Tag Archives: Physical Therapy

Physical Medicine Best Practices Project

The Physical Medicine Best Practices Project undertaken by the WA Department of Labor and Industries seeks to bring increased standardization of care and care reporting by physical and occupational therapists. The pilot project is a collaboration with community experts to implement best practices that ensure workers receive:

  • Effective physical and occupational therapy services.
  • Clinically meaningful improvement in function.
  • Focusing on return to work.

Learn more about the Physical Medicine Best Practices Project, including the stakeholders involved in the project, and watch the video, below, for an overview.

Understand How Your Providers Report to DLI

Under the Physical Medicine Best Practices Project, your physical or occupational therapist will report to your attending physician and your claims manager on a regular basis. Your therapist will use the Physical Medicine Progress Report form to document your treatment, progress, and functional ability levels. If you have an assigned vocational counselor, this report form may be used to clarify your physical abilities for purposes of documenting your ability to work. The form is currently used by your therapist on a voluntary basis, but it will be phased in and will become mandatory soon.

In addition to standardizing care and reporting, this project and, by extension, the reporting form, encourages your physical or occupational therapist to engage with you, the patient, and your doctor. Your therapist’s suggestions for evaluation by additional types of providers or for additional treatment services can be noted and shared using this form.

Best Practices Quick Reference Card

Although meant for medical providers, the Department’s Best Practices Quick Reference Card provides an injured worker with clear information about the intent of the Physical Medicine Best Practices Project. It shows the focus on patient engagement and increased communication, and outcome documentation and tracking.

Reviewing the quick reference card will give you a clear understanding of the goals and expectations for your progress in physical therapy.

Functional Capacities Evaluations Explained

Functional capacities evaluations (FCE’s) are used in many workers’ compensation claims and other legal cases. FCE’s can help determine functional ability, assess client effort, and determine appropriate work restrictions after an injury.

Unfortunately, there is no standardization for this type of examination. Many different systems and processes are used, some resulting in controversy in the overall effectiveness. Too often, the functional capacities evaluations provide inaccurate results. In some cases, this can be damaging to a legal case.

The objective of this article is to explain the functional capacities evaluation process, how the FCE is useful to you, as well as potential pitfalls to avoid.

The Functional Capacities Examination

A FCE can be performed in 4-8 hours, typically at a physical therapy facility where equipment is available for evaluating a variety of physical activities. Often, the examiner will have the patient perform tasks similar to the their job, simulating a day of work. Activities of daily living can also be simulated.

Tasks such as stair and/or ladder climbing, lifting, carrying, pushing and pulling of items at various weights will be tested to tolerance, possibly multiple times. Sitting and standing, crawling, and kneeling may be examined. Hand strength, keyboarding and fine-finger activities are also tested.

Throughout the evaluation process, the examiner will ask how the patient is feeling after each task, testing for whether the task meets or exceeds the limitations of the individual. The goal is to determine maximum abilities that can be sustained over a work day. This includes the ability to perform the tasks, as well as the stamina to do so repetitively.

See a sample functional capacities evaluation report, here.

Tips to Follow for an Accurate FCE

Put Forth a Good Effort

An FCE is typically scheduled to occur on one day, rarely over two days. It likely will not be an accurate reflection of your work ability if you try to breeze through the tests, which can seem simple.

The examiner will be tracking your heart rate, respiratory rate other indications of full effort. They will encourage you to do more, while noting signs of exertion, such as sweating or having you answer questions to see if your sentences are interrupted due to you breathing hard after the exercise.

Increase Activity Levels Prior to the Evaluation

Try to remember that the FCE is meant to test your ability to perform tasks over a full-time work week. In order to gain an accurate assessment, try to be active in the days leading up to your examination. Don’t knock yourself out, but don’t sit on the couch, either.

The day or two before your evaluation, try to perform activities that are similar to those you do at your job. If you spend all day at work on your feet, try going for a nice walk, or do a large grocery shop, on the day prior to the examination. If you sit at a desk all day when working, maybe go to a movie or spend a couple of hours at the library sitting at a desk or table prior to your evaluation.

Try to make sure that the examiner is able to determine what your condition would be like on Friday afternoon back on the job, after working all week. You don’t want to have their report reflect your ability on Monday morning after resting up all weekend.

Answer Questions Honestly and Thoroughly

The functional capacities evaluation takes place over the course of a day. The examiner’s report will be a better assessment of your abilities if you are forthright with your answers. If the examiner asks if you feel pain or some other sensation, this is not the time to exaggerate nor to minimize your symptoms.

Acting tough or pushing through pain may result in your exertion scores being high – you’re putting forth great effort! – but, if the results of this exertion are not accurately documented, you may be found able to perform at a level that is not realistic.

Over-stating your response to an activity also leads to a poor FCE result. If the examiner feels that you are capable of doing more than your test results reflect, or that you are complaining of difficulties out of proportion to your apparent levels of stress, this can be noted in the final report.

It may be helpful to let the examiner know the type of symptoms you generally experience, how long they last and what steps you take to reduce or alleviate those symptoms. This kind of openness and honesty will let the examiner know that you are in tune with your situation and are focused on improving your condition.

Usefulness of an FCE

An accurate functional capacity evaluation can be very useful to you in your claim or legal case. It can ensure appropriate treatment, vocational services and impairment awards are provided under your claim.

Medical Uses for a FCE

Your doctor may use the results to support that work restrictions are needed, or that a course of work conditioning treatment is needed to improve strength and stamina. An FCE can also help show that a certain rating of permanent impairment is appropriate.

The medical information within the final report, including symptoms present due to exertion and activity, allow your doctor to opine on your current condition and whether your condition could be improved with additional treatment.

Vocational Uses for a FCE

When a vocational counselor is assigned to a claim or case, they must make a determination of your ability to work. Typically, they will determine if you are able to return to work at your regular job, or a modified version of your job, with the same employer.

If not, they will look at your physical abilities together with your skills and education to determine if you could work in some other type of work. If you have transferable skills to another line of work, they will document the availability of these potential jobs and the willingness of employers to hire someone with your work restrictions.

Ultimately, the vocational counselor will write a report detailing your ability to obtain and maintain employment. The report will indicate whether you can return to work with your current skills and abilities, based on the functional capacity evaluation, or whether retraining services are needed.

Do you Need Legal Help?

You do not necessarily need legal advice when facing a FCE. If you have any concerns, questions, or if your instincts tell you that something doesn’t feel right, then talking with an attorney may be appropriate. Many firms, like ours, offer free consultations. Why not get answers to your questions before your evaluation?

See this prior post:


NYTimes: Lower Back Ache? Be Active and Wait It Out, New Guidelines Say

Dr. James Weinstein, a back pain specialist and chief executive of Dartmouth-Hitchcock Health System, has some advice for most people with lower back pain: Take two aspirin and don’t call me in the morning.

On Monday, the American College of Physicians published updated guidelines that say much the same. In making the new recommendations for the treatment of most people with lower back pain, the group is bucking what many doctors do and changing its previous guidelines, which called for medication as first-line therapy.

Dr. Nitin Damle, president of the group’s board of regents and a practicing internist, said pills, even over-the-counter pain relievers and anti-inflammatories, should not be the first choice. “We need to look at therapies that are nonpharmacological first,” he said. “That is a change.”

The recommendations come as the United States is struggling with an epidemic of opioid addiction that often begins with a simple prescription for ailments like back pain. In recent years, a number of states have enacted measures aimed at curbing prescription painkillers. The problem has also led many doctors around the country to reassess prescribing practices.

The group did not address surgery. Its focus was on noninvasive treatment.

The new guidelines said that doctors should avoid prescribing opioid painkillers for relief of back pain and suggested that before patients try anti-inflammatories or muscle relaxants, they should try alternative therapies like exercise, acupuncture, massage therapy or yoga. Doctors should reassure their patients that they will get better no matter what treatment they try, the group said. The guidelines also said that steroid injections were not helpful, and neither was acetaminophen, like Tylenol, although other over-the-counter pain relievers like aspirin, naproxen or ibuprofen could provide some relief.

“Many people with chronic back pain tend to shut down, avoiding their usual activities, afraid of making things worse…”

Dr. Weinstein, who was not an author of the guidelines, said patients have to stay active and wait it out. “Back pain has a natural course that does not require intervention,” he said.

In fact, for most of the people with acute back pain — defined as present for four weeks or less that does not radiate down the leg — there is no need to see a doctor at all, said Dr. Rick Deyo, a spine researcher and professor at the Oregon Health and Science University in Portland, Ore., and an author of the new guidelines.

“For acute back pain, the analogy is to the common cold,” Dr. Deyo said. “It is very common and very annoying when it happens. But most of the time it will not result in anything major or serious. ”

Even those with chronic back pain — lasting at least 12 weeks — should start with nonpharmacological treatments, the guidelines say. If patients still want medication, they can try over-the-counter drugs like ibuprofen or aspirin.

Scans, like an M.R.I., for diagnosis are worse than useless for back pain patients, members of the group said in telephone interviews. The results can be misleading, showing what look like abnormalities that actually are not related to the pain.

Measures that help patients get back to their usual routines can help along the way, as Sommer Kleweno Walley, 43, of Seattle, can attest. Last spring, she slipped on the stairs in her house and fell down hard, on her back.

“After a couple of hours I could barely walk,” she said. “I was in real pain.”

She saw a physical therapist, but the pain persisted. Eleven days later, she showed up at the office of Dr. Christopher J. Standaert, a spine specialist at the University of Washington and Harborview Medical Center. She expected to receive an M.R.I., at least, and maybe a drug for pain.

But Dr. Standaert told her an M.R.I. would not make any difference in her diagnosis or recovery and that the main thing was to keep active. She ended up getting anti-inflammatory medication and doing physical therapy. A few months later, her back stopped hurting.

[Read the rest of the NY Times article here.]

Photo credit: Dreaming in the deep south via Foter.com / CC BY