Posted by Sandy Goldstein on Mon, Jun 20, 2011 @ 03:32 PM
A strong indication of case management gone wrong, is how many days a worker is on modified duty. The number of days a worker is performing modified duty needs to be managed by the return-to-work team, typically comprised of a physical or occupational therapist, a return-to-work coordinator and the worker's supervisor. 
We have known for a long time that "work is therapy" and that workers' job tasks can be reassigned in a progressive manner, simply by adding more physically demanding job tasks as the worker heals. The primary goal is to bring the worker back to full duty with no restrictions as safely and efficiently as we can. The secondary goal is to identify potential ergonomic adaptations that may be effective in preventing an exacerbation or reaggravation of the worker's condition.
A visit by the work site team can yield extraordinary results
In order to progressively reassign job tasks, we have to first determine what the job tasks are. Often times, a simple work site visit by the return-to-work team can provide detailed job task information that can be used to determine the best route to take to progress the worker back. More often than not, this team is led by a physical or occupational therapist that has expertise in occupational health and knowledge in how to make ergonomic adaptations at the work site.
Once the detailed job task information is determined, the therapists can now develop functional tests that are specific to the physical demands of the job. This information can provide a baseline of the worker's function prior to returning to work. This way, the worker can be retested each week, and job task progression decisions can be made using real-time functional data regarding the worker's improvements in function.
Return to the same job, same employer is the primary goal. By providing weekly functional tests that are specific to the physical demands of the job, workers are able to return more efficiently and safely.
Sandy Goldstein, PT, CDMS is the principal of Sandy Goldstein & Associates based in Scottsdale, Arizona. He has developed hundreds of formalized return to work programs for employers including Burger King, Kent State University, Western Reserve Historical Society, Subway, and McGraw Hill, to name a few. His specialties include functional testing, development of fitness-for-duty and return-to-work programs and injury prevention. He can be reached at sgoldstein@measurabilities.com or www.measurabilities.com.
Posted by Sandy Goldstein on Thu, May 12, 2011 @ 07:46 AM
I will never forget the time I was taking a history from an evaluee during a Functional Capacity Evaluation. This 50-something-year-old male had suffered a compression fracture of his thoracic spine eight years prior. After surgery and extensive physical rehabilitation, he was declared maximum medically improved with permanent restrictions.
He was not tested; rather his physician gave him a note stating he should not lift more than 20 lbs. The note had no timeline associated with it, and no follow up was scheduled. My evaluee literally folded up the note, placed it in his wallet, and ceased working as a plumber.
He left his career of nearly 25 years. For the subsequent eight years he was “unable to perform his past work as a plumber,” he had been on Social Security Disability and was seeking vocational assistance.
Functional testing I performed revealed he could safely lift 50 lbs. Based on a reasonable degree of medical and ergonomic certainty, I concluded that he could have likely worked as a plumber all along.
A lesson to all medical, vocational, and human resources professionals: The advantages of going the extra step and using objective functional testing to assess function and fitness-for-duty cannot be overstated.
Research supports that job-specific testing is superior to functional estimates by a physician outside of the workplace.
The well-known research study Comparing self-report, clinical examination and functional testing in the assessment of work-related limitations in patients with chronic low back pain, 2005, (Disab and Rehabilitation, 2005 Sep 2;27 (17): 999-1005) showed the importance of actually testing subjects.
The researchers, Brouwer et al, concluded that that limitations derived from the clinical examination were higher than those derived from Functional Capacity Evaluation.
With our clients’ lives and livelihoods at risk, I strongly advocate objective functional and fitness-for-duty testing. Not because it is my line of work; it‘s simply the right thing to do.
Ethically and legally, we medical, vocational and human resources professionals owe it to our clients to not cut corners when assessing function and fitness-for-duty.
When objective testing is performed, the results provide evidence-based information on which stakeholders can rely to place a worker into a specific job, or at least, to specific job tasks.
Posted by Sandy Goldstein on Mon, Apr 18, 2011 @ 07:11 AM
A recent entry by Jack Richman MD, CCBOM, FACOEM, FAADEP, CIME on the Work Fitness & Disability Roundtable reminds us of the dramatic difference that experience, individual circumstances, motivation and adaptation can make when determining fitness-for-duty and return-to-work decisions.
Dr. Richman's story highlights the fact that many workers with impairments that we may consider disabling are not to the experienced and well motivated worker who adapts well to their circumstances.
His particular story is about visual impairment. In Ontario where the doctor practices, in order to drive, the vision in the best eye need only be 20/40 and so an individual can be blind in the other eye and still drive.
Dr. Richman once passed a Driver Instructor to continue working where he instructed at a skid school for over 25 years. The worker had developed diabetic retinopathy and was 20/200 in both his eyes and he could only see shapes and images. The worker begged Dr. Richman to let him continue working.
Dr. Richman felt bad for the worker and said only if he went out with him on the skid school and saw him perform with Dr. Richman as the passenger. Dr. Richman stated that he was absolutely positive the worker could not do a specific maneuver which required that the worker immediately react at an intersection when a sudden spill of oil occurred and the car went into a rapid spin.
The instructor position requires that the worker demonstrate to the student how to steer and maneuver the vehicle using the right amount of steering and brake and come to a complete stop on a predetermined mark within a second or two.
Well, when the vehicle hit the oil slick, the worker did the 180 and then brought the vehicle right back to where he had to, within an inch of the required spot.
Dr. Richman summarized, "after I cleaned myself up, I passed him". He further explained, "I do remember the fear I experienced placing myself in the hands of a virtually blind driver. I then realized he had been doing this several times a day 5 days a week for over 25 years and it was nothing to him. I could not do it and I could see fine".
Dr. Richman points out that he often gives his patients a trial of work and then judges based on their work performance. He adds, "the great majority do well and remain good productive members of society -- better than being on a small disability pension".
Dr. Jack Richman works in Canada for AssessMed Inc.
Posted by Sandy Goldstein on Tue, Apr 12, 2011 @ 07:50 AM
Sandy Goldstein & Associates is excited to announce the addition of our newest associate.
Kara Rice, MOT, CEAS-II, CKTP, CPI is Licensed Occupational Therapist, a Certified Ergonomic Assessment Specialist, Certified Kinesiotaping Practitioner, and Certified Pilates Instructor. She completed her Bachelor’s degree in Kinesiology from the University of Illinois, Urbana-Champaign. Kara completed her Masters in Occupational Therapy from Midwestern University, Downers Grove, IL in December 2004. She has spent her career specializing in neurological rehabilitation and orthopedic rehabilitation with interest and involvement in occupational health rehabilitation. She continues to advance her career with current education in Functional Capacity Evaluations and Ergonomics. She is an adjunct faculty instructor at Brown Mackie College in Phoenix, AZ. She began working with SG&A in March 2011 performing Functional Capacity Evaluations, Ergonomic Assessments, Job Analyses and Worksite Based Rehabilitation Interventions.
Ms. Rice can be reached at krice@measurabilities.com
Posted by Sandy Goldstein on Mon, Feb 07, 2011 @ 07:13 AM
Physical and occupational therapists and case managers with expertise in the stay-at-work/return-to-work (SAW/RTW) process often bring a valuable perspective to the team effort required for successful continued employment.
Expert in transitional work therapies, Sandy Goldstein PT, CDMS, offers best practices for helping employees return to work – or continue working – by utilizing an effective return-to-work strategy.
Help employees retain employment despite illness or injury
By Sandy Goldstein PT, CDMS of Sandy Goldstein & Associates
Often, a communication gap exists between the medical office and the employer when an injury or illness prevents full-duty work reintegration. The medical office is typically juggling the ball presuming “the stay-at-work/return-to-work (SAW/RTW) process is not a medical issue.”
On the other hand, the employer is also juggling the ball presuming, “the SAW/RTW process is a medical issue.” The typical result is delay and uncertainty with subsequent needless work absence, job loss, and even permanent withdrawal from the workforce. 
Best practices in either keeping employees working or returning employees to work include utilizing an effective return-to-work strategy. This can have a win-win-win effect on all stakeholders as follows:
- For the employee prevents disruption of daily life, career, image.
- For the employer prevents reduction in productivity and helps avoid unnecessary expense.
- For the economy prevents waste, fraud, and corruption.
There are six basic steps to help an employee return to work after a work-related (or non-work related) injury or illness.
Step 1. Contact the employee and start the interactive process.
Step 2. Define the "essential functions" and usual duties of the employee's job.
Step 3. Obtain the employee's current "functional capacity" and compare to his/her current restrictions.
Step 4. Explore ways to accommodate the employee's injury or illness.
Step 5. Decide on a reasonable accommodation and make an offer of work.
Step 6. Once working, monitor and assess the employee's progress and reduce or remove restrictions as his/her condition improves.
Research shows that employers benefit from providing accommodations for employees with disabilities, far outweighing the costs.
Collaboration between physical and occupational therapists with expertise in occupational health, physicians, employers, employees, and case managers can facilitate effective ways to accommodate work- or non-work related injuries and illnesses. It will also contribute to the health, well-being, and equal opportunity in employment for our workforce and society.
Sandy Goldstein & Associates are experts at providing transitional work therapy services. The services primarily focus on using the injured worker's functional work tasks to progress the worker to a target job. Progressive conditioning, therapeutic exercises, training in safe work practices such as proper body mechanics and other work-site services may also be used as part of the therapeutic program developed for that injured worker. For more information, contact Sandy Goldstein PT, CDMS @http://www.measurabilities.com/consulting/transitional-work-therapy-services/
Posted by Sandy Goldstein on Wed, Jan 19, 2011 @ 06:57 PM
I read an interesting posting recently on the Webility Disability Roundtable regarding human motivation and return to work. It was posted by a fellow Functional Capacity Evaluator out of Vancouver, BC named Brent Armstrong.
Brent had just completed a Functional Capacity Evaluation on an individual with a diagnosis of "low back strain". He had a difficult time getting this person motivated to complete the necessary testing let alone getting him interested in returning to his job or to life as a whole. Brent did his best to coach the evaluee to attend a local college to speak with a job counselor.
As Brent left the clinic to get a cup of coffee he saw a fellow with no arms or legs, sitting in a wheelchair and propelling himself along the sidewalk with two crutches that were strapped to his shoulder blades! He stopped to speak with him and asked where he was off to. The gentleman replied "to work".
The human spirit is truly amazing. The professional literature typically shows a weak relationship between impairment and disability. It's not what you have; it's how you deal with it which in turn is a result of a lot of factors.
That is why it is so important to have injured or ill employees assessed by qualified disability management specialists, occupational or physical therapists that specialize in dealing with the multidisciplinary aspects of stay-at-work and return-to-work. Often, impairments may seem limiting on the surface, but end up not posing any disruption to work function.
Sandy Goldstein & Associates are "Physical Abilities Measurement Experts" for individuals, attorneys, physicians, case managers, claims adjustors, employers or anyone else that is trying to measure an individual's ability to work. Physical abilities can and should be measured for Social Security Disability, Short Term Disability, Long Term Disability, Personal Injury, Workers' Compensation and Vocational Case Management cases.
Posted by Sandy Goldstein on Mon, Jan 10, 2011 @ 07:07 AM
A Functional Capacity Evaluation (FCE) is the objective measurement of a person's ability to perform functional work activities.
Anytime someone is attempting to determine a person's ability to work, functional testing deepens the available medical information and provides useful information to assist with:
Whenever a determination is needed for vocational planning and employment, the FCE is the exam of choice and can provide valuable information regarding:
- Can the individual return to past work?
- Can the individual return to other work?
- What type of jobs can the individual perform?
- What is the individual's rehab potential?
- What is a reasonable transitional return-to-work plan for the individual?
The FCE is performed as a one-to-one examination typically for up to 4 hours. 2-day exams may be appropriate when trying to determine the effect of chronic pain conditions on function.
The FCE is considered an important part of the return-to-work or disability determination process. When used appropriately, it interfaces with information from many professionals on the return-to-work team and can be an important component of the return-to-work process (Isernhagen, 2009).
References:
Introduction to Functional Capacity Evaluation. In Genovese E, & Galper S. Guide to the Evaluation of Functional Ability. USA: AMA; 2009
Posted by Sandy Goldstein on Mon, Jan 03, 2011 @ 03:33 PM
The below blog posting was originally posted at 6:52 AM on July 28th, 2010 by Dennis Westlind on Stoel Rives World of Employment.
Yesterday the Ninth Circuit Court of Appeals issued a decision approving of an employer's use of a "preemptive" fitness for duty examination for an employee who exhibited bizarre and erratic behavior in the workplace, even though that behavior had not yet impacted his job performance. Click here to read the full opinion in Brownfield v. City of Yakima.
In Brownfield, a police officer was ordered to undergo a fitness for duty examination after he displayed several strange behaviors in and out of the workplace: swearing at and arguing with another officer, becoming upset after a child teased him during a traffic stop, domestic violence at home, and making vague suicidal comments . The City required Brownfield to undergo a fitness for duty examinations to determine whether he could perform police duties. When Brownfield refused, the City terminated him. Brownfield sued, alleging the City violated the Americans with Disabilities Act ("ADA") by unlawfully requiring a fitness for duty examination.
The Ninth Circuit held that the City did not violate the ADA by requiring the fitness for duty examination. Under the ADA, an employer may not require a fitness for duty examination "unless such examination ... is shown to be job-related and consistent with business necessity." The Ninth Circuit rejected Brownfield's argument that the examination could not be job-related unless the City showed Brownfield's job performance was affected by his behavior. Rather, the court held that a "propyhlacitc psychological examination" following an employee's erratic behavior may be job-related and satisfy the business necessity standard even though job performance is not impacted.
When can an employer order an employee who is behaving erratically to undergo a fitness for duty examination? In Brownfield, the Ninth Circuit adopted a "reasonable person" standard: the employer can order the examination when faced with "significant evidence that could cause a reasonable person to inquire as to whether an employee is still capable of performing his job." The court also warned against overuse of such examinations, however: "an employee's behavior cannot be merely annoying or inefficient to justify an examination; rather, there must be genuine reason to doubt whether that employee can perform job-related functions."
Brownfield will give employers in the Ninth Circuit greater leeway in addressing an employee's erratic behavior. Before ordering such an examination, however, employers should consider whether the behavior could raise a serious question of whether the employee can still perform the essential functions of his job. Overuse of such examinations could lead to meritorious discrimination claims.
Sandy Goldstein, PT, CDMS provides stay-at-work/return-to-work consulting services. He can be contacted at 480-285-6212 or sanfordgoldstein@hotmail.com to discuss your company's absence management strategy.
Posted by Sandy Goldstein on Wed, Sep 22, 2010 @ 07:46 AM
Press Release: Contact Paul Larson: 847-475-1283
Guide to High-Value Physician Services Seeks to Increase Best Practices
and Improve Health Outcomes in Workers’ Compensation
(Sept. 20, 2010) The American College of Occupational and Environmental Medicine (ACOEM), working in partnership with the International Association of Industrial Accident Boards and Commissions (IAIABC), has released a guide to help employers and employees, insurers, regulatory agencies and others in the workers’ compensation system identify the best available physicians to provide care for people who have suffered work-related injuries and illnesses.
Titled “A Guide to High-Value Physician Services in Workers’ Compensation: How to find the best available care for your injured workers,” the multi-page document provides practical advice, checklists and other resources and tools to help identify physicians who adhere to best practices and are most likely to provide the best medical outcomes when treating workers’ compensation patients.
“Most participants in the workers’ compensation system want to direct workers to high-quality medical care, but rarely have access to accurate and comprehensive data about physician practice patterns,” said ACOEM Executive Director Barry Eisenberg. “This guide provides a practical alternative – a methodical approach that helps them ask the right questions and find the information they need to ensure excellent care.”
Included is advice for identifying potential candidates, checking credentials and other criteria, learning about a physician’s practice style and general approach to care, and evaluating relevant clinical performance metrics. The guide includes tips for building a long-term relationship with physicians, including a periodic review process.
The guide is a synthesis of ideas and best practices contributed by a multi-stakeholder group of workers’ compensation system experts – practicing physicians, employers, insurers and regulatory agencies -- in a summit convened by ACOEM and IAIABC earlier this year in Nashville, Tennessee. The meeting is one of several steps ACOEM and IAIABC are undertaking together to raise awareness of issues in worker’s compensation that are diminishing the quality of medical care for injured and ill workers and negatively impacting employers.
Statistics show that workers’ compensation medical costs per claim are rising much faster than medical costs in general and faster than indemnity costs per claim. Despite the rise in costs, health outcomes within the workers’ compensation system, according to several major studies, are often worse than those obtained under other benefits systems. Studies also show there are inefficiencies in care delivery in the system and a lack of incentives for medical providers to promote effective, efficient and outcomes-oriented treatment as they diagnose and care for injured and ill workers.
“It is our hope that resources such as this guide will encourage workers, employers, insurers and others to increasingly seek out the physicians who are most likely to deliver the best care outcomes, and in the process help drive overall improvement in the workers’ compensation system,” said IAIABC Executive Director Greg Krohm.
Free copies of the guide are available for downloading at the ACOEM website (www.acoem.org) and the IAIABC website (www.iaiabc.org). At the IAIABC website, go to the “News” section.
About IAIABC
The International Association of Industrial Accident Boards and Commissions is a not-for-profit association representing most of the government agencies charged with the administration of workers’ compensation systems throughout the United States, Canada, and other nations and territories as well as other workers’ compensation professionals in the private sector. Its mission is to advance the efficiency and effectiveness of workers’ compensation systems throughout the world. It is governed by an Executive Committee of jurisdictional agency leaders, and maintains a staff headquarters in Madison, Wisconsin, USA. For more information, visit www.iaiabc.org.
About ACOEM
The American College of Occupational and Environmental Medicine (ACOEM) represents nearly 5,000 physicians specializing in occupational and environmental medicine. Founded in 1916, ACOEM is the nation’s largest medical society dedicated to promoting the health of workers through preventive medicine, clinical care, disability management, research, and education. For more information, visit www.acoem.org.
Posted by Sandy Goldstein on Fri, Aug 27, 2010 @ 04:02 PM
On-Site Transitional Work Therapy is provided by a Physical Therapist (PT) to an injured worker early in the rehabilitation process to facilitate a safe and efficient return-to-work. It is frequently an overlooked, but crucial step in the recovery of an injured worker.
On-Site Transitional Work Therapy is provided at the work site. The services primarily focus on using the injured worker’s functional work tasks to progress the worker to a target job. Progressive conditioning, therapeutic exercises, training in safe work practices such as proper body mechanics and other work-site services may also be used as part of the therapeutic program developed for that injured worker. The services should be provided within a specified time limit which is usually determined by the employer’s overall Return-to-Work program guidelines.
On-Site Transitional Work Therapy services are separate and distinct from Occupational or Physical Therapy services provided at a clinic. The services are no longer required once the injured worker has successfully been transitioned back to full-time, regular duty without restrictions.
Too frequently, the current clinic based model leaves a broad mismatch between the physical demands of the injured worker’s target job and their functional capacity to perform the work.
On-Site Transitional Work Therapy offers earlier attention to job demands, provision of materials handling equipment and training in safe work methods that can expedite recovery and return the injured employee to regular duties sooner by lowering job demands and reducing the job risk factors contributing to ongoing complaints. This just DOESN’T HAPPEN in the clinic.
It’s important to remember, traditional medical treatment such as surgery, clinic based physical therapy and work conditioning can only address the worker ability, which is half of the wellness equation. On-Site Transitional Work Therapy “seals the deal” by solving the ergonomic risk factors that prevent full recovery.
Sandy Goldstein& Associates are experts at providing transitional work therapy services. The services primarily focus on using the injured worker's functional work tasks to progress the worker to a target job. Progressive conditioning, therapeutic exercises, training in safe work practices such as proper body mechanics and other work-site services may also be used as part of the therapeutic program developed for that injured worker. For more information, contact Sandy Goldstein PT, CDMS @http://www.measurabilities.com/consulting/transitional-work-therapy-services/