FCE Grid and Test Correlations

1. FCE Grid and Test Correlations WorkWell Prevention & Care

2. Webinar Objectives: • Participants will understand: • All sections of the FCE Test Results Document (“Grid”) • How to complete the FCE Grid • How to correlate test items

3. Webinar Courtesy Your phone system may disturb all others participating in the webinar. Please DO NOT put your phone on “hold” – we will hear your music or advertising Eliminate background noises if on speaker we will hear your co-workers talking, laughing, etc.

4. Webinar • “WorkWell’s FCE Professional Guidelines and Advanced Documentation” seminar • Based on years of working as a Clinical Therapist for WorkWell • Webinar is based on a portion of this seminar • 8 hour seminar • Interactive – discussions, questions and answers • Seminars are listed in the Newsletter

5. “FCE Grid”

6. “FCE Grid” #1- Results based on specific work factors. #2 Interpretation of observed function #3 Test results

7. WorkWell FCE Test Results The interpretation of WorkWell’s standardized functional testing is based on assumptions including normal breaks, basic ergonomic conditions and that the tested functions are usually not required more than 2/3 of a normal working day. If a function is required continuously, job related testing should be performed.

8. Based on Assumptions • # 1 - Normal breaks • 8 hour working day • (2) 15 min. breaks • 30 min. to an hour for lunch • Example: If working a 7:00 – 3:30 shift (8.5 hours) 2 hours work – 15 min. AM break 2 hours work - 30 min. Lunch 2 hours work - 15 min. PM break 2 hours work - Home

9. Based on Assumptions • #2 – Basic ergonomic conditions • Ergonomic Risk Factors: • Repetitions • Forces • Awkward postures • Vibration - direct contact trauma • Temperature

10. Based on Assumptions • #3 – Testing function not required more than 2/3 of the day (frequently) • If an activity is required continuously 67-100% of the day, job related testing should be performed. • How many activities can be performed continuously?

11. FCE test results (grid) Interpretation of observed function regarding activity during a normal work day. Interpretation of observed function regarding activity during a normal work day.

12. FCE test results (grid)

13. FCE test results (grid)

14. Quantitative and Qualitative Results • Quantitative – defined by test protocols • Amount of weight • Distance • Time completed • Example: Standing Work • Never: Unable to perform, totally contraindicated • Rare: Significant limitation < 10 min. • Occasional: Some limitation 10 min. - < 30 min. • Frequent: Slight / No limitation 30 min.

15. Quantitative and Qualitative Results • Qualitative – observed objective aspects of performance • Antalgic gait • Frequent weight shifting • Limited strength / giving way / compensates • Pace • Stability – compensatory movement • Balance • Using support

16. Final Score • Quantitative + Qualitative Results • Considerations • Individual test result per protocol • Magnitude of observed difficulty • Based on observation • Consider % of workday definitions

17. Review of the FCE Test Results and Interpretation - “Grid” There are numerous variables impacting Push/Pull including load, equipment, surface, etc. This is not meant to indicate the “weight that is move”

18. FCE Grid

19. Limitations • Observation – increased lumbar lordosis and frequent weight shifting • Limitation – • decreased core trunk strength • limited LE strength • decreased hip flexibility – tight hip flexors • dermatome radicular pattern L4-5 pain

20. Recommendations • Think “ergonomics” • Use of carts, ladders, dollies, wheelbarrow, etc. • Frequent, short rest breaks when doing this activity • Alternate job tasks to decrease duration of heavy lifting • Raise work surface

21. FCE Grid Examples Maximum performance in a return to work FCE Client with poor outcome in a R RCR Client that Self –limits Correlating FCE Test Results

22. “Grid” Patient referred for return to work determinations There are numerous variables impacting Push/Pull including load, equipment, surface, etc. This is not meant to indicate the “weight that is move”

23. Return to work FCE • Get a job description prior to testing • Add job specific testing • Use the job match grid

24. FCE GridPatient with poor outcome from R RCR

25. FCE GridPatient with poor outcome from R RCR

26. FCE Grid

27. Patient with poor outcome from a R RCR • What would you expect to read in this FCE? • Diagnosis and history to support R RCR • Patient reporting problems in ADL’s and work at chest level or higher • Decreased ROM and Strength in the Physical Exam. • Difficulty with Waist to Crown lifting, Elevated work, and any job simulation that requires working at chest level or higher

28. Self-limiting • Client stops the test activity prior to therapist observing maximum effort. • Generally due to pain or fear of reinjury • Be clear in your report which tests were self-limited • Watch for confliction statements • Client gave maximum effort on all tests • Client had limitations on some tests • Client self-limited some tests

29. Self-limiting FCE Grid

30. Self-limiting FCE Grid

31. Correlating test items • The 6MWT - walking • Rare – must have an appropriate corresponding diagnosis to support this low distance. Rare = 0 -24 min. in a workday, an average of 3 min. per hour. • Review protocol – • must walk “fast” • Frequent turns may cause a lower score • Review “factors associated with a shorter 6MWT

32. Walking correlations • If a client is limited in walking, then activities that require walking will also be limited. • What other tests require walking? • Carrying an object (front, L or R carries) • Stairs • Ladders

33. FCE Grid – Walking LimitationsFinal analysis with correlations There are numerous variables impacting Push/Pull including load, equipment, surface, etc. This is not meant to indicate the “weight that is move”

34. FCE Grid – Walking LimitationsFinal analysis with correlations

35. Correlations for Standing Work • If a client is limited in standing work, then other activities that require this will also be limited. • What other tests require standing work • Waist to floor lift • Waist to crown lift • Short carry • Forward bending – standing

36. Standing work Standing work is tested during the lifts and carries (30 min.) The test results may be limited due to the client being unable to tolerate the extra load imposed with lifting and carrying weight. You may restart the standing work timer after lifts and carries to determine standing work ability when weight is not involved.

37. FCE Grid – Standing Work LimitationsFinal analysis with correlations There are numerous variables impacting Push/Pull including load, equipment, surface, etc. This is not meant to indicate the “weight that is move”

38. FCE Grid – Standing Work LimitationsFinal analysis with correlations

39. Wrap Up • Webinar format limits abilities for discussions • Watch your newsletter for the 8 hour seminar “Advanced Documentation” • If you are interested in hosting a session, please email slarue@workwell.com • Include your: • Name • Facility • City • State

40. Webinar Critique • We appreciate your participation • Please complete the critique form • If you have any suggestions for future webinars, please include them in your critique

41. Thank you!