Exam tests rehabbed workers

Technology advancements allow therapists, physicians to assess progress quickly
Mike McLean
Spokane Journal of Business
February 10, 2011

A rigorous work-readiness evaluation, such as a state-approved test conducted regularly here by St. Luke's Rehabilitation Institute, aims to determine when and under what conditions an injured worker is capable of returning to the job.

The goal of the evaluation, called a physical-capacity exam (PCE), is to place the injured worker, the employer, the case manager, the vocational counselor, and health-care professionals on the same page following rehabilitation, potentially expediting the employee's return to work, says Diane Tapp, lead physical therapist at St. Luke's.

Tapp says St. Luke's, located at 711 S. Cowley in Spokane's medical district on the lower South Hill, has been conducting the evaluations for a number of years, but advances in technology and communications are reducing bureaucratic delays and likely helping people return to work faster.

"I think the ability to communicate with claims managers and doctors is evolving," she says, referring to sharing PCE results with a patient's case handlers. "Information is more readily available to the physician and vocational counselor."

Also, computerized results are instantaneous, Tapp says.

"I can tell the patient the results the same day and have a report done within one to two days of an evaluation," she says.

Tapp says she and another physical therapist at St. Luke's conduct an average of one or two PCEs a week.

Sarah Martin, an Olympia-based therapy services coordinator for the Washington state Department of Labor and Industries, says St. Luke's is among about a dozen Spokane-area therapy providers that perform physical-capacity exams.

Goals of the assessment include promoting an injured worker's return to the job by measuring the subject's abilities to perform specific job-related tasks and determining whether to recommend temporary or permanent restrictions, Martin says.

Tapp adds, "It gives objective data to help determine the next step to get the employee back to work as soon as possible."

PCEs can be ordered by claims managers who represent L&I or an insurance provider. Physicians and vocational counselors also can request PCEs, although such requests must be approved by a claims manager, because each test costs several hundred dollars, she says.

L&I pays up to $706 for a covered PCE, Martin says.

Injured workers who undergo PCEs at a certain point in their rehabilitation generally are looking to return to physically demanding jobs, ranging from parts assembly to construction work, she says.

"Jobs that are less physically demanding have less risk for injury," Tapp says.

A PCE is conducted over a two-day period, with about four hours of testing on the first day and two to four hours on the second day, she says. One of the main purposes of the test is to indicate whether a patient can tolerate the physical demands of a full workday.

"We try to relate it to an eight-hour workday," she says.

Prior to the test, a vocational counselor prepares a job analysis, which defines the rigors of the workday for each test subject. St. Luke's has one full-time vocational counselor, but in most cases, L&I provides vocational counselors to help the injured worker identify return-to-work options, Tapp says.

"Every analysis includes detailed demands of what the employee needs to be capable of doing," she says. "It includes information on how much they need to bend, stand, sit, lift, and reach, and how many times they need to do each activity a day."

Before administering a test, Tapp reviews the patient's medical history and conducts a cursory musculoskeletal exam to determine whether to expect any physical limitations, she says. Throughout the course of the test, she monitors the subject's heart rate and watches body movements for signs of stress.

The tests are customized to mimic work tasks as much as possible, Tapp says.

A roofer, for example, would be asked to wear work clothes and bring in tools.

Some tasks, such as manual assembly, are simulated by having the subject reach through various openings in box-shaped frames and attempting to thread nuts onto bolts.

Other job simulations include stacking various items on racks.

Tapp says she often requests more than one job analysis to help determine whether the subject can handle other jobs within a range of physical demands.

"I just want to see what each person's safe maximums are," she says. "Even if they don't want to do a job that requires them to lift 50 pounds, it's nice to know if they could do it safely."

Tapp enters the degree of success for each task on a laptop, which does instantaneous calculations, allowing her to share the results with patients, followed by a report with recommendations.

Her recommendations can range from proposing an injured worker return to work with no change to pre-injury conditions, return to work gradually, return with modifications to the work environment, return to a less demanding job, or not return at all.

The evaluation also might indicate the patient would benefit from additional rehabilitation, she says. In such a case, she might recommend the patient enter a work-hardening program. St. Luke's work-hardening program is an intensive four-week program aimed at stepping up worker endurance.

"When they complete it, they are ready to go back to work the next day," Tapp says.

Mike McLean
(509) 344-1266

St. Luke's Rehabilitation Institute
711 S. Cowley St.
Spokane, WA 99202-1330

Inpatient Information: (509) 473-6058
Outpatient Information: (509) 473-6869