Rehabilitation Ergonomics - Fundamentals and Assessment Tools for Occupational Ergonomics - page 478

As a result, rehabilitation professionals developed four specialties that bridge the gap between treatment
and return to work. In brief, they are:

. Functional capacity evaluation (FCE): FCE adds work relevance to testing by using functional
activities such as lifting, pushing, pulling, carrying, gripping, climbing, walking, balancing, reach-
ing, sitting, and standing.
. Work rehabilitation: Work-related rehabilitation provides a structured regime that allows the
injured worker to increase function and regain work capabilities.
. Job modification: At the worksite, modifications match the work to the capacity of the worker to
promote return to work and prevention of reinjury.
. Early intervention: Immediate intervention when a work injury or illness threatens work ability,
reduces the lost time for the worker and increases healing and functional work capability.

22.4.1 Functional Capacity Testing
Functional capacity evaluations (FCE) were developed to evaluate the physical work-related abilities of
an injured worker. 11 - 13 The impetus came from workers' compensation administrators who determined
that physicians restrictions alone did not provide adequate specific information for an employer to bring
a worker back to work. Specific work functions were listed and physicians were asked to rate the worker
on each category. In turn, therapists were called upon to develop an objective means to measure work
function that could be used as an adjunct for the medical release to work.
Functional evaluation is an objective measure of the ability of a worker to perform actual work tasks.
There are two types, FCE and work-related tests.
FCEs utilize the listing of job tasks developed by the U.S. Department of Labor and Industry. 14 Tests are
standardized for each physical task and the results are given in each category. By designing functional
capacity tests for these work items, it was possible to match a worker's functional capacities with the
requirements of the job. This allowed appropriate job or jobs to be selected and to define what modifi-
cations would be necessary to allow safe work return.
Figure 22.3 is an example of the matching of a job description with functional abilities of a worker. The
XXX denotes areas where specific comments would be made.
As functional capacity technology grew, so did the numbers and types of tests. To ensure confidence in
an FCE, studies determined which FCEs are scientifically reliable. 15 - 22 This provides assurance to the
referrer, end user and evacuee that the test is reproducible. Validity studies demonstrate that certain
FCEs can have impact outside of the clinical setting. 23 - 25
Specific work-related tests differ from standardized FCEs. They are based on job descriptions.
Reliability and reproducibility are more difficult, as each job description requires a different test. 26

1. Rehabilitation ergonomist: rehabilitation professional educated in ergonomics
and workplace issues

2. Functional evaluation that identifies the safe capacities of a worker combined
with a functional job description to provide the match of the worker and work,
defining what matches and what needs modification

3. Job modifications used immediately at the worksite, to keep the
worker at work safely or allow an early return to work

4. Enhancement of the work abilities as the workers healing or progress toward
return to work

5. Relationship with the team of medical manager, case manager, human resource
professional, safety manager, and worksite supervisors

FIGURE 22.3 Structure of rehabilitation ergonomics in return to work.