Functional Capacity Evaluation - Assignment Example

FUNСTIОNАL САРАСITY ЕVАLUАTIОN ASSIGNMENT TASK 3- FINAL ASSIGNMENT Purpose of assessing a job This assignment focusses on justifying the appropriateness of a client undertaking a functional capacity evaluation in order to determine if he/she is able to return to his pre-injury employment. It also provides justifications as to which testing methods are used and how these methods may be different if the client is returning to their pre-injury employment or going for a vocational employment option. A 45 years old Mr. Mustafa, suffered a lower back pain injury-a prolapse of L5-S1 vertebral disc while in his pre-injury job as an office worker about six months ago (Innes, 2013). He reportedly exhibits lumbar symptoms and recurrent radiculopathy on his lower limbs literally. Mustafa’s condition may causatively be explained by a possible loss of hydration in the standard aging process which according to Spine universe, leads to the collapse of discs resulting to an increased strain on the fibres. Placement of extra force on such strained fibres causes herniation, a condition known to be very common in young to middle aged patients (Mustafa’s age group). Notable is the fact that in both scenarios as underscored in WorkCover NSW, it is in order to clarify to all parties (injured worker, medical and treatment doctor, employer and rehabilitation psychologist) in the assessment, the importance of a functional assessment. SCENARIO 1 (client with a job to return to) Data collection Information on Mustafa’s medical and work history will be gathered through interviews with, and reviews of his doctor’s and therapist’s reports on his functional tolerances, his employer as well as an interview with the client. Similarly, the assessment will abide by NSW WorkCover Return to Work Hierarchy. Indicators for a functional assessment A close review of Mustafa’s case reveals indicators that call for functional assessment if he is to go back to his pre-injury job. Foremost, the doctor observes that Mustafa is capable of better physical functioning than the reported tolerances, which raises a concern. Second, is the nature of his injury versus the uncontrolled pre-injury working environment, he will need functional assessment in a clinical setting which is more controlled. These build key reasons for a functional assessment for Mustafa if he is to go back to his pre-injury job. Relevant pre-injury work duties and tasks As an office worker, Mustafa was engaged in duties like receiving and making customer phone calls, computer operations, scanning and shredding of documents. Tasks Phone calls Receive up to 30 calls a day on dispatch of products using a landline telephone Extending the right elbow to get the telephone Flex his elbow to bring the phone to the right ear Occasional multitasking of being on the phone with a client as he checks the computer and scribbles notes Scanning Scanning individual sheets of inventory to the designated company file-applies a unilateral grip of 5-10 A4 from his work station, stands and walks to the scanner about meters away, then unilaterally lifts up the scanner’s lid to place the paper to be scanned and presses scan button- a repetitive procedure till all sheets have been scanned Shredding Shredding machine located about 10 meteres away from his work station. H He bilaterally picks the tray with about 100 A4 papers for shredding and feeds them to the shredding machine, a process that takes about 2-5 mins; he is standing all the while Computer tasks Emails He uses Microsoft outlook to read and reply to about 30 emails on average daily to customers and suppliers while seated on his desk Database operations He undertakes data input as part of most of his daily work (80-85%), majorly updating customer files. This task requires sustained sitting, bilateral upper limb typing, repetitive unilateral right handed mouse operations, continued concentration, mental processing and problem solving. A lot of visual reviewing also involved Assessment for a worker with a job to return to (scenario 1) Overall summary of job demands Work Task Physical Requirements Psychological /Cognitive Social and environmental Phone calls Duration of 10-15 minutes while seated and a 90 degree knee and hip flexion A minimal neck rotation to see the phone at 10-15 degrees Full extension of the right elbow, shoulder forward flexion and a 60-65 degrees slight lateral raise while reaching the phone Ability to grasp the phone Ability to lift and hold the phone (150-200 grams) for about 10-15 minutes 10-15 degrees right-sided lateral neck and forward flexion to position the phone Ability to sustain above mentioned phone position throughout the calls Ability to lower the phone to its initial position up on end of call requiring reverse action as opposed to picking the phone 10-15 minutes of concentration and mental processing Multi-tasking (notes taking and engaging customers) while viewing from the computer A shared 4 x 4 metres office with one other officer Air conditioned office at 21-22 degrees, sufficient artificial lighting A fall hazard as office has hard floor and was covered with a torn carpet Low level noise from co-workers in neighbouring offices Scanning Continued standing with a dynamic forward truck flexion 10-15 degrees for 5-10 minutes Ability to lift scanner’s cover by a left elbow flex at 45 degrees, 90 degrees lateral shoulder raise, 90 degrees left forearm pronation and left hand digit extension an grasping A bench height right elbow extension, a pincer grip of the right hand to get the papers as well as a 90 degrees right elbow pronation to pick the papers and place them in the scanner Same procedure as above to reach and press scan button Ability to reversed action of lifting scanner cover to place documents scanned in the shredding machine located on the bench at the height of the waist Minimal concentration multi-tasking in placing the papers in their correct position about 5-10 minutes No social demands Shredding Walking from work station to machine’s location while carrying 2-4 kgs heavy tray of papers to be shredded at a bilateral elbow flexion of 80-90 degrees and gripping and back after shredding Static standing at the shredder for about 5 minutes Left hand gripping of the plastic tray where the papers are held with an elbow flex of 80-90 degrees to prevent tray from falling Ability to press with right hand index finger to operate the shredder, right index finger extension and pressing to turn off shredder High level concentration to avoid injuries Low level multi-tasking required Due to individual performance, low social demand Machine produces moderate noise while in use Shredder has a push button operation Computer operations Receiving, reading and sending emails Continued sitting 90 degrees knee and hip for about an hour Keyboard typing needs 10 degrees cervical flexion for its observation Hands on keyboard needs 90 degrees bilateral elbow flexion Repetitive flexion and extension movements in typing For mouse operation, 90 degrees right elbow flexion, right shoulder external rotation of 15 degrees and an extreme ulnar deviation of the right wrist to click the mouse with a 10-15 right index finger flexion Sustained concentration of up to an hour daily on average Problem solving skills Multi-tasking essential in sorting emails in order of importance and urgency Social media platform communication abilities Data base operations Sustained sitting 90 degrees knee and hip flexion Keyboard typing needs 10 degrees cervical flexion for its observation Hands on keyboard needs 90 degrees bilateral elbow flexion Repetitive flexion and extension movements in typing For mouse operation, 90 degrees right elbow flexion, right shoulder external rotation of 15 degrees and an extreme ulnar deviation of the right wrist to click the mouse with a 10-15 right index finger flexion Concentration and ability to alter tasks whenever needed Calculation, processing and moderate problem solving May require multi-tasking Sufficient lighting and ventilation Floor presents flipping risk SCENARIO 2 (client without a job to return to) Indicators for a functional assessment The indicators of conflicting information on Mustafa’s physical ability and the fact that he will not be returning to his pre-injury job will also necessitate for a work-related assessment to check his physical capabilities for specific vocational options. Further, it will help identify possible work barriers including psychosocial barriers. Data collection Data collection tools will include literature review on vocational assessments in regard with the physical demands, a review of Mustafa’s reported functional tolerances and his medical history, interviews and administration of questionnaires to Mustafa’s treating doctors, as well as liaising with Rehabilitation psychologist. Additionally, observations, and Ergonomic measurements will inform on all physical, psychological, cognitive and environmental demands that would be obtained for roles at different functional levels (Wallace, 2017). An interview with the client will ensure that he communicates any concerns about the assessment process through self-reporting. Transferrable skills An assessor must first understand the tasks of the identified vocational option before proceeding with physical testing. This helps in identification of critical demands to be assessed. An assessor’s knowledge of transferrable skills possessed by the evaluate is crucial. Such transferable skills may be obtained through a liaison with the psychologist who completed vocational assessment, work place assessment reviews as conducted by pre-injury employer, as well as treating practitioners’ reports reviews. NSW Work Cover observe that transferable skills are the versatile skills that a worker can apply and make use of in a number of varied roles. A review of Mustafa’s case study and previous work place assessment reveals the following transferable skills; Basic English skills (both reading and writing) Administrative roles Customer service Ability to team work Ability to follow instruction Ability to meet work deadlines with no close supervision Database management Work Cover for NSW provides that vocational assessment is an undertaking for helping the worker to identify vocational options and recommended strategies to achieve vocational options. Therefore prior to commencement of physical testing, the assessor should have knowledge of various vocational options especially from previous job analyses which will enable them simulate to work place situations and thus allowing for reliability and validity of the results as provided for by NSW. In this regard, putting Mustafa’s case study and his pre-injury work place assessment as an office worker in juxtaposition with review of Australian and New Zealand’s standard classification of occupations (ANZSCO) database, below are three vocational options that were identified as appropriate for Mr. Mustafa to return to given his assessed transferrable skills; Assistant Office Administrator at pre-injury employer Customer care desk officer Liaison officer Suitable work tasks/Duties A clear understanding of job tasks that comprise possible vocational options will guide the assessor in identifying individual job tasks for the identified above three vocational options. Apparently, this will be realised from previous workplace assessment, job role analysis or ergonomic assessments. Databases such as ANZSCO may also be used by an assessor to review the tasks involved against each vocational option proposed. Listed below are job descriptions including tasks of each vocational option as gained from ANZSCO in the case of Mustafa. Assistant Office Administrator at pre-injury employer The key role as stated by ANZSCO is to support managers and other professionals in the organization by retrieving, organising, manipulating and storing information. Setting, reviewing and control of office functions, data processing, receiving clients, clerical works, administration of contacts, projects and programs and response to inquiries, are among the key tasks for an assistant office administrator. Customer care desk officer ANZSCO indicates that key roles for the holder of this position is to attend to clients and new customers’ inquiries. Tasks include face to face and making phone calls to customers to attend to the inquiries, clarifying to customers about the organization’s products, reception and referral of visitors to relevant departments, clerical and office messenger tasks and maintenance of database on customers’ needs and preferences among others. Overall summary of functional tasks According to Gouttebarge, V., et al. (2010), the assessor needs to review assessment methods, components and tools in accordance to the assessment’s purpose and objective, the workers injury and critical demands for them to be able to determine the functional tasks which need to be assessed. In reference to the above discussed two positions and considering Mustafa’s reported tolerances, these are the functional tasks identified for assessment to determine his capacity to accomplish identified vocational options. Functional task to be assessed Vocational option for which task is required Job task of vocational option Criteria on which to assess function Sitting Assistant office administrator Customers service desk Sitting as they work with the computer for database management, making calls, attending to customers one on one for both vocational options Sitting for 30 minutes in an ergonomically correct desk. This involves the back of the chair angled between 100 and 110 degree. Flexion of the hips at 90 degree with knees also flexed to 100 degree whilst remaining seated. Standing Customer service desk As they perform clerical works Standing for approximately 30 minutes at one time on flat surfaces Walking Assistant office administrator Customer service desk Walking around the office Performing tasks such as delivering messages across the departments of customer files Walking over uneven ground for up to 2 hours per day for 15 minutes at a time. This is intermittent with static standing on uneven ground Hand grasp Assistant office administrator Customers service desk Required for completion of physical tasks Grip strength when holding weights less than five kilograms including telephone and papers either for scanning/shredding Upper limb Assistant office administrator Bilateral upper limb range of motion required for all actions including above head height, in front of body and below shoulder height to complete administration tasks. Range of movement to complete tasks such as answering of phones picking up equipment from desk or surrounding areas. This is with loads less than 5 kilograms of weight with arms at approximately 45 degree from body. Lower limb Assistant office administrator Lower limb range of movement when alternating postures between sitting/ standing and walking Bilateral lower limb range of movement when walking around the office over even ground. This range of motion does not require lower limbs to be raised above 90 degree from the hip Critical work demands of the identified vocational options Physical demands Psychological/cognitive demands Social and environmental demands Assistant office administrator Database management Supporting organizational professionals Phone calls Emails Sustained sitting 90 degrees knee and hip flexion Keyboard typing needs 10 degrees cervical flexion for its observation Hands on keyboard needs 90 degrees bilateral elbow flexion Repetitive flexion and extension movements in typing For mouse operation, 90 degrees right elbow flexion, right shoulder external rotation of 15 degrees and an extreme ulnar deviation of the right wrist to click the mouse with a 10-15 right index finger flexion Continued sitting 90 degrees knee and hip for about an hour Keyboard typing needs 10 degrees cervical flexion for its observation Hands on keyboard needs 90 degrees bilateral elbow flexion Repetitive flexion and extension movements in typing For mouse operation, 90 degrees right elbow flexion, right shoulder external rotation of 15 degrees and an extreme ulnar deviation of the right wrist to click the mouse with a 10-15 right index finger flexion Concentration and ability to alter tasks whenever needed Calculation, processing and moderate problem solving May require multi-tasking Sustained concentration of up to an hour daily on average Problem solving skills Multi-tasking essential in sorting emails in order of importance and urgency Sufficient lighting and ventilation Floor presents flipping risk Interaction with other staff and visitors as they enter the office. Inside work with nil variations to noise, temperature or lighting Customer service desk Receiving visitors and attending to inquiries Clerical works (messages delivery, scanning, photocopying, shredding) Repetitive walking, standing and sitting of up to 2-3 hours on a daily basis to the machines from their work station High level concentration to avoid injuries Low level multi-tasking required Due to individual performance, low social demand Machine produces moderate noise while in use Shredder has a push button operation Assessment methods/tools and justification for each Considering all physical tasks and functional tolerances together with physical, psychological, social and environmental demands for Mustafa’s pre-injury role and vocational options suggested, these assessment methods and tools among others, should be deliberated while conducting a functional assessment in both scenarios. Assessment method/tool: Review of Mustafa’s medical report This kind of reports are gathered via interviews, questionnaires or medical documentation received from medical and treating practitioners. It should also include a review of previous work place assessments, transferrable skills and current workers compensation together with specialists’ reports. Justification for use: The WorkCover for NSW has clarified that information concerning a client’s injury should be gathered from varied data sources. It is from these that the assessor gets knowledge on compensational claim as well as the client’s current medical status and possible psychosocial barriers that may crop up. Such reviews will also help determine the client’s work tasks, as well as transferable skills. Assessment method/tool: Use of a heart rate monitor during physical testing to assess Mr Mustafa’s changes in heart rate during testing The client is requested to wear a heart rate monitor throughout the physical assessment so it may record pulse rate whether he is walking, sitting or standing. Justification for use: It will help in eliminating any potential biases between the assessor and the client. Additionally, it will ensure client’s safety by monitoring physiological changes so as to stop the process if need be, assuming pain levels went high for instance. In such a case, that becomes the end point, another way of pointing out the client’s tolerance level. Assessment method/tool: Cognitive/ psychologica/ social demands testing The assessor should look out for consistency in Mustafa’s conversation throughout physical testing as well as during pre-testing screening. More observation should be done at the commencement to work by the client especially when there is noise from his co-workers in neighbouring offices to check for his concentration levels. Justification for use: His role as an office worker calls for utmost concentration especially when it comes to database management and sending and responding to emails and phone calls. It would be risky to put him in the position if he cannot concentrate moderately especially in the presence of minimal noise. Assessment method/tool: Observation by the tester whilst Mr Mustafa is completing physical tests (NSW WorkCover, Functional assessment) The assessor should keenly observe Mustafa’s capabilities in posture maintenance especially eye contact as well as cognitive abilities since his role will entail dealing with customers. Justification for use: To check posture for any indications of Mustafa experiencing pain. Anything indicating a change in pace of things or a change in psychosocial factors should be noted as it may indicate discomfort and thus a need to prevent for further injury. Assessment method/tool: Sitting As an assistant office administrator, Mustafa will spent some time while seated. This will require him to bend his hips at 90 degrees. He therefore should participate in a sitting test and end point will be observed from changes in posture or reporting of experiencing pain. This should be done in a chair without lumbar support or ergonomic controls for a true reflection of similar postural requirements. Justification for use: The test method will enable the assessor to test Mustafa’s sitting ability against the pre-injury job role demands of sitting for the specified time span (Wallace, 2017). Thus be able to justify if or not Mustafa is fit for the job. Assessment method/tool: Lifting-waist height WorkHab lifting test Justification for use: WorkHab (2013) observe that WorkHab FCE, an internationally recognized evaluation tool enables licenced evaluators to determine, measure and report objectively on the lifting capacity of a client. This is a tool that apparently allows a distinguished flexibility level enabling it to assess any task. In Mustafa’s case therefore, the tool allows for the completion of a standardized test to assess his ability to lift things (trays with papers either for scanning or shredding, telephone, scanner cover e.t.c) in a controlled manner. Further, it helps in looking out for end point determination factors like recruitment of accessory muscle or postural changes. Assessment method/tool: Liaison with rehabilitation consultant The assessor should prior to the physical assessment get in touch with the rehabilitation psychologist who completed Mustafa’s vocational assessment. This is essentially to gather details on Mustafa’s social and cognitive abilities during vocational assessment to determine any transferable skills or psychosocial barriers. Justification for use: WorkCover for NSW have observed that the review of transferable skills or vocational training assessment is a performance standard for a functional assessment of a jobless worker. Therefore this liaison equips the assessor with a clearer understanding of the transferable skills and/or job options along with possible yellow flags as may have been presented during vocational assessment. Evaluation of three levels of individual or job Level Method Example Task Assessment of specific tasks for an assistant office administrator via use of workplace assessment reports the establishment of an appropriate functional assessment for Mustafa. Various tools for data collection and assessment like interviews, ergonomic measurements and interviews were employed. A classic example of a task that was analysed is database management; where in the functional assessment individual tasks were discussed including the skills required. Skill An assessment of the tasks for office worker by use of workplace assessment reports has further enabled the development of a good functional assessment for Mustafa. Additionally, various tools were used in the workplace assessment. A skill that was well analysed here is that of ability to multi-task when engaging a client on the phone as he scribbles notes as well as checking for details in the computer database of customers. Body system Observance of the body’s physiological responses throughout the physical assessment has also enabled the assessor to identify end points and establish Mustafa’s tolerance level and this was matched and compared with information contained in the reports and reviews provided by medical and treatment doctors as well as from workplace assessments. An example of the body system analysed is the heart’s pulse rate using the heart rate level monitor. It helps to check Mustafa’s tolerance to establish end point. References Gouttebarge, V., et al. (2010). How to assess physical work-ability with Functional Capacity Evaluation methods in a more specific and efficient way? Work, 37(1), 111-115. Innes, E. (2013). Assessment Case Study, Mustafa - Low back injury/chronic pain. Lismore : Southern Cross University. NSW Government. SIRA workers compensation guide for medical practitioners, retrieved from http://www.sira.nsw.gov.au/resources-library/workers-compensation-resources/publications/health-professionals-for-workers-compensation/workcover-nsw-medical-guide accessed on February 22nd 2017 NSW WorkCover (2012). WorkCover Work Capacity Guidelines. Retrieved from, http://gowgates.com.au/uploads/contentFiles/files/workcover-work-capacity-guidelines-WC03897.pdf accessed on February 22nd 2017 Spine universe. Lumbar Herniated Disc. Retrieved from, https://www.spineuniverse.com/conditions/herniated-disc/lumbar-herniated-disc accessed on February 22nd 2017 Wallace James. NSW WorkCover: Assessments and a multimodal approach, retrieved from, http://sswgpl.com.au/html/workcover.html accessed on February 22nd 2017 Read More