How Orthopedic Specialists Use Job Function Matching · How Orthopedic Specialists Use Job Function...

4/9/2013

1

How Orthopedic Specialists

Use Job Function Matching

Session #56

Nancy Bellendorf, OTR of Work Safe Therapy & Ergonomics

and

Barb Machtan, MS, CRC, CCM of Bone & Joint Clinic S.C.

Agenda

� Case Example: Pulling a Fast One

� Into the Minds of the Medical Team:

� Perspective of the Not-So-Forward Thinkers

� Perspective of the Forward Thinkers

� About Job Function Matching

� Job Function Matching: A Comparison

Case Example

Pulling a Fast One?

� Mechanism of Injury:

� Medical Care: Conservative Managementof PT and work restrictions;

ultimately surgery

� Work Status:

� Modified duty until surgery,

then off work post-op

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Work Recommendations at 6 weeks post-op

� Light work duty with right handed duty only.

Patient is not to use the left hand for any

work.

� Duration: 6 weeks.

The Calls….

*RE*RE*RE*RE----ENACTMENT*ENACTMENT*ENACTMENT*ENACTMENT*

Now What ???

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The Mind of the Not-So-Forward-

Thinking Medical Professional

� The employer is going to kill him.

� Off work until 100% strength & motion

� Perform general therapy exercises &

modalities- not including discussion or

practice of work specific activities

� Not performing a job site visit and/or

obtaining objective job information; take the

patient’s “word” for what is required at work

� Do FCE if employer pushes for RTW

Wearing the Shoes of an Orthopedist

photo � Expertise in orthopedics

� Limited training in RTW- OTJ training

� They learn when there is “opportunity” to learn

� Outcomes

� Biomechanical & medical healing

� Functional RTW

Trained in Medicine……

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Pressure on Physicians

� From employers, case managers, claim

adjustors, and patients to develop a timely and

meaningful RTW plan

� Without resources- this is difficult

� Advantage- already have a sports medicine

model-focus on function.

� Transfer this knowledge to the “industrial athlete”

concept

Current RTW Methodology

� Physician determines restrictions based on

medical factors

Disabling…….

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Physicians FormatPhysicians FormatPhysicians FormatPhysicians Format

Not Job SpecificNot Job SpecificNot Job SpecificNot Job Specific

Lifting: & Never & Occ & Freq & Const

________#

Push-Pull:& Never & Occ & Freq & Const

Bend: &Never & Occ & Freq & Const

Hand Activity: &Never &Occ &Freq &Const

� But we employ

normal humans

� How do we

identify if this

worker is

capable and safe

to perform her

particular job?

New Approach:

Job Function Matching ®

� Match Job Demands and Worker’s Capability � Job analysis and job function description

(JFD)- essential job functions, physical demands

� Test worker against specific job demands –Job Function Test and Job Function Match ®Job specific conditioning

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The Mind of the Forward-Thinking

Orthopedist

� Patient may be afraid of re-injury. I am too.

� I need to get patient back into the work routine

� How can I do this safely? (I’m really not sure what he does)

� Job Function Matching ®

� Keeps my patient safe from re-injury

� Therapist is trained to evaluate work duties as well as the patient’s functional abilities.

The Mind of the Forward-Thinking

Therapist

� What are the functional job requirements?

(i.e. sports medicine approach)

� What tasks can this worker safely perform?

� What “matches” between the physical

requirements of the job and the worker’s current

function

� How do I inform the MD and employer- in

functional terms- what the worker can do

Case #1- What happened

� Job site visit

� Reason for referral- fear, concerns

� Current restrictions

� Light work, right hand work only

� Current activities

� PT- wean sling, avoid ER with abduction, biceps

loading

� Work- cleaning with shop vac, dust. Bored

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Let’s Measure the Job

DSI Job Function Description

Veneer Specialist ©

Essential function

Force Demands

Movement & Position Demands

1. Drive forklift Grip 35-40# left hand

(brake)

Push/pull 10# -levers on rt- 30” ht

Reach to 64”-handle

Brake-20” ht on left

Sit

Climb 20”, 8” steps

2. Re-pile up to 4’

sticks, cut banding, remove

staples

Grip 35# pref. hand

Lift/carry 8#

Stand / Walk

Bend/Reach-4-44” hts

Job Function Description

Veneer Specialist cont ©

Essential Function

Force Demands


3. Feed cross bands

into glue machines-2 pieces at a time

Pinch 5# both hands Stand/Walk

Bend/reach- push

forward at 40 & 45” ht-forward reach 1-2 ft

4. Band packs; handle

pallets (1 or 2 people)

Lift/lower 40#

Lift/carry 9# power

bander

Stand/Walk

Bend/reach- band 45”

range, lower pallets from 55” to floor

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Essential Function

Force Demands


5. Operate spa table-

feed veneer from adj. lift into machine;

handle 62# cull boards-

(2 people)

Lift/carry 31# (17-53”)

Grip 30#- palm down-

bilateral (on veneer)

Stand/walk

Bend/reach (feed rt to

left at 47” ht)

6a. Operate sander- flip

1 of each veneer pair; feed into sander

Lift up to 20-28#

(2’x6’8” – 4’x8’)

Pinch 5-7#

Stand/walk

Feed right to left- 44.5”

ht- 100-150/hour

Overhead reach to 6’



Essential Function

Force Demands


6b. Change sander

belt- oval shape; 8’ long- 52” deep

Lift/carry 8#- on 61” ht

rack, carry 10 ft, place at 6-6.5’ ht

Stand/walk

Elevated activity

Climb- 8.5” stool (opt)

Approved tasks in current restrictions

� Clean –rags and shop vac

� Remove staples from boards

� Re-pile 2.5” x 2.5” boards

� Inspection

� Varied tasks-changing about every 30-60 min.

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Tasks added with MD updates

� The doctor revised the work recommendations

to include:

� “primarily right arm duty”

� light assist with the left arm, as long as the

forward flexion not to exceed 30-degrees

� no abduction.

� (PT added external rotation; minimal loading of

biceps)

DSI Job Function Test DSI Job Function Test DSI Job Function Test DSI Job Function Test ©Essential function Score To Pass Passed1. Drive forklift Grip __# L 40#- left-20”

Push/pull __#

Reach _’ rt; _’ Lft

Step __”

10#

Reach 64”

20” step

2. Misc tasks: re-pile, cut

banding

Lift/carry __#

Grip __# R

8#

35# R or L

Reach to _’L,_’Rt 4-44” ht

3. Feed Cross bands Pinch __#-R & L 5#Rt & Left

FR _’ at 40-45”ht FR 2’- 40,45”

4. a. Band packs

b. handle pallets

a.Lift/lower __#

b.Lift/carry _#

a. 40# fr 55”

b. 9# to 45”

5. Spa table; cull boards Lift/carry __#

Grip __#R, __#L

31#- 17-53”

Grip 30# R& L

6. Sander & change blade Lift _#- OH

Pinch _#- both

Reach to side- __

26# chin;OH

7# Rt & L

Reach to side

DSI Job Function Test DSI Job Function Test DSI Job Function Test DSI Job Function Test ©Essential function Score To Pass Passed1. Drive forklift Grip 50# L 40#- left-20” Yes

Push/pull 20#

Reach 6’ rt; 5’ Lft

Step 20”

10#

Reach 64”

20” step

Yes

Yes- Rt only

Yes


banding; remove staples

Lift/carry 10#

Grip 80# R

8#

35# R or L

Yes

Yes

Reach to 5’L,6’Rt 4-44” ht Yes

3. Feed Cross bands Pinch 8#-R & L 5#Rt & Left Yes

no

FR 1’ at 40-45”ht FR 2’- 40,45”

4. a. Band packs

b. handle pallets

a.Lift/lower 10#

b.Lift/carry 9#

a. 40# fr 55”

b. 9# to 45”

a. No

b. Yes

5. Spa table; cull boards Lift/carry 10#

Grip 80#R, 50#L

31#- 17-53”

Grip 30# R& L

No

yes

6. Sander & change blade Lift 0#- OH

Pinch 8#- both

Reach to side- no

26# chin;OH

7# Rt & L

Reach to side

No

Yes

no

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Can this job be modified if

essential function not passed?

Return to Work Match ©Essential function Pass Modify Pass

1. Operate forklift Yes Yes

2. Re-pile, cut band

Yes Yes

3. Cross bands No Tool Yes

4. a. Band

b. pallets

a.Yes

b. No

a.Yes

b. no

5. Spa table/cull boards

No No

6. Sander/change belt

No no

DSI Job Function Test DSI Job Function Test DSI Job Function Test DSI Job Function Test ©

Essential function Score To Pass Passed1. Drive forklift Grip Left 102# 40#- left-20” Yes

Push52/pull56#

Reach 6’ both

Step 20”

10#

Reach 64”

20” step

Yes

Yes

Yes


banding

Lift/carry 35#

Grip 130# R

8# to 44”

35# R or L

Yes

Yes

Reach 4-44”+ 4-44” ht Yes


No-yes with modFR 1.5’ @40-45” FR 2’- 40,45”

4. a. Band packs

b. handle pallets

a.Lift/lower 35#; 50# waist

b.Lift/carry 9+#

a. 40# fr 55”

b. 9# to 45”

a.No-yes if 2,coach

b. Yes

5. Spa table; cull boards Lift/carry 35-50

Grip 130R,102#L

31#- 17-53”

Grip 30# R& L

Yes- (coach)

Yes

6. Sander & change blade Lift 20# chin; OH

Pinch 16#- both

Reach to side- no

26# chin: OH

7# Rt & L

Reach to side

No

Yes

no

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DSI Job Function Test DSI Job Function Test DSI Job Function Test DSI Job Function Test ©Essential function Score To Pass Passed1. Drive forklift Grip 122#L 40#- left-20” Yes

Push 66/pull80#

Reach 6’

Step 20”

10#

Reach 64”

20” step

Yes

Yes

Yes


banding

Lift/carry 35-65

Grip 136# R

8#-44”

35# R or L

Yes

Yes

Reach 4-44”+ 4-44” ht Yes


yes

FR 2’ at 40-45”ht FR 2’- 40,45”

4. a. Band packs

b. handle pallets

a.Lift/lower

35 chin-65#wst

b.Lift/carry 9#+

a. 40# fr 55”

b. 9# to 45”

a.Yes-coach

b. Yes

5. Spa table; cull boards Lift/carry 35-65

Grip 136R/122L

31#- 17-53”

Grip 30# R& L

Yes-coach

yes

6. Sander & change blade Lift 35#: OH

Pinch 21#- both

Reach to side- no

26#chin; OH

7# Rt & L

Reach to side

yes

Yes

Yes(MD OK)

Transitional Duty

� Measured the physical requirements

� Confirmed job activities within abilities

� Team (MD, PT, employer, worker, OT)

discussion and plan – add activities

� On-site functional testing and coaching

� Updated ability/return to work form

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Employer FeedbackPhoto � Quantifies- objective vs

subjective data on restrictions & activities done.

� Specifics for employer/worker

� A “go-between”-transition between medical & employer

� Shows employee we care

� A lot invested in our workers� “Can’t coach experience”

Physician Feedback

� Photo

Congratulations on Your New Job!

4/9/2013

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Janitor Job Description

� Lift up your chair

� Move left/right

� Pick up the paper underneath

How Much Does

Your Chair Weigh?

Uh Oh….You Got Hurt!

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….But It’s Back to Work Time!

Your Treating Physician Says:

� Sedentary Duty x 6 weeks� 10# max; alternate sit/stand/walk; therapy; Rx pain meds;

no bend

� Light Duty x 4 weeks� 20# max; alternate sit/stand walk; therapy & TENS unit

� Medium Duty x 4 weeks� 50# max- alternate sit/stand/walk

� Regular Duty

� Follow up as needed

Regular Job Tasks

� Wipe and dust furniture and baseboards

� Move tables & chairs, set up or clean

� Clear tables of dishes, etc after conference and cart

to kitchen

� Vacuum floors

Traditional Return to Work Plan

� Week 1: Sedentary






� Week 7: Light

� Week 8: Light

� Week 9: Light

� Week 10: Light

� Week 11: Medium

� Week 12: Medium

� Week 13: Medium

� Week 14: Medium

� Week 15: Regular !

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Job Function Matching ®

Starting Restrictions

� Sedentary duty for 2 weeks

(10# max, alternate

sit/stand/walk; no bend)-

until next office visit and

results of JFM available

Job & worker Measurements

Functional Test items/observations

� Grip

� Push

� Pull

� Lift- including max and repetition

� Stand tolerance

� Walk

DSI Job Function Description

Kalahari Cleaner ©

Essential function

Force Demands


1. Wipe/dust furniture & baseboards

Grip 20# preferred hand

Stand / Walk

Bend/Reach floor to 6’

2. Move tables & chairs- set up or clean

Push/pull 35#-10 ft; 10 tables

Lift/carry 13# 10 ft, 50 chairs

Stand / Walk

Bend/Reach

4/9/2013

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Kalahari Cleaner Cont…. ©

Essential Function

Force Demands


3. Clear off tables after

conference-use tote & cart to kitchen

Lift/carry up 5-20#

(preferred-min of 5#) from table- 5 ft to 32”

cart

Push/pull 15#-32” ht handle; up to 100 yds;

5 carts

Stand/Walk

Bend/reach

4. Vacuum floors Grip pref. hand 40#

Push/pull 15#-hip ht

Up to 30 min/room-2

rooms

Stand/Walk

Bend/reach


Essential function Score To Pass Passed1. Wipe & dust furniture Grip 50# Rt,

40# left

20# Yes

Reach- 2’ to

5’

Floor to 6’ No

2. Move tables & chairs;

set up to clean

Push 24#

Pull 28#

35#

Push/pull

No

Lift/carry

15#

13# Yes

3. Clear off tables- cart to

kitchen

Lift/carry

15#

5-20# Partial

yesPush 24#

Pull 28#

15#

4. Vacuum floors Grip 50#

Vacuum 3

min

40#

5 minutes

Yes

No-

partial

Return to Work Match ©

Essential function Pass Modify Pass

1. Wipe/dust furniture

No Long handle duster

Yes

2. Move tables/chairs no Move chairs only

Partial

3. Clear off tables-use cart

No Partially fill totes

yes

4. Vacuum floors No Use upright sweeper

Yes

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How does this compare to the

traditional model’s activities?� Week 1: Sedentary






� Week 7: Light

� Week 8: Light

� Week 9: Light

� Week 10: Light

___% of Regular Duty??

___% of Regular duty



40# left

20# Yes

Reach- 1’ to

6’

Floor to 6’ Partial


set up to clean

Push 36#

Pull 30#

35#

Push/pull

Partial

Lift/carry

20#

13# Yes


kitchen

Lift/carry

20#

5-20# Yes

yesPush 36#

Pull 30#

15#

4. Vacuum floors Grip 50#

Vacuum 4

min

40#

5 minutes

Yes

No-

partial




No Long handle duster

Yes

2. Move tables/chairs no Push vs pull Yes


Yes

4. Vacuum floors No Use upright sweeper

Yes

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How does this compare to the

traditional model’s activities?� Week 1: Sedentary






� Week 7: Light

� Week 8: Light

� Week 9: Light

� Week 10: Light

___% of Regular Duty??

___% of Regular duty



55# left

20# Yes

Reach- Floor

to 6’

Floor to 6’ Yes


set up to clean

Push 39#

Pull 36#

35#

Push/pull

yes

Lift/carry

25#

13# Yes


kitchen

Lift/carry

25#

5-20# yes

yesPush 39#

Pull 36#

15#

4. Vacuum floors Grip 55-60#

Vacuum 5

min

40#

5 minutes

Yes

yes




Yes

2. Move tables/chairs Yes


Yes

4. Vacuum floors Yes

4/9/2013

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Return to Work Plan

� Add weights as worker progresses

� Add time to activities to build endurance

� Transition to regular job

� Job coaching

� Follow ups

� Team meetings

Worker Feedback

� How do you feel?

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Worker Feedback

� “For the first time someone on the medical team is understanding what I do!”

� “I was thinking my employer was trying to hurt me. Now I know he cares.”

� “This gave me the confidence to get back to work, when I was afraid of re-injury”

Employer Feedback

� How do you feel?

� What are the benefits?

Employer Feedback

� Photo � Facilitates physician

understanding of job

� Matches the job

assignment and worker

abilities

� Completes the circle of

communication

� Reduces transitional

duty time

4/9/2013

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A Few Words from an Employer � “I think the most difficult issue is the treating physician not understanding the

total function of a job or task and prescribing restrictions so severe the employee is not able to do anything.”

� “The Job Function Matching helps our employees return to work because it matches the stresses of the job with the worker’s current physical ability.”

� “I think Job Function Matching completes the circle of communication. Having the therapist in the loop, someone who can talk on the same level as the treating physicians adds opportunity for better treatment, quicker healing, and less aggravation for the injured employee because the therapist understands the functionality of the job and can recommend a more progressive course of treatment.

� “I think one of the most important things we have to do to help the injured employee return to full duty, is communicate. I don’t think we do that well enough… anywhere. Job Function Matching certainly helps.”

� “I was absolutely impressed with the Job Function Matching process. I believe that our employee was able to return to his fullest capacity in less time than if he had worked only with PT. I see Job Function Matching as an exciting trend in complete patient care.”

Who benefits from DSI Job

Function Matching ®

� Workers

� Employers

� Case Managers and insurers

� Physicians/ medical providers

� Therapist -with JFM- acts as a link of

information among all stakeholders

DSI System to be Used for DSI System to be Used for DSI System to be Used for DSI System to be Used for

EarlyEarlyEarlyEarly RTWRTWRTWRTW

� Perform validated job related test- early

after injury – “early intervention”

� Job Function Match format allows a

column for RTW with job modification

� JFM form also can be used for

reasonable accommodation

4/9/2013

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DSI Job Function Matching DSI Job Function Matching DSI Job Function Matching DSI Job Function Matching ®®®®

in early RTWin early RTWin early RTWin early RTW

� Physician utilizes JFM information for RTW

release; functional data sharing with therapist

� Supervisor uses JFM to place worker at

original job w/ temporary modifications

� Worker received targeted rehab or heals

� Sequential JFM tests show progression of

worker to full duty.

Work Injury Prevention &

Management: Expected Outcomes

� Objective functional ability data used to match

with functional requirements of regular or

transitional duty positions; tends to speed RTW to

regular job; reductions in lost time & restricted

duty

� Case management assist

� Objective data used by providers to tailor

treatment plan, design transitional RTW plan,

expedite RTW (full duty).

� Avoids disability issues- focus on “ability”

Prevention StrategiesPrevention StrategiesPrevention StrategiesPrevention Strategies

� Ergonomics: If a job has MSD stressors, ergonomics

can be used first.

� Education: Upon or prior to return to work, on-site

training and education should be enhanced

� Job Specific Conditioning: Therapy more customized

to job demands

� Worker Satisfaction/morale: Onsite understanding of

job & worker’s safe ability; care attitude

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Foundation is BuiltFoundation is BuiltFoundation is BuiltFoundation is Built

� Objectivity

� Fairness

� Measurement

� Job Knowledge

� Dedication to injury

� Prevention for WORKER

Job Function Matching Job Function Matching Job Function Matching Job Function Matching ®

� Can be Utilized in the Continuum of Work

�Hiring

�Placement

�Return to Work

�Job Modifications

�Disability Reduction

Q&A

4/9/2013

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Thank you

Nancy Bellendorf, OT

[email protected]

C: 715-499-1147

Barb Machtan, MS,CRC,CCM

[email protected]

P: 715-393-0332

How Orthopedic Specialists Use Job Function Matching · How Orthopedic Specialists Use Job Function...

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