Peoples Injury Network NW (PINN)

1. Peoples Injury Network NW (PINN) • PINN is an Industrial Rehabilitation therapy provider • We have been in business for over 12 years • Each PINN Clinic specializes in treating the Injured Worker through a multidiscipline approach with both Physical & Occupational Therapy • PINN has a thorough understanding of the industrial rehabilitation needs of the Injured Worker • Our PINN Clinics are at least 5,000 square feet in size

2. Peoples Injury Network NW (PINN) What services do we provide? Physical Therapy Work Conditioning Work Hardening Physical Capacity Evaluations (PCE’s) Ergonomic Assessments On-Site Services for Job Analysis & Job Modification Extended EvaluationsVibrasym Driving Evaluation (PINN Kent) Post-Operative Testing

3. PBPCE –Performance Based Physical Capacity Evaluation or FCE Functional Capacity Evaluation Presented by: Peoples Injury Network Northwest, (PINN)

4. Physical Capacity Evaluation Is “a process of measuring an individual’s ability to dependably sustain performance in response to broadly defined physical work demands over time”

5. A Physical Capacity Evaluation can… • Evaluate current work tolerances and potential work capacity • Provide information to help determine if an individual can return to the usual occupation or perform the work demands of a new job being considered • If no vocational goals are established provide guidelines related to the individual’s physical capacities to assist with the vocational exploration process • Assist the Medical Professional in completing the Attending Physician Form (APF)

6. PCE’s should be performed with the following practice hierarchy: • Safety • Reliability • Validity • Practicality • Utility • Respect

7. Who can request a PCE? • Doctors • Chiropractors • Claims Managers • Attorneys • Vocational Rehabilitation Counselors • Nurse Case Managers

8. Initial Contact with the Client • Explain the purpose of the evaluation • Collect reliable information • Current physical and functional abilities as that relates to vocational considerations • Inform the client that they need to participate with: • High level of effort • Reliability of Pain and Disability Report • Do not perform any activity that they perceive to be unsafe

9. Physical Capacity Evaluation’s • Usually 1-2 days • Determine level of physical effort and reliability of pain and disability report. • Evaluator must be objective • Should answer the referral sources questions

10. Oregon PCE Levels • First Level PCE- • Limited evaluation primarily to measure musculoskeletal components of a specific body part • Active range of motion • Motor Power Using the 5/5 scale • Sensation • No less than 45 minutes of actual patient contact OAR 436-009-0070(4)(a)

11. Oregon PCE Levels continued • Second Level PCE • This evaluation is to measure general residual function capacity to perform work or provide other general information. • Musculoskeletal evaluation • To establish Residual Functional Capacities for claim closure • No less than two hours of patient contact OAR 436-009-0070(4)(b)

12. Oregon PCE Levels continued • Third Level PCE (WCE)- • This is a Residual Functional Capacities evaluation. • Musculoskeletal evaluation for a single body part • Endurance • Assess ability to perform essential physical functions of the job based on a specific job analysis as related to the accepted condition • Assess ability to sustain activity over time • Assess reliability of the evaluation findings • No less than 4 hours of patient contact OAR 436-009-0070(4)(c)

13. Interviewing Strategies • Give brief explanation of what to expect in the evaluation • Privacy • Communicate Respect • Establish Rapport • Have tissues and extra pens available

14. Interview Process • Mechanism of Injury • DOI/Onset & Diagnosis • Physician/ Physician restrictions • Diagnostic Testing • Medications • Age

15. Interview continued • Assistive Devices • Previous medical treatment & Other medical conditions • Current sleep duration • ADL’s • Subjective Tolerance Levels

16. Objective Data • Height • Weight • Blood Pressure • Pulse • Smoker • Alcohol Usage • Medication Usage

17. A PCE Summary should include • Sitting, Standing, Walking Tolerance • Total hours alternating sit/stand/walk at one time • Total hours alternating stand/walk (being on feet) • Lifting capability frequency and levels • Carry capability frequency and levels • Push/Pull capability frequency and levels

18. PCE summary continued • Reaching • Fine Manipulation, pinching • Grasping, gripping, forceful grasp • Operate foot controls • Operate hand controls • Twisting • Squatting • Kneeling • Bend/Stoop • Crouch • Climb Stairs • Climb Ladders • Crawling

19. Job Analysis Definition • A Job Site Analysis is a detailed description of the essential and non-essential job tasks/functions and the relevant physical demands to perform the essential and non-essential job tasks. • PCE should address the client’s demonstrated physical and functional tolerances in relation to essential job tasks and required physical demands.

20. THE PHYSICAL DEMAND LEVELS OF WORK *Occasional, Frequent, and Constant are terms defined by the Dictionary of Occupational Titles that refer to the frequency of “exerting a force,” including lifting, carrying, pushing, pulling, or any other physical activity.

21. Physical Effort “Physical Effort Testing concerns to an individuals levels of physical exertion during encountered testing procedures. This type of testing is best evaluated via a multi-facted approach under distraction based clinical conditions. Results of such testing are not intended to imply intent” (Kyi, 1997-2009)

22. Three categories of physical effort testing • Isometric – Jamar Grip • Cardiovascular – EPIC and NIOSH heart rate guidelines • Behavioral

23. Jamar Grip Strength Jamar Dynamometer Evaluates: Strength Consistency of effort • Rapid Exchange • Bell Curve & SD • Coefficient variation cut points

24. Cardiovascular • NIOSH 65-70% of age predicted maximum • EPIC - >150% of Standing Resting Heart Rate

25. Behavioral (Competitive Test Performance) “The musculoskeletal and/or behavioral tendency to maximize one’s test score and performance under evaluation conditions. CTP is best evaluated in a distraction-based testing environment (Kyi, 1997-2009 RMA)

26. Musculoskeletal Evaluation • Posture and Alignment • Flexibility/mobility • Strength • Neurological Examination • Gait • Special Tests Waddell and Placebo Tests • Movement patterns, quality of movement, comparison of movement and pain • Palpation

27. Special Tests • Finklestein’s Test • Phalen’s Test • Tinel’s Sign • Femoral Nerve Test • Straight-Leg Raise Test • Patrick’s test (FABERE) • Thomas Test • Cubital Tunnel Syndrome • Yergasson’s Test • Waddell’s Non-Organic Physical Signs and Placebo test

28. Objective Data • Posture • Range of Motion • Gait PCE should determine if these objective findings are or are not reliable and consistent as the client did/did not self limit secondary to reported pain

29. When to stop/terminate testing • Biomechanical • Cardiovascular – Metabolic • Psychophysical • Blood Pressure exceeds 160/100 • Heart rate exceeds the target zone of 85% of MAAHR • Client develops chest pain, nausea, vomiting, dizziness, blurred vision, pale • Client is unsafe or is unable to perform activity or movement patterns • Request to stop

30. Types of Testing • MET/Endurance Testing • Risk Factors • Single Stage Treadmill Protocol • Modified Bruce Treadmill Test • Balke Substandard Treadmill Test • Bench Step Test • Circuit Testing (Material Handling or non-material handling)

31. Lifting • Purpose is to assess safe maximum occasional lifting capacity • Instructions for specific test protocol and safety • Termination of the Tests: 1. biomechanical failure 2. heart rate 3. client request

32. Dynamic Lifting, Carrying, Pushing or Pulling • Isoinertial Lifting • PILE test, Lumbar PILE and the Cervical PILE • WEST II Lifting Evaluation • EPIC • Normative data for maximum acceptable weights and forces • Stover H.Snook and V.M.Ciriello • Ergonomics,1991 vol. 34, No.9,1197-1213

33. Repetitive or sustained material handling or work postures • Endurance circuit to determine Frequent Material Handling or Frequent tolerances for work postures • Work simulation to determine Frequent or Constant tolerances for work postures • Performed in 30-60 minute increments

34. Standardized Testing • Method-Time Measurement • “is a procedure which analyzes any manual operation or method into the basic motions required to perform it and assigns to each motion a predetermined time standard which is determined by the nature of the motion and the conditions under which the motion is made”

35. MTM vs. Normative • Normative - Based on a sample population may be biased by race, gender • Percentile scores do not necessarily predict whether or not someone meets industry standards • MTM - Based on Industry standards which are more reliable in determining suitability to a job

36. Introduction to Standardized Tests • Reliability and Validity • Assess the various diagnoses of the clients to be seen • Can used assess the type of industry near the clinic and the type of work performed • Can be used for evaluation or work simulation

37. Valpar 9 (Whole Body ROM) and West 7 Bus Bench • Evaluates physical tolerances for prolonged standing, repetitive and sustained horizontal reaching, stooping , prolonged light strength work, hand and finger dexterity

38. Mobility • Valpar 9 (Whole Body ROM) • WEST 7 Bus Bench • Balancing • Crawling • Stairs • Ladder • Flexibility • Squatting • Crouching

39. Purdue Pegboard • Used to evaluate a person’s ability to manipulate very fine objects.

40. Minnesota Rate of Manipulation • Evaluates a person’s ability to manipulate small objects

41. Valpar 202 • Four tests that require proper selection, placement and use of hand tools.

42. Bennett Hand Tool Dexterity Test • Evaluates manipulative skill independent of intellectual factors such as understanding of mechanical principles or the ability to plan a task or follow directions

43. Crawford Small Parts Dexterity Test Measures dexterity or hand function

44. Pinch Grip • Measures strength and dexterity • 3 point or palmer pinch • Tip pinch or finger pinch • Lateral pinch

45. Jamar Grip Strength Jamar Dynamometer Evaluates: Strength Consistency of effort • Rapid Exchange • Bell Curve & SD • Coefficient variation cut points

46. Reliability of Pain and Disability Reports RPDR “involves completion of a battery of tests designed to asses the dependability and accuracy of a client’s subjective reports of pain and associated disability. The battery includes test which evaluate the presence or absence of non-organic findings as well as tests which compare a client’s subjective report to their demonstrate ability through distraction- based clinical observations.”

47. SORTS • Use to obtain a subjective rating of perceived ability to perform various household, work and daily activities • Use for evaluation of client’s with a wide variety of physical limitations • Evaluates “work function themes” • Evaluates “ unrealistic self-perception of ability”

48. SORT Tools • WEST Tool Sort/Loma Linda Activities Sort • PACT Spinal Function Sort • EPIC Hand Function Sort

49. Functional Pain Scale • 0 = no pain • 1-2 = pain is present but not limiting • 3-4 = pain is starting to affect your ability to perform current activity • 5 = pain causes you to be unable to complete current activity • 7 = you cannot use or move the painful area, can’t talk, are tearful, need to lie down • 10 = requires immediate hospitalization

50. Waddell and Placebo test • Performed during assessment of range of motion, strength and movement patterns