FUNCTIONAL FUNCTIONAL TESTING 101…TESTING 101…

The Role of The Role of Function Function in in Injury Prevention and Injury Prevention and

Loss Control Loss Control ProgrammingProgramming

Larry Feeler, PT, CEAS Larry Feeler, PT, CEAS CEO, WorkSTEPS CEO, WorkSTEPS

Jack’s PictureJack’s Picture

DEFINITIONDEFINITION::

SystemSystem of of ADA compliantADA compliant employment tests designed to employment tests designed to prevent injuries, control injury prevent injuries, control injury related costs and combat related costs and combat fraudulent claims.fraudulent claims.

Testing Customized to Testing Customized to Look At:Look At:

• Job specific strengthJob specific strength• BaselineBaseline full body full body functionfunction• ““Significant” medical risks Significant” medical risks • Common cumulative traumas Common cumulative traumas

““Significant” Cumulative Significant” Cumulative Traumas :Traumas :

• Torn Rotator Cuff Torn Rotator Cuff (Shoulder)(Shoulder)

• Bad Backs Bad Backs (Neurologic)(Neurologic)

• Torn knee Torn knee ligamentligament

• Carpal TunnelCarpal Tunnel• Operated PartsOperated Parts• ETC !!!ETC !!!

DELIVERY MODELDELIVERY MODEL650+ Medical Clinic Providers in 46 650+ Medical Clinic Providers in 46 States “certified” in processStates “certified” in processOver 1,000,000 workers tested !!Over 1,000,000 workers tested !!

Companies Utilizing Companies Utilizing Testing:Testing:• Leggett and PlattLeggett and Platt• William Charles Const.William Charles Const.• Knight TransportationKnight Transportation• Hon FurnitureHon Furniture• Nabors DrillingNabors Drilling• Frontier AirlinesFrontier Airlines• Waste ManagementWaste Management• HalliburtonHalliburton• DOW ChemicalDOW Chemical• MoDOTMoDOT• General MillsGeneral Mills• Jeanie Overhead DoorJeanie Overhead Door• ComairComair• Loma Linda/Purdue UniLoma Linda/Purdue Uni• Hundreds of Cities and CountiesHundreds of Cities and Counties

• University of TexasUniversity of Texas• Dana CorporationDana Corporation• SchenectetySchenectety• Heinz KetchupHeinz Ketchup• Cox CommunicationCox Communication• Berg ElectricBerg Electric• RubbermaidRubbermaid• Austin CommercialAustin Commercial• MV TransitMV Transit• FleetwoodFleetwood• Madera ISD Madera ISD (CAL)(CAL)• Thousands More !!!Thousands More !!!

Employer Nightmares:Employer Nightmares:

New-hiresNew-hires• Hiring EE’s w/o Hiring EE’s w/o

measuring job measuring job related strengthrelated strength

• Hiring EE’s w/ Hiring EE’s w/ significant significant medical medical conditioncondition

Existing EE’sExisting EE’s• Not measuring Not measuring

continued job continued job capability capability (physical and (physical and medical)medical)

• Not proving the Not proving the legitimacy of legitimacy of any injuryany injury

Another Problem:Another Problem:Worker’s Comp AssumesWorker’s Comp Assumes

• Worker’s are Worker’s are perfect when perfect when hiredhired

• Worker’s never Worker’s never grow oldgrow old

• Whatever Whatever happens to the happens to the worker, the worker, the employer causedemployer caused

Changes in EconomyChanges in Economy

• Downturns Downturns – Cut safety programsCut safety programs– Expand physical Expand physical

responsibilitiesresponsibilities– Downsizing Downsizing – More qualified applicants in More qualified applicants in

poorer physical shapepoorer physical shape– More protracted injuries and More protracted injuries and

false claimsfalse claims

UPTURNSUPTURNSYou HIRE ANYYONE !!You HIRE ANYYONE !!

High salaries cause everyone to High salaries cause everyone to apply—even those who have apply—even those who have not done physical labor in not done physical labor in yearsyears

Rejected EEs go to YOUR Co.Rejected EEs go to YOUR Co.

New-Hire Tests…New-Hire Tests…ADAADA

Post offer (Basic or Post offer (Basic or Comp)Comp)–Most leeway–Most leeway

May select hardest May select hardest physical positions or physical positions or ones with highest ones with highest injuriesinjuries

Must test ALL applicants Must test ALL applicants applying for that applying for that positionposition

Post offer – Most leewayPost offer – Most leeway

• ER may perform background checks: ER may perform background checks: driving, criminal, etcdriving, criminal, etc

• May ask applicant if they can perform May ask applicant if they can perform specific job tasksspecific job tasks

• May interview and pick the most May interview and pick the most qualified applicantqualified applicant

• Will hire contingent upon passing the Will hire contingent upon passing the post offer physical (just like a drug test)post offer physical (just like a drug test)

Pretty….does it have Pretty….does it have an engine ?an engine ?

Standardized Process for Each Part Standardized Process for Each Part of Test Development…of Test Development…Job AnalysisJob Analysis

Highest InjuryHighest InjuryJOBSJOBS

CHANGES IN PROCEDURESCHANGES IN PROCEDURES

LIFTINGLIFTINGSIDEWAYS…SIDEWAYS…

• WRONGWRONG

• EducationEducation

ClassesClasses

LIFTINGLIFTINGSIDEWAYS…SIDEWAYS…

• RIGHTRIGHT

VIBRATIONVIBRATION

Static Static PosturesPostures

Carpal Tunnel…Carpal Tunnel…

• 1/31/3 occur in first year occur in first year of employment of employment

• 15%15% occur in first 3 occur in first 3 monthsmonths

• $30,000$30,000 ave cost ave cost• 34 lost days34 lost days per claim per claim• $50-300,00$50-300,00 with with

surgery surgery • 90 lost days90 lost days with with

surgerysurgery

CTD News 2004CTD News 2004

Accurate Essential Accurate Essential Function Descriptions: Function Descriptions:

• 18.5” Step up 5x18.5” Step up 5x• Lift and carry 75 lb tool box 30 feet Lift and carry 75 lb tool box 30 feet

on uneven terrain, kneel …on uneven terrain, kneel …• Lift from ground and place or throw Lift from ground and place or throw

48” skids to a height of 60 inches. 48” skids to a height of 60 inches. Must accomplish up to 25 reps Must accomplish up to 25 reps under 80% MPHRunder 80% MPHR

• NIOSH force:NIOSH force: Floor lift-- Floor lift--100 lbs.100 lbs. To To overhead-overhead-55lbs, 55lbs, PushPush 100 lbs 100 lbs

STRENGTHSTRENGTH

Standard Standard NIOSHNIOSH boxesboxes

• 4 Postures4 Postures• Body mechanics Body mechanics

training training • Must lift enough to Must lift enough to

attempt job attempt job related testsrelated tests

Shoulder to OverheadShoulder to Overhead

• Instruct in Instruct in proper body proper body mechanicsmechanics

• Avoid twist while Avoid twist while liftinglifting

• Give max safe Give max safe limitslimits

KNOW YOUR LIMITS and GET KNOW YOUR LIMITS and GET HELP !!!HELP !!!

JOB SPECIFIC TESTSJOB SPECIFIC TESTS

• PosturePosture• RepetitionRepetition• ForceForce• Aerobic DemandAerobic Demand• ““Virtual” TestingVirtual” Testing

Cardiovascular Tests…Cardiovascular Tests…

““Baseline”Baseline” FullFull BodyBodyMusculoskeletal Eval:Musculoskeletal Eval:Evidence Based !!!!Evidence Based !!!!

• PosturePosture• Range of Motion (IMP measures)Range of Motion (IMP measures)• Joint Flexibility/ Wear and TearJoint Flexibility/ Wear and Tear• StrengthStrength• PalpationPalpation• Investigation of Damaged PartsInvestigation of Damaged Parts• Medical evidence to support “not Medical evidence to support “not

capable” for medical riskcapable” for medical risk

POSTURE POSTURE

Medical TestsMedical Tests

PALPATIONPALPATION

Centinela’sCentinela’s / Empty Can / Empty Can Rotator CuffRotator Cuff Test Test

RANGE OF MOTION MEASURES:RANGE OF MOTION MEASURES:

According to AMA GuidesAccording to AMA Guides

Legs Wrapped 3x?Legs Wrapped 3x?

ApportionmentApportionment

• Any Any “individualized assessment”“individualized assessment” leading to quantified medical leading to quantified medical documentation of a pre-existing documentation of a pre-existing conditioncondition

• “…“…ordering impairment and ordering impairment and supplemental benefits supplemental benefits reduced by reduced by 40%40%””

Chief Appeals Judge, Case #950268, TexasChief Appeals Judge, Case #950268, Texas

Measured Return to Pre-Measured Return to Pre-injury Status…..injury Status…..

• STOPS BENEFITS !!!STOPS BENEFITS !!!• Is facilitated by knowing baseline Is facilitated by knowing baseline

strength and deficitsstrength and deficits• Leads to faster RTW Leads to faster RTW • ALWAYSALWAYS supersedes speculation or supersedes speculation or

UNMEASURED OPINIONSUNMEASURED OPINIONS (Porter v. (Porter v. Alumoweld)Alumoweld)

Reasons to Withdraw OfferReasons to Withdraw Offer

• Lie on Medical HX Lie on Medical HX TAM IX-7TAM IX-7• Bad AttitudeBad Attitude• Have Significant Medical RiskHave Significant Medical Risk• Can’t Lift Enough WeightCan’t Lift Enough Weight• Fail a Part of Job Specific TestFail a Part of Job Specific Test• Fail Drug TestFail Drug Test

1,000,000 Workers!1,000,000 Workers!

20082008

Return on InvestmentReturn on Investment !!! !!!

Stop one carpal tunnel, one back Stop one carpal tunnel, one back injury, and one fraudulent claim. injury, and one fraudulent claim.

Pays for individualized test on:Pays for individualized test on:

2500 EMPLOYEES2500 EMPLOYEES

$$$ SAVINGS $$$…$$$ SAVINGS $$$…

•50%50% AVE AVE REDUCTION REDUCTION

11STST YEAR !!! YEAR !!!

•79%79% Soft Soft Tissue Injury Tissue Injury REDUCTION REDUCTION

11stst year testing year testing

7,000 workers7,000 workers

WORK INJURY MANAGEMENTWORK INJURY MANAGEMENT

Fit For Duty (Existing)Fit For Duty (Existing)TAM VI-12TAM VI-12

““The need for the exam may be The need for the exam may be triggered by some evidence of triggered by some evidence of problems related to job performanceproblems related to job performance of safety, or… “to determine whether of safety, or… “to determine whether individuals in individuals in physically demanding physically demanding jobs continue to be fit for duty.”jobs continue to be fit for duty.”

PARAMEDIC 2Reclassify:Reclassify:

““Reasonable Accommodation”Reasonable Accommodation”

Fit for Duty—Post InjuryFit for Duty—Post Injury

• ““Under ADA, medical information or Under ADA, medical information or medical exams medical exams may be required when may be required when an employee suffers an injuryan employee suffers an injury on the job. on the job.

• Such an exam may be required when an Such an exam may be required when an employee employee wishes to return to work after wishes to return to work after an injuryan injury or illness, if it is job related and or illness, if it is job related and consistent with business necessity.”consistent with business necessity.” TAM VI-13TAM VI-13

Policy 1-1Policy 1-1“Fit for Duty” Post Injury“Fit for Duty” Post Injury

• Effective date, EEs who suffer WR Effective date, EEs who suffer WR or NWR injury exceeding 5 lost days or NWR injury exceeding 5 lost days will be subject to FFD…will be subject to FFD…

• ……to determine extent of to determine extent of disabilitydisability

• ……to determine job capability to determine job capability • ……to determine reasonable to determine reasonable

accommodationaccommodation

PREVENTPREVENTRECORDABLESRECORDABLES

MAY HAVE TOMAY HAVE TOFIND BEST WAYFIND BEST WAYTO PERFORM JOB TO PERFORM JOB SAFELYSAFELY

MEASURED MEASURED CAPABILITYCAPABILITY

EFFECTIVE RTWEFFECTIVE RTW

VALID EEVALID EE

Simultaneous Bilateral PositionSimultaneous Bilateral Position

Peer reviewPeer reviewPublishedPublished20042004

FunctionalFunctional Testing PAYS for Testing PAYS for ITSELF: SignificantITSELF: Significant $$ $$avingsavings

• Ability to test high risk newhiresAbility to test high risk newhires –Paid –Paid for by not hiring your next claimant / by for by not hiring your next claimant / by matching strength to job. matching strength to job.

• Ability to test existing EE’s—Ability to test existing EE’s—Paid for by Paid for by reclassifying, accommodating, reclassifying, accommodating, conditioning, medical retirement, conditioning, medical retirement, detecting symptoms early, job matchdetecting symptoms early, job match

• Ability to ALWAYS test injured EE’s—Ability to ALWAYS test injured EE’s—Paid Paid for by immediate accountability re for by immediate accountability re symptoms, sincerity of effort, realistic symptoms, sincerity of effort, realistic goals (baseline) and ability to RTW in a goals (baseline) and ability to RTW in a measured capacitymeasured capacity

  Dear Robert:Dear Robert: October 11, 2007October 11, 2007

I wanted to take a moment to thank you and your staff for the work you have I wanted to take a moment to thank you and your staff for the work you have done since the beginning of our post offer work simulation physicals for done since the beginning of our post offer work simulation physicals for MODOT. After studying our most physically demanding job title, maintenance MODOT. After studying our most physically demanding job title, maintenance worker, we worked with your facility to design and implement work simulation worker, we worked with your facility to design and implement work simulation tasks that would be performed by our applicants who had been given tasks that would be performed by our applicants who had been given conditional offers of employment. conditional offers of employment.  We began our statewide program in January of 2006. After our first year of  We began our statewide program in January of 2006. After our first year of

using your program, using your program, we reduced our lost time incidents by 61% we reduced our lost time incidents by 61% and our lost workdays by 69%. and our lost workdays by 69%. We were so thrilled with our results We were so thrilled with our results we began studying other physically demanding job titles and have just begun we began studying other physically demanding job titles and have just begun testing those applicants. In addition to the reduction in both lost time testing those applicants. In addition to the reduction in both lost time

incidents and lost workdaysincidents and lost workdays, , we are proud to say we saved the we are proud to say we saved the tax payers of Missouri $7,000,000.00 tax payers of Missouri $7,000,000.00 by reducing our workers' by reducing our workers' compensation costs! compensation costs! 

Another bit of good news is that during the first two quarters of 2007, we Another bit of good news is that during the first two quarters of 2007, we

have have reduced our lost workdays another 55% and our lost reduced our lost workdays another 55% and our lost time incidents by an additional 36%.time incidents by an additional 36%. As you can tell, we are very As you can tell, we are very pleased with the results of our program.pleased with the results of our program. We look forward to our continued partnership in the future. We look forward to our continued partnership in the future.Sincerely,Sincerely,

Jean Endsley, M.S.Jean Endsley, M.S.Employee Safety and Health Manager Employee Safety and Health Manager

DATA IS POWERDATA IS POWER ..…..…No Matter How You Use IT No Matter How You Use IT ! ! !! ! !

• BE ABLE TO BE ABLE TO PUT THE PUT THE SCALES IN SCALES IN YOUR FAVOR YOUR FAVOR … IF YOU … IF YOU NEED TO !!NEED TO !!

Why Wouldn’t Why Wouldn’t YOUYOU Test?Test? Thank you! Thank you!

THE ENDTHE END