Workplace Injury Management and Prevention

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Workplace Injury Management and Prevention

• Presented by
• Dr. Jonathan Reynolds, PhD, PT, CWCE

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The Cost of an Injury
Bloswick, 2000
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Post Offer Evaluation

• Americans with Disabilities Act
• EEOC
• Technical Assistance Manual
• Chapters 5 and 6
• Ch. 5
• Nondiscrimination in the Hiring Process
• Ch. 6
• Medical Examinations and Inquiries

http//www.adata.org/adaportal/Employment/Browse_T
AM_I/Browse_TOC.html
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An Employer May...

• Ask questions about ability to perform work tasks
• Condition a job offer on a physical examination
• Withdraw the offer of employment if
• The applicant is unsuccessful
• The test is job related of business necessity

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Post-Offer Testing

• Tests may include
• Aptitude
• Knowledge
• Skill
• Intelligence
• Agility
• Job Demonstrations

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Medical Examinations and Inquiries

• Post offer
• Disqualify an individual who poses a direct
  threat to health safety of self and others
• Cannot disqualify based on anticipated
  expectation of an injury.
• Employer must demonstrate certain, imminent risk
  of substantial harm
• Employee Medical Examination
• Confidentiality
• Drug Testing

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Medical Examinations and Inquiries

• Applicant meets/satisfies other criteria
• Aptitudes
• Licenses
• Conditional offer of employment is extended
• Test mental or physical capacities
• Same test for all applicants for the same job
  category
• Do not need to test all categories

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Post-Offer Process

• Job Site Analysis
• Work site tour and planning
• Data collection
• Determine Essential Functions
• Post Offer Planning
• Essential Functions
• Select tests
• Business Necessity
• Job Related
• Create a Test Protocol
• Pass / Fail criteria

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Physical Demands of Work

• Work Postures
• Work Activities
• Material Handling
• Mobility
• Balance, agility, etc.
• Aerobic Fitness
• Hand Function
• Senses
• Environmental Exposures
• Heat, temperature, altitude, radiation,
  explosives etc.
• Equipment operation
• Tools, work aids, machines, vehicles

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Essential Function

• The fundamental job duties of the employment
  position the individual with the disability holds
  or desires.
• Do current employees actually perform the
  function?
• Would removing the function fundamentally change
  the position?
• Does the position exist to perform the function?
• Are there a limited number of employees who can
  perform the function?
• Is the function highly specialized?
• Employers specific requirements

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Example Food Delivery Driver
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Driver Essential Functions

• Lift 80 lbs. 6 to 48
• Lift 40 lbs. 36 to 60
• Carry 80 lbs. 10
• Push/Pull 110 lbs. 30
• Push Pull 60 lbs. 600
• Sit and Drive 35 Minutes sustained
• Dynamic stand 3 min. sustained
• Walk 4 min. sustained

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Driver Post-Offer Examination

• Blood Pressure (lt160 SBP, lt100 DBP)
• Heart Rate (lt100 bpm)
• Range of Motion Arms, Legs and Spine
• Work Activities
• Squat 10 repetitions rapidly
• Heel Walk
• Toe Walk
• Material Handling
• Grip Test

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Driver Post-Offer Examination

• Material Handling
• Occasional Lift 6 - 36
• Occasional Lift 36 - 60
• Occasional Push and pull 600
• Frequent Lift 6 - 36
• Frequent Lift 36 - 60
• Cardiovascular Test Standardized step test

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Test Systems

• Functional testing (FCE)
• Various systems
• Non-standardized
• Based on JSA and simulation
• Static lifting
• Standardized testing
• Isokinetic testing
• Cost Reduction Technologies

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Material Handling

• Lifting
• From Floor
• From 12
• Pivot
• To Shoulder
• To Overhead
• One-handed
• Simulated

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Material Handling

• Carrying
• Two Hands
• One Hand
• Carrying while climbing
• Simulated

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Material Handling

• Pushing / Pulling
• One Hand
• Two Hands
• Simulated

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Work Simulation
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Test Systems

• Functional testing (FCE)
• Various systems
• Non-standardized
• Based on JSA and simulation
• Static lifting
• Standardized testing
• Isokinetic testing
• Cost Reduction Technologies

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FCE Vs. Computerized Tests- Work Simulation

• Functional Testing

• Computer systems

• Functional Tests based on job demands
• Job related
• Business necessity
• Actual apparatus used
• Applicant relates the test to the job demand
• Respects the testing process
• Understands failed test

• No work simulation
• Newton and Waddell, 1993
• King et al, 1998

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FCE Vs. Computerized Tests Repeatability

• Functional Testing

• Computer systems

• Standardized test protocol
• Detailed description of tests
• Skilled evaluators

• Good repeatability since all tests are the same
• Tests are not specific to what is performed
  functionally at work

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FCE Vs. Computerized Tests Test Posture

• Functional Testing

• Computer systems

• Work task specific
• Simulated testing
• Skilled job analyst
• Orthopaedic tests
• Knee
• Shoulder
• Spine
• Other

• Test positions do not simulate or emulate work
• Positions actually restrict motion (shoulder)
• One plane of motion
• Granata Marras, 1999
• Spinal acceleration Vs. isokinetic testing

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FCE Vs. Computerized Tests Velocity

• Functional Testing

• Computer systems

• Self selected velocity
• Matches work demand
• Reduced velocity used to determine biomechanical
  overload

• Velocity dependent on constant force of machine
• Isokinetic exercise does not resemble functional
  activity

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FCE Vs. Computerized Tests Motor Control

• Functional Testing

• Computer systems

• Motor control restraints
• Load
• Balance
• Velocity
• Terrain
• Repetition
• Fatigue
• Aerobic capacity
• Sustained Posture

• Fewer constraints
• Constant force ? constant velocity
• Less challenge to motor control
• Varied load conditions
• Terrain
• Balance
• Posture

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FCE Vs. Computerized Tests Aerobic Capacity

• Functional Testing

• Computer systems

• Constant monitoring
• 220-Age X 0.85
• Comparison to US DOL Physical Demand Level
• Matheson et al, 2002
• Lift Capacity
• Aerobic Capacity
• Sub-Maximal Fitness Test
• Treadmill test
• Step test

• Aerobic capacity not accounted for

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FCE Vs. Computerized Tests Standardized Testing

• Functional Testing

• Computer systems

• No standards exist
• Job Related
• Business Necessity
• Technical Assistance Manual
• Test Protocol
• Same test
• Job Specific

• Everyone gets the same test
• Everyone!
• Pass score derived from JSA
• Physical Demand Level
• Depends on skill of CRT job analyst
• No published research for CRT

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Burial Vault Manufacture and Installation

• 73 Applicants tested since 11/26/2006
• Failed 15 (20) applicants
• 7 of 15 failures (50) passed CRT test
• All applicants who passed CRT passed FCE
• 2 back injuries within 90 days (2.7)
• Test cost 110 (8,030)
• JSA cost 800

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FCE Vs. CRT Burial Vault Manufacture and
Installation

• Functional Testing

• Computer systems

• Failed applicants
• Lifting mechanics
• Aerobic limit exceeded
• Biomechanical overload
• Functional strength deficit
• Multiplanar
• Dependent on ergonomics

• 50 who passed FCE, passed CRT
• 100 who passed CRT, passed FCE

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Twist Drill Manufacturer

• 112 Applicants tested since 1/9/2004
• Failed 9 (8) applicants
• No injuries within 1 year of test
• 3 Injuries since 1/9/2004
• Shoulder after 4 years
• Shoulder after 3 years
• Back after 18 months
• Test cost 110 (12,320)
• JSA Cost 1,800
• Union Challenge

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Waste Management Company

• 112 Applicants tested since 1/24/2008
• Failed 2 applicants (1.8)
• No injuries to date
• Test cost 80 (8,960)
• JSA Cost 1,800

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Questions
Reynolds Rehabilitation Enterprises,
Inc. Minneapolis Eagan Exposition Hall at
Riverplace Cedar Cliff Shopping Center 43 Main
Street SE 2119 Cliff Road Suite 223 Eagan
MN 55122 Minneapolis MN 55414 (612)
331-5757 [phone] email
Info_at_reynoldsrehabpt.com