L15: FCE's Flashcards
(36 cards)
1
Q
Why Functional Testing (4)?
A
- Function is objective / pain is subjective
- Provides a systematic process of measuring, recording and analysing an individual’s ability to perform activities defined by their work demands
- Functional testing is a useful adjunct to other forms of medical or physical assessment and provides a useful tool to measure and demonstrate changes that may have taken place over time that may not be as clearly evident using physical or medical testing.
- As Physiotherapists we
- THINK function
- OBSERVE function
- are the EXPERTS at function
- Treat functional impairments rather than pathology
- Function (objective) is a better outcome measure than pain (subjective)
2
Q
Why Capacity (5)?
A
- Functional testing is a safe and effective way to determine capacity to perform and provides limits to safe maximums
- Provides capacity NOT willingness to perform
- Provides essential baseline data to begin a process
- Limits can be modified to adapt to situation
- Skill in using capacity is vital
3
Q
What are 4 functional testing continuum?
A
- Functional Capacity Evaluation – detailed analysis which requires definitive outcome - post injury
- Functional Assessment – used in conjunction with other medical and physical testing or examinations to strengthen the overall assessment
- Functional Testing - used as a means to demonstrate and measure changes over time
- Functional Screening – used as a means to screen large numbers to determine if further testing or investigation is required – usually Pre Employment testing
4
Q
What is the definition of FCE?
A
- An FCE is an evaluation of capacity of activities that is used to make recommendations for participation in work while considering the person’s body functions and structures, environmental factors, personal factors and health status
- A systematic process of measuring, recording and analysing an individual’s ability to perform activities in response to broadly defined work demands.
5
Q
Why is an FCE conducted (5)?
A
- Return to Work (RTW)
- Can someone return to work – restricted or full
- Progression of duties
- Medico-legal
- Pre-employment and periodical testing
- Ongoing risk management
- Rehab planning
Used within a healthy business model, functional assessments have an essential role to play in injury management and prevention strategies
6
Q
What are 7 considerations of Standardised v Non-Standardised FCE?
A
- Inter and intra - rater reliability
- Test -retest reliability
- Validity
- Equipment and measurements used
- Accuracy and consistency
- Cross referencing abilities
- Commercial considerations
7
Q
What are 6 considerations of the FCE?
A
- Legal ramifications
- Financial implications
- Multiple stakeholders
- Varying jurisdictions
- Varying environments and testing conditions
- Defining purpose is all important - This is a MUST!
8
Q
What are standarised FCE in different countries? (NOT EXAMINABLE)
A
9
Q
A
10
Q
What is WorkHab like for FCE?
A
11
Q
What are 7 characteristics of Blankenship?
A
Used for the past 20 years as a standardized evaluation of the worker’s ability to perform a given scenario of physical tasks related to job tasks, including:
- Behavioural Profile
- Musculoskeletal evaluation – ROM
- Repetitive motion evaluation
- Static strength
- Occasional, frequent and constant material handling
- Hand evaluation
- Non-material handling
12
Q
What are 2 characteristics of “2 x 5 min repetitive tests of Functional Assessment Screening Test” for F.A.S.T?
A
- Repetitive stooping of small bolts from floor to overhead at own speed
- Repetitive twisting at waist in standing from R-L, L-R
13
Q
What are the 3 characteristics of the Reliability of FCEs?
A
The extent to which a test/measure is consistent and free from error
- Types: Test-retest; Intra-rater; Inter-rater reliability
- Few assessments have demonstrated levels of reliability sufficient for clinical (and legal) purposes
- No single assessment has been comprehensively investigated for all aspects of reliability
14
Q
What are the 4 characteristics of the Validity of FCEs?
A
- Most work-related assessments have limited evidence of validity
- Of those that had adequate evidence, validity ranged from poor to good
- There was no instrument that demonstrated moderate to good validity in all areas
- “As the test situation simulates reality more closely, control becomes more difficult. . . the more closely one tries to simulate a real criterion situation, the less reliable will be one’s measurement of performance”
15
Q
Do FCE’s Predict RTW (3)?
A
- Point in time assessment and not predictive of return to work outcomes
- FCEs will provide maximum ability or maximal acceptable ability
- Lots of things not just function predict overall outcome ie RTW
- Legal process (Eg. secondary claim (sueing employer))
- Claims status
- Pain beliefs, beliefs, motivation, understanding
- Psycho social factors (workplace support, ability to accommodate
- Organisations factors (workplace size)
16
Q
What are 10 choices of FCE protocol?
A
- Purpose of test
- Outcome expected
- Complexity of case
- Time
- Price
- Training available
- Equipment
- Testing venue
- Evaluators professional background
- Political, corporate, legal climate
17
Q
What are 7 FCE contraindications?
A
- Unstable medical condition, recent flu, infection etc
- Recent surgery or injury within 6 weeks
- Why? Not healed (must be >6 weeks)
- Substantial psychiatric and behavioural issues
- Can be very intense mentally
- Communication barriers that prevent instructions being understood – interpreter can be used
- Non-compensable medical co-morbidities restricting performance or exclusion from work
- Inappropriately dressed – safety issues
- If concerned get: Medical approval prior to proceeding
18
Q
What are 3 stages (4/5) of FCE?
A
- Preparation:
- Gather medical reports
- Purpose of FCE
- Authority to exchange information
- Informed consent
- Execution:
- Client/Patient interview
- Subjective Ax
- Objective Ax – brief neuromuscular, and physical screen, functional testing, work specific activities
- Safety considerations
- Post test symptoms
- Contact 24-48 hrs after (can have delayed pain response/latency)
- Report writing – match findings with work demands
19
Q
What are 7 characteristics of informed consent of FCE?
A
- Essential as participation is voluntary, (often no real choice)
- Usually asked from the insurer or employer
- What is it, why it is being done, explain tests, safety measures, clothing requirements
- Assess ability, not to treat
- Sets out rights and obligations
- Clarify pain and re-injury during and post Ax
- What will be done with the report? Who owns it?
- Authority to exchange information esp if require medical clearance
- Assess ability, not to treat
- Chance to gain rapport which is essential
20
Q
What are 8 tools used in FCE?
A
- Heart Rate Monitor
- Blood Pressure Cuff
- Hand dynamometer to measure grip strength
- Varying weights
- Items to be lifted – boxes, weights, specific work items such as tools, cables,
- Equipment specific to persons work duties – ladder, shovel, work tools
- Fitness Ax equip – bike, steps,
- Equipment depends on the type of FCE to be performed
21
Q
What are 2 subjective tools for FCE? What are 7 optional tools?
A
- VAS for pain reporting
- Berg’s Perceived Exertion Score
Importance: where the patient believes their baseline is
Optional tools
- Oswestry or Roland Morris
- Pain Disability Index Neck Disability Index
- McGill
- Beck Depression Inventory
- FABQ
- Coping Strategies Q
- Pain Catastrophising scale
22
Q
What are 13 interview components of FCE?
A
- History, progress to date
- Medical History
- Diagnostic Tests
- Types of Medical Treatment
- Medication
- Pain Description
- Contraindications
- Current ADL
- Employment History
- Training/Education
- Employment Goals
- Job Description Review
- Individual perception of abilities
23
Q
What are 5 objective assessments of FCE?
A
- Blood pressure (if above 195/100 obtain medical approval)
- Safety measure –> make sure they are cardio stable
- Basic ROM , muscle strength, posture
- Neuro-musculoskeletal
- Fitness tests – step up or bicycle ergometer
- Any other useful physical measurement that would be appropriate to the purpose of the FCE
24
Q
What are 2 characteristics of Generic vs Job Specific FCE (-/5)?
A
- Generic FCE tests the whole body in all basic work components (based on US Dept Labor DOT)
- Job Specific FCE tests for work demands of a specific job
- Must have very good idea of the work demands to be assured of a reliable and valid result
- Suggest that a ‘job description’ suuplied by HR is NOT adequate
- As a Physio, try and assess the job demands yourself
- Ideal means of understanding the processes
- Allows the evaluator to understand all the essential demands of the job
25
What are the 20 physical demands assessed (job factors) for FCE?
1. standing
2. walking
3. sitting
4. lifting
5. carrying
6. pushing
7. pulling
8. climbing
9. balancing
10. stooping
11. kneeling
12. crouching
13. crawling
14. reaching
15. handling (seizing, holding, grasping, turning)
16. fingering (picking, pinching)
17. feeling (size, shape, temperature, texture)
18. talking
19. hearing
20. seeing (acuity, depth perception, field vision, accommodation, color vision).
26
What does the whole job physical summary look like?
Rare: \<5%
Occasional: \<33%
Constant :\>66%
27
What are 7 characteristics of **safety and lifting** of FCE?
1. What is a safe lift?
2. Should you show someone safe lifting prior to testing?
3. Should you stop someone from lifting in a way you perceive to be unsafe?
4. What about other actions such as stooping, reaching overhead, reaching forward, crawling?
5. At what load or weight should I stop the participant?
6. Is 40kgs too heavy for a participant to lift?
7. What are the ‘rules’ regarding lifting ?
Get them to do the patient does movements? (unless unsafe --\> then STOP)
Look at the movement rather than the weight carried (when observing)
* Might bias (be blinded)
28
What are 5 **signs of fatigue** of FCE?
1. Biomechanical slowing
2. Accessory muscle usage: Recruitment of accessory muscles (ie. SCM, Traps)
3. Sliding the load over self or using lower extremity to push or nudge the load
4. Using the lower extremity to nudge the load from the floor to a shelf.
5. Trembling or muscle fatigue:
6. Tremulousness as evidence muscle fatigue
29
What are 3 characteristics of "Determining End-points of Performance"?
1. **Physical / Biomechanical**: asymmetrical postures, muscle tremors, changes in cadence, loss of control, load controlling person- At risk of injury
2. **Physiological**: heart rate and blood pressure eg HR≥ 85% max HR; \>70% if on beta blockers
* Submaximal test --\> FCE
3. **Psychophysical**: pain intensity, fear of movement/(re)injury, pain behaviours person identifies their own limits
30
What is important about Cognition, Distraction and Motor Dexterity in FCE?
31
WHat are 4 characteristics to "Get The Best Outcome" (5) in FCE?
1. Much of the participant behaviour is reflected by your behaviour
2. Remember – you are assessing not treating!
3. To obtain the best results,
1. You must believe in the value of the FCE
2. Be well organised
3. Be confident
4. Always remain in control of the assessment
5. Accurate assessment of function as an indicator of recovery from a work-related injury is dependent on a patient’s
Need to be encouraging, give good feedback, look confident (while letting patient know you are not treating patient)
1. willingness to exert maximal effort during the evaluation
2. Word the report in relation to the purpose of the report
32
What are 7 characteristics of the **consistency in performance** in FCE?
1. FCE results
2. Physiological Function
3. Distracted Function
4. Clinical Function
5. Normative data – Grip strength
6. ADL reports (L flexion impossible yet can make bed)
7. \*Waddell's non-organic signs (3 or more +ve signs is clinically significant)
33
What are 4 characteristics of "not judging pre-maturely" of FCE?
1. Need a methodology to standardise test results and to assist with collation of results
2. Cannot just rely on observations
1. Pain ratings
2. Perceived exertion
3. Heart Rate (safety)
4. Manual handling technique
5. Pain behaviours
6. Physical responses
3. Does everything add up?
4. Is it Pass / Fail?
Do not be bias from past information
34
What are 6 characteristics of **sincere/insincere effort** in FCE?
1. Be careful of the legal liabilities and language used
2. Little evidence that we can detect ‘malingering’ or judge ‘insincerity’
3. Look for inconsistencies and non-symptomatic behaviours
4. Often behaviour is based around fear of pain
5. Submaximal performance is often related to issues other that the direct result of the injury and is common
6. FCE always uses non discriminatory language but can define whether the limits are from a physical or non physical ‘barrier’
35
What are 9 characteristics of the FCE report?
1. Word this VERY CAREFULLY
2. Direct toward the purpose
3. Participant's overall level of work – sedentary to very heavy
4. Abilities on specific tasks
5. Tolerance for an 8-hr day
6. Level of cooperation or sincerity of effort
7. Comparison of current abilities with job demands
8. Conclusion
9. Recommendations
36
What are 5 characteristics of the FCE?
Functional testing
1. provides an essential dimension to most aspects of physiotherapy
2. provides a means of both qualitative and quantitative measures to skill levels
3. encompasses and strengthens our clinical skills
4. opens up many vocational pathways to further explore our professional lives
5. Provides a valuable service to the community
