• 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 (PINN)

What services do we provide?

Physical Therapy Work ConditioningWork HardeningPhysical Capacity Evaluations (PCE’s)Ergonomic AssessmentsOn-Site Services for Job Analysis & Job ModificationExtended EvaluationsVibrasym Driving Evaluation (PINN Kent)Post-Operative Testing

Peoples Injury Network NW (PINN)

PBPCE –Performance Based Physical

Capacity Evaluationor

FCEFunctional Capacity Evaluation

Presented by:

Peoples Injury Network Northwest, (PINN)

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

Physical Capacity Evaluation

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)

A Physical Capacity Evaluation can…

Safety Reliability Validity Practicality Utility Respect

PCE’s should be performed with the following practice hierarchy:

Who can request a PCE?

Doctors Chiropractors Claims Managers Attorneys Vocational

Rehabilitation Counselors

Nurse Case Managers

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

Initial Contact with the Client

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

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

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 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)

Oregon PCE Levels continued

Interviewing Strategies

Give brief explanation of what to expect in the evaluation

Privacy Communicate

Respect Establish Rapport Have tissues and

extra pens available

Mechanism of Injury

DOI/Onset & Diagnosis

Physician/ Physician restrictions

Diagnostic Testing

Medications

Age

Interview Process

Assistive Devices

Previous medical treatment & Other medical conditions

• Current sleep duration

• ADL’s

• Subjective Tolerance Levels

Interview continued

Objective Data

Height Weight Blood Pressure Pulse Smoker Alcohol Usage Medication

Usage

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

A PCE Summary should include

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

• 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.

Job Analysis Definition

THE PHYSICAL DEMAND LEVELS OF WORK

PHYSCIAL DEMAND

LEVEL

OCCASIONAL*

0 – 33% OF TIME

FREQUENT*34 – 66% OF

TIME

CONSTANT*67 – 100% OF

TIME

SEDENTARY 10 lbs. Negligible Negligible

LIGHT 20 lbs.10 lbs.

(walk/stand and/or push/pull of arm-leg

controls)

Negligible (push/pull of arm-leg controls while sitting)

MEDIUM 50 lbs. 20 lbs. 10 lbs.

HEAVY 100 lbs. 50 lbs. 20 lbs.

VERY HEAVY Over 100 lbs. Over 50 lbs. Over 20 lbs.

*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 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)

Physical Effort

Isometric – Jamar Grip

Cardiovascular – EPIC and NIOSH heart rate guidelines

Behavioral

Three categories of physical effort testing

Rapid Exchange Bell Curve & SD Coefficient variation cut points

Jamar Dynamometer Evaluates: Strength Consistency of effort

Jamar Grip Strength

NIOSH 65-70% of age predicted maximum

EPIC - >150% of Standing Resting Heart Rate

Cardiovascular

“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)

Behavioral (Competitive Test Performance)

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

Musculoskeletal Evaluation

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

Special Tests

• 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

Objective Data

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

When to stop/terminate 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)

Types of Testing

Lifting Purpose is to assess safe

maximum occasional lifting capacity

Instructions for specific test protocol and safety

Termination of the Tests:1. biomechanical failure2. heart rate3. client request

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

Dynamic Lifting, Carrying, Pushing or Pulling

• 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

Repetitive or sustained material handling or work postures

• 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”

Standardized Testing

MTM - Based on Industry standards which are more reliable in determining suitability to a job

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 vs. Normative

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

Introduction to Standardized Tests

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) and West 7 Bus Bench

Mobility Valpar 9 (Whole

Body ROM) WEST 7 Bus

Bench Balancing Crawling Stairs Ladder Flexibility Squatting Crouching

Used to evaluate a person’s ability to manipulate very fine objects.

Purdue Pegboard

Evaluates a person’s ability to manipulate small objects

Minnesota Rate of Manipulation

Four tests that require proper selection, placement and use of hand tools.

Valpar 202

Evaluates manipulative skill independent of intellectual factors such as understanding of mechanical principles or the ability to plan a task or follow directions

Bennett Hand Tool Dexterity Test

Measures dexterity or

hand function

Crawford Small Parts Dexterity Test

Measures strength and dexterity

◦3 point or palmer pinch

◦Tip pinch or finger pinch

◦Lateral pinch

Pinch Grip

Jamar Dynamometer Evaluates: Strength Consistency of effort

◦Rapid Exchange◦Bell Curve & SD◦Coefficient variation cut points

Jamar Grip Strength

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.”

Reliability of Pain and Disability Reports

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”

SORTS

WEST Tool Sort/Loma Linda Activities Sort

PACT Spinal Function Sort

EPIC Hand Function Sort

SORT Tools

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

Functional Pain Scale

Performed during assessment of range of motion, strength and movement patterns

Waddell and Placebo test

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

Repetitive Movement Testing

“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.

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 for Feasibility

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

Red Flags continued

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.

Resolving Feasibility

Questions?

U.S. Department of Labor Dictionary of Occupational Titles, fourth Edition

www.lni.wa.gov Washington State Labor and Industries

Roy Matheson and Associates www.oregon.gov Department of Consumer

and Business Services Workers Compensation Division

Bibliography

The End

Peoples Injury Network Northwest, (PINN)

Thank you

PINN Kent20640 84th Ave SKent, WA 98032253-395-1131

PINN Olympia2120 Mottman RdTumwater, WA 98512360-357-7466

Peoples Injury Network NW

PINN Tacoma6704 Tacoma Mall Blvd Tacoma, WA 98409253-475-7466

PINN Vancouver2501 SE Columbia Way Suite 120Vancouver, WA 98661360-260-7466