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Topics In PT > Industrial Medicine > Flashcards

Industrial Medicine Flashcards

1
Q

3 key players in worker’s compensation cases

A
  1. Claim adjuster
  2. Case manager
  3. Vocational evaluator
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2
Q

What does claims adjuster do?

A

Handles all workers comp cases
- 1st report of injury
- Sets reserves based on ICD 10 codes
- Authorizes/denies all medical and clinical treatment so we have to communicate with them on regular basis

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3
Q

What does case manager do?

A

These people only assigned to cases that are complicated, catastrophic, or have history of work-related injuries.
- Manages individual case to ensure the claimant moves through the various phases of medical treatment and rehab smoothly.
- goal is to make sure client gets optimum treatment and follows through with all treatment recommendations.

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4
Q

What does vocational evaluator do

A

These people only brought into case if injured worker appears to be unable to return to previous job
- determines claimant’s employability, job placement, wage earning capacity.
- identifies appropriate job objectives based on education level and transferable skills with vocational and transferable skills asssesment
- they help worker get back to work ASAP

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5
Q

What is FCE definition

A

Generic term used in medical and vocational rehab communities to denote a form of functional evaluation that consists of battery of tests focusing on selected work tolerance areas, consistency of effort, and reliability of pain reports.

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6
Q

What is FCE for

A
  • Provides objective information about client’s ability to perform the essential functions of their job over an 8 hour day
  • consistency of effort
  • reliability of pain reports
  • need for job modification or on site RTW consult
  • rules out surgical intervention
  • helps with work placement
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7
Q

What percentage of FCE referrals require work conditioning

A

40%

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8
Q

What are the 3 considerations for needing an FCE done

A
  1. Medical considerations
  2. Behavioral considerations
  3. Legal considerations
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9
Q

What are the medical considerations

A
  1. Job history of injury or re-injury
  2. Job involves repetitive work tasks
  3. Job involves medium to heavy work
  4. Complaints of pain with no substantial clinical findings
  5. Plateau in PT/OT/Medicine but functional difficulties still there
  6. Decreased work tolerance.
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10
Q

What are the behavioral considerations

A
  1. Off work for more than 3 months
  2. Negative attitude about returning to work
  3. Fear of injury
  4. Suspected sub-max effort/compliance issues
  5. Questionable legitimacy of injury
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11
Q

What are the legal considerations

A
  1. Objective documentation needed for RTW
  2. Conflict of medical opinion about worker’s status
  3. RTW will require job modification
  4. Attorney resists work release
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12
Q

What are the FCE admission criteria for Physical Readiness?

A
  1. Client is medically stable
  2. Pain has stabilized
  3. Inflammation and/or swelling has stabilized
  4. Soft tissue dysfunctions have been addressed.
  5. Passive mobility has plateaued over 2 weeks
  6. Client can tolerate 2 hours of exercise/activity
  7. Client should demonstrate absence of major psychiatric disorder
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13
Q

What are admission criteria for lumbo-sacral injuries?

A
  1. Pelvic symmetry or status plateaued.
  2. Trunk strengthening addressed
  3. 45 deg hamstring length
  4. 30 second static partial sit-up
  5. 75% squat for 45 seconds
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14
Q

Admission requirements for cervical shoulder injuries

A

Need scapular strength addressed

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15
Q

What is a baseline FCE

A
  1. Assessment of functional ability to perform the spectrum of work tolerance related to the physical demand factors of job tasks
    * best suited when restricted duty is available for RTW to previous job is highly improbably
    * initiated with MSK eval
    consistency of effort and reliability of pain testing
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16
Q

What is Job-Specific FCE/WCE

A
  1. Assessment of the match between the client’s functional capabilities and the critical demands of a specific job.
    * answers “can the client RTW to previous job”
    * accomplished by evaluating work tolerances with specific parameters and the use of structural work simulations
    * also initiated with MSK eval
    Consistency of effort and reliability of pain
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17
Q

What is the UE FCE?

A
  1. Assessment of only the physical capabilities and tolerances that incorporate UE usage.
    * also initiated with MSK eval
    * will NOT evaluate sitting, standing, stoop, squat, kneel, crouch, stair climb
    Consistency of effort and reliability of pain
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18
Q

How do you answer “can the client return to work to the previous job”

A

USE THE JOB SPECIFIC FCE
— it only tests the physical capabilities and tolerances specific to the job

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19
Q

How do you answer “with restricted duty available - what can the client do now?”

A

USE BASELINE FCE
— evaluate ALL the physical capabilities and tolerances
— may be a candidate for on site work hardening

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20
Q

How do you assess a catastrophic case with poor probability to RTW to previous position and what can the client functionally do?

A

EVALUATE ALL PHYSICAL CAPABILITIES AND TOLERANCES
— determine employability
— must be candidate for on site RTW consultation to assist in work transition.

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21
Q

What determines the stopping point for FCE?

A

For an eval — stopping point for client will be determined by the most limiting of three domains
1. Biomechanical
2. Cardiovascular - metabolic
3. Psycho-physical

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22
Q

What is the most limiting domain?

A

PSYCHO-PHYSICAL DOMAIN
*governs expended effort in biomechanical and/or cardiovascular-metabolic domains
good evaluation is skilled in the reliable evaluation of psychophysical domain
safety is top priority

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23
Q

What is useful if believed to be questionable pain behavior

A

Physical effort testing
— rules out fatigue, fear, and biomechanical impairment which may lead to inconsistent performance.

24
Q

What does reliability of pain reports indicate

A

Extent to which we can rely on client’s subjective report
not a measure of effort

25
Q

How does reliability of pain reports work

A

— clinician uses tests designed to assess the dependability and accuracy of a client’s subjective reports of pain and disability
— includes tests which compare client’s subjective reports of pain to their demonstrated ability through distraction based testing and clinical observation

26
Q

What happens if reliability of pain reports are unreliable?

A

Need to consider complaints with caution
— more weight is placed on objective findings (kinesio-physical) rather than on subjective reports of pain or subjective estimates of ability

27
Q

What are clues from the intake interview during ROP test that might suggest issues

A
  1. Medical inconsistencies
  2. Adjusting history
  3. Client avoids answering direct questions
  4. Blaming others
  5. Symptom reports and functional limitations are inconsistent with posture and movement patterns.
28
Q

What are clues from the Ransford Pain Drawing during ROP test that might suggest issues

A
  1. Total body and non specific drawings
  2. Does not follow pain referral pattern
  3. Combination of multiple symptoms
29
Q

What are clues from the symptoms grading scale (0-10 scale) during ROP test that might suggest issues

A
  1. Almost always a 7 or above. Lists 10 when sitting or doing easy tasks
  2. May be reported as 15-20 on scale of 0-10
  3. No attempt to decrease symptoms with proper posture
  4. Symptoms do not decrease with rest or medication
30
Q

What are some MSK evaluation tests to assess ROP?

A
  1. Repetitive movement tests
  2. Waddell’s non-organic signs - for LB patients only
  3. Hoovers test
  4. Distractionary testing
31
Q

What is purpose of consistency of effort (COE) testing?

A
  • Determine maximal vs. Sub-max effort
  • Identify unresolved medical/rehab deficits
  • Provide case direction/resolution.
    important to have a battery of objective tests, research tests that can withstand a legal challenge
32
Q

What are the types of physical effort

A

(These are testing during COE)
1. Maximal effort — consistent performance
2. Questionable effort — concern is raised
3. Sub-max effort — inconsistent performance

with 2 and 3 the client is capable of greater functional ability than those demonstrated OR client is capable of functioning at a higher category of work

33
Q

What are the physical demand levels

A
  1. 2 hand lifting
  2. 2 hand carrying
  3. 2 hand push/pull force
    all these above are most prevalent
  4. Walking
  5. MET level
34
Q

What are the 3 lifting levels

A
  1. Floor to waist
  2. Waist to shoulder
  3. Shoulder overhead
35
Q

What are the medium dexterity tests

A

Valpar #9
Bennet hand tool dexterity
Minnesota rate of manipulation
9 hole peg test

36
Q

What are the fine motor dexterity tests

A

Purdue pegboard test

37
Q

What is work conditioning

A

Intensive, work-related, goal oriented conditioning program designed specifically to restore systemic neuromuscular functions and cardiopulmonary functions.
objective is to restore physical capacity and function to enable the patient/client to RTW

38
Q

What are the neuromusculoskeletal functions from work conditioning

A

Strength
Endurance
Movement
Flexibility
Motor control

39
Q

How does work conditioning work

A

Up to 4 hours per day, 3-5 times per week
- uses physical conditioning functional activities related to work in a circuit format
- one discipline

40
Q

What are the entry criteria for work conditioning

A
  • Patient is no longer in acute phase of therapy, or needs hands on, mostly doing exercises
  • Can’t return to work due to weakness or de conditioning
  • Client needs to increase functional tolerances and/or endurance/workplace tolerance
  • Doc prescription needed, program approved by insurance
  • Should be requesting finite duration based on client needs.
41
Q

What is work hardening

A

Highly structured, goal-oriented conditioning program designed specifically to return the client to work.
interdisciplinary in nature
These programs use real or simulated work activities designed to restore physical behavioral and vocational functions.

42
Q

What does work hardening address

A

Issues of productivity, safety, physical tolerances, and worker behaviors.

43
Q

What does work hardening look like

A

Up to 8 hours/day 5 times per week for 4-6 weeks
- Uses simulated work actions
- Interdisciplinary model

44
Q

Criteria for work hardening

A
  1. Full ambulation
  2. Unable to safely return to full duty
  3. Non related medical problem stabilized
  4. Able to tolerate more than 3-4hours/day for more than 3 days/week
  5. No need for therapy, need doc prescription, program approved by insurance.
  6. Should be preceded with functional testing in acute PT/OT or work conditioning eval
45
Q

Should an FCE be needed after work conditioning or work hardening?

A

No!!! Client should be performing functional tolerances on a daily basis.

46
Q

Is work conditioning recommended if I client demonstrates inconsistent effort or problems with ROP during the FCE?

A

NO ITS CONTRAINDICATED — probably of successful outcome is low.
that way the employer is not wasting money and resources for treatment when a client is showing sub-max performance.

47
Q

What are the indications that a client will have difficulty RTW full duty?

A
  • Consistent performance (COE + ROP) during FCE
  • More than 30 pound disparity between the current and required physical deman level.

enables employer to research alternative options while client goes to work conditioning.

48
Q

What is the definition of ergonomics

A

Relationship among the worker, the work that is being done, the actions/tasks/activities inherent in the work and the environment in which the work is performed.
ergonomics uses scientific and engineering principles to improve safety, efficiency, and quality of movement involved in work

49
Q

Do we fit the person to the job or job to the person

A

FIT THE JOB TO THE PERSON’S ANATOMICAL AND PHYSIOLOGICAL CHARACTERISTICS IN A WAY THAT ENHANCES HUMAN EFFICIENCY AND PERFORMANCE.

50
Q

What is primary goal of ergonomics

A

To improve worker safety and performance.

51
Q

Where does ergonomics fit

A
  1. Workers comp
  2. Americans with disabilities act
  3. Disability
  4. Rehab
52
Q

What government agencies do we consider when taking about ergonomics

A
  1. Occupational Safety and Health Administration (OSHA)
  2. National Institute of Occupational Safety and Health (NIOSH)
53
Q

WHat is OSHA

A

They have regulations which address MSK Disorders
That define workplace and determine the presence of liability and the likelihood of benefits.

54
Q

Risk factors for poor ergonomics

A
  1. Repetition
  2. Awkward postures
  3. Force
  4. Contact stress
  5. Vibration

“Roxie Awkwardly Forces Cuddles on Vino”

55
Q

What does NIOSH do

A

Develops standards for safety in the workplace.

56
Q

What is ADA Job Analysis

A

Defines the essential functions and marginal functions of a job and physical demands of the job.
Assists in deterring what’s parts of a job can be accommodated.
Not specific to a particular worker.
Collects objective data about the essential tasks required to perform a job
Describes the physical demands of the job
Evaluates the job
May lead to recommendation to ergonomic analysis

Topics In PT (4 decks)

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