Physical Therapy UpdateComputer Technology Revolutionizes the Functional Capacity Evaluation Process |
Gary M. Souza, P.T.
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Suite 100Advances in Functional Capacity Evaluations
Changes in Worker's Compensation laws have necessitated a more objective means to assess and rehabilitate injured workers. A Functional Capacity Evaluation objectively measures a worker's current ability to perform work related tasks, and predicts their ability to work for a given amount of time. Physical therapists at Gary M. Souza, PT and Associates employ an innovative system for performing Functional Capacity Evaluations (FCE). This system, developed by the Blankenship Corporation, documents the patient's current ability to perform work from a physical, medical behavioral and ergonomic perspective.
The Blankenship System differs from other FCE systems in that it tests for 160 different validity criteria and employs computer technology to directly record the data for increased accuracy. The validity criteria are then used to develop a patient profile, which is based on the number of valid, equivocal, or invalid results recorded during testing. A statement can then be made on whether the worker exerted good or sub-maximal effort.
Two types of functional capacity evaluations can be performed, job specific or non-job specific. Job specific functional capacity evaluation is based on a worker's specific occupational requirements, and allows the evaluator to determine if and when a patient is capable of returning to work and at what level. It can also be used for post-job offer screening for performance of a specific occupational function. Non-job specific FCE's are a crucial step in preparation for vocational rehabilitation or vocational re-training.
Components of the FCE test include:
- Musculoskeletal evaluation including Myotest computerized strength testing
- AcuLift computerized lift task analysis.
- Hand testing including computerized grip/pinch strength and fine motor skills.
- Static strength testing.
- Nonmaterial handling tests: reaching, bending, climbing, squatting ability.
- Material handling tests: lifting, pushing, pulling, carrying ability.
- Formulation of a behavioral profile.
At Gary M. Souza, PT and Associates, we believe that the musculoskeletal
evaluation is a key component in determination of functional capacity. The evaluation begins with a thorough history of the injury and occupational background. Computerized range of motion measurements are taken using the AcuROM computerized inclinometer and/or a standard goniometer. Strength is measured dynametrically using the Myotest system, which utilizes a computer integrated force gauge. Using Myotest, the evaluator can objectively and accurate quantify muscle weakness through percentile comparisons and comparison with the corresponding muscle group on the opposite side. The Myotest system also produces force curve data, which can be used by the evaluator to check for signs of sub-maximal effort by the worker. Advantages of using computerized testing technology included improved accuracy and speed of testing and increased objectivity of data.
At Gary M. Souza, PT and Associates, we utilize the AcuLift system as a component of our functional capacity evaluation process. The AcuLift system has a state of the art computer integrated lifting box which incorporates lifting force data and a corresponding digitized video image of each performed lift. The physical therapist can utilize the video image and force curve data to objectively determine a worker's safe lifting weight by identifying the weight at which signs of biomechanical overload become apparent. In addition, if a worker is not giving a valid effort during the lift, the force curves and video analysis can be used to objectively document sub-maximal effort. Additional advantages of the AcuLift system are that digitized video can be replayed frame-by frame or in real time, and lifting data can be stored on a CD-ROM so that video imaging can be included as part of the FCE report.
Hand strength is also tested using the computer system. Data from the grip and pinch tests are recorded by the computer for greater accuracy. This information is compared bilaterally to determine right-to-left strength deficits as well as percentile comparisons from a national database. Rapid exchange grip testing can also be performed as a check for exertion of sub-maximal effort and as a validity check based on consistency of effort.
When NIOSH Static Strength Testing is performed, the data is recorded by the computer and provides the therapist with a force curve. The force curves can be analyzed to determine consistency of effort, peak force output, percentile of strength, and rate of fatigue. Static Strength Testing also allows the therapist to predict the worker's Dynamic Lifting Ability with excellent accuracy before the Occasional Material Handling Tests are performed.
Material Handling Tests are performed to help identify the patients' maximum safe lifting weight. Box lifting using torso, floor, shoulder, and overhead lifts are performed according the Design of Material Handling Tasks described by Snook and Cirriello. Pushing, pulling, and carrying can also be tested.
Non-material handling activities such as time spent sitting, standing walking, reaching, bending and squatting are either tested directly or extrapolated from material handling and repetitive activities. Workers that have special functions in their jobs and require frequent use of arm and leg controls, crawling, and balancing activities are tested directly for these functions.
One of the most critical components of a functional capacity evaluation is the development of a behavioral profile. The workers behavior during testing is evaluated for appropriateness based on objective findings and correlated with their reported level of symptoms. Behavior is analyzed through the integration of pain questionnaires, testing consistency and cross-correlation of test data. The behavioral profile assists the physical therapist in determining if the worker is cooperating with the FCE and motivated to return to work.
FCE Report
The FCE report generated by Gary M. Souza, PT and Associates contains a summary of the FCE results, the worker's suggested Physical Demand Classification according to the Dictionary of Occupational Titles, and supportive documentation. Supportive documentation includes objective measures of the worker's effort during the evaluation. The most significant report, however, may be the behavioral profile, which is comprised of three independent but interrelated components of test performance: symptom exaggeration, inappropriate illness behavior and the validity profile.
The reports generated by the Blankenship FCE System are:
- Validity profile: Based upon the number of valid, equivocal, or invalid results on each individual test or between tests. This is then formulated as a percentage of the total validity criteria and a statement made on whether it appears the workers was exerting good effort, submaximal effort, or that the results were invalid. The worker must pass 75% of the validity criteria to qualify as exerting maximal effort.
- The amount of weight a worker can safely lift, push, or pull at an occasional, frequent, or constant frequency.
- Hand function, which indicates if the worker is able to use his/her hands for simple grasping, fine motor tasks, low speed assembly, or high speed assembly.
- Physical Demand Classification: Qualifies the patient for sedentary, light, moderate or heavy physical activity.
A final advantage of the functional capacity evaluation provided at Gary M. Souza, PT and Associates is that assessments are provided via concise and easy to interpret reports. This assists referring physicians with making prompt recommendations for return to work. In addition, the information generated by the Blankenship FCE process is supported by published medical research including a bibliography of over 95 references to assure credibility and legal defensibility.
For additional information about Functional Capacity Evaluation or AcuLift lift task analysis provided by Gary M. Souza, PT and Associates; please contact:
Gary M. Souza, DPT, OCS
909) 861-3511
