Cost Reduction Technology. Simplifying the Management of Post-injury Musculoskeletal Disorder Injuries

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Dulcie Bates
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1 Cost Reduction Technology Simplifying the Management of Post-injury Musculoskeletal Disorder Injuries

2 Soft-Tissue Injury Management OBJECTIVE Introduce attendees to isokinetic testing and the advantages it provides in managing workers compensation injuries.

3 Take Away Fact-based evidence utilizing science and technology will always prevail over subjective analysis in the Courts. The Courts only require two things from employers in the event of a soft-tissue injury: Identify the injured joint Return the injured joint to pre-injury level

4 Isokinetic Technology CRT Isokinetic testing examines the dynamic muscle performance of: Knees, Shoulders, and Back (83% of muscle systems used in physically demanding jobs). Isokinetics is the only form of testing which applies accommodating resistance and creates a force curve for each joint tested. Isokinetics is also Objective, Standardized, Reproducible, Non-Discriminatory, and Legally Defensible.

5 Isokinetic Benefits Self accommodating resistance safe to administer Readily accepted by medical community Provides a strength-duration curve to show consistency of effort Objective, not subjective (science not a system) Large database possible used for post injury assessments Can show isolation of muscle groups Accepted by the Courts

6 Credibility of Isokinetics Isokinetics has been used by orthopedic physicians for over 4 decades 3,345 peer-reviewed citations in Medline search It is presently used in physical assessments by: NASA US Military Academies Professional Sports & America s Leading Employers

7 Soft Tissue Injuries Are A Challenge Soft tissue injuries can be a challenge to physicians especially when: Determining the severity of the injury Assessing the ability of the injured employee to perform essential job duties Setting meaningful work restrictions Deciding when an employee can safely return to work

8 Identify Injured Joint Soft-tissue injury (sprain, strain) not identified by subjective testing MRI about 85% effective at identifying pathology in connective tissue, CT Scan slightly better X-Ray effective with fracture or break MRI, CT Scan, or X-Ray ineffective for soft-tissue injuries because of cost and reliability Isokinetic testing in the upper 90 s and cost effective

9 The CRT Joint Comparison Evaluation as an Injury Diagnostic Tool Performed as part of physician s initial evaluation for every MSD-related injury involving the knees, shoulders, and back. When claimant has full, or near-full, range of motion of the joint and is moderately relieved of pain (ideally within 7 days of reported injury). Isokinetics can validate and determine degree of injury compared to preemployment test or CRT normative data. Isolate joints for comparison. Ensure inappropriate diagnostic tests are not ordered, effective rehabilitation is requested, and facilitate early return to work.

10 What Force Curves Reveal The following slides depict the difference between well developed muscles and those with deficiencies

11 Isokinetic Normal Curve Left Knee Left Shoulder Flexion(Set 1,set 2) set1rep1 set1rep2 set1rep3 set1rep4 set1rep5 set2rep1 set2rep2

12 A Consistent Isokinetic Joint Test When claimants are clearly injured, their force curves will be consistent, even when the muscles are weak and injured. As the patient engages in progressive rehabilitation, both the strength and flexibility of the joint should improve dramatically over a 2-4 week period. Should this not happen, yet the tests continue to show consistency in effort, the doctor then has objective data to indicate the need for further evaluation.

13 Trunk Extension-Poor Hamstrings Trunk Torque (lb - ft) Extension (Set 1,Set 2) Very Poor Hamstrings degrees set1rep2 set 1rep3 set 1rep4 set1 rep5 set2rep1 set2 rep2 set2 rep3 set 2 rep4 set2 rep5 set1rep Angle(degrees) Torque (lb - ft) Extension (Set 1,Set 2) set1rep2 set 1rep3 set 1rep4 set1 rep5 set2rep1 set2 rep2 set2 rep3 set 2 rep4 set2 rep5 set1rep Angle(degrees)

14 Trunk Test Interpretation 0-90 Range of Motion tested Peak torque (strength) measured on Y-axis Range of motion measured on X-axis Lower curve is normal in size, shape and height Top curve shows a large loss of strength from This primarily is the hamstring/buttock muscle groups Top curve shows a poor transfer of strength from hamstrings buttocks to back extensors showing susceptibility to back injury. Trunk extensor curve on lower curve is smooth and relatively stable. Trunk extensor curve on top is quite jagged and doesn t reach peak until 45.

15 Curve Discrepancies Right Knee Left Knee Extension(Set 1, Set 2) set1rep1 set1rep2 se1rep3 set1rep4 set1rep5 set2rep1 set2rep2 set2rep3 set2rep4 set2rep5

16 Knee Test Interpretation 0-90º Range of Motion Tested Peak torque (strength) measured on Y-axis Range of motion measured on X-axis Top curve is normal in size, shape and height Lower curve has a huge deficit from 65º-40º, indicating instability Normally would look at left knee flexion curve to see if hamstrings are strong enough to stabilize this lower curve knee

17 Curve Discrepancies Left Shoulder Flexion(Set 1,set 2) set1rep1 set1rep2 set1rep3 set1rep4 set1rep5 set2rep1 set2rep Left Shoulder Flexion(Set 1,set 2) set1rep1 set1rep2 set1rep3 set1rep4 set1rep5 set2rep1 set2rep2

18 Shoulder Test Interpretation Range of Motion tested. Peak torque (strength) measured on Y-axis. Range of motion measured on X-axis. Top curve is normal in size, shape and height. Lower curve shows poor initial strength available. Lower curve shows a dip in strength 0-90, particularly 30-60, showing danger if strength is needed. Lower curve shows possible impingement syndrome or rotator cuff injury.

19 This Test Shows Invalid Effort Treating physicians can identify when patients with MSD claims give less than maximum effort during post-injury testing as shown in these joint tests. Since muscles have no short term memory, variations in force curves indicate the patient s failure to give maximum effort in their joint strength testing. It is virtually impossible for a patient to produce the same false torque at the same degree of angle throughout the five repetitions as these force curves show. The CRT algorithm analyzes consistency of effort throughout the entire range of motion during each repetition.

20 The Benefit of CRT Return to Work Tests To Employer Physician can demonstrate findings and recommendations to employers, employees, and insurance adjusters using objective data and graphs greatly simplifying the communication process. Pre-injury levels can be determined using the patient s existing CRT pre-employment test, preinjury baseline test or CRT normative data based on more than 500,000 tests. Restrictions, if needed, can be based on test data.

21 Meaningful Restrictions 1. Patient can carry: 58 lbs. Occasionally 33 lbs. Frequently 15 lbs. Continually 2. Patient can lift from knees to waist: 58 lbs. Occasionally 33 lbs. Frequently 15 lbs. Continually 3. Patient can lift over head: 35 lbs. Occasionally 21 lbs. Frequently 11 lbs. Continually 4. Patient can push and pull from waist height: 50 lbs. Occasionally 30 lbs. Frequently 15 lbs. Continually

22 Isokinetics - The Right Tool for Post-Injury Claims Management Prevent false claims Identify malingering early in the medical management process More effective and targeted treatment plans result in reduce costs Prevents premature RTW Objective data useful in tracking progress of rehab Objectively validates the physician s modified work restrictions

23 Isokinetics - The Right Tool for Post- Injury Claims Management cont. Meets the Courts requirements to identify injured joint and return employee back to pre-injury level Evaluates more than 96 different Isokinetic variables, including peak torque, range of motion and endurance. Limit adversarial conflicts between claimant, employer, insurance carrier and treating physician(s). Reproducible, standardized, safe, defensible, 100% objective - leads to fewer challenges Saves money and reduces frustration

24 Questions to Ask RTW Provider How do you identify the injured joint (quantify strength, range of motion, endurance)? Are you able to establish pre-injury level as a matter of scientific fact? How do you protect the employer from premature RTW? Are you able to provide meaningful restrictions based on objective data? Are you able to objectively identify when an injured joint is back to pre-injury level?

25 Final Thoughts Return to work evaluations should be end result of an assertive injury management process. Must satisfy the requirements of the Courts If you fail to manage the work comp injury the work comp injury will manage you.

Preventing Workplace Injuries with Ergonomics

Preventing Workplace Injuries with Ergonomics Richard W. Bunch, PhD, PT, CBES ISR Institute / Dr. Bunch Preventing Musculoskeletal Disorders (MSDs) Low Back Injuries- #1 Disabling Orthopedic Injury Among