Ronald W. Porter is a recognized expert in the field of
Occupational Safety and Health, and Ergonomics. In the past
30 years, since becoming Director of the
The Back School, he has instructed over 1000 workshops and
seminars on Ergonomics Awareness and Musculoskeletal
Disorder Prevention to physical and occupational therapists,
medical doctors, occupational health nurses, and industrial
health and safety professionals. Ron has worked with over
200 industries, including Lockheed Martin Aeronautics, E.I.
Du Pont, DS Waters, Shell Oil, International Paper, Cingular
Wireless and the United States Navy, on the development and
implementation of innovative ergonomics programs for both
individual plant sites and entire corporations. He is often
an featured presenter at national safety and health
association conferences including the 2007 - 2010 American
Society of Safety Engineers Professional Development
Conferences, the 1995 - 2005 American Occupational Health
Conferences, SEAK Annual National Workers' Compensation and
Occupational Medicine Conferences in 2005-2007 and a March
2010 national webinar on the Aging Workforce for the ASSE
Virtual Classroom. His Bachelor of Science degree is from
the University of Tennessee-Knoxville and his Graduate
Degree in Physical Therapy from Emory University in Atlanta,
GA. He is a member of the Human Factors and Ergonomics
Society, American Physical Therapy
Association, American Society of Safety Engineers and the
American Industrial Hygiene Association.
|
The “Six W’s” Of Functional
Baseline Testing |
Functional Baseline Testing is a method by which Physical
and Occupational Therapists may address functional
activities with workers’ compensation patients. This testing
and treatment process will enable the therapist to provide
an alternative to Work Hardening Therapy, a program
increasingly fraught with reimbursement issues requiring
expensive equipment and excessive square footage. Here are
some fast facts about Functional Baseline Testing:
WHAT IS FUNCTIONAL BASELINE TESTING?
A method to incorporate functional activities into a
traditional physical rehab program:
• Without the space and equipment expense required for Work Hardening
facilities:
- Functional Baseline Testing and Treatment equipment needs can be
met for under $2500.00 (in addition to standard clinic
equipment).
- Functional Baseline Testing and Treatment can be done in a
standard, already equipped PT clinic.
• A method to prepare an injured worker for return to work:
- Every job has Material Handling and Non-Material Handling
requirements. Functional Baseline Testing emphasizes
job-matching and precise goal setting in these key areas of
work.
• A method to increase Workers’ Compensation revenues by
retaining patients formerly lost to providers with Work
Hardening program.
WHY DO FUNCTIONAL BASELINE TESTING?
Decreased utilization of traditional Work Hardening.
• Provider perspective – Expensive to provide & litigious
patients:
- Equipment, space, time, and staff expense.
- Liability concerns, “I got hurt in Work Hardening defense”.
• Payer perspective – Insurance Companies do not think Work
Hardening is a good investment:
- Work Hardening is “expensive baby-sitting”.
- Mixed outcomes results in Work Hardening – “50-80% success” and
“Outcomes are unclear” per the research.
• “Modified Duty” work + increased pressure for early return
to work.
• The need to furnish the appropriate treatment pathway for
workers with behavioral obstacles preventing return to
normal activity.
WHEN SHOULD FUNCTIONAL BASELINE TESTING BE DONE IN A
REHAB PROGRAM?
When an acute patient enters the strengthening phase of a
physical rehabilitation program:
• OT/PT patient is medically stable
- No medical or surgical contraindications for care
• OT/PT patient is ready for “conditioning”
- Aerobic & Progressive Resistance exercise
• OT/PT patient is ready to begin at least light lifting,
pushing, and pulling tasks.
• OT/PT patient is ready to begin working on required
postures and positions assumed at work safely.
WHO CAN PERFORM FUNCTIONAL BASELINE TESTING?
• OT’s/PT’s should check with State Division of Professional
Registration.
• OT’s/PT’s should check with State PT or OT Association.
• In general:
- Evaluations – Licensed Physical or Occupational Therapist.
- Treatment Planning – as above.
- Treatment – Licensed PTA, COTA, or well-trained therapy aide with
direct supervision.
WHERE CAN FUNCTIONAL BASELINE TESTING BE DONE?
Traditional therapy clinic with the proper equipment:
• Conditioning – Cardio & Progressive Resistance Equipment
• Functional activity:
- Lifting (lift boxes, weights, lifting shelves)
- Pushing/pulling (force gauge)
- Climbing (sturdy ladder & stairs)
- Positional tolerances (adequate space to allow for skills circuits –
bending, squatting, crawling, kneeling tasks)
• Treatment should coordinate w/ Modified Duty Work:
- Restricted work per the treating physician
- Patient can work in modified duty work and attend Functional Baseline
Treatment on the same day.
HOW IS FUNCTIONAL BASELINE TESTING DONE?
• Appropriate patient is determined ready for Functional
Baseline Testing Program. Employer is contacted for Job
Description.
• Initial Functional Baseline Test is done with appropriate
patient:
- FBT assesses material handling and non-material handling
- FBT assesses effort and presence of non-organic signs.
• Based on the functional deficit areas, a treatment plan is
written and reviewed with the patient.
- Goals coordinate with job description – functional goal setting.
• Patient begins a goal-oriented conditioning and activity
program.
- Includes conditioning, material handling, non-material handling.
• Every week goals attainment is reviewed and new goals are
set for the following week. Patient signs off on treatment
plan.
• Every 2 weeks a new Functional Baseline Test is performed.
• When plateau reached, 1 of the following discharge
pathways occur:
- Goals met for return to full-duty work – Patient returns to work.
- Goals not met for return to full-duty work – Patient undergoes a
traditional Functional Capacity Evaluation to determine:
- If restrictions are needed and what they are.
- If non-organic pain behaviors are the obstacle to progress.
- Workers’ Compensation Case is closed.
For more information on Functional Baseline Testing, check
out the
online course by The Back School HERE
Last revised: April 24, 2016
by Ronald Porter, PT, CEAS III