Transcript Document

Functional Capacity
Evaluation using the
Matheson System
Alison Biggs, Healthywork Ltd
www.healthywork.org.uk
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Matheson System
Dr Leonard Matheson, Psychologist researcher.
Roy Matheson, training programmes. 4 - 5 day
course – then Accreditation system. Retrain after 7
years.
Therapist chooses suitable tests for questions to be
answered and the client’s diagnosis.
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Matheson Evaluation Philosophy
• Purpose of FCE – to collect reliable information about current
vocational status & estimate potential vocational status.
• Hierarchical Professional Value System: respect for client:
Safety (Highest) - minimize re-injury
Reliability – dependable test scores and test effort to ensure
reliable results
Validity - measure intended target task
Practicality – reasonable direct/indirect costs of test procedures
Utility – maximise case resolution
Skilled clinical judgement to balance safety and utility issues.
Change tests to get the answer rather than compromising safety
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• Feasibility. Acceptability of the worker generally.
• Internal threats to reliability. Tell then to give full safe effort.
• Stopping points determined by:
Biomechanical.
Psychophysical. (should be the most limiting factor, they say
when they want to stop)
Cardiovascular-metabolic.
• Allow modifications.
• Extra instruction. Yes, if this is not focus of test. Allow Trials.
• Correction of body mechanics if at risk.
• Psychophysical approach. Increased function + improved
method = further improvement.
• Pain should be treated as a tool and factual. Questionable
pain behaviour – distraction and effort testing, incl HR.
Replace pain behaviour with productive behaviour. Activity
linked to control of symptoms.
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Physical demand characteristics of work
(1993 Leonard Matheson & Ministry of Labor)
Physical
Demand
Level
Occasional
0-33% work
day
Frequent
34-66% of
workday
Constant
67-100% of
workday
Typical Energy
Required
Sedentary
10 lbs
Negligible Negligible
1.5 -2.1 METS
Light
20 lbs
10 lbs
Negligible
2.2 – 3.5
METS
Medium
20-50 lbs
10-25 lbs
10 lbs
3.6 – 6.3
METS
Heavy
50-100 lbs
25-50 lbs
10-20 lbs
6.4 – 7.5
METS
Very
Heavy
Over 100
lbs
Over 50
lbs
Over 20 lbs Over 7.5
METS
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Matheson FCE Content
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Client info & job info.
Pain scales & standardised questionnaires.
MSE assessment.
Spinal Sort/Hand Sort. Loma Linda, West tool
sort.
Jamar.
Dexterity.
Handling.
Fitness and Cardiovascular.
Mobility.
Lifting, carrying, pushing & pulling.
Review.
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Pain reporting
• Pain scales: Functional Pain
Scale and Visual Analogue Scale.
• Standardised questionnaires.
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MSE and Sorts
• MSE: upper, lower, cervical, thoracic,
lumbar. Posture, tests (ROM, mmt /5),
special tests, measurement (circum,
volumetric, pre and post), palpation.
• Sorts: West tool Sort, Loma Linda,
PACT (Performance Assessment &
Capability Testing) Spinal Function Sort
and EPIC Hand Function Sort.
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Hand Dynamometer
Jamar grip test
Grip
Effort
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Dexterity and upper limb tests
Purdue Pegboard
• Several different
tests.
• Timed
• Distraction
testing
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Minnesota Test
• Several tests.
• Pinch gauge
• Valpar 4 and 8 (assembly
tests).
• Crawford small parts test.
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Valpar 9
Whole body Range of
Motion
• 4 panels of shape transfer
positions.
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Handling
• Bennett Hand
tool dexterity
test (Norm).
• Valpar 202
(MTM).
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Fitness & Cardiovascular
• Intake questions for safety.
• CSTF - Canadian Standardised Test of Fitness (push
ups, curls, trunk flexion, aerobic).
• NBFT - National Back Fitness Test (back flex, lower
abdo strength, hip flexor flexib, L, R, lateral trunk
muscle strength, L, R.
• Aerobic – walking, jogging, jumping.
• Cardiac – Bruce, Balke, Bench step test, Rockport
walking test.
• Bench step test.
• Walking/treadmill test.
• Jogging.
• Jumping.
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Mobility
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Balance.
Crouching/squatting.
Kneeling/floor mobility.
Repetitive movement
screening.
Trunk flexibility.
Crawling.
Stairs.
Ladder mobility.
West bus bench.
Work simulation.
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Lifting Tests
Eg Pile (frequent), Snook or West
or
EPIC (Employment Potential
Improvement Corporation) Lift
Capacity
• Tests occasional and frequent
lifting.
• Standardised shelf heights.
• How much does this weigh? List of
possible responses
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Carrying, Pushing, Pulling
Push/pull sled
• Handle heights.
• Increase weights on
platform.
• Measure with Force
gauge.
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Matheson Review
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Job match table.
Physical effort.
Reliability of client reports.
Conclusions.
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Job Match Table
Mobility
Sitting
Static Standing
Job Demand
Demonstrated Ability
Match?
Occasional. 1-17%
Admin tasks
Sitting on the floor whilst
performing low level
tasks
Breaks
No limits reported or observed
Yes
Performed over 50% of
day.
Varies depending on
task. Can be lengthy
periods of time.
Demonstrated short periods of standing,
Heel pain reported after 7 minutes and then
increased to heel and base of foot pain.
Maximum standing duration demonstrated 22
minutes before requesting to sit.
Mr Stone reported that the pain in his leg
when standing on it to assess his standing
tolerance was 3/10 on the Functional Pain
Scale (2003), where 3 = ‘Pain starting to
visibly disable you, cause difficulty moving or
applying strength through the painful area,
affecting your productivity or performance.
Causes you to take small breaks to rest or
stretch’. He reported that at home he would
elevate the leg to relieve the pain symptoms.
If he can vary static standing with dynamic
standing and walking then this tolerance could
be increased, but it is likely that tolerances will
need to be broken up with sitting in order to
manage the pain in the right foot. A padded in
sole may ease the discomfort.
Carry a small folding metal stool; possibly use
this during some jobs?
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Points of view on Matheson
• Instruments whose reliability and
validity has been determined through
peer reviewed research, available in
the public domain.
• Equipment available from a range of
vendors.
• Work simulation.
• Weights.
• Jamar.
• Workday tolerances.
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• Assessment length.
• Answering case-resolution relevant
questions while adhering to the
Practice Hierarchy.
• Training certification/accreditation and
retraining requirements.
• Support.
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Assessment requirements
• Choose a practitioner who has attended suitable training to
use standardised tests/system.
• Ensure client is ready for the assessment – needs to be
work ready, able to participate fully in assessment, at end of
rehab not too early. Can give info more quickly in a case.
• Ensure client and job is appropriate for this assessment.
Good for physical jobs. Analyse effort, reliability of client
reports and techniques for Manual Handling etc.
• Be clear what you want to find out from Assessment.
Specific information required and questions. Reason for this
assessment is... Also to defend its use to the payer.
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Assessment requirements cont
• Tell the assessor what information you need to know.
RTW yet?
• Unsafe to RTW? Look at alternatives.
• FCE shows they can RTW, even if they don’t think
they can?
• GRTW hours? Which job tasks can they do?
Frequency and kg of lifting/carrying?
• Other issues preventing RTW (social/psychological)?
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Hierarchy of RTW
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Hierarchy of objectives:
Same work and same employer
Same work (modified) and same employer
Different work and same employer
Similar work with different employer
Different work with different employer
Retrain and/or re-educate the worker
(Workers Compensation Board of Manitoba www.wcb.mb.ca )
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Other considerations
• Client travelling to assessment.
• Gather detailed job info prior to the assessment, so
that the testing can more accurately reflect the job
demands. Ask for a Job Demands Analysis if req.
• Consents and access to medical records.
• Cardiac Arrest – defib requirements? Approp
assessment/job?
• Follow ups, next day?
• Other standardized assessments can be used,
eg. Numeracy tests, The Cognitive Test of
Minnesota.
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Occupational Questionnaire
N/A
1%17%
18%33%
34%50%
51%66%
67%84%
85%100%
Additional
information
Lifting
Carrying
Pushing
Pulling
Driving
vehicle type:
Sitting (not driving)
Walking
Standing - static
Standing - moving
Bending/stooping
Twisting/spinal rotation
Crouching/squatting
Crawling/kneeling
Climbing stairs
Climbing ladders etc
Reaching/stretching
Is a lift available?
Eg overhead or
hip height:
Above shoulder work
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Links
• www.roymatheson.com
• www.epicrehab.com
• www.khavalpar.co.uk
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