FCE JSA EJA. When is your patient safe to return to work? Introduction. The Industrial Rehabilitation System. Work Conditioning.

Transcription

1 When is your patient safe to return to work? Introduction Presented by: Jonathan Reynolds, PhD, PT Bloswick, 2000 INJURY FCE JSA EJA Physician Chiropractor Physical Therapist Occ. Therapist CASE RESOLUTION REHABILITATION Work Conditioning Modified Duty and Rehab RETURN TO WORK The Industrial Rehabilitation System Work Conditioning Vocational Rehabilitation Ergonomics 1

2 Functional Capacity Evaluation Detailed evaluation of: Work capacity or ADL Reliability of effort Reliability of symptoms & perceived function Barriers to Case Resolution Recommendations for case resolution Return to work Rehabilitation Work conditioning Aerobic Lifting, etc. Ergonomic intervention JOB JOB ANALYSIS TASK ANALYSIS JOB PLACEMENT COMPARISON MODIFY WORK MODIFY WORKER WORKER FUNCTIONAL CAPACITY EVALUATION TASK SPECIFIC EVALUATION MODIFY JOB TASK Comparison Job Site Analysis Detailed Task Specific Analysis Essential Functions Work Description Work Pace Material Handling Posture Analysis Movement Analysis 2

3 Ergonomic Analysis Awkward Posture Sustained Postures Repetition Forceful Exertion Vibration Cold Localized Mechanical Stress FCE Activities Medical Record Review Intake Interview Chronic Pain Assessment Physical Examination Hand Function Work Activities and Postures Material Handling Aerobic Fitness Work Simulation Consistency of Effort Reliability of Client Reports Co-efficients of variation Grip MMT etc. Heart Rate Changes Velocity of Motion Posture Muscle Recruitment Consistent Movement Patterns High effort behavior Symptom Magnification Abnormal Illness Behavior Malingering Pain behavior Chronic pain assessment 3

4 Chronic Pain Assessment Ransford Pain Drawing Revised Oswestry LBDQ Neck Disability Index Shoulder Rating Questionnaire PACT Spinal Function Sort EPIC Hand Function Sort Algometry Distraction Testing Nonorganic Signs (Waddell et al) Somatic Amplification Rating Scale (Korbon et al) Physical Examination Posture Active and passive ROM MMT Neurology Abnormal Illness Behavior signs Distraction tests Other special tests (ligaments, impingements etc.) Nerve Tension Tests Movement patterns (symmetry) Palpation Pressure pain threshold Gait Hand Function 5-Position Grip Rapid Exchange Grip Pinch Dexterity Heart Rate Changes Velocity of Motion Posture Muscle Recruitment Physical Discomfort Signs Consistent Movement Patterns High effort behavior Work Postures (Timed) Sitting Standing Walking Kneeling Crawling Reaching Hand Posture Neck Posture Bending 4

5 Posture and Dexterity Dexterity Ability Posture Tolerance Repetition Posture and Dexterity Dexterity Ability Posture Tolerance Repetition Competitive Performance Distraction Coordination Aerobic Capacity Testing Maximum Aerobic Power (MAP) Relationship between MAP and Lift Capacity (Matheson et al) Submaximal MET Test Modified Bruce Treadmill Test Step Test Material Handling Lifting From Floor From 12 Pivot To Shoulder To Overhead 5

6 Material Handling Material Handling Lifting From Floor From12 Pivot To Shoulder To Overhead Carrying Lifting From Floor From 12 Pivot To Shoulder To Overhead Carry Pushing / Pulling Material Handling Job/Work Simulation Lifting From Floor From 12 Pivot To Shoulder To Overhead Carrying Pushing / Pulling Simulation 6

7 Observation and Distraction Movement Patterns Signs of Discomfort Competitive Test Performance Body Mechanics Velocity of Motion Muscle Recruitment Testing Behavior Recommendations Plan of Rehabilitation Case Resolution Interventions Projected time-frame Projected cost Players (PT, OT etc.) Re-test Time-frame Cost Anticipated result Estimated return-to-work status One-Day Vs Two-Day FCE Systems Lower Cost As reliable Time efficient Consistency Limited On-Site Higher Cost Consistency Repeat Tests Data Comparison Added activities from Day 1 On-Site Testing Matheson The WorkStation JTech Medical - Tracker Blankenship Isernhagen Work Systems ErgoScience Hanoun/BTE Valpar - Joule 7

8 Case Study 1 Case Study 1 64 year old Semi Truck Driver Hauls anhydrous ammonia and liquid asphalt Rotator Cuff Repair 1 year prior to FCE No signs of submaximal effort Some signs of symptom magnification Poor perception of work ability Concerns King-Pin pull Ladder Climb Retirement Medical Record Review Inadequate home exercise program Poor tracking of outcomes Recommendations Case Study 1 Return to work with accommodations Drive a particular truck with light king-pin Not to load asphalt first (pipe is stiff when cold) Custom made bar used to loosen asphalt pipe Keep rim of the hatch clean Use a tire iron to loosen the hatch Limited trailer changes 1 session of therapy: exercise program poor mechanics Case Study 2 45 Year-old gentleman Collection agent (computer work all day) 3 years on Workers Comp for C7/T1 disk protrusion; C4/5, C5/6 spinal stenosis Extensive PT, Chiropractic, Back and Neck Programs Long Medical History, Long list of Medications Functional Capacity Evaluation (FCE) 8

9 Case Study 2 Case Study 2 High Numeric Pain Rating (8/10) Range of Motion: Cervical Rotation R: 23 o Several Nonorganic Signs (Waddell et al) Perceived Function: Sedentary High Disability Perception (Neck Disability Index) Low Algometry scores for PTh, PTo Failed Consistency of Effort tests Failed Repeat Consistency of Effort Tests Range of Motion improved when distracted Admitted that pain was exaggerated Acknowledged higher perceived ability Case closed 90 days after FCE! FCE Work Simulation Thank You 9