Reliability of independent observer judgments of level of lift effort in a kinesiophysical Functional Capacity Evaluation.

Functional Capacity Evaluation includes manual materials handling as a primary component. Return to work decisions are often made or influenced by both the heaviest amount of weight that can be safely lifted and the weight that can be handled repetitiously. Kinesiophysical observational criteria were developed to allow trained judges to categorize lifting in order to identify the category of lift effort. Bothinter rater and intrarater reliability were high. When light or heavy categories were isolated for accuracy there were no errors in judge's ratings.

Rehabilitation ergonomists: standards for development.

Ergonomics, in the traditional definition, is the science of design of work sites and work methods which influence production performance. In recent years, worker complaints and reports of injuries have caused evaluation of the effect of work stressors on workers. Currently, the rehabilitation specialist plays a pivotal role in both prevention and management of physical work related complaints. Rehabilitation ergonomic practitioners combine a scientific background in function and pathology with the act of developing preventive or restorative remedies. A volunteer group of sixteen rehabilitation professionals who utilize ergonomic principles in the workplace developed a document, identifying job functions of the newly defined field. This paper presents philosophy and a model for educational development and potential credentialing areas for rehabilitation ergonomists.

Impact of the Dayton Tire case.

Three of the more pertinent legal cases in the United States concerning the performance of ergonomists are summarized. The results of the cited cases have impact on the validity of the NIOSH lifting formulae, the lack of scientific evidence relating performance of jobs with alleged ergonomic stressors with specific medical pathology, and the gold standard for expert witness testimony. The cases, taken together, should act as a catalyst for ergonomists to improve their level of scientific justification for their work and conclusions.

Nonclinical competencies: a survey of occupational health physical therapists.

Consulting with business and industry represents a very new world for physical therapists--a world in which most have had little formal academic preparation. Some competencies in consulting in occupational health physical therapy are beyond specific clinical skills and knowledge. The purpose of this research was to survey occupational health physical therapists (OHPTs) concerning a previously identified list of nonclinical competencies in consulting with business and industry. The survey addressed how OHPTs rated the importance of these competencies, how they rated their own level of competence for each, and how they developed these competencies. The survey sample was based on members of the American Physical Therapy Association Orthopaedic Section's Special Interest Group in Occupational Health Physical Therapy. The response rate was 98% (61/62). Mean importance of competencies was 3.66/4.00 (range 3.00-3.88), which further validated the list of nonclinical competencies. The mean level of competence was 3.17/4.00 (range 2.40-3.50). The mean importance of individual competencies was consistently higher than level of competence. This discrepancy is of practical significance in terms of professional development of OHPTs consulting with business and industry. Primary sources of competence were practical experience (59.87%) and continuing education for physical therapists (15.51%). These results may indicate that current continuing education programs are not meeting OHPTs' educational needs and may serve as a basis for developing programs to better meet these needs. The survey instrument may help OHPTs identify and prioritize their own educational needs and to plan their own professional development accordingly.

Women: (not) the weaker sex at work?

Women's role has developed and changed dramatically in the last twenty years. Women now are prevalent in the work force and assuming work tasks not in their traditional pattern. Society and work injury managers are beginning to come to terms with women as a gender (different from men), women's specific strengths and weaknesses, and female oriented work injury problems. Science and logic blend to produce a clearer picture of women's physical parameters related to work.

Nonclinical competencies for physical therapists consulting with business and industry.

Industrial physical therapists (IPTs) are working as external consultants with business and industry to provide injury prevention and/or rehabilitation services. This consulting presents a very new practice setting for therapists and requires specialized nonclinical competencies. The purpose of this study was to identify these nonclinical competencies. The research was based on an evaluation research model using a stakeholder group. Stakeholders represented five groups: 1) IPTs, 2) continuing education providers, 3) business and industry employers of IPTs, 4) safety/risk managers, and 5) human resource development professionals. Thirty-five nonclinical competencies were identified through qualitative analysis of in-depth interviews with 17 subject matter experts representing the five groups. The competencies addressed marketing, program planning, managing the consulting process, training, and understanding organizations. This list of nonclinical competencies may serve as a self-assessment tool that IPTs can use to help plan their professional development. It may also facilitate planning continuing education programs for IPTs.

Guidelines for functional capacity evaluation of people with medical conditions.

Functional capacity evaluation is an important and widely available service provided by rehabilitation professionals, including many physical therapists. In the absence of agreed-upon professional standards, guidelines for practice have been developed. These guidelines provide a basis for the development of standards of practice which the authors believe should be undertaken on an interdisciplinary basis. These guidelines provide a baseline level of care that should be maintained by physical therapists and others who provide functional capacity evaluation services.

General program parameters.

The necessary components of an effective back injury prevention program are discussed. The effectiveness of various teaching methods and teaching levels is addressed and the benefits of this type of program are described.

Principles of prevention for cumulative trauma.

Cumulative trauma results when repetitive activity damages body parts. Because jobs are holistic in nature and do not affect only one joint or only one muscle, cumulative trauma often occurs in several parts of the body simultaneously. The author examines the causes of cumulative trauma and discusses the value of an effective cumulative trauma prevention program.

Functional capacity evaluation: Rationale, procedure, utility of the kinesiophysical approach.

The return to work process of an injured worker is dependent upon matching the physical abilities of the worker with physical demands of work tasks. Functional work movements and tasks are complex. Machines, equipment and isolated musculoskeletal testing have not produced data that is broad enough to project multi-faceted work ability. Functional capacity evaluations, which are sets of dynamic work tests, have seen a growing acceptance because of their whole-worker approach. The basic items of functional evaluations (lifting, carrying, bending, reaching, climbing) are compiled into a comprehensive test which results in information about the whole of work and overall ability of the worker. Projections into an eight-hour day and comparison to physical demands of the job are included in outcome of a functional capacity evaluation. The Kinesiophysical design approach also produces information on safety, compliance, movement characteristics and physical reasons behind work limitations. Utility of functional evaluation is exemplified when employers, and physicians use it as a basis for safe work return of the employee.

Physical therapy and occupational rehabilitation.

Occupational rehabilitation, while acknowledged as a multidisciplinary field, is only as effective as contributions of its individual disciplines. Physical therapy has been and is continuing to be an integral part of both the clinical and scientific portions of the team. Inherent in the physical therapy profession are three educational components which makes it a particularly suitable addition: movement science, pathology, and functional analysis. Physical therapists are active in each of the primary areas of occupational rehabilitation: musculoskeletal treatment, injury prevention education, functional capacity evaluation, restorative exercise, work hardening, ergonomics, and pre-work screening. Future challenges encompass increased skill in ergonomics, effectiveness in the return-to-work process, and in the scientific study of physical therapy techniques and their effectiveness.