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job testing

1/17/2019

 
Job offer testing - Uses the information gathered in a job site analysis to examen the physical abilities of job applicants.  Job testing can be performed prior to a job offer  (pre-offer) or  following a conditional job offer (post-offer).  

Pre-offer testing allows you to determine if the applicant meets the physical demands of a job.  It does not allow investigation of medical history and does not require a job offer. If you determine the applicant’s ability to meet job demands first, you will not only save time but you will be hiring from an applicant pool that you have confirmed meets required job demands.  Pre-offer testing places the burden of job fitness on the applicant. The result is that your hiring process becomes  more efficient and the number of injuries are reduced.

Post-offer testing is conditional upon a job offer, allows you to investigate medical history, and places the burden of job fitness on the employer. Post-offer testing is usually administered by an independent provider.

Best results are attained with a comprehensive approach utilizing both pre- and post-offer testing.
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functional capacity evaluation

1/17/2019

 
We've written extensively on our blog regarding functional capacity evaluations (FCE).  The first thing to remember is that all FCEs are not the same.  Prior-method testing was too open to subjective manipulation.  A new testing method has been developed that uses a repeated-measures protocol.    This approach has proven much more accurate, sensitive, and valid in determining sincerity of effort.  
It is also fully supported by multiple studies.  Find those studies here:
exhibit_4_st._james_hand_strength__part_ii.pdf
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exhibit_2_under_loading_study.pdf
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exhibit_3_decision_making_data__expectations_for.6__1_.pdf
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work conditioning

1/17/2019

 
Work conditioning is a topic we love to talk about because so much progress can be made here!  A common thing that you see with providers of work conditioning, unfortunately, is that there is a large variety in how work conditioning is administered.   Some may see their clients only two times a week for a few weeks or three, or five.  It appears to be random with very little structure or it's really just 'extended' physical therapy- the same physical therapy exercises that were done in the acute phase.  Just done for a longer period of time.  

So let's bring some structure to the approach.  The most important consideration for work conditioning is when should it happen?  The answer is at the end of the acute phase of healing (see our post on acute physical therapy).  The healing is still occurring but the tissue is at a stage where it can be strengthened.  Using the principles of wound healing and exercise physiology, great gains in performance can be made in a safe and effective way.  During this time we test to see if the client is giving a full effort.  If full effort is being given we will continue until job goals are met.  If full effort is not being given then we will reassess at intervals to determine the best course of treatment.  We may recommend a functional capacity evaluation if attendance was an issue but often enough data is available  to make a functional capacity evaluation unnecessary.  

This approach results in less time spent in physical therapy, less time in work conditioning, lower cost, and defensible results.

Acute Physical therapy

1/17/2019

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Acute physical therapy is that which occurs in the acute phase of healing.  This is about the first 4-6 weeks with soft tissue injuries (e.g., muscles and ligaments) and 8-12 weeks with bone fractures or surgeries. This is not an absolute timetable as many variables can be present in a biological system but it's a starting point for discussion.  During the the acute phase the aim of physical therapy is to reduce pain and swelling while conservatively encouraging range of motion and strengthening.  Progress may be difficult to gauge across a general population but there should be progress as seen in less pain, less swelling and more movement and strength.  So the general expectation is that gradual progress should be made during the acute phase unless a re-injury occurs or there is a metabolic variable present (e.g., diabetes).  
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Job site Analysis

1/17/2019

 
What is a job site analysis and how will it help decrease injuries?  When we speak of a job site analysis we are referencing the core physical demands of the job.  The main reason to do an accurate job site analysis is so that you place a physically capable person in a  job that they can perform.  It may sound obvious but often a potential applicant is not tested.  They are usually taken at their word that they can do the job.  If you have a restricted applicant pool you may be tempted to get the job filled and soon as possible.  But you may be taking a chance that they won't be injured due to lack of fitness.  If they can meet the physical demand there is a decreased chance of  injury.  

If the job demands are accurately documented then they can be used to test applicants and return injured workers back to work.  How is this type of job analysis done?  What are the key elements?   First, we want to identify what the core physical elements of the job are.  We need to know what is carried, pushed, pulled, lifted, how frequently, and how far?  We also need to know if there are any physically significant but rarely performed tasks.  Measurements are taken so that this information is documented and accurate. We'll also interview management and labor to ensure that everyone is in agreement.  Once this information is gathered, a report will be generated that will define the job demands and provide visual documentation.  This report can then be used for hiring or rehab as needed.


Functional Capacity Evaluation overview

1/17/2019

 
What is a functional capacity evaluation (FCE)?  Typically, it is a test that assesses function following an injury.  It is often used in worker's compensation injuries but can also be used when their is a question of meeting work demands.  In other words, a work injury need not to have occurred.  
The test is typically about two hours long and will include the following; the client's medical and injury history, assessment of pain complaints, a physical therapy evaluation that assesses range of motion and general strength, a hand strength assessment if warranted by injury history or presentation, and a material handling test.  In addition, specific job demands may be assessed if this information is available or can be duplicated at the test site.
If the information gathered is based on sound scientific principles then it can be very useful in determining if the person tested fully participated and if they meet given job demands.  

FCE - Repeated measures

11/19/2018

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Why are repeated measures critical for a valid FCE?  
Repeated measures provide the necessary data to classify validity of effort. If you have one set of lifting attempts performed by an individual, how can you be certain that full effort was given? Doesn't comparing one set of lifts to another set of lifts make more sense when trying to determine if full effort was given, rather than trying to find a trend in one set of data?  Of course it does.
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Most FCE systems cannot determine if maximal effort was given because they don't gather enough data and are limited by subjective interference. The point here is that the basic premise of the former test approaches is flawed.  


XRTS uses the client's effort compared to a repeated effort to determine if maximal effort was given. In practice, that means comparing one set of lifts to another set of lifts. Variation within an acceptable range indicates maximal effort was likely given. Variation greater that an acceptable range indicates maximal effort was likely not given. 
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XRTS Material handling

11/16/2018

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The XRTS Material Handling Assessment sets this FCE testing methodology apart from all others. The material handling assessment compares a set of baseline lifts to the same lifts repeated on the XRTS lever arm and compares an individual’s reported maximum efforts with workloads of different physical appearance. 

This allows for an objective measure of effort through data comparison. Other methods for measuring effort during material handling rely on an evaluator’s opinion of observed movement patterns or changes in heart rate which lack objective, data- derived criteria. 
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XRTS Hand Strength Assessment

11/13/2018

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Today's topic is the XRTS Hand Strength Assessment. It is the most accurate hand test available today, detecting feigned weakness at 99.5% accuracy. This compares to 70% accuracy in the Bell Curve test.   

Used in upper extremity or neck injuries, the reason for the higher accuracy is that the research methodology developed criteria for identifying feigned weakness. Criteria for identifying feigned weakness were developed by identifying measures specific to individuals known to be giving a perceived 50% effort. 

The XRTS Hand Strength Assessment also incorporates simultaneous bilateral testing which is unique to this testing protocol.
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FCE - Statistical Analysis

11/13/2018

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Statistical analysis allows for FCE results to be determined by calculation, as opposed to clinician interpretation. This eliminates subjectivity or evaluator bias.    

The criteria used to compare calculated results has been subject to peer review with known sensitivity and specificity measures. Sensitivity is the ability to correctly identify those giving a sub-maximal effort. Specificity is the ability to correctly identify those giving maximal effort.

The XRTS FCE has a specificity rate of 100%. This means that there are no false positives - none of the subjects are identified as giving a sub-maximal effort when they have given a maximal effort. 
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