Transcript EVALUATION OF FCE FROM WORK DEMANDS PERSPECTIVE

EXERCISE FOR
OPTIMIZATION OF WORK
PERFORMANCE AND
OCCUPATIONAL
REHABILITATION
WORK DEMANDS
Physical Task
Demands
Work Content
Mental Task
Demands
Required
Qualification
Processor
Physical
Environment Demands
Non-physical
Environment Demands
Work
Context
Job placement assessment Job Modification
Work
Demands
Education &
Training
Workers’
Qualification
Work
Conditioning
weight of load
lifting/
lowering
repetition
carrying
horizontal
distance
pushing/
pulling
Object
Handling
Demands
Physical Demands
height of
lift/lower
Work
other
Content
duration
Extremity-Postural
Demands
Mental Demands
twisting angle
Work Demands
Physical Environment
Work
Non-Physical
Environment
Context
Seating
Standing
Walking
Kneeling
Squatting
Extremity postural
Demands
One-legged
Crouching
Crawling
Climbing
Others
Repetitive work
Body segment
Force and Posture
Static work
Seating
Standing
Walking
Dynamic work
Kneeling
Squatting
One-legged
Extremity postural
Demands
Crouching
Crawling
Climbing
Others
Static
Aerobic
Physical Fitness
Energy
System
Anaerobic
Circulatory Function
Cardiorespiratory
System
Heart Function
Respiratory Function
Flexibility
Neuromuscular
System
Body
Composition
ROM
Joint
Muscular
Neural
Fat Mass
Fat-free Mass
Tissue
Stress
Strain
Biomechanical
Physiological
Psychological
Disorders
TISSUE RESPONSES TO PHYSICAL STRESSORS
Load
Response
Symptoms
Adaptation
Impairment
Disability
TYPICAL PHYSICAL WORK
DEMANDS OF TEACHER

Standing
WORK RISK FACTORS OF
PROLONGED STANDING
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Circulation
Muscle fatigue
Joint compression
Develop and improve:
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Strength
Endurance
Cardiovascular fitness
Work
Mobility
Demands
Flexibility
Stability
Co-ordination, balance and functional
skills
LOW BACK DISORDERS AS
AN EXAMPLE FOR
PHYSICAL ACTIVITIES
Introduction

Low back pain is the most common workrelated msuculoskeletal disorders, and cause
most socio-economical burden.

LBP claims account for 16% of all workers
compensation claims and 33% of total
claims costs (Bernard et al., 1997)
Definition

Prevalence
 percentage of people in a certain
population who suffer from the condition
concerned

Point Prevalence
 percentage who are found to be suffering
at a certain moment in time ( i.e. when
the survey is conducted)
LBP Prevalence

About 70% of people will suffer from one
or more episodes of LBP at some time or
another during their lives
Bernard 1997
PREVALENCE OF LOW
BACK DISORDERS
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
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Local:
39% in general population (Lau et al., 1995)
58% in a group of manual handling
workers
LBP Natural History

Most episodes of LBP are relatively shortlived (subsided within 6 weeks).

Recurrent rate is very high (60%)
Biering-Sroenson 1983
Sickness Absence

6 months absence: likelihood of returning
to work fall to about 50%

After 1 year absence: 25%
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After 2 years absence: virtually nil
Work-Related Risk Factors

Physical Factors
 Heavy physical work
 Lifting and forceful movements
 Bending and twisting
 Whole body vibration
 Static work postures

Non-physical factors
 Psychosocial factors
Bernard 1997
EFFECTS OF PHYSICAL
ACTIVITIES IN THE PREVENTION
OF LBP

Strong evidence that PA has a primary
preventive effect on LBP
EFFECTS OF PA IN SECONDARY
PREVENTION (Van Tulder et al.,
2000)
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Acute LBP - strong evidence that
exercise therapy is NOT more
effective than inactive treatments or
other active treatments.
Low stress aerobic activity during the
first 2 weeks is indicative to improve
recovery and lessen disability.
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Chronic LBP – strong evidence that
exercise therapy and conventional
physiotherapy are equally effective and
exercise therapy is more effective than
usual care by GP
Strong evidence that strengthening
exercises are more effective than other
types of exercise.
Strong evidence that exercise diminishes
the musculoskeletal and cardiorespiratory
effects
TYPES OF EXERCISE AND
TRAINING PRINCIPLES
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FITT
TYPES: STRENGTHENING
STABILIZER
 ENDURANCE
 STRENGTH
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TYPES: MOBILIZING
EXERCISE TO IMPROVE
LIFTING CAPACITIES
RATIONALE:

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Relationship between the probability of injury
and percentage of strength capacity used by
the worker at work. (Chaffin 1973)
Relationship between the incidence of
firefighter back injuries and level of physical
fitness. 7.1% least fit, 3.2% moderate, 0.8%
most fit (Candy et al., 1979)
EFFECTS OF A FOUR-WEEK
MUSCLE STRENGTHENING
PROGRAM ON MAXIMUM
ACCEPTABLE LIFTING LOAD
Yeung SS. et al., 1998
METHOD
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Subjects= university students (N=19)
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Isokinetic measurements of back extensors,
knee extensors, shoulder abductors, and
elb. Flexors.
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Maximal acceptable lifting load
(psychophysical approach)
TRAINING PROTOCOL
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4 WEEKS OF TRAINING
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LOAD: 80% PEAK TORQUE
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WEEKLY ADJUSTMENT BY 5%
RESULTS
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Significant training effect on MALL and
back extensors
EFFECTS OF SQUAT LIFT
TRAINING AND FREE WEIGHT
MUSCLE TRAINING ON MAXIMUM
LIFTING LOAD AND ISOKINETIC
PEAK TORQUE OF YOUNG
ADULTS
WITHOUT IMPAIRMENTS
Yeung SS., & Ng GYF 2000
METHOD
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36 University Students
Training approach:
1. free weight muscle strengthening program;
2. Task specific training programme; and
3. Control
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RESULTS
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Significant improvement in MALL and
back extensors
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No significant differences between the
training protocol
LOW BACK EXERCISES
FOR LOW BACK
DISORDERS
McGill 1998
OBJECTIVES
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To stress both damaged tissue and
healthy tissues for tissue repair but
avoid excessive loading
Exercises that challenge muscle but
impose minimal joint loads
EXERCISE PRINCIPLES
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Frequency: most beneficial when performed daily
No pain No gain ?
General conditioning exercise is important
Endurance more protective value than strength
Flexibility (mobilizing) should best be performed
at unloaded position
No fixed recipes, exercise should be tailored
made
BACK EXTENSORS
1 leg ext
RA
3.3
EO
8.4
IO
12.0
LD
8.1
TES
5.7
LES
19.7
MF
21.9
Compression 2.3
1 leg/arm
4.0
16.2
15.6
12.0
11.5
28.4
31.5
3.2
prone
4.7
4.3
12.1
11.2
66.1
59.2
51.9
4.3
½ supp
3.1
3.7
12.7
6.5
45.4
57.8
47.5
4.3
BACK EXTENSOR EXERCISE
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Pr lying arch back
½ support back extension
Single leg extension with hand and knee
support
ABDOMINAL EXERCISES
ex
QL
PS
EO IO
TA RA RF
ES
Sit-up (st)
24
44
15
11
48
16
4
Sit-up (kn
12
bent)
Curl up (kn) 11
28
43
16
10
55
14
6
10
19
14
12
62
8
6
SLR
33
26
9
6
37
23
7
12
43
36
39
22
11
24
9
Side support 54
ABDOMINAL EXERCISE
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No single abdominal exercise challenges
all of the abdominal musculature:
Curl-up challenges mainly RA
Sit-ups (leg straight or knee bent) = high
psoas activation and disc compression
Leg raises causes even higher activation
and compression
Isometric side support for QL
OCCUPATIONAL
REHABILITATION


To facilitate a return to work or ensure an
employee remains at work, ideally in his or
her original job
Different terminology:work, industrial,
vocational rehabilitation
DISABILITY MANAGEMENT
Work
Conditioning
FCE
Injury
Acute Mx
Work
Demand
Analysis
Work
Hardening
Work
Modification
FUNCTIONAL CAPACITY
EVALUATION
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Functional:
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Capacity:
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Evaluation:
Meaningful, useful and
purposeful
maximum ability and
capability
Systematic approach
including observation,
measurement, reasoning
and conclusion
FUNCTIONAL CAPACITY
EVALUATION
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Systematic, comprehensive approach
Objective and valid measurements to
predict a person’s ability to perform work
related tasks.
FUNCTIONAL CAPACITY
EVALUATION
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Generic - Baseline Capacity Evaluation
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Job oriented – Job capacity Evaluation
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Usually based on physical demands of DOT
Focus on the match of the worker’s ability to the
work demands of specific job
Worker oriented – Work capacity Evaluation

Determine worker’s capabilities to the basic
demands of earning occupation
APPLICATION



Ensure workers’ health and safety in job
placement (OSHA);
Identify an individual’s physical abilities
and limitations (ADA)
Determine an injured worker wage-earning
potential and return to work abilities
(Insurance company and legal profession)
EVALUATION SYSTEM
COMMONLY USED IN HONG
KONG
FCEs
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ARCON
BLANKENSHIPS
TRACKER
BTE
ERIC
MVE Battery Tests
Non-computerized system
TYPICAL COMPONENTS OF FCES
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Interview – patient information
Job analysis (questionnaire)
Behavioural profile
Physical measures/muscuoskeletal evaluation
Physiological measures
Functional measures
Comparison of testing with job requirements
FUNCTIONAL MEASURES
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Isometric strength test (6 positions)
Material handling test (3 positions)
Frequency of manual handling:
Occasional (0-33%), frequent (34-66),
and constant (67-100%) manual handling
Hand function – hand and pinch grip
Fine hand dexterity
Non-materials handling test
Positional tolerance test
ISOMETRIC STRENGTH TEST
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Arm Lift
Torso Lift
Leg Lift
High Far Lift
Floor Lift
High Near Lift
OCCASIONAL MATERIAL
HANDLING TESTS
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0-33% of the working day, <32 repetitions
Psychophysical approach
Floor to knuckle
Shoulder lift
Overhead lift
Carrying - 30 ft.
Pushing/Pulling - 30 ft.
FREQUENT MATERIAL
HANDLING TESTS
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33-66% of working day or 32-200
repetition per day.
4 lifts in 20 seconds
HAND TESTS
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Maximum Grip Strength Test - Jamar
5-position Grip Test
Rapid Exchange Grip Test
NON MATERIAL HANDLING
ACTIVITIES
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Sitting
Standing
Walking
Bending
Reaching
Squatting
Kneeling
NON MATERIAL HANDLING
ACTIVITIES
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Crawling
Climbing
Balancing
Arm Controls / Leg Controls
ARCON SYSTEM
Blankenshi
p
Valpar
Jmed
ACRON
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Interview
Physical
measures/muscuoskeletal
evaluation
Physiological measures
Functional measures
Comparison of testing
with job requirements
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Standardized format
Hand Strength
Testing System
Pinch Strength
Testing System
Electronic
Goniometer
Lifting platform
Methods-Time
Measurement
OCCUPATIONAL
REHABILITATION



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Initial Occupational Assessment
Functional assessment
Advice or assistance in vocational reeducation
Advice or assistance in job-seeking
Work Conditioning
OCCUPATIONAL
REHABILITATION
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Occupational Rehabilitation Counselling
Functional Education
Workplace Analysis
Vocational Assessment
Vocational Re-education
TEAM APPROACH
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Injured worker (worker’s family)
Physician
Therapist
Psychologist
Vocational specialist
Ergonomist
RETURN TO WORK
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How much can this injured work perform?
Suitability of job
job demand
restrictions / limitation
how to imposed
RETURN TO WORK
PROGRAM

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Initial Occupational Rehabilitation
Assessment
Functional Assessment
Vocational Re-education
Assistance in Job seeking
Working Conditioning
weight of load
lifting/
lowering
repetition
carrying
horizontal
distance
pushing/
pulling
Object
Handling
Demands
Physical Demands
height of
lift/lower
Work
other
Content
duration
Extremity-Postural
Demands
Mental Demands
twisting angle
Work Demands
Physical Environment
Work
Non-Physical
Environment
Context
Seating
Standing
Walking
Dynamic work
Kneeling
Squatting
One-legged
Extremity postural
Demands
Crouching
Crawling
Climbing
Others
Static
WORK CONDITIONING AND
HARDENING




A structured, goal-oriented, individualised
program
To improve the biomechanical,
neuromuscular, cardiovascular/metabolic,
behaviour and vocational function
Education of injury prevention
Work-risk identification
WORK CONDITIONING

Training should be based on job
requirement (job analysis) and work
functional limitation (FCE)
Typical work conditioning program
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Warm-up and stretching exercise
Cardiovascular training – ergometer, treadmill,
stair-stepper
Lumber stabilization training – therapeutic balls
Strength & endurance training – circuit training
(multi-gym), dead wt, isokinetic training)
Balance – BAPS, therapeutic balls
Functional activities – MMH
Work simulation activities
Dexterity training – hand or upper limbs injury
(e.g. Perdue peg board, Valpar)
Education & pain management
WORK HARDENING




Interdisciplinary
use real or simulated work activities in a
relevant work environment and
conditioning tasks.
Address patient’s physical, behavioural and
vocational needs
Daily sessions: 4-8 hrs/day
Difference between work conditioning
and health related conditioning



Exercise prescription based on job
requirement and FCE (job goal oriented)
Identifiable outcome measure (work nature
that can be performed)
Multiple components involves education
components related to work
weight of load
lifting/
lowering
repetition
carrying
horizontal
distance
pushing/
pulling
Object
Handling
Demands
Physical Demands
height of
lift/lower
Work
other
Content
duration
Extremity-Postural
Demands
Mental Demands
twisting angle
Work Demands
Physical Environment
Work
Non-Physical
Environment
Context
Seating
Standing
Walking
Dynamic work
Kneeling
Squatting
One-legged
Extremity postural
Demands
Crouching
Crawling
Climbing
Others
Static
WORK CONDITIONING AND
HARDENING



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
Potential client
Chronic injured worker
Poor physical conditioning
Compromised cardiovascular status
Pain on activities
Psychosocial dysfunction
Conditioning Work conditioning
Work Hardening
Strength
Endurance
Cardiovascular fitness
Job simulation Vocational
Flexibility Education Rehabilitation
Mobility
Psychosocial
Training
Stability
Rehabilitation
Co-ordination
REFERENCES




Key GL. (1995) Industrial Therapy, Mosby- YearBook
Inc., Chapter: 14-15, 21.
Isernhagen JS. (1997) Industrial Physical Therapy In:
Orthopaedic and Sports Physical therapy. Ed. Malone TR,
McPoil T. & Nitz AJ. 3rd edition, Mosby.
Yeung, S.S., Chan, M.C., Leung, D.C., Ma, M.S., Tsang,
S.Y., 1998, The effects of a four-week muscle
strengthening program on maximum acceptable lifting
load, Journal of Occupational Rehabilitation, 8(4): 265272.
Yeung, S.S., Ng, G.Y.F., 2000 Effects of Functional
Lifting Training and Free Weight Muscle Training on
Maximum Acceptable Lifting Load and Isokinetic
Peak Torque of Normal Young Adults. Physical
Therapy, 80:570-577.

McGill SM. 1998, Low back Exercise:
Evidence for improving exercise regimens.
Physical therapy 78: 754-765.