By Virginia “Ginnie” Halling, PT
The benefits of a proactive, comprehensive work injury management and prevention program are substantial to all parties. A community’s employers will have a partner that can assist them anywhere along the spectrum of safety to disability management. The provider generates revenue well beyond the insurance reimbursement spectrum. Workers and their families trust the provider and refer family members and friends. Negative, defensive, and reactive approaches won’t work here. As a community resource, the rehab provider must be seen as objective and helpful in the mission of helping employers hire and retain a productive workforce that is kept safe and healthy.
Injury Management and Prevention: The Components of Functional Capacity Evaluations
While the functional capacity evaluation (FCE) remains a sought-after service by physicians, insurers, and employers, it must be recognized for how it is utilized today. It is commonly engaged at the “end stage,” which represents missed opportunities to have made a difference in an individual’s recovery period. There are certainly situations in which this may be the only feasible choice if an injury, illness, and/or the challenges presented during the recovery period dictate. However, this is not the case in the majority of situations. When an FCE is referred and provided, the professionals should be seeking to understand what was missing and what could have been done earlier in the course of management to have avoided arriving at the need for the FCE.
Job Analysis and Documentation
The most critical step to the success of a work injury management and prevention system is the development of accurate job function and physical demands documents. It removes doubt and negativity by focusing all parties on agreed-upon evidence relating to a job. All aspects of what a provider can offer flow from an accurate job function description, including ergonomic opportunities, education, rehabilitation (traditional and work hardening/conditioning), and matching workers to jobs across the spectrum of point of hire to separation from employment.
Post-Offer and Return-to-Work Testing
There are some important things to consider before including testing of any kind in employment and return-to-work decision-making. When an employer uses such testing, they are further committing to their responsibility to keep employees working safely and not discriminate in their decision-making when hiring or returning an individual to work. Any method chosen to test workers to determine if they are physically suited to the job, or capable of returning to their job post injury or illness, must show a clear and indisputable relationship to the job in order to withstand such scrutiny.
Case law has often demonstrated that the worker’s input about what a job requires is given significant merit. It takes an employer’s written, validated job description, including physical demands, to challenge an employee’s subjective statement, because employees are generally considered (by the Occupational Safety and Health Administration (OSHA) and the Equal Employment Opportunity Commission (EEOC) ) to be experts of the work they perform. So in job analysis and test design, the worker’s involvement in validating the accuracy of any description of, or testing of the physical nature of, a job is very important. Testing must be monitored and upgraded when job changes occur, and this requires having policies and procedures to assure that this happens, and the supporting documentation must be kept current. Indeed, some employers choose to avoid testing altogether because of this added commitment—and, as such, they usually pay a higher price in work injury costs, employee turnover, and litigation.
Employers hire employees to do jobs—which have physical demand requirements. Employers are often scrutinized by agencies such as OSHA and the EEOC, as well we know, and the physical demands associated with a job can certainly be a reason for such scrutiny. The physical demands definitions are well-known to professionals in human resources, safety, and governing agencies. The kinesiophysical method is strongly based on job functions and directly tests associated physical demands. As such it is a content valid method and therefore meets the EEOC’s requirements. Kinesiophysical testing is well-researched and published in peer-reviewed journals, and has shown to have excellent inter-rater and intra-rater reliability. It is often given high marks in outcomes reporting as having a positive and proactive influence.
The Job Function Matching (JFM) method tests only the physical demands clearly required with a particular job—such as lifting, carrying, walking, climbing, etc. It is not a generic test asking the individual to perform potentially more than the job would require them to do. The physical demands and associated tests are very recognizable in their relationship to the job, and these physical demands are listed in documentation that has legal credibility—such as job function descriptions and US Department of Labor definitions of work. This documentation shows the direct relationship to the physical demands of a job and, as such, doesn’t require much interpretation by those who might review it. That may be a key reason why properly prepared providers and employer clients report that they don’t spend as much time in deposition or court proceedings. Also, it is easy for experienced workers to take the JFM test and have confidence in the results, because it clearly is representative of what the job requires them to do.
The Job Function Matching approach requires that both Job Function Descriptions and Job Functions Tests be validated by experienced employees as well as management representatives. Other methods of testing that rely more on strength and flexibility are often not recognizable as work-related—the relationship of muscle performance to work-related physical demands is an inferred one. Because of this, employers and providers are likely called to deposition or court to “explain” this association when questions or challenges arise. This can result in increased cost of time spent and legal fees. Indeed, workers often question “how” this testing shows whether or not they could perform the job.
When rehab providers have information that clearly shows the functional and physical gaps that are present for their patient/client, it is not difficult to incorporate these gaps into goal setting that addresses the worker’s ability to perform their job. Since traditionally this information is absent or vague, return to work is often minimally addressed, if at all, until a work hardening or work conditioning referral is made. This is costly to all parties, and further signifies the need for all parties to actively seek objective job function and physical demands information as soon as it is evident that an individual’s ability to work is impacted.
A Job Function Matching system, by utilizing the kinesiophysical method, addresses methods to prevent injuries and keep recovering workers on the job, as well as methods to manage disabled workers, with strategies including work modifications (whether temporary or permanent) that can significantly reduce days away from work or restricted work days. The JFM system can help the employer manage “stay at work” efforts, and this can be done early and on an ongoing basis throughout a case. This results in substantial cost savings, more positive relationships between stakeholders, and earns the provider recognition as a community partner in developing and maintaining a healthy workforce. RM
Virginia “Ginnie” Halling, PT, is CEO of DSI Work Solutions. For more information, contact RehabEditor@medqor.com.