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Dr. Worst Exam 1 > FCE- Power Point > Flashcards

FCE- Power Point Flashcards

1
Q

What are the goals of a work rehabilitation program? RIP

A
  • Return patient to work
  • Increase tolerance
  • Prevent chronicity
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2
Q

What should FCE treatment emphasize?

A

Restoration of work-related function and reconditioning

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3
Q

Working on what type of skill could improve return to work time?

A

Coping skills

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4
Q

Therapists recommendation for work rehabilitation program

(two categories, 1st has 2 points, 2nd has 3 points)

A

Patient Education

  • Their injury, anticipated healing time, treatment processes and goals
  • Their responsibilities of practicing their home/self care, attending therapy, and adherence with all medical and therapy recommendations

Encourage the patient to:

  • Progressively increase their activity
  • Remain at work if possible or work with modified duties until full recovery
  • Evidence that if out of work more than 3 months, not a high likelihood for return to work ever
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5
Q

What is work conditioning?

Designed to (5)

Length of sessions

A

Intense, work related, conditioning program

Designed to restore:

  • Neuromusculoskeletal functions
  • Muscle performance
  • Motor function
  • ROM
  • Cardiovascular/Pulmonary functions

2-4 hrs/day

  • PT treats others patients while guiding injured worker
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6
Q

What is work hardening?

Designed to (5)

Lenght of sessions

A

Highly structured, goal-oriented, individualized intervention program

Designed to:

  • Return the patient to work
  • Use real or simulated work activities to restore:
  • Physical functions
  • Behavioral functions
  • Vocational functions

8 hrs/day

  • Can combine PT, OT, psychologist, and vocational rehab
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7
Q

Objective of work conditioning:

A

Restore physical capacity and function to enable the patient/client to return to work

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8
Q

Objective of work hardening:

A

Address the issues of productivity, safety, physical tolerances, and worker behaviors

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9
Q

The most significant predictor of return to work (RTW) and chronic work disability

A

Psychological factors

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10
Q

Orange Flags

A

Clinical mental disorders

  • Clinical depression, anxiety disorders, personality disorders
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11
Q

Yellow Flags

A

Emotional responses

  • Any distress not meeting criteria for clinical diagnosis of mental disorder

Beliefs, appraisals, and judgements

  • Internal vs external locus of control
  • expectations of poor treatment outcome

Pain behavior, including pain coping strategies

  • Avoiding activities due to expectations of pain or reinjury
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12
Q

Blue Flags

A

Related to perception of the relationship between work and health

  • Negative expectations of return to work
  • Job dissatisfaction
  • Stress at work
  • Work-related fear avoidance beliefs
  • Perceptions of physical job demands
  • Poor co-worker or supervisor relationships
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13
Q

Black Flags

A

Work conditions external to individual’s control

  • Access to treatment
  • Attitude of employers to helping people back to work
  • Conflict with insurance staff over injury claim
  • Heavy work with little accomodations
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14
Q

Significant predictors of RTW (4)

A
  • Expectations of recovery
  • SF-36: Vitality subscale
  • SF-36: Mental Health subscale
  • Waddell symptoms
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15
Q

2 components of SF-36

A
  • Vitality: ‘feels tired and worn out all the time’ - ‘feels full of pep and energy all the time’
  • Mental Health: ‘feelings of nervousness and depression all the time’ - ‘feels peaceful, happy, and calm all the time
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16
Q

Significant predictors of chronic disability

(three main categories)

A

Expectations of recovery

  • Declined to rate, 4x
  • 0-6/10, 3x

Offer of job accommodation, 2x

Others that were less significant

  • FABQW
  • Functional status
  • Job psychosocial conditions
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17
Q

Assessment & management of psychosocial factors:

What do the majority of physiotherapists do?

What should they do?

How?

What else should they have?

A

Systematic review found majority of physiotherapists either are not addressing psychosocial factor or inadequate at doing so

Learn how to identify the different flags

Using reliable and valid instruments

  • FABQW
  • SF-36
  • Psychosocial Risk for Occupational Disability

Training in interpreting results from instruments

18
Q

What is FCE? (APTA definition)

A

“Detailed evaluation that objectively measures the patient’s current level of function primarily within the context of the demands of competitive employment, ADLs, or leisure activities”

-American Physical Therapy Association

19
Q

What is FCE used for? (6)

A
  1. Return-to-work and job-placement decisions
  2. Disability evaluation
  3. Determination of how injuries impact work performance
  4. Determination of functioning in non-occupational setting
  5. Intervention and treatment planning
  6. Case management and case closure
20
Q

2 Types of FCE

A
  • General Purpose FCE
  • Job Specific FCE
21
Q

General Purpose FCE (4)

A
  • Consists of standardized tests and measures that are applied to all patients
  • Appropriate when a targeted job does not exist or functional job requirements have not yet been determined
  • Location- More commonly done in the clinic
  • Overall Purpose- Evaluate a patient’s compatibility with specific job or occupational demands when more information or options become available for consideration
22
Q

Job-specific FCE (3)

A
  • Designed with emphasis on measurement of a patient’s ability to perform the physical demands of a specific, identified job
  • Location- More commonly done at the work-site to determine their ability to safely perform the required work tasks. Can also be done in clinic, if needed
  • Overall Purpose- Decide whether there are participation restrictions or specific job restrictions
23
Q

True / False, FCE can be administered by any PT or OT?

A

False

  • FCE can only be administered by a trained/certified healthcare professional
  • PT or OT
24
Q

Length of time FCE should be administered:

A
  • Approximately 3-6 hours to administer for single day exam
  • Approximately 5-8 hours to administer for a two-day exam
25
Q

Is a full standardized FCE always needed?

A

No, could either do:

•Work hardening or conditioning program

26
Q

FCE Indications: (6-10)

A
  1. Patient is no longer making functional gains with treatment
  2. Patient has not returned to full or modified duty
  3. Patient is working, but having difficulty maintaining job/activity function
  4. Report from health care provider that patient displays discrepancy between subjective complaints and objective findings
  5. Patient requires an opportunity to demonstrate safe performance of functional tasks
  6. Supporting documentation is requested to:
  • Determine disability or loss of earning capacity
  • Assist with litigation settlement or case resolution
  • Assist with future rehab or vocational planning
  • Help render a job-placement decision
27
Q

FCE Contraindications (3)

A
  • Performance of the test would compromise the patient’s safety or medical condition
  • Communication barriers prevent understanding instructions, communicating concerns, and interpreting the patient’s responses during the FCE
  • Patient does not give consent to participate in an FCE
28
Q

Components of FCE: DATA GATHERING

A
  • Intake information & record reviews- Contraindications/precautions for testing
  • Client questionnaire and informed consent
  • Client interview
  • History
  • Systems review
  • Insight into patient’s perceptions about their own abilities
29
Q

Components of FCE: OBJECTIVE

A
  • Physical examination and referral questions
  • Functional performance measurements
  • Observation of patient- Measures of full effort
  • Evaluation of history, records, and test results to recommend safe work abilities
  • Comparison of patient’s safe work abilities with job demands
30
Q

Components of FCE (2)

A
  • Data Gathering
  • Objective
31
Q

What is Reliability:

Types of reliability (4)

A

Can it reliably measure the functional physical ability of a person to perform a work-related series of tasks?

  • Intra-rater reliability
  • Inter-rater reliability:
  • Test-retest reliability: Are repeated tests comparable on the same subject
  • Reliable effort: repeat tasks over a period of time and then compare the effort over time- Be as objective as you can be
32
Q

What is Validity?

Types of validity (3)

A

Does it measure what it intended to measure?

  • Face validity: Does it measure what it intends?
  • Content validity: Is this going to accurately portray ability to return to work?
  • Criterion related validity: Compared to the Gold Standard?

Generalizability:

  • NOT generalizable
  • Job specific measurements
33
Q

Who or what is covered by the states workers comp program? (5)

A

❖Any employee of a company that has more than 3 full time workers

❖If the correct job is being performed but in haste, the employee is still covered.

❖If the incident occurs because of another employee’s wrong doing, the injured employee is still covered.

❖Occupational related diseases

❖Repetitive motion injuries (doesn’t have to be traumatic)

34
Q

What is not covered in a workers comp program? (3)

A

❖If the injury occurs during employee misconduct (fight, horseplay, drug or alcohol abuse on the job, etc.) all rights of worker’s compensation are revoked.

❖Spouses are not covered like they may be if there is health insurance provided through a company.

❖Heart attack or stroke

35
Q

Medical expenses covered by workers comp: (5)

A

❖Physician’s Visits

❖Surgical Procedures

❖Imaging

❖Therapeutic Interventions

❖Pharmacological Interventions

36
Q

Process of claiming workers comp after an incident (4)

A
  1. Report
  2. Find a Physician
  3. Follow your treatment plan
  4. Close Claim OR Settle
37
Q

Workers comp income benefits (4)

A

❖Temporary Total Disability Benefits

❖Temporary Partial Disability Benefits

❖Permanent Partial Disability Benefits

❖Death Benefits

38
Q

FCE Billing

A

❖“No more than four physical medicine procedures, modalities or time units will be reimbursed in one visit by each type of medical provider. No more than two of the four CPT code charges can be modality codes”

❖CPT Code: 99750

➢Limit of $600 reimbursed

➢Work rehabilitation programs fall under the same code

2 Codes per treatment session: max amount $267

❖Modifier 59

➢Ability to perform physical performance tests/measures plus and FCE in the same day

39
Q

What is the punishment for true malingering as a worker’s comp patient?

A

“You shall be guilty of a misdemeanor and upon conviction shall be punished by a fine of not more than $10,000 or imprisonment up to 12 months, or both for making false or misleading statements when claiming benefits. Also, any false statements or false evidence given under oath during the course of any administrative or appellate division hearing is perjury”

40
Q

Conclusions of FCE presentation? (6)

A
  1. A work conditioning program can be combined with a work hardening program to make a work rehab program focusing on restoring functional abilities required for specific occupations to return the patient to work
  2. Psychosocial factors are the most significant predictors of RTW and chronic work disability
  3. We as PTs need to include identification of flags with appropriate instruments to modify our treatments accordingly
  4. FCEs are important tools as they assist with return to work decisions, establishing work limitations, case closure, disability determination, and intervention strategies
  5. Worker’s Compensation is a very intricate system that provides an array of benefits to your patients
  6. Billing for worker’s compensation patients is somewhat of a different process and requires extra attention to detail for proper usage

Dr. Worst Exam 1 (5 decks)

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