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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

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peoples injury network nw pinn
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
peoples injury network nw pinn1
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

pbpce performance based physical capacity evaluation

PBPCE –Performance Based Physical Capacity Evaluation



Functional Capacity Evaluation

Presented by:

Peoples Injury Network Northwest, (PINN)

physical capacity evaluation
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”

a physical capacity evaluation can
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)
pce s should be performed with the following practice hierarchy
PCE’s should be performed with the following practice hierarchy:
  • Safety
  • Reliability
  • Validity
  • Practicality
  • Utility
  • Respect
who can request a pce
Who can request a PCE?
  • Doctors
  • Chiropractors
  • Claims Managers
  • Attorneys
  • Vocational Rehabilitation Counselors
  • Nurse Case Managers
initial contact with the client
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
physical capacity evaluation s
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
oregon pce levels
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)

oregon pce levels continued
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)

oregon pce levels continued1
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)

interviewing strategies
Interviewing Strategies
  • Give brief explanation of what to expect in the evaluation
  • Privacy
  • Communicate Respect
  • Establish Rapport
  • Have tissues and extra pens available
interview process
Interview Process
  • Mechanism of Injury
  • DOI/Onset & Diagnosis
  • Physician/ Physician restrictions
  • Diagnostic Testing
  • Medications
  • Age
interview continued
Interview continued
  • Assistive Devices
  • Previous medical treatment & Other medical conditions
  • Current sleep duration
  • ADL’s
  • Subjective Tolerance Levels
objective data
Objective Data
  • Height
  • Weight
  • Blood Pressure
  • Pulse
  • Smoker
  • Alcohol Usage
  • Medication Usage
a pce summary should i nclude
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
pce summary continued
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
job analysis definition
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.
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.

physical effort
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)

three categories of physical effort testing
Three categories of physical effort testing
  • Isometric – Jamar Grip
  • Cardiovascular – EPIC and NIOSH heart rate guidelines
  • Behavioral
jamar grip strength
Jamar Grip Strength

Jamar Dynamometer Evaluates:

Strength Consistency of effort

  • Rapid Exchange
  • Bell Curve & SD
  • Coefficient variation cut points
  • NIOSH 65-70% of age predicted maximum
  • EPIC - >150% of Standing Resting Heart Rate
behavioral competitive test performance
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)

musculoskeletal evaluation
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
special tests
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
objective data1
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

when to stop terminate testing
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
types of testing
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)
  • 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

dynamic lifting carrying pushing or pulling
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
repetitive or sustained material handling or work postures
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
standardized testing
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”
mtm vs normative
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
introduction to standardized tests
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
valpar 9 whole body rom and west 7 bus bench
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
  • Valpar 9 (Whole Body ROM)
  • WEST 7 Bus Bench
  • Balancing
  • Crawling
  • Stairs
  • Ladder
  • Flexibility
  • Squatting
  • Crouching
purdue pegboard
Purdue Pegboard
  • Used to evaluate a person’s ability to manipulate very fine objects.
minnesota rate of manipulation
Minnesota Rate of Manipulation
  • Evaluates a person’s ability to manipulate small objects
valpar 202
Valpar 202
  • Four tests that require proper selection, placement and use of hand tools.
bennett hand tool dexterity test
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
crawford small parts dexterity test
Crawford Small Parts Dexterity Test

Measures dexterity or

hand function

pinch grip
Pinch Grip
  • Measures strength and dexterity
    • 3 point or palmer pinch
    • Tip pinch or finger pinch
    • Lateral pinch
jamar grip strength1
Jamar Grip Strength

Jamar Dynamometer

Evaluates: Strength Consistency of effort

  • Rapid Exchange
  • Bell Curve & SD
  • Coefficient variation cut points
reliability of pain and disability reports
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.”

  • 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”
sort tools
SORT Tools
  • WEST Tool Sort/Loma Linda Activities Sort
  • PACT Spinal Function Sort
  • EPIC Hand Function Sort
functional pain scale
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
waddell and placebo test
Waddell and Placebo test
  • Performed during assessment of range of motion, strength and movement patterns
repetitive movement testing
Repetitive Movement Testing
  • Performed Pre and Post testing
  • Look for change in movement patterns in comparison to reported pain and disability
  • Look for change in performance time in comparison to reported pain and disability

“The acceptability of the worker in the general sense i.e. worker traits and behaviors”

The person being evaluated perceives themselves in the “worker role” and not in the “patient” role.

red flags for feasibility
Red Flags for Feasibility
  • Lack of attention to the evaluator
  • Resistance to testing - voiced refusal or fearful of testing
  • Signs of Anger
  • Descriptions are too explicit or vague
  • No future goals or goals are simple with no detail
  • Want a better doctor to “fix them”
  • Lack of active control of symptoms
red flags continued
Red Flags continued
  • Regional symptoms that do not make anatomical sense
  • Inactive lifestyle or “couch potato”
  • Has others perform ADL’s/chores
  • Reinforcement of behaviors by others
  • Noncompliance
  • Length of time off work is extensive
resolving feasibility
Resolving Feasibility
  • Evaluate Physical effort and RPDR
  • Intervene and confront the evaluee in a respectful manner to attempt to foster physical effort and RPDR
  • Document the PCE to provide functional validity.
  • U.S. Department of Labor Dictionary of Occupational Titles, fourth Edition
  • Washington State Labor and Industries
  • Roy Matheson and Associates
  • Department of Consumer and Business Services Workers Compensation Division
thank you
Thank you

Peoples Injury Network Northwest, (PINN)

peoples injury network nw
Peoples Injury Network NW


20640 84th Ave S

Kent, WA 98032


PINN Olympia

2120 Mottman Rd

Tumwater, WA 98512


PINN Tacoma

6704 Tacoma Mall Blvd Tacoma, WA 98409


PINN Vancouver

2501 SE Columbia Way Suite 120

Vancouver, WA 98661