examiner concluded death caused by
    preexisting heart condition
  • court sided with med examiner

21
History - Workers Compensation
  • 1920s saw decline in the workers compensation
    system
  • Disputes arose over whether injuries were
    work-related and the extent of disability
  • By mid-1930s debate began over whether to add
    disability to the social security system

22
History Social Security Disability
  • Social Security system added disability coverage
    in increments
  • 54 disabled exempt from making social security
    payments
  • 56 disability benefits began for those between
    50 and 65 were unable to work due to disability
  • 58 monthly benefits paid to dependents
  • 60 age limitation of 50 years removed
  • 65 12-month requirement added
  • 72 benefits increased Medicare benefits
    available to those whose disability lasted for at
    least 2 years

23
SSAs Definition of Disability
  • The inability to do any substantial gainful
    activity (SGA) by reason of any medically
    determinable physical or mental impairment which
    can be expected to result in death or which has
    lasted or can be expected to last for a
    continuous period of not less than 12 months.

24
SSAs Definition of Disability
  • Impairment must be so severe that person is not
    only unable to do past work but considering age,
    education, and work experience engage in any
    other substantial gainful work which exists in
    the national economy

25
Five Step SSA Disability Determination Process
  • Is the individual engaged in SGA?
  • Does the individual have a severe impairment?
  • Does the impairment meet the listings?
  • Can the individual do past relevant work?
  • Can the individual do other work?

26
History - Rehabilitation
  • World War I - disabled veterans vocational needs
  • 1920 - Passage of Vocational Rehab Act - Provided
    funds for vocational rehab
  • veterans WWI
  • industrially injured
  • Amendments in 1943 1954

27
History - Employment Selection
  • Americans with Disabilities Act (ADA) July
    26,1992
  • extended legal protection from employment
    discrimination to handicapped Americans
  • goes beyond traditional equal employment law and
    affirmative action by requiring individualized
    treatment on a better-than-equal basis
  • tests cannot be used to screen out disabled
    individuals unless they are job-related

28
ADA
  • All employers of 15 or more people
  • protects qualified persons with a disability
  • physical or mental impairment substantially
    limits one or more major life activities
  • record of
  • regarded as having
  • has requisite skills, experience, education,
    other job-related requirements
  • able to perform essential functions with or
    without reasonable accommodations

29
ADA - Substantial Limitation of Major Life
Activity
  • Caring for self
  • Performing manual tasks
  • Walking
  • Seeing
  • Hearing
  • Speaking
  • Breathing
  • Learning
  • Working
  • Participating in community affairs

30
ADA - Essential Functions
  • Job function considered essential if
  • reason job exists is to perform function
  • limited number of employees available among whom
    performance of function can be distributed
  • highly specialized so that the incumbent is hired
    for the ability to perform the function

31
ADA - Reasonable Accommodations
  • modifications or adjustments to job to enable
    impaired person to enjoy equal employment
  • job application process
  • work environment
  • benefits privileges

32
ADA - Undue hardship
  • If necessary modifications create undue
    hardship employer does not have to provide
  • Factors considered
  • nature and cost
  • financial resources of employer
  • effect on the operation of the facilities/business

33
History - Injury Prevention
  • Williams-Steiger Occupational Safety Health Act
    1970
  • assure safe and healthful working conditions for
    men and women
  • no specific ergonomic standards
  • ergonomic considerations covered under the
    general duty clause
  • employers responsible for furnishing employees a
    place of employment free from recognized hazards
    that are likely to cause death or serious
    physical harm to employees

34
OSHA
  • Regulatory body
  • Employers of 11 or more people
  • Reduce hazards/comply with standards
  • Conducts inspections
  • Issues fines
  • No ergonomic standards per se

35
History - Injury Prevention
  • 1991 - OSHA published Ergonomics Program
    Management for Meatpacking Plants covering
    primary components of an effective ergonomics
    program
  • Worksite Analysis
  • Hazard Prevention Control
  • Medical Management
  • Training education

36
NIOSH
  • set up by same act that established OSHA
  • directed by Secretary of Health Human Services
  • authorized to develop standards conduct
    research
  • Work Practices Guide for Manual Lifting including
    formula for calculating recommended weight limit
    for lifting tasks

37
Governmental agencies
  • Department of Labor
  • description/classification of work
  • Social Security Administration
  • disability determination
  • NIOSH
  • research
  • OSHA
  • regulatory

38
Overview of Course
  • History, Regulations, and Agencies
  • The Continuum of Care and Services
  • Functional Capacity Evaluation The Well
    Designed Test
  • Job Demands Analysis
  • Post Offer Screening
  • Marketing Selling Your Services to Business
    Industry

39
The BIG PICTURE...
  • Continuum of Care
  • Medical Model vs Work Recovery Model
  • Acute, Subacute, Chronic
  • medical management
  • work recovery management
  • Role of assessment
  • Importance of function

40
Continuum of Care
  • Work Recovery Model
  • Off Work
  • Transitional modified duty
  • Return to full duty
  • Permanent modified duty
  • New permanent position
  • Disability
  • Medical Model
  • Acute
  • Sub-acute
  • Chronic

41
Acute Care Medical Side
  • Acute
  • promote healing of tissue
  • minimize symptoms
  • maximize function
  • Important to begin asking about job tasks and
    demands early!
  • usually patient or employer self-report
  • can explore occupational information
  • DOT
  • Job Exploration Software

42
Work Related Function
  • Early emphasis on work-related function is one of
    the hallmarks of a holistic clinician!

43
Acute Care Work Recovery
  • Acute- Off work Begin by asking about home
    function
  • Be specific
  • activity
  • duration
  • performing functional activities at home
  • sitting
  • standing
  • walking
  • lying
  • light materials handling

44
Acute Care Work Recovery
  • Aim for graded progression of home function
  • Scheduled and structured
  • As a measure of outcome
  • Set stage for
  • problem solving
  • pain management
  • exercise
  • positioning

45
Work Function
  • Based on demands of job
  • Work simulation
  • Work conditioning exercises
  • Graded with specific goals

46
Acute Care Work Recovery
  • Acute -Transitional modified work
  • original job
  • new temporary job
  • meaningful work is optimal
  • guided by functional testing
  • communication with supervisory personnel is
    essential
  • progression

47
Importance of Function
  • Only way we have of knowing whether we are making
    a significant difference in the lives of the
    patients we treat is to find out about function
    of patient work demands
  • self-report
  • accuracy
  • motivation
  • observational measurement is preferable

48
Importance of Work-Related Functional Assessment
  • Only objective means of determining whether
    patient abilities meet functional demands of work
    is to evaluate
  • asking patient to perform functional task
  • measuring physical demands of work
  • match?
  • yes return to work
  • no further treatment or modified work

49
Appropriate Measurement for the Acute Stage
  • Not full blown FCE
  • Not formal job demands analysis
  • Instead
  • informal visit to the job site
  • observe the job
  • use the information to develop a brief screen of
    the most demanding aspects of the job

50
What does the informal job site visit accomplish?
  • Increases your
  • comfort level with the industrial environment
  • credibility in the eyes of your patient
  • patients level of trust
  • ability to market other industrial services
  • value in the scheme of treatment
  • physicians
  • case managers

51
To maximize effectiveness in treating
work-related injuries -get out of the clinic and
into the work place!
52
Acute Management
  • Hands-on does not preclude patient participation
  • Self mobilization
  • Home program
  • Home administration of modalities
  • Home positioning
  • Functional activity
  • Patient should have goals related to function

53
Example Home Program for Acute Back Patient
  • Spend five 20-minute sessions in side lying with
    towel roll between iliac crest and rib cage
  • Perform 10 reps of extension exercise every hour
  • Apply ice pack for 20 minutes twice a day
  • Walk for 15 minutes 5 times per day
  • Stand for 15 minutes 5 times per day
  • Perform 10 reps of stretching exercises 2 times
    per day

54
What Dont Want...
  • Inactivity!
  • Unstructured daily regimen
  • Because...
  • promotes the sick role
  • encourages
  • Disuse atrophy
  • De-conditioning
  • Decreased mobility

55
Essential Elements of Success
  • Program should be regimented with patient keeping
    a home program log
  • Set specific measurable goals
  • Begin return to work/modified work discussions
    early
  • Demonstrate interest and knowledge regarding
    functional/work activities

56
Knowledge of Work-Related Function
  • Therapist knowledge regarding work function
  • creates face validity for worker
  • builds trust
  • improves quality of treatment
  • work simulation
  • work conditioning
  • transitional duty

57
Subacute Medical Management
  • Subacute - Shift toward more
  • work simulation
  • work conditioning
  • work recovery/transitional duty
  • posture/body mechanics training
  • functional testing
  • By the end of the sub-acute phase, should know
    whether the patient can return to former work.

58
Subacute Work Recovery
  • Transitional modified duty
  • duration increases
  • duties increase
  • Work conditioning
  • job specific
  • strengthen, stretching, endurance
  • Work simulation
  • to assist with progression to next stage of
    transitional work/full duty

59
Chronic Medical Management
  • Shifts more toward
  • pain management
  • psychological interventions
  • coping with residual functional capacity

60
Chronic Work Recovery
  • Former job with modifications
  • Placement in same line of work, different job
  • same employer
  • different employer
  • Vocational assessment, exploration, counseling,
    retraining for new work

61
The Functional FoundationMatching the Worker to
the Work
  • Pre-Work
  • Screens

Return to Work
Work Simulation /Conditioning
Transitional Modified Duty
Job Demands Analysis // Functional Assessment
62
Traditional Return-to-WorkDisability
Decision-Making
  • Client self-report
  • Do you think you are ready to go back to work?
  • Do you think you are able to work?
  • Impairment/diagnosis-based decision
  • Imaging studies
  • Range of motion
  • General impressions
  • No objective information regarding job
  • demands or patients functional abilities

63
The Well-Designed FCE
  • Comprehensive
  • Standardized Yet Flexible
  • Clear Report Format
  • Safe
  • Practical
  • Objective
  • Reliable
  • Valid

64
Comprehensive
  • Covers all physical demands defined by DOL in the
    Dictionary of Occupational Titles
  • Does not focus exclusively on materials handling

65
Standardized Yet Flexible
  • Procedures
  • Equipment
  • Verbal Instructions
  • Scoring System
  • Ability to chose individual items for
    job-specific testing

66
A Clear FCE Report
  • Overall level of work (Sedentary, Light, Medium,
    Heavy, Very Heavy)
  • Percent of day individual demands can be
    performed (Constantly, Frequently, Occasionally,
    Never)
  • Tolerance for the 8 hour day

FCE Summary Report
67
A Clear FCE Report
  • of tasks with self-limiting behavior
  • Inconsistencies in performance
  • Interpretations/Conclusions
  • Major areas of dysfunction
  • Factors underlying limitations
  • Discrepancy between job demands
  • pt abilities
  • If indicated
  • Job Specific Testing
  • Job/Occupation Comparisons
  • Recommendations

68
Safe
  • Minimize chance of injury during FCE
  • Heart rate monitor
  • Allow patient to stop if need arises
  • Therapist observing body mechanics/alignment
  • Well-defined safe stopping points
  • Clear contraindications and pre-cautions

69
Objective Projections
  • Minimize clinical guesswork
  • Projecting to 8-hour day

70
The Common FCE Scoring
?
?
?
Report Generation
FCE Protocol
Clinicians Observation
Examiner Bias
The Gray Zone
71
The PWPE Scoring System
Scoring System Directs Therapists
Observations Classification System for
Documenting Formulas for Combining Multiple
Observations Formulas for Projecting Performance
to 8-Hour Day
FCE Report Generation
FCE Protocol
Overall Work Level Rating
Sincerity of Effort Rating
Tolerance 8 hour Day Rating
72
What is Reliability?
  • Reliability Consistency
  • If different therapists administer an FCE to the
    same patient, will they obtain the same results?

73
What is Validity?
  • Validity Accuracy
  • Can the FCE accurately predict a safe maximum
    level of work?

Reliability and validity are critical to trusting
FCE results!
74
Why Are Reliability and Validity Important?
  • Without proven reliability and validity, you and
    the patient do not know if test results are
    accurate
  • Legal defensibility Daubert v. Merrill Dow
    Pharmaceuticals 1993 Supreme Court Ruling
  • If testimony does not meet standards FCE results
    may be considered inadmissible

75
Reliability and Validity of FCE
  • Smith et al Am J Occup Ther, 1986
  • Dusik et al J Occup Med, 1993
  • Saunders et al. Physical Therapy, 1997
  • Alpert et al. J Occup Rehab, 1991
  • Matheson et al. Spine, 1995

76
Summary of Research
  • All of these studies made important
    contributions to the literature
  • However, limitations include
  • Many studies focused primarily on the manual
    materials handling aspect of FCE
  • Many studies addressed either reliability or
    validity but not both
  • Methodological flaws with several of the studies

77
Interrater Reliability and Concurrent Validity
  • Lechner et al Journal of Occupational
    Medicine, 1994
  • Two therapists evaluated the same 50 patients for
    reliability using a new FCE protocol, Physical
    Work Performance Evaluation (PWPE)
  • Concurrent validity PWPE (FCE) predictions
    were compared to actual work status

78
Reliability Validity
  • Reliability Kappa for Test as whole .83
    Almost Perfect
  • Validity 86 agreement between PWPE and actual
    work

79
Predictive Validity
  • Lechner, Page, Sheffield (abstract) Physical
    Therapy 1996
  • Study conducted at Baptist Medical Center
    Montclair, Birmingham, AL
  • 30 Workers Compensation patients who were
    admitted to a interdisciplinary work hardening
    program using PWPE (FCE) protocol
  • Compared PWPE recommendations to actual return
    to work level

80
Predictive Validity
  • Recommendations based on discharge PWPE
  • RTW - full duty
  • RTW - modified duty
  • No RTW
  • Substantial agreement between recommendations
    and
  • Initial RTW Kappa of .74
  • 3 month follow up Kappa of .69
  • 6 month follow up Kappa of .71

81
Contributions of PWPE Research
  • These studies are the only ones that have
    examined both reliability and validity of a
    comprehensive test published in the peer-reviewed
    medical literature

82
Common Misuse of FCE
Catch the Faker!
83
Cant Catch the Faker, Why Not?
  • Many of the traditional tests used to catch the
    faker have not been adequately researched
  • It is impossible to infer motivation from these
    tests, in a legally defensible way
  • Clinicians who are marketing their services and
    making this claim are misrepresenting themselves

84
Sincerity of Effort
  • Any statement that implies decreased motivation
  • symptom magnification
  • exaggerated pain behavior
  • invalid or conditionally valid FCE
  • malingerer

85
Sincerity of Effort
  • Measures typically used to justify statements
    about sincerity of effort
  • Coefficient of Variation (CV, COV)
  • Waddells Non-Organic Signs (NOS)
  • Bell-shaped curve
  • Rapid exchange grip
  • Correlation of heart rate to pain scores
  • Correlation of pain scale to behavior
  • Correlation of impairment measures (ROM, MMT,
    etc.) to function
  • Validity scales

86
Sincerity of Effort
  • If any of these measures are used to justify
    accusations of a lack of sincere effort or
    motivation
  • Problem
  • Research supporting the reliability and
    validity if these protocols for the purpose of
    detecting sincerity of effort/motivation is
    lackingnot defensible

87
The Good News
  • We can document self-limiting behavior (stopping
    before maximum effort is reached)
  • We know the extent of self-limiting behavior in
    motivated patients
  • We can document inconsistent performance
  • New research-based protocols becoming available
    that allow us to link inconsistencies with
    non-compliance
  • We can document atypical performance

88
Sincerity of Effort
  • Test results need to be expressed very carefully
  • Patient self-limited on
  • Patient demonstrated the following functional
    inconsistencies
  • Patients test results were similar to a
    research group who were instructed to
    intentionally withhold.

89
The Challenge
  • To distinguish between appropriate and
    inappropriate tests of sincerity of effort
  • Not overstate test results and increase exposure
    to litigation

90
Additional Information
  • Lechner et al. Detecting Sincerity of Effort
    A Summary of Methods and Approaches. Physical
    Therapy, July 1998.
  • Review article Discusses in detail the problems
    with commonly utilized methods for evaluating
    sincerity effort.

91
Additional Information
  • Schapmire et al Simultaneous Bilateral Testing
    Validation of a New Protocol to Detect Insincere
    Effort During Grip and Pinch Strength Testing.
    Journal of Hand Therapy, Vol 15, No. 3.
  • Research supporting new sincerity of effort
    testing.

92
What Is Job Demands Analysis?
  • Job Demands Analysis defines
  • essential functions or tasks of the job
  • physical demands of those functions
  • percent of day spent performing the physical
    demands
  • forces being exerted
  • environmental conditions
  • equipment used

93
Difference Between JDA and Hazard Identification
  • JDA
  • defines the essential physical demands of the job
  • Hazard Identification
  • identifies physical demands that exceed safe
    limits
  • Can the two overlap? Yes, one can lead to the
    other but need to know the employers purpose for
    analysis.

94
How are the Results of Job Demands Analysis Used?
  • ADA job descriptions
  • Pre-Work screening
  • Transitional duty
  • Return-to-work decisions
  • Setting pay rates
  • Matching worker abilities to job demands!

95
The Importance of Job Classification
  • Report the results of JDA by using a
    classification system defined by the DOL
  • Provide additional information
  • Climbing (stairs ladder)
  • Reaching (Overhead forward)
  • Lifting (above vs. below waist)

96
Classification of Job Demands
  • Defined in DOT, SCO, COJ
  • Classifies manual materials handling demands
  • Occasional Frequent (50) Constant (20)
  • Very Heavy gt 100 lb. gt 50 gt 20
  • Heavy 51 - 100 lb. 25 - 50 10 - 20
  • Medium 21 - 50 lb. 10 -25 1 - 10
  • Light 11-20 lb. 1 - 10
  • Sedentary 1 -10 lb.
  • negligible weight

97
Classification of Physical Job Demands
  • kneeling
  • crawling
  • climbing
  • handling
  • fingering
  • balancing
  • Non-materials handling demands
  • standing
  • walking
  • sitting
  • reaching
  • crouching
  • stooping

98
Classification of Physical Job Demands
  • Non-materials handling tasks classified according
    to duration of demand within the work day
  • Constantly 2/3 to the full day
  • Frequently 1/3 to 2/3 of day
  • Occasionally up to 1/3 of day
  • Never not required

99
Classification of Physical Job Demands
  • Dexterity Demands
  • classified as an aptitude by the DOT
  • Rated on a 1 -5 scale
  • 1 top 10 of population
  • 2 highest 1/3, exclusive of top 10
  • 3 middle 1/3
  • 4 lowest 1/3, exclusive of bottom 10
  • 5 lowest 10 of population

100
Classification of Physical Job Demands
  • Two types of dexterity
  • Manual
  • Ability to move hands easily and skillfully. To
    work with hands in placing and turning.
  • Finger
  • Ability to move fingers and manipulate small
    objects with fingers, rapidly or accurately.

101
Classification of Physical Job Demands
  • Shortcomings with DOT classification system
  • Very general
  • climbing - ? ladder Vs stairs
  • reaching - ? overhead, forward, backward
  • Categories very broad
  • 1/3 to 2/3 of day
  • 21 - 50 lb.

102
Reliability
  • Pilot studies showed that when therapists perform
    JDA without a structured format, it was not very
    reliable
  • Two therapists analyzing the same job had
    different results
  • REQUIRES STANDARDIZED PROCESS TO ACHIEVE
    CONSISTENCY AND ACCURACY

103
Basic Steps of Job Analysis
  • Determine the tasks of the job
  • Determine the frequency duration of each task
  • Determine day task is performed
  • Observe/videotape the tasks
  • Measure forces and distances

104
Basic Steps of Job Analysis
  • Determine the percent of task each demand is
    performed
  • Determine the adjusted percent of day each demand
    is performed by
  • multiplying the task x demand
  • Sum the adjusted percentages to determine the
    total percent of day each demand is performed

105
Basic Steps of Job Analysis
  • Translate the into
  • Constantly
  • Frequently
  • Occasionally
  • Never
  • Determine the highest weight/force handled for
    each type of lift to classify the job Sed to V.
    Heavy

106
Contents of Report
  • Tasks
  • Environment
  • Tools/equipment
  • Protective equipment
  • Overall level of work
  • Percent of day performing each demand
  • C,F,O,N
  • Force demands
  • Distance over which forces applied

107
Optional Aspects of Report
  • Comparisons to patient abilities
  • Recommendations for transitional duty
  • Recommendations for post-offer screening
  • Areas for further hazard assessment
  • Selection of these components will depend on
    what the employer wants.

108
The Functional FoundationMatching the Worker to
the Work
  • Pre-Work
  • Screens

Return to Work
Work Simulation /Conditioning
Transitional Modified Duty
Job Demands Analysis // Functional Assessment
109
Why Preemployment Screening ?
  • The Promise
  • Decrease injuries
  • Decrease injury-related expenses
  • Improve productivity
  • Improve profit margin

110
Maximize Effectiveness One Element of a
Comprehensive Program
  • Pre-employment screening
  • Graded work entry
  • Education and training
  • Hazard prevention and control
  • Fitness/wellness
  • Post-injury management

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Three MUSTS for Preemployment Screening
  • JOB RELATED JOB RELATED JOB RELATED!
  • DOCUMENT DOCUMENT DOCUMENT!
  • FOLLOW-UP FOLLOW-UP FOLLOW-UP!

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Important Considerations
  • Americans with Disabilities Act
  • (ADA)
  • Test only the essential
  • functions of the job!

113
Optimal Sequence
  • Interview
  • Conditional offer
  • Post-offer/ screen
  • medical screen
  • physical abilities testing
  • drug screening

114
Traps to AVOID!
  • Pre-offer testing
  • Predicting future injury
  • General strength testing
  • Making comparisons to normative data
  • Adverse impact

ADA
EEOC
115
PROBLEMS with Pre-Offer Tests
  • Safety Issues
  • Cannot perform medical screening
  • Cannot monitor physiological responses to testing

116
PROBLEMS with Pre-Offer Testing
  • As a health care professional, your pre-offer
    exam may be considered medical just because it
    was administered by a health professional

117
Predicting Future Injury
  • Consensus among the medico-legal community
  • Virtually impossible to deny employment based on
    pre-offer testing that predicts future injury

118
Predicting Injury
  • Based on speculation
  • Applicant perceived as person with a disability
  • Must make reasonable accommodation
  • PROBLEMS!
  • LITIGATION!

119
INSTEAD...
  • DETERMINE WHETHER PHYSICAL ABILITIES MEET JOB
    DEMANDS
  • AVOID PROBLEMS!
  • AVOID LITIGATION

120
Avoid Causing Adverse Impact
  • Adverse impact
  • selection rate for any race, sex, or ethnic group
    less than 80 of rate for the group with the
    highest selection rate.

121
Example of Adverse Impact
  • Example
  • 60 of male applicants pass post-offer screen but
    only 15 of female applicants pass (.15 /.60
    .25)
  • Considered adverse impact the pass rate for
    women is only 25 of the pass rate for men.

122
General Strength Testing
  • Faculty at Washington University Dueker JA,
    Ritchie SM, Knox TJ, Rose SJ in JOM, Jan 94
  • isokinetic trunk evaluation was of no value in
    employee selection

123
General Strength Testing
  • Faculty from the Department of Orthopaedic
    Surgery, Glasgow, Scotland Newton M Waddell G
    in Spine 93
  • ...inadequate scientific evidence
  • to support the use of iso-machines in
    pre-employment screening ...or medico legal
    evaluation.

124
Litigation Against General Strength Testing
  • 1982 New York City firefighter case
  • Berkman v. City of New York
  • physical agility test items defined by Fleisheman
  • None of women passed, 46 of men did
  • Ruling Nothing in the concepts of dynamic
    strength, gross body equilibrium, stamina, and
    the like, has such a grounding in observable
    behavior of they way firefighters operate that
    one could say with confidence that a person who
    possesses a high degree of these abilities as
    opposed to others will perform well on the job.

125
Traps to AVOID!
  • Comparison to normative database
  • Percentile rankings of physical abilities are
    useless !

ADA
EEOC
126
Compare Abilities to Job DemandsAfter
Conditional Offer
  • Abilities match job demands
  • HIRE AND PLACE

127
Compare abilities to job demands After
Conditional Offer
  • Abilities do not match job demands
  • Qualified person with disability
    reasonable accommodation
  • Non-disability -do not
    hire -alternative placement -job
    modification
  • -applicant remediation

128
Policy for Handling Test Failures
  • Discuss and encourage the company to establish
    written policy for handling test failures with
    the employer prior to initiating screening
  • Do not become involved in implementing policy -
    leave it to the companys HR department

129
Two Possible Legal Challenges
  • Test items do not reflect relevant physical
    duties and performance requirements adequately
  • Sample of incumbents tested was not sufficiently
    large or did not represent the population of
    workers
  • Job demands analysis and incumbent testing can go
    a long way toward refuting

130
Steps of the Post-Offer Screening Process
  • Focusing the Post-Offer screening
  • Determine physical demands
  • Customize screening
  • Establish Procedures
  • Test incumbents
  • Modification
  • Implementation

131
The Details of this lecture were provided by
  • Deborah E. Lechner, PT, MS
  • President, ErgoScience, Inc.

132
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