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- Static Strength Leg test- coefficient of variance for grip strength on the L
Mr Doe exhibited consistent effort with spinal inclinameter testing for flexion, extension, and (B) side bend, Jamar hand gripfor bell shaped curve, CV's for (R) grip strength, hand strength between the norms, comparison of functional performancewith 1 and 2 hand lifting, 2 hand occasional and frequent lifting, etc.
Reliability of Pain
Reliability of PainReliability of Pain testing is performed to determine whether this clientʼs pain reports can be considered as limiting factorsduring functional testing. The following evidence based items were tested as unreliable pain reports:- Score of 3 on Waddell's Non-Organic Signs- Score of 35 on McGills Pain Questionaire
Other testing that revealed reliable pain reports include: Ransford Pain Drawing, Oswestry, correlation of the client'sperceived exertion and his heart rate on all occasional material handling, frequent material handling, and job simulation. Theevidence of attempting all tasks and presence of clinical objective findings to support the reason for stopping.
Joseph Smith, M.D., Barb Smith and U.S. Customs Patrol, thank you for the opportunity to work with your client. If I can beof assistance in interpreting the aforementioned data regarding this Functional Capacity Evaluation, please feel free tocontact me at:
OccuPro - Woodstock1118 N. Seminary AvenueWoodstock, IL 60098(815) [email protected]
Sincerely,
John Q Sample, MS, OTR/L
John Doe Functional Capacity Evaluation, March 13, 2015
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John Q Sample, MS, OTR/L
Movement Description Range
Lumbar Flexion (60º) T12 ROM 70 70 40 70 70
Sacral ROM 10 10 10 10 10
Lumbar Flexion Angle 60 60 30 60 60
+-10% or 5 Yes
Maximum Lumbar Flexion Angle = 60 % Impairment
Lumbar Extension (25º) T12 ROM 30 32 29
Sacral ROM 5 7 6
Lumbar Extension Angle 25 25 23
+-10% or 5 Yes
Maximum Lumbar Extension Angle = 60 % Impairment
Straight Leg Raising (SLR), Left Left SLR 20 20 20
+-10% or 5 Yes
Straight Leg Raising (SLR), Right Right SLR 20 20 20
+-10% or 5 Yes
Straight Leg Raising (SLR), Validity Motion at Midsacrum 15 17 16
SLR Validity No
Maximum Midsacral Motion 17
Lumbar Left Lateral Bending Angle (25º) T12 ROM 30 30 30
Sacral ROM 5 5 5
Left Lateral Bending Angle 25 25 25
+-10% or 5 Yes
Maximum Left Lateral Bending Angle = 25 % Impairment
Lumbar Right Lateral Bending Angle (25º) T12 ROM 30 30 30
Sacral ROM 5 5 5
Right Lateral Bending Angle 25 25 25
+-10% or 5 Yes
Maximum Right Lateral Bending Angle = 25 % Impairment
Spine Musculoskeletal TestingUsing spinal inclinameter, client displays 30 degrees of trunk flexion (60 degress WNL's), 10 degrees of extension (25degrees WNL's), and 15 degrees (L) SB and 20 degrees of (R) SB (25 degrees WNL's).
Special Tests: dural stretch, ASIS compression and distraction, lumbar compression & distraction, (B) Kernig, Laseque,Fabere, SI provocation, backward & forward torsion, and hip provocation.
Consistency of Effort
Consistency of EffortConsistency of Effort is determined based on this client demonstrating consistent or inconsistent biomechanical,observational, and evidence based consistency of effort criteria. The following items were deemed to be inconsistent duringthis assessment:- right five span grip strength testing inconsistencies secondary to higher right rapid grip exchange results- left five span grip strength testing inconsistencies secondary to higher left rapid grip exchange results- Static Strength Arm test- Static Strength Push test
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Client Abilities in this Evaluation Physical Demands Gathered FromOn-Site Job Demands Analysis Job Demand Match?
Repetitive Kneeling Occasional Occasional Yes Walking Occasional Frequent No
Forward Reaching Constant Constant Yes Above Shoulder Reaching Frequent Occasional Yes
Climbing
Stair Climbing Occasional Occasional Yes Static Balance Occasional Occasional Yes
Dynamic Balance Occasional Occasional Yes
Job Specific Testing
Suspect Tackling Avoid Occasional No Sprinting Occasional Occasional Yes
Fence Climbing Occasional Occasional Yes
Basic Diagnostics
Medical History and Present Status
History of Present ConditionMr. John Doe is a 43 y.o. (R) dominant Police Officer who reportedly sustained a work-related injury to his low back on10/05/13 while lifting a heavy box at the station. He stated that "I thought I just pulled a muscle and it would go away". Theclient went to see his primary care physician, Dr. Tee, who ordered physical therapy for 3 months. In January, 2014, anMRI was ordered that revealed a herniated disc at L4-L-5. The client was then referred to a specialist, Dr. Smith, whomordered a CT scan and performed a series of three steroid injections in conjunction with physical therapy from March toJune, 2014. In July, 2014, the client underwent a lumbar fusion L4-L5. He participated in physical therapy and workhardening program for a total of 5 months. He does not participate in therapy at this time.
Musculoskeletal Testing
Lumbar Range of Motion (Inclinometric)
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accurate representation of this client's overall physical capabilities. The functional results of this evaluation represent aminimal level of functioning for this client. During objective functional testing, the items that were inconsistent resulting inself limiting behavior/sub-maximal effort included range of motion inconsistencies, muscle testing inconsistencies, righthand grip strength inconsistencies, left hand grip strength inconsistencies, right five span versus right grip inconsistencies,right grip strength testing inconsistencies secondary to higher right rapid grip exchange results and biomechanicalinconsistencies during floor to waist lifting.
Reliability of Pain RatingsThroughout objective functional testing, this client reported reliable pain ratings 89.3% of the time which would suggest thatpain could have been considered a limiting factor during functional testing.
Recommendations
Return to Work RecommendationsBased on the results of objective functional testing this client demonstrated the ability to return to work on modified/lightduty within the functional abilities outlined in this report over the course of 4 weeks until follow up with physician.
Summary
Limiting Factors Noted During TestingDuring this evaluation, the client was unable to achieve 100% of the physical demands of their job/occupation and thelimiting factors noted during these objective functional tests include: compensatory techniques, evaluator stopped, generalfatigue, heart rate exceeds aerobic limiter, increased pain, maximum effort, mechanical changes, mechanical deficits andsubstitution patterns.
Assessment Purpose / Reason for ReferralMr. John Doe is being referred for a Job Specific Functional Capacity Evaluation to determine his feasibility to return towork as a Police officer, and to determine whether there are physical barriers that may exist which prevent him fromreturning to work.
Job Demands Match Table
Client Abilities in this Evaluation Physical Demands Gathered FromOn-Site Job Demands Analysis Job Demand Match?
Material Handling
Occasional Squat Lift 55 Pounds 75 Pounds No Frequent Squat Lift 20 Pounds 50 Pounds No
Occasional Power Lift 50 Pounds 75 Pounds No Frequent Power Lift 25 Pounds 50 Pounds No
Occasional Shoulder Lift 25 Pounds 30 Pounds No Occasional Overhead Lift 15 Pounds 20 Pounds No Occasional Unilateral Lift 25 Pounds 25 Pounds Yes Occasional Bilateral Carry 40 Pounds 50 Pounds No Frequent Bilateral Carry 20 Pounds 25 Pounds No
Occasional Unilateral Carry 20 Pounds 25 Pounds No Frequent Unilateral Carry 10 Pounds 10 Pounds Yes
Occasional Pushing 50 HFP 75 HFP No Occasional Pulling 45 HFP 75 HFP No
Upper Extremity
Gross Coordination Constant Constant Yes Fine Coordination Occasional Occasional Yes Simple Grasping Constant Constant Yes Firm Grasping Frequent Frequent Yes
Pinching Frequent Occasional Yes
Non-Material Handling
Bending Avoid Frequent No Squatting Occasional Frequent No
Sustained Squatting Avoid Occasional No Sustained Kneeling Occasional Occasional Yes
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Functional Capacity EvaluationClient: John DoeGender: Male
Date of Birth: 5/14/1962
Evaluation Date: 03/13/2015
Diagnosis: S/P L4-L5 Fusion
Referring Dr.: Joseph Smith, M.D.
Other Doctors: Don Tee, M.D.
Case Manager: Barb Smith
Employer: U.S. Customs Patrol
Occupation: Police Officer
Job Title: Law Enforcement Officer
Date of Injury: 10/5/2013
SurgeryDate(s):
7/12/2014
Evaluator: John Sample, MS, OTR/L
Results
Material Handling AbilitiesBilateral Lifting: 50 poundsFrequent Bilateral Lifting: 25 poundsBilateral Carrying: 40 pounds
Bilateral Shoulder Lifting: 25 poundsPushing: 50 horizontal force poundsPulling: 45 horizontal force pounds
Functional Abilities to Job Demands MatchThis job specific evaluation was performed in a 100% kinesiophysical approach and this client demonstrated the ability toperform 76.8% of the physical demands of their job as a Police Officer. The return to work test items this client was unableto achieve successfully during this evaluation include: Occasional Squat Lifting, Frequent Squat Lifting, Occasional PowerLifting, Frequent Power Lifting, Occasional Shoulder Lifting, Occasional Overhead Lifting, Occasional Bilateral Carrying,Frequent Bilateral Carrying, Occasional Unilateral Carrying, Occasional Pushing, Occasional Pulling, Bending, Squatting,Sustained Squatting, Walking and Suspect Tackling.
Client/Occupation Physical Demand CategoryClient demonstrated the ability to perform within the MEDIUM Physical Demand Category based on the definitionsdeveloped by the US Department of Labor and outlined in the Dictionary of Occupational Titles. It should be noted that thisclient's job as a Police Officer is classified within the HEAVY Physical Demand Category.
Consistency of EffortDuring objective functional testing, this client demonstrated consistent effort throughout 56.5% of this test which wouldsuggest significant observational and evidenced based contradictions resulting in consistency of effort discrepancies,self-limiting behaviors, and/or sub-maximal effort. The overall results of this evaluation do not represent a true and
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Functional Capacity Evaluation ServiceA FCEs primary purpose is to determine individual’s functional abilities and limitations in the context of a safe environment while focusing on productive work tasks.
The service we provide is a valuable tool in assessing an employee’s safe working abilities and/or establishing baseline abilities for disability evaluations.
Our FCE correlates a client’s functional abilities to the essential physical demands of their job to determine whether they meet these physical demands.
Consistency of effort and reliability of pain ratings are important elements of our evaluation, which is why over 70 separate criteria throughout the FCE help determine if a client is putting forth consistent effort and whether their subjective pain ratings are reliable.
Additionally, the Functional Capacity Evaluation testing method we use has consistently stood up in a court of law with reliability and validity research to support the testing method.
FUNCTIONALCAPACITY EVALUATION
Software and Report Benefits
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• Considered the best and easiest-to-read FCE reports on the market
• Most important information appear on the first pages of the report
• Can easily perform workers’ compensation, disability and personal injury FCEs
• The latest FCE research is incorporated into our testing so you know your findings will stand up to legal scrutiny
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