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

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Industrial rehabilitation

Industrial Rehabilitation

George T. Edelman MPT, MTC

Rick Hayward MPT, OCS, OMPT


Scope of the problem

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.


Industrial rehabilitation

INJURY COSTSMedical CostsEmployee WagesBenefit Package PaymentsSalary of Replacement PersonnelTraining of Replacement PersonnelOvertime Payments for Current Personnel


What do i need to know

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


What do i need to know1

What do I need to know?

  • Work conditioning

  • Work simulation

  • Injury Prevention Education

  • Fitness

  • Governmental agencies

  • Regulatory issues

  • Reimbursement issues

  • Marketing


Players

Players

  • Worker/patient

  • Employers

  • Physician

  • PTs/OTs/ Exercise physiologist

  • Vocational Rehab consultant

  • Psychologist

  • Attorney

  • Case manager


Scope of practice

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


Overview of lecture

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


History regulations and agencies

History,

Regulations,

and

Agencies


History 3 major areas

History - 3 Major Areas

  • Workers Compensation

  • Social Security

  • Employment Selection


History workers compensation

History: Workers’ Compensation

  • Early 1900’s - 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


Workers compensation law

Workers’ Compensation Law

  • Early 1900’s 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


History workers compensation1

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


Workers compensation law1

Workers’ Compensation Law

  • varies from state to state

  • costs are paid by employer to state fund or insurer

  • each state determines specific benefits received


History workers compensation2

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.


Understanding workers comp

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


Who is covered

Who is Covered

  • Everyone except

    • Baby-sitters

    • Temporary agriculture

    • Religious school teaching

    • Part-time domestic help

    • Family members in family business


What is covered

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


Pre existing conditions pre disposing to injury

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”


Pre existing conditions causing injury

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


History workers compensation3

History - Workers’ Compensation

  • 1920’s saw decline in the workers compensation system

  • Disputes arose over whether injuries were work-related and the extent of disability

  • By mid-1930’s debate began over whether to add disability to the social security system


History social security disability

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


Ssa s definition of disability

SSA’s 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.


Ssa s definition of disability1

SSA’s 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


Five step ssa disability determination process

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?


History rehabilitation

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


History employment selection

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


Industrial rehabilitation

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


Ada substantial limitation of major life activity

ADA - Substantial Limitation of Major Life Activity

  • Caring for self

  • Performing manual tasks

  • Walking

  • Seeing

  • Hearing

  • Speaking

  • Breathing

  • Learning

  • Working

  • Participating in community affairs


Ada essential functions

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


Ada reasonable accommodations

ADA - Reasonable Accommodations

  • modifications or adjustments to job to enable impaired person to enjoy equal employment

    • job application process

    • work environment

    • benefits & privileges


Ada undue hardship

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


History injury prevention

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


Industrial rehabilitation

OSHA

  • Regulatory body

  • Employers of 11 or more people

  • Reduce hazards/comply with standards

  • Conducts inspections

  • Issues fines

  • No ergonomic standards per se


History injury prevention1

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


Niosh

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


Governmental agencies

Governmental agencies

  • Department of Labor

    • description/classification of work

  • Social Security Administration

    • disability determination

  • NIOSH

    • research

  • OSHA

    • regulatory


Overview of course

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


The big picture

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


Continuum of care

Medical Model

Acute

Sub-acute

Chronic

Work Recovery Model

Off Work

Transitional modified duty

Return to full duty

Permanent modified duty

New permanent position

Disability

Continuum of Care


Acute care medical side

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


Work related function

Work Related Function

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


Acute care work recovery

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


Acute care work recovery1

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


Work function

Work Function

  • Based on demands of job

    • Work simulation

    • Work conditioning exercises

    • Graded with specific goals


Acute care work recovery2

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


Importance of function

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


Importance of work related functional assessment

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

      • nofurther treatment or modified work


Appropriate measurement for the acute stage

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


What does the informal job site visit accomplish

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


Industrial rehabilitation

To maximize effectiveness in treating work-related injuries -get out of the clinic and into the work place!


Acute management

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


Example home program for acute back patient

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


What don t want

What Don’t Want...

  • Inactivity!

  • Unstructured daily regimen

    Because...

  • promotes the sick role

  • encourages

    • Disuse atrophy

    • De-conditioning

    • Decreased mobility


Essential elements of success

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


Knowledge of work related function

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


Subacute medical management

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.


Subacute work recovery

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


Chronic medical management

Chronic: Medical Management

  • Shifts more toward

    • pain management

    • psychological interventions

    • coping with residual functional capacity


Chronic work recovery

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


The functional foundation matching the worker to the work

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


Traditional return to work disability decision making

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


The well designed fce

The Well-Designed FCE

  • Comprehensive

  • Standardized Yet Flexible

  • Clear Report Format

  • Safe

  • Practical

  • Objective

  • Reliable

  • Valid


Comprehensive

Comprehensive

  • Covers all physical demands defined by DOL in the Dictionary of Occupational Titles

  • Does not focus exclusively on materials handling


Standardized yet flexible

Standardized Yet Flexible

  • Procedures

  • Equipment

  • Verbal Instructions

  • Scoring System

  • Ability to chose individual items for job-specific testing


A clear fce report

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


A clear fce report1

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


Industrial rehabilitation

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


Objective projections

Objective Projections

  • Minimize clinical “guesswork”

  • Projecting to 8-hour day


The common fce scoring

The Common FCE Scoring

?

?

?

Report

Generation

FCE

Protocol

Clinician’s

Observation

Examiner Bias

The “Gray” Zone


The pwpe scoring system

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


What is reliability

What is Reliability?

  • Reliability = Consistency

    • If different therapists administer an FCE to the same patient, will they obtain the same results?


What is validity

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!


Why are reliability and validity important

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


Reliability and validity of fce

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


Summary of research

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


Interrater reliability and concurrent validity

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


Reliability validity

Reliability & Validity

Reliability: Kappa for Test as whole = .83 Almost Perfect

Validity: 86% agreement between PWPE and actual work


Predictive validity

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


Predictive validity1

Predictive Validity

  • Recommendations based on discharge PWPE:

    • RTW - full duty

    • RTW - modified duty

    • No RTW

  • Substantial agreement between recommendations and:

    • Initial RTWKappa of .74

    • 3 month follow up Kappa of .69

    • 6 month follow upKappa of .71


  • Contributions of pwpe research

    Contributions of PWPE Research

    • These studies are the only ones that have examined both reliabilityandvalidity of a comprehensive test published in the peer-reviewed medical literature


    Common misuse of fce

    Common Misuse of FCE

    Catch the Faker!


    Can t catch the faker why not

    “Can’t 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


    Sincerity of effort

    Sincerity of Effort

    Any statement that implies decreased motivation

    • “symptom magnification”

    • “exaggerated pain behavior”

    • “invalid or conditionally valid FCE”

    • “malingerer”


    Sincerity of effort1

    Sincerity of Effort

    “Measures” typically used to justify statements about sincerity of effort

    • Coefficient of Variation (CV, COV)

    • Waddell’s 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”


    Sincerity of effort2

    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 lacking…not defensible


    The good news

    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


    Sincerity of effort3

    Sincerity of Effort

    Test results need to be expressed very carefully

    • “Patient self-limited on…”

    • “Patient demonstrated the following functional inconsistencies”

    • “Patient’s test results were similar to a research group who were instructed to intentionally withhold.”


    The challenge

    The Challenge

    • To distinguish between appropriate and inappropriate tests of sincerity of effort

    • Not overstate test results and increase exposure to litigation


    Additional information

    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.


    Additional information1

    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.


    What is job demands analysis

    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


    Difference between jda and hazard identification

    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 employer’s purpose for analysis.


    How are the results of job demands analysis used

    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!


    The importance of job classification

    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)


    Classification of job demands

    Classification of Job Demands

    • Defined in DOT, SCO, & COJ

    • Classifies manual materials handling demands:

      OccasionalFrequent (50%) Constant (20%)

      • Very Heavy> 100 lb.> 50> 20

      • Heavy51 - 100 lb.25 - 5010 - 20

      • Medium21 - 50 lb.10 -251 - 10

      • Light11-20 lb.1 - 10 *

      • Sedentary1 -10 lb. * *

        * negligible weight


    Classification of physical job demands

    Non-materials handling demands

    standing

    walking

    sitting

    reaching

    crouching

    stooping

    kneeling

    crawling

    climbing

    handling

    fingering

    balancing

    Classification of Physical Job Demands


    Classification of physical job demands1

    Classification of Physical Job Demands

    • Non-materials handling tasks classified according to duration of demand within the work day

      • Constantly2/3 to the full day

      • Frequently1/3 to 2/3 of day

      • Occasionallyup to 1/3 of day

      • Nevernot required


    Classification of physical job demands2

    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


    Classification of physical job demands3

    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.”


    Classification of physical job demands4

    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.


    Reliability

    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


    Basic steps of job analysis

    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


    Basic steps of job analysis1

    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


    Basic steps of job analysis2

    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


    Contents of report

    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


    Optional aspects of report

    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.


    The functional foundation matching the worker to the work1

    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


    Why preemployment screening

    Why Preemployment Screening ?

    The Promise:

    • Decrease injuries

    • Decrease injury-related expenses

    • Improve productivity

    • Improve profit margin


    Maximize effectiveness one element of a comprehensive program

    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


    Three musts for preemployment screening

    Three MUSTS for Preemployment Screening

    • JOB RELATEDJOB RELATEDJOB RELATED!

    • DOCUMENTDOCUMENTDOCUMENT!

    • FOLLOW-UPFOLLOW-UPFOLLOW-UP!


    Important considerations

    Important Considerations

    Americans with Disabilities Act

    (ADA)

    Test only the essential

    functions of the job!


    Optimal sequence

    Optimal Sequence

    • Interview

    • Conditional offer

    • Post-offer/ screen

      • medical screen

      • physical abilities testing

      • drug screening


    Traps to avoid

    Traps to AVOID!

    • Pre-offer testing

    • Predicting future injury

    • General strength testing

    • Making comparisons to normative data

    • Adverse impact

    ADA

    EEOC


    Problems with pre offer tests

    PROBLEMS with Pre-Offer Tests

    Safety Issues

    • Cannot perform medical screening

    • Cannot monitor physiological responses to testing


    Problems with pre offer testing

    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


    Predicting future injury

    Predicting Future Injury

    Consensus among the medico-legal community:

    Virtually impossible to denyemployment based on pre-offer testing that predicts future injury


    Predicting injury

    Predicting Injury

    • Based on speculation

    • Applicant perceived as person with a disability

      Must make reasonable accommodation

      PROBLEMS!

      LITIGATION!


    Instead

    INSTEAD...

    DETERMINE WHETHER PHYSICAL ABILITIES MEET JOB DEMANDS

    AVOID PROBLEMS!

    AVOID LITIGATION


    Avoid causing adverse impact

    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.


    Example of adverse impact

    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.


    General strength testing

    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”


    General strength testing1

    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.”


    Litigation against general strength testing

    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.”


    Traps to avoid1

    Traps to AVOID!

    Comparison to normative database

    Percentile rankings of physical abilities are useless !

    ADA

    EEOC


    Compare abilities to job demands after conditional offer

    Compare Abilities to Job DemandsAfter Conditional Offer

    Abilities match job demands

    HIRE AND PLACE


    Compare abilities to job demands after conditional offer1

    Compare abilities to job demandsAfter 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


    Policy for handling test failures

    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 company’s HR department


    Two possible legal challenges

    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


    Steps of the post offer screening process

    Steps of the Post-Offer Screening Process

    • Focusing the Post-Offer screening

    • Determine physical demands

    • Customize screening

    • Establish Procedures

    • Test incumbents

    • Modification

    • Implementation


    The details of this lecture were provided by

    The Details of this lecture were provided by:

    Deborah E. Lechner, PT, MS

    President, ErgoScience, Inc.


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