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Topics in PT > Industrial Rehabilitation > Flashcards

Industrial Rehabilitation Flashcards

1
Q

What makes treating an injured worker
different than a Medicare patient or
group health patient (with the same diagnosis)?

A

They are more likely to do heavy lifting/ have larger requirements to meet

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2
Q

Role of a Claims Adjuster

A
  • Handles all Worker’s Comp cases
  • 1st report of injury
  • Sets Reserves based on ICD-10 code
  • Authorizes/Denies all medical and clinical
    treatment
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3
Q

Role of Case Manager

A
  • Only assigned to cases that are complicated,
    catastrophic, or with Hx of work-related injuries.
  • Manages the individual case to insure the claimant moves through the various phases of medical treatment and rehabilitation smoothly
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4
Q

Main goal of a case manager

A

To ensure the claimant receives optimum
treatment, and follows through with all treatment recommendations

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5
Q

Definition of case management

A

A collaborative process which assesses,
plans, implements, coordinates, monitors
and evaluates the options and services
required to meet an individual’s health
needs, using communication and available
resources to promote quality, cost- effective outcomes

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6
Q

Role of vocational evaluator

A
  • Only brought into the case when it appears that the injured worker will be unable to return to the previous job.
  • Determine a claimant’s employability, job placement and wage earning capacity.
  • Identifies appropriate job objectives based on education level, transferable skills, etc.
  • Helps with returning injured worker back to work as quickly and safely as possible
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7
Q

The purpose of administering a complete and thorough vocational assessment is to determine a person’s

A
  • aptitude levels
  • achievement levels
  • vocational skills
  • temperaments
  • work values
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8
Q

Industrial Rehabilitation Services

A
  • FCE (baseline, job specific, UE)
  • Work Conditioning/Hardening
  • On-Site Work Hardening
  • Job Analysis
  • On-Site RTW Consultation
  • Job Coaching
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9
Q

FCE Defintion

A

The FCE is a generic term used in the medical
and vocational rehabilitation communities to
denote a form of functional evaluation that
consists of a battery of tests focusing on selected work tolerance areas, consistency of effort and reliability of pain reports

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10
Q

What is an FCE for?

A
  • Provides objective information about the client’s ability to perform the essential functions of their job over an 8 hr. day
  • Provides concrete data on Consistency of Effort testing
  • Evaluates Reliability of Pain Reports
  • Identifies the need for job modification and/or an On-site RTW Consultation
  • Rules out need for surgical intervention
  • Aides in appropriate work placement/case resolution (only 40% of FCE referrals require Work Conditioning)
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11
Q

Do you need an MD script for FCE?

A

not at direct access sites

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12
Q

3 Indicators for FCE

A

Medical, Legal, Behavior

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13
Q

Medical considerations for FCE

A

– Job history of injury/re-injury
– Job involves repetitive work tasks
– Job involves Medium to Heavy work
– Complaints of pain with no substantiated
clinical findings
– Plateau in PT/OT/Medical (MTI/MMI), yet
functional difficulties evident
– Decreased work tolerance

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14
Q

Behavioral Considerations

A

– Off work for more than 3 months
– Negative attitude about returning to work
– Fear of re-injury
– Suspected sub-maximal effort/compliance
issues
– Questionable legitimacy of injury

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15
Q

Legal Considerations

A
  • Objective documentation needed to RTW
  • Conflict of medical opinion about worker’s
    status (ie. Ortho MD & Occ. Med MD)
  • RTW will require job modification
  • Attorney resists work release
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16
Q

Different FCE Philosophies

A
  • Standardized: KEY Method, Matherson
  • Non Standardized: Hybrid, Developed In-House
  • Psychophysical: patient is in charge, based on pain and subjective complaints
  • Kinesiophysical: based on biomechanical changes
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17
Q

FCE Admission Criteria

A
  • Client is medically stable (i.e. resting BP <
    160/100, pulse < 100)
  • Pain has stabilized
  • Inflammation and/or swelling has stabilized
  • Soft tissue dysfunctions have been
    addressed
  • Passive mobility has plateaued over a 2 week period
  • Client can tolerate 2 hrs. exercise/activity
  • Client should demonstrate absence of major psychiatric
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18
Q

What are the admission requirements for patients with lumbo-sacral injuries?

A

– Pelvic symmetry or status plateaued
– Trunk strengthening addressed
– 45° hamstring length
– 30 second static partial sit up
– 75% squat for 45 seconds

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19
Q

before doing an FCE for a patient with cervical and shoulder injuries what should you assess?

A

scapular strength

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20
Q

Baseline FCE

A
  • Assessment of the functional ability to perform the spectrum of work tolerances related to the physical demand factors of job tasks
  • Best suited when restricted duty is available or RTW to previous job is highly improbably
  • initiated with M-S eval
  • Addresses consistency of effort and reliability of pain testing
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21
Q

Job Specific FCE/WCE

A

– Assessment of the match between the client’s functional capabilities and the critical demands of a specific job
– Answers the referral question: “Can the client return to work to the previous job?”
– Accomplished by evaluating work tolerances with specific parameters and the use of structured work simulations
– Initiated with M-S eval
– Addresses Consistency of Effort (COE) and Reliability of Pain (ROP) testing

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22
Q

UE FCE

A
  • Initiated with M-S eval
  • Assessment of only the physical capabilities and tolerances that incorporate UE usage
  • Will NOT evaluate sitting, standing, stoop, squat, kneel, couch, stair climb
  • Address COE and ROP testing
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23
Q

When answering the question “can the client return to work to the previous job?,” what should you test?

A

only the physical capabilities and tolerances specific to job

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24
Q

When answering the question, “with restricted duty available, what can the client do now?” what should you test?

A
  • evaluate all the physical capabilities and tolerances
  • may be candidate for on-site work hardening
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25
Q

when answering the question “with a catastrophic case, what can the client functionally do?” what should you test?

A
  • Evaluate ALL physical capability and tolerances
  • determine employability
  • may be candidate for On-Site RTW Consultation to assist in work transition
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26
Q

Evaluation Process

A
  • Varies: 3-5 hours; avg. 4 hrs.
  • Musculo-Skeletal Evaluation
  • Consistency of Effort (COE) testing
  • Reliability of Pain (ROP) testing
  • Objective Functional Tolerance testing
  • Repeat 1 & 2 hand lifting (reliability)
  • Functional Simulation Circuit
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27
Q

What determines the stopping point of the FCE?

A
  • determined by the most limiting of the 3 domains (biomechanical, cardiovascular-metabolic, psycho-physical)
  • HR can go up 20 bpm
28
Q

What is the most limiting domain?

A

Psychophysical
– Governs expended effort in biomechanical
and/or cardiovascular-metabolic domains
– Good evaluator is skilled in the reliable
evaluation of psychophysical domain.

29
Q

What approach should be taken when pain behavior is believed to be questionable?

A
  • Physical effort testing is particularly useful
    to rule-out fatigue, fear and biomechanical
    impairment which may lead to inconsistent performance
30
Q

Reliability of Pain Reports

A
  • Indication as to the extent to which one is able to rely on clients subjective reports (not a measure of effort)
  • Subject of client reported pain has been a
    dividing issue between various FCE systems
31
Q

Tests for reliability of client reports

A
  • intro/intake interview
  • Sorts (Spine Function Sort, Hand Function Sort)
  • Pain Questionnaires
  • Activity Questionnaires
32
Q

Clients Behaviors, Observations, and Movements Which When Present, May Suggest Issues With ROP

A
  • Medical inconsistencies
  • adjusting history
  • Client avoids answering direct question
  • Blaming others
  • Symptoms reports and functional limitations which are inconsistent with posture and movement patterns
33
Q

Red Flags on Ransford Pain Drawing

A
  • total body and non specific drawing
  • does not follow pain referral pattern
  • Combination of multiple systems
  • 0-2: more reliable
  • 3 or more: there’s a problem
34
Q

Red Flags with Symptoms Grading Scale

A

– Almost always 7 or above; often 10 when sitting or doing easy tasks. Should be in obvious distress.
– May be reported as 15 - 20 on scale of 1-10 – No attempt to decrease symptoms with proper
posture
– Symptoms do not decrease with rest or medication

35
Q

Other ROP Tools

A
  • Visual analog scale (should be within 1.5 to numeric pain scale)
  • McGills Pain Questionnaire
  • Oswestry: LBP
  • NDI: Cervical
  • DASH: UE
  • LEFS
  • Pain disability index
36
Q

Tests for Reliability of Pain Reports within MS Evaluation

A
  • Repetitive movement tests
  • Waddell’s Non-Organic Signs (LB pts)
  • Hoovers Test
  • Distractionary Testing
37
Q

Purpose of consistency of effort testing

A
  • Determine maximal vs. sub max effort
  • identify unresolved medical/rehab deficits
  • provide case direction/resolution
    ** to be statically significant, you need 20 to 30 things tested
38
Q

When should you perform consistency of effort testing?

A

throughout the FCE

39
Q

COE Tests

A
  • HR Monitoring
  • Spinal Inclinometer
  • Jamar Hand Grip Testing
  • Rapid Exchange Grip Test
  • Pinch Testing (or distal UE diagnoses)
  • Static Strength Testing (arm, push, leg)
40
Q

Types of Physical Effort

A
  1. Maximal effort: consistent performance (70% or above)
  2. Questionable Effort: concern is raised (60-69;99%)
  3. Sub maximal effort: inconsistent performance (<60%)
    **With 2 & 3 client is capable of greater functional abilities than those demonstrated or client is capable of functioning at a higher category of work
41
Q

learn the strength chart for sedentary, light, medium, etc

A
42
Q

defining physical demand level

A

2 hand lifting
2 hand carrying
2 hand push/pull
walking
MET level

43
Q

lifting levels

A

floor to waist
waist to shoulder
shoulder to overhead

44
Q

fitness testing

A
  • metabolic endurance testing
  • according to Dictionary of Occupational Titles
  • can also use client’s MET level to identify physical demand level classification
45
Q

Medium dexterity tests

A

– Valpar #9 – Whole Body ROM
– Bennett Hand Tool Dexterity
– Minnesota Rate of Manipulation
– 9 Hole Peg Test

46
Q

Fine motor dexterity tests

A

― Purdue Pegboard Test
― Various Valpar work samples available

47
Q

Definition of work conditioning

A

– An intensive, work-related, goal oriented
conditioning program designed specifically to restore systemic neuromusculoskeletal functions and cardiopulmonary functions

48
Q

what is the objective of work conditioning

A

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

49
Q

how often/long is work conditioning

A
  • up to 4 hr/day
  • 3-5 times/week
  • 3-4 weeks
50
Q

what format is work conditioning

A

circuit
- utilizes physical conditioning functional activities related to work

51
Q

short term work conditioning program

A
  • strength
  • flexibility
  • endurance
  • coordination
  • return to work goal
52
Q

Entry criteria for work conditioning

A
  • no longer in acute phase of therapy –> don’t need hands on
  • unable to safely return to work due to weakness or deconditioning
  • client needs to increase functional tolerance or endurance
  • program approved by insurance
  • should be requesting finite duration based on clients needs
53
Q

does work conditioning require a doctors prescription?

A

yes

54
Q

3 phases of APTA work conditioning guidelines

A
  • aerobic phase
  • strengthening phase
  • functional phase
55
Q

definition of work hardening

A

– A highly structured, goal-oriented conditioning
program designed specifically to return the client to work
- Often interdisciplinary in nature, use real or simulated work activities designed to restore physical, behavioral, and vocational functions.
- Addresses issues of productivity, safety, physical tolerances, and worker behaviors

56
Q

is work hardening a prevalent service in most states?

A

nope

57
Q

How often is work hardening?

A
  • Up to 8 hr/day
  • 5 times/week
  • 4-6 weeks
58
Q

aspects of work hardening

A
  • utilizes simulated work action
  • interdisciplinary model
  • behavioral and vocational dysfunction
  • productivity
  • safety
  • physical tolerances
  • work behaviors
59
Q

Entry criteria for work hardening

A
  • Full ambulation
  • Unable to safely return to full duty
  • Non-related medical problem stabilized
  • Able to tolerate more than 3-4 hrs/day
  • Able to tolerate more than 3 days/week
  • No need for therapy
  • Doctor prescription
  • Program approved by insurance
  • Should be preceded with functional testing (in
    acute PT/OT or a Work Conditioning Eval
60
Q

do you need an FCE after work conditioning/work hardening?

A

nope

61
Q

Will work conditioning be successful if the client demonstrates an inconsistent effort or issues with ROP during FCE?

A

probs not

62
Q

what happens if a client exhibits a consistent performance (COE & ROP) during the FCE and there is more than a 30# disparity between the current and required physical demand level?

A

there is a high probability that the client will have difficulty returning to full work duty

63
Q

Ergonomics definition

A

– The relationship among the worker; the work
that is done; the actions, tasks, or activities inherent in the work and the environment in which the work is performed

64
Q

what is the primary goal of ergonomics

A

to improve worker safety and performance

65
Q

OSHA

A

Occupational Safety and Health Administration
– OSHA has regulations which address
musculoskeletal disorders (MSD’s).
– These regulations define workplace musculoskeletal disorders (WMSD’s).
– By defining WMSD’s, one can determine the
presence of liability and the likelihood of benefits

66
Q

risk factors for ergonomic problems

A
  • repetition
  • awkward postures
  • force
  • contact stress
  • vibration
67
Q

NIOSH

A

National Institute of Occupational Safety and Health
* NIOSH develops standards for safety in the
workplace

Topics in PT (9 decks)

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