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Post-offer, pre-placement testing in industry
Abstract
Pre-placement testing was implemented during World War II. Its current use has been reshaped by economic factors, litigation, legislation, and advances in medicine. In response to a request from a local industry intent upon lowering their work-related injuries, a post-offer screening program was developed and implemented. The aim of this study was to develop a testing protocol for determining physical capacity that could be adapted for a post-offer, pre-placement program.
Functional capacity evaluation (FCE) testing was used to determine the physical capacity of 2,482 uninjured, healthy prospective new employees of a large food production plant. A comprehensive medical history and 20 different anthropometric, fitness, strength, and lifting tests were administered to all new hires in the first phase of this study to determine if injury incidence could be estimated through functional screening testing. The second study was designed to determine the effectiveness of the application of a post-offer, pre-placement program in an electrical equipment manufacturing facility.
Strength testing alone was of no predictive value for work injury incidence. There was a strong correlation of physical capacity to physical job requirements. If an employee had the physical capability to perform the essential functions of the job, there was a lower injury rate as compared to the employee not demonstrating the physical strength or ability to perform the essential functions of the job. The incidence of low back injuries in those workers with the physical capabilities to perform the required functions of their job was 3%. However, among those workers who did not demonstrate the strength or physical abilities to perform their job, there was a 33% incidence of low back injuries.
This study indicates that physical capacity testing that compares lifting ability to job lifting requirements correlates to work injury incidence. The application of appropriate post-offer, pre-placement testing is shown to be a cost-effective method to lower the incidence of work-related injuries.
... 1 Personnel who are not physically capable of performing manual handling tasks are more susceptible of injury. 2,3 There are two major approaches to mitigating the risk of injury and improving productivity in manual handling tasks. The first involves re-engineering or manipulating task demands to match the physical capacity of the worker population. ...
... The first involves re-engineering or manipulating task demands to match the physical capacity of the worker population. [2][3][4] The second involves improving the physical capability of the worker population to match job demands. 2,3 Although physical and technical training is paramount to a physically capable work force, the inherent limits in physical capacity for an individual vary widely. ...
... [2][3][4] The second involves improving the physical capability of the worker population to match job demands. 2,3 Although physical and technical training is paramount to a physically capable work force, the inherent limits in physical capacity for an individual vary widely. As such, selecting workers physically capable of meeting the requirements of the job is central to matching the physical capacity of the worker population with the demands of the job. ...
Soldiers undergo regular physical testing to assess their functional capacity. However, current physical tests, such as push-ups, sit-ups, and pull-ups, do not necessarily assess job-specific physical capability. This article assesses the utility of generic predictive tests and a task-related predictive test in predicting performance against four job-critical military manual handling tasks. The box lift and place test was found to be the superior predictor in performance of four job tasks; a pack lift and place (R2 = 0.76), artillery gunner loading simulation (R2 = 0.36), bombing up an M1 tank simulation, (R2 = 0.47) and a bridge building simulation (R2 = 0.63). Pull-ups and push-ups were poor predictors of performance in the majority of job tasks. Although the box lift and place had a larger correlation with the artillery gunner loading task than the generic assessment, it only accounted for 36% of the variance, indicating that a task simulation may be more appropriate to assess soldiers’ capacity to perform this job task. These results support the use of a box lift and place rather than generic fitness tests for the evaluation of military manual handling tasks. © Association of Military Surgeons of the U.S. All rights reserved.
... As a result, employers have turned to preemployment and post-offer assessments and screening. 2. Pre-employment and post-offer assessments and screening N Studies assessing the predictability of screening tools such as isometric strength tests, [23][24][25][26][27][28][29] cardiovascular fitness, 24,26,27,30 and isokinetic strength tests 24,27,28,31,32 have had variable results in regards to their predictability of injuries based on assessment criteria. However, as with tests that included dynamic lifting components, 27,29,32 the predictability of the tests improves as the occupational physical demands approach or exceed the worker's demonstrated capability. ...
... As a result, employers have turned to preemployment and post-offer assessments and screening. 2. Pre-employment and post-offer assessments and screening N Studies assessing the predictability of screening tools such as isometric strength tests, [23][24][25][26][27][28][29] cardiovascular fitness, 24,26,27,30 and isokinetic strength tests 24,27,28,31,32 have had variable results in regards to their predictability of injuries based on assessment criteria. However, as with tests that included dynamic lifting components, 27,29,32 the predictability of the tests improves as the occupational physical demands approach or exceed the worker's demonstrated capability. ...
... As a result, employers have turned to preemployment and post-offer assessments and screening. 2. Pre-employment and post-offer assessments and screening N Studies assessing the predictability of screening tools such as isometric strength tests, [23][24][25][26][27][28][29] cardiovascular fitness, 24,26,27,30 and isokinetic strength tests 24,27,28,31,32 have had variable results in regards to their predictability of injuries based on assessment criteria. However, as with tests that included dynamic lifting components, 27,29,32 the predictability of the tests improves as the occupational physical demands approach or exceed the worker's demonstrated capability. ...
Musculoskeletal injuries account for the largest proportion of workplace injuries. In an attempt to predict, and subsequently manage, the risk of sprains and strains in the workplace, employers are turning to pre-employment screening. Functional capacity evaluations (FCEs) are increasing in popularity as a tool for pre-employment screening despite limited published evidence for their validity in healthy working populations.
This narrative review will present an overview of the state of the evidence for pre-employment functional testing, propose a framework for decision-making to determine the suitability of assessment tools, and discuss the role and potential ethical challenges for physiotherapists conducting pre-employment functional testing.
Much of the evidence surrounding the validity of functional testing is in the context of the injured worker and prediction of return to work. In healthy populations, FCE components, such as aerobic fitness and manual handling activities, have demonstrated predictability of workplace injury in a small number of studies. This predictability improves when workers' performance is compared with the job demands. This job-specific approach is also required to meet anti-discrimination requirements. There are a number of practical limitations to functional testing, although these are not limited to the pre-employment domain. Physiotherapists need to have a clear understanding of the legal requirements and potential ethical challenges that they may face when conducting pre-employment functional assessments (PEFAs).
Further research is needed into the efficacy of pre-employment testing for workplace injury prevention. Physiotherapists and PEFAs are just one part of a holistic approach to workplace injury prevention.
... One cross sectional study among cleaners found that those with better musculoskeletal health had higher muscular strength, [16] although a longitudinal study of food production workers found that physical strength did not predict musculoskeletal injuries. [17] A systematic review of longitudinal studies investigating the relationship between lifting strength and neck/shoulder physical capacity and future low back and neck/shoulder musculoskeletal pain reported no conclusive evidence among studies that were available in the literature. [18] There were no studies of distal upper extremity strength in the review. ...
... Other studies have shown similar low levels of strength in workers. [17,31] The workers in all groups were relatively young so they may not have achieved their lifetime peak potential strength. A large number of the workers with repeated grip values showed an increase in strength after 3 years of work. ...
... Our findings are consistent with one study conducted in 2005 of 2000 workers, which found that muscular strength and physical capacity alone were not predictive of future musculoskeletal injuries. [17] This study did report that rates of sprains and strains in all body parts were higher among the small number of workers whose physical capabilities were "mismatched" to their jobs based on lifting requirements. Overall, there are few high quality studies of the very common practice of POPP screening: based on existing studies, a Cochrane review of pre-employment examinations for preventing occupational injury in workers [33] and a systematic review for investigating the relationship between physical capacity and musculoskeletal health problems of the low back and neck/shoulder [18] were unable to draw any conclusions about the relationship between worker physical testing and risk of future musculoskeletal disorders. ...
Purpose:
Grip strength is often tested during post-offer pre-placement screening for workers in hand-intensive jobs. The purpose of this study was to evaluate the association between grip strength and upper extremity symptoms, work disability, and upper extremity musculoskeletal disorders (UE MSDs) in a group of workers newly employed in both high and low hand intensive work.
Methods:
1,107 recently-hired workers completed physical examinations including grip strength measurements. Repeated surveys obtained over 3 years described the presence of upper extremity symptoms, report of physician-diagnosed musculoskeletal disorders (MSDs), and job titles. Baseline measured grip values were used in analytic models as continuous and categorized values to predict upper extremity symptoms, work disability, or UE MSD diagnosis.
Results:
Twenty-six percent of males and 20 % of females had low baseline hand strength compared to normative data. Multivariate logistic regression analyses showed no consistent associations between grip strength and three health outcomes (UE symptoms, work disability, and MSDs) in this young cohort (mean age 30 years). Past MSD and work type were significant predictors of these outcomes.
Conclusions:
Physical hand strength testing was not useful for identifying workers at risk for developing UE MSDs, and may be an inappropriate measure for post-offer job screens.
... When lifting capacity results were compared with job requirements, those workers who met the physical job demands were found to have significantly lower injury rates than those workers who did not demonstrate the required physical capacities (Harbin & Olson, 2005). Strength testing alone, however, had no predictive value for determining the incidence of work injuries. ...
... Despite the difficulty of assessing functional capacity, several studies showed that it may be possible to reduce the length and complexity of FCEs by matching them more closely with specific job demands, and only including items that are shown to relate to return to work (Gross, Battié, & Cassidy, 2004;Harbin & Olson, 2005;Matheson, Isernhagen, & Hart, 2002;Reneman, Dijkstra, et al., 2002). ...
... This may be due to the difficulty in determining acceptable standards against which to compare FCE performance. There also appear to be some conflicting findings between FCEs.While the PILE was able to predict future back injury in healthy workers (Harbin & Olson, 2005), the IWS FCE was not able to predict recurrence of back injury , 2005b.This may be an issue of healthy versus injured populations, rather than the predictive validity of the specific FCEs; however, this very important issue requires further investigation. ...
Functional capacity evaluations (FCEs) and other work-related assessments continue to be used in occupational rehabilitation to determine the capacity of injured and disabled workers to either return to their preinjury jobs, or to determine what they are capable of doing in a work context. New instruments have been developed and others refined. There is a continuing call however for these systems to demonstrate acceptable reliability and validity. Comprehensive reviews of reliability and validity of work-related assessments were published and included information up to the end of 1997. This study updates that information by examining research conducted on five FCEs over the subsequent 8-year period (January 1998–March 2006). The Isernhagen Work Systems (IWS) FCE had the most comprehensive coverage of all aspects of reliability and validity, while the Progressive Isoinertial Lifting Evaluation (PILE) was also extensively researched. Newer FCEs show promise and should continue to be investigated. Clinicians and others are encouraged to be informed consumers of the evidence that exists for the reliability and validity of FCEs and other work-related assessments.
... For the past several decades, social policy in many countries has been focused on helping individuals with a chronic disease or disability that restricts participation in work roles, to enter or re-enter the labor market [38]. In order to assist in finding suitable jobs for people with a disability, knowledge of their work capacities is essential [21] . Performance-based tests provide information that allows professionals to base their workability assessment on concrete evidence rather, than intuitive principles or presumptive facts [40] . ...
... For successful placement of people with a disability, in addition to knowledge concerning work capacities, the work demands of the jobs must also be known. It is the match between work capacities and work demands that is needed to ensure safe placement of employees, preventing people with a disability from being placed in jobs in which they will be physically or psychosocially underor overloaded, which may subsequently contribute to appropriate work participation [21]. The definition of overload is when demands exceed an individual's capacity to deal with them. ...
... Chaffin et al. [7] concluded in 1978 that a worker's likelihood of sustaining a back injury or musculoskeletal illness increases when job lifting requirements approach or exceed the strength capacity of the employee . Harbin and Olson [21] developed a testing protocol for physical capacity that could be adapted as a post-offer, pre-placement program and also described the work demands. They concluded that if an employee had the physical capacity to perform the essential work demands, there was a lower injury rate as compared to the employee who is unable to demonstrate the physical capacity to perform the work demands. ...
To determine whether employees with disabilities were initially assigned to jobs with work demands that matched their work capacities.
Forty-six employees with various physical, mental, sensory and multiple disabilities working in a sheltered workshop.
Physical and psychosocial work capacities were assessed post-offer and pre-placement using the Ergo-Kit and Melba. Work demands of the jobs were determined by workplace assessments with TRAC and Melba and were compared with the work capacities.
Of the 46 employees, 25 employees were not physically overloaded. When physical overload occurred, it was most often due to regular lifting. All employees were physically underloaded on six or more work activities, most often due to finger dexterity and manipulation. Almost all employees (n=43) showed psychosocial overload or underload on one or more psychosocial characteristics. Psychosocial overload was most often due to endurance (long-term work performance), while psychosocial underload was most often due to speaking and writing.
Despite the assessment of work capacities at job placement, underload and overload occurred on both physical activities and psychosocial characteristics. Assessing both work capacities and work demands before job placement is recommended. At job placement more attention should be paid to overloading due to lifting and long-term work performance.
... For such occupations, mitigating the risk of injury can be achieved through preselection of physically capable workers (13,22). Preselection is a means of matching the physical attributes of the worker with the demands of the task and is a proven method of injury prevention and productivity enhancement (3,17). ...
... Preselection is a means of matching the physical attributes of the worker with the demands of the task and is a proven method of injury prevention and productivity enhancement (3,17). Matching worker capability with task demand is a well-documented process (5,13,20), which typically involves quantifying the demands of the job, identifying the physical capacities required, and establishing valid performance assessments. ...
... Psychophysical measurements, such as the maximum acceptable lift (25), involve the estimation and self-determination of a tolerable limit for a manual handling task demand, which favors the safety of the individual. This estimate is strongly correlated with maximal lifting capacity and is thought to encompass both biomechanical and physiological feedback (2,8,10,13). ...
Psychophysical assessments, such as the maximum acceptable lift, have been used to establish worker capability and set safe load limits for manual handling tasks in occupational settings. However, in military settings, in which task demand is set and capable workers must be selected, subjective measurements are inadequate, and maximal capacity testing must be used to assess lifting capability. The aim of this study was to establish and compare the relationship between maximal lifting capacity and a self-determined tolerable lifting limit, maximum acceptable lift, across a range of military-relevant lifting tasks. Seventy male soldiers (age 23.7 ± 6.1 years) from the Australian Army performed 7 strength-based lifting tasks to determine their maximum lifting capacity and maximum acceptable lift. Comparisons were performed to identify maximum acceptable lift relative to maximum lifting capacity for each individual task. Linear regression was used to identify the relationship across all tasks when the data were pooled. Strong correlations existed between all 7 lifting tasks (rrange = 0.87-0.96, p < 0.05). No differences were found in maximum acceptable lift relative to maximum lifting capacity across all tasks (p = 0.46). When data were pooled, maximum acceptable lift was equal to 84 ± 8% of the maximum lifting capacity. This study is the first to illustrate the strong and consistent relationship between maximum lifting capacity and maximum acceptable lift for multiple single lifting tasks. The relationship developed between these indices may be used to help assess self-selected manual handling capability through occupationally relevant maximal performance tests.
... FCEs have also become popular as a proactive tool to reduce injury rates associated with manual materials handling jobs [5], specific to applications related to pre-offer or post-offer employment testing. FCEs permit testing of physical capacity (i.e., maximum lifting capacity) and movement competency (i.e., lifting strategy), which may both be implicated in injury pathways. ...
... Informed Consent All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helinski Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study. ...
Purpose The objective of this study was to determine the agreement of kinematic parameters calculated from motion data collected via a 2D video-based pose-estimation (markerless motion capture) approach and a laboratory-based 3D motion capture approach during a floor-to-waist height functional lifting test. Method Twenty healthy participants each performed three floor-to-waist height lifts. Participants’ lifts were captured simultaneously using 2D video (camcorder) in the sagittal plane and 3D motion capture (Vicon, Oxford, UK). The three lifts were representative of a perceived light, medium, and heavy load. Post-collection, video data were processed through a pose-estimation software (i.e., markerless motion capture). Motion data from 3D motion capture and video-based markerless motion capture were each used to calculate objective measures of interest relevant to a functional capacity evaluation (i.e., posture, balance, distance of the load from the body, and coordination). Bland–Altman analyses were used to calculate agreement between the two methods. Results Bland–Altman analysis revealed that mean differences ranged from 1.9° to 22.1° for posture and coordination-based metrics calculated using markerless and 3D motion capture, respectively. Limits of agreement for most posture and coordination measures were approximately + 20°. Conclusions 2D video-based pose estimation offers a strategy to objectively measure movement and subsequently calculated metrics of interest within an FCE context and setting, but at present the agreement between metrics calculated using 2D video-based methods and 3D motion capture is insufficient. Therefore, continued effort is required to improve the accuracy of 2D-video based pose estimation prior to inclusion into functional testing paradigms.
... Whether used in the hiring process, or to support RTW, the results are used to match job candidates with jobs for which they demonstrate the required physical capability to complete, known as job matching (Armstrong et al. 2001;Dempsey et al. 2000). Job matching has emerged as a common administrative control to enhance RTW and to proactively reduce injury rates associated with physically demanding jobs (Harbin and Olson 2005;Jackson and Taylor 1994;Legge, Burgess-Limerick, and Peeters 2013). As job candidates complete a physical test protocol, clinicians observe job candidate's performance documenting their physical capacity (e.g. ...
... A second future direction to explore is to consider movement strategy used in job matching protocols. Since job matching is a proactive ergonomics tool with a goal of reducing injury rates associated with physically demanding jobs (Harbin and Olson 2005;Jackson and Taylor 1994;Legge, Burgess-Limerick, and Peeters 2013), the movement strategy used should be considered as it may reveal injury risks, in addition to evaluating capacity. By ignoring movement strategy in physical employment testing protocols, we may not be maximising their potential as a proactive injury reduction tool (Armstrong et al. 2019). ...
Generalized predictive tests may be viable screening tools to evaluate job candidate workability if movement strategy used in assessment is consistent with movement strategy used in work. This study investigated if deep squat kinematics could predict floor-to-waist height lifting kinematics. Participants performed three deep squat repetitions, and ten lifts of both a 10 kg and 20 kg box. Whole body kinematics were collected to calculate knee, hip and low back angles, and coordination as measured by relative phase angles. Movement features of lower extremity control, including knee and hip angles and coordination, were significantly correlated (r = 0.43 - 0.85) between the deep squat and lifting. However, low back movement features, measures linked to injury risk, were not significantly correlated between the deep squat and lifting. These findings do not support the deep squat as a suitable movement screen to predict lifting strategy, specifically when considering low back control.
Practitioner Summary: This study investigated whether lifting strategy could be inferred from deep squat performance. Knee and hip movement strategy were associated between the deep squat and lifting. However, inconsistencies in low back control between the deep squat and lifting limit the deep squat’s injury risk assessment potential.
... 82 However, inferences can be made from peer-reviewed studies where work-specific FCEs (ie, simulating the essential function of the job), used in the pre-placement or pre-employment process, reduced the incidence of work of future injuries. [89][90][91][92][93] Work-related isometric strength measurements have been shown as predictors for risk of future injuries if the measurements are closely matched to the specific material handling demands. 63,64 Workers exceeding their physicophysical strength capabilities determined when isoinertial strength have been demonstrated to have less prevalent low back injuries 94,95 Isokinetic strength measurements are poor predictors for back injuries. ...
... When a workers' capacity is matched to a job requiring similar capacities, studies have demonstrated a decrease in the incidents of work-related injuries. 91 However, FCEs have not been demonstrated to predict whether or not injuries would occur. ...
It is beneficial for both worker and employer for the worker to return to work (RTW) as early as possible after an illness, injury, or prolonged absence. Because employers are ultimately responsible for the RTW decision, a medical RTW assessment is commonly required to assure that the worker is medically able to and physically capable of performing the job tasks. Consequently, many employers depend on opinions from medical providers. Valid functional capacity evaluations can provide objective measurements of work-related strength capabilities and are useful in supporting a medical provider's opinion of a worker's ability to RTW or fitness for duty.
... The study reported that the probability of a worker suffering a manual materials handling injury was 3 times higher among workers who did not demonstrate the minimum physical capabilities for the job [12]. This was consistent with a previous prospective cohort study demonstrating improved prognostic ability when PES components were matched to job requirement, but poor prognostic ability of strengthbased measures alone [13]. Considering evidence [12,13] and contemporary theory [14,15], the relationship between PES performance and injury risk may be strongest when PES are designed to closely replicate the physical demands of the job (i.e., simulation-based), both in terms of physical effort, and work layout and dynamic movement requirements. ...
... This was consistent with a previous prospective cohort study demonstrating improved prognostic ability when PES components were matched to job requirement, but poor prognostic ability of strengthbased measures alone [13]. Considering evidence [12,13] and contemporary theory [14,15], the relationship between PES performance and injury risk may be strongest when PES are designed to closely replicate the physical demands of the job (i.e., simulation-based), both in terms of physical effort, and work layout and dynamic movement requirements. These findings suggest that an individual's physical capability and the movement strategy they choose to leverage that capacity to meet the job requirements (herein referred to as movement competency) are likely mutually important when using PES as a prognostic tool for MSD prevention. ...
Background:
Physical employment standards (PES) ensure that candidates can demonstrate the physical capacity required to perform duties of work. However, movement competency, or an individual's movement strategy, can relate to injury risk and safety, and therefore should be considered in PES.
Objective:
Demonstrate the utility of using artificial intelligence (AI) to detect risk-potential of different movement strategies within PES.
Methods:
Biomechanical analysis was used to calculate peak flexion angles and peak extensor moment about the lumbar spine during participants' performance of a backboard lifting task. Lifts performed with relatively lower and higher exposure to postural and moment loading on the spine were characterized as "low" or "high" exposure, respectively. An AI model including principal component and linear discriminant analyses was then trained to detect and classify backboard lifts as "low" or "high".
Results:
The AI model accurately classified over 85% of lifts as "low" or "high" exposure using only motion data as an input.
Conclusions:
This proof-of-principle demonstrates that movement competency can be assessed in PES using AI. Similar classification approaches could be used to improve the utility of PES as a musculoskeletal disorders (MSD) prevention tool by proactively identifying candidates at higher risk of MSD based on movement competency.
... There is a vast number of physical fitness tests and standards that have been implemented in occupations that carry a high risk of occupational injuries in an effort to reduce such risks and optimize workforce productivity. For example, new employees at a food production plant and electrical equipment manufacturing facility who met the physical requirements of their jobs subsequently had a lower risk and rate of work-related musculoskeletal injuries than those who failed the test (Harbin and Olson 2005). Similarly, at an industrial yard that distributes building materials, new employees who were screened and matched to the physical demands of the job were less susceptible to musculoskeletal injuries compared with their unscreened counterparts (Rosenblum and Shankar 2006). ...
... These findings highlight the importance of pre-employment physical fitness testing in minimizing the incidence of injuries in the workplace. Moreover, with fewer workplace injuries, health care costs to employers are reduced (Anderson and Briggs 2008;Harbin and Olson 2005;Rosenblum and Shankar 2006). ...
Many physically demanding occupations in both developed and developing economies involve exposure to extreme thermal environments that can affect work capacity and ultimately health. Thermal extremes may be present in either an outdoor or an indoor work environment, and can be due to a combination of the natural or artificial ambient environment, the rate of metabolic heat generation from physical work, processes specific to the workplace (e.g., steel manufacturing), or through the requirement for protective clothing impairing heat dissipation. Together, thermal exposure can elicit acute impairment of work capacity and also chronic effects on health, greatly contributing to worker health risk and reduced productivity. Surprisingly, in most occupations even in developed economies, there are rarely any standards regarding enforced heat or cold safety for workers. Furthermore, specific physical employment standards or accommodations for thermal stressors are rare, with workers commonly tested under near-perfect conditions. This review surveys the major occupational impact of thermal extremes and existing employment standards, proposing guidelines for improvement and areas for future research.
... More recent studies show even more promising results. A functional capacity evaluation based on the comparison of the lifting capabilities of prospective workers before placement with the lifting demands of the job was shown to be an effective WLBD' control measure (Harbin and Olson, 2005). Researchers found a 3% incidence of WLBD (sprains and strains in this study) in workers that demonstrated adequate functional capacity to accomplish the job lifting demands, while the incidence among the workers that did not demonstrate adequate lifting capacity was 33%. ...
... It is important to highlight that strength and physical capacity alone (without consideration of job physical demands) was not a significant predictor of injury. Matching the functional capacity of the workers to the work physical demands also resulted on a reduction of medical costs of more than 86% (from over $70,000 to under $10,000 in a 4 year period), and resulted on a 99% reduction in days lost (from 700 to 7 days lost) even with increased number of workers (from 170 to over 200 workers) (Harbin and Olson, 2005). Picavet and Schouten (2000) found that removing physical load risk factors could potentially reduce the incidence of WLBD between 13% and 18%. ...
... (5) Admission assessment has proved solidly effective in preventing physical injuries to the worker when properly performed. (6,7) The headache, however, does not seem to Avaliação admissional e o diagnóstico de cefaleias have its owing heed in the most of admissive evaluations, and its prevention starting from this evaluation is not well established. ...
Objectives: To question and to describe the headache prevalence in a population undergone admissive evaluation. Methods: 607 individuals were undergone admissive evaluation, whose data were catalogued by the examiner neurologist. The questions "Do you have headache? Does headache interfere in your life quality?" were made to all patients, and the prevalence was compared with the literature. Results: The sample was composed of individuals from 17 to 66 years old (27.72 on average), in which 98.35% were male. About 5% of the individuals answered YES to both questions, 0.65% answered YES to only the first question, and no female answered YES to both questions. Conclusions: The observed headache prevalence is smaller than in other studies of healthy populations. It is possible that the hopeful applicant omit this information during the admissive evaluation by fearing that this information would interfere negatively in their hiring.
... This finding is in line with the findings of Wong and Kwok (2012), showing that the health care support staff with the highest physical job demands had the lowest level of handgrip strength. Similar findings have been reported in other studies (Grobler, 2013;Harbin & Olson, 2005). Conversely, high handgrip strength does not necessarily mean that a person is good at manual material handling, which is essential in the day to day operations of health care workers. ...
Objective
While musculoskeletal disorders (MSD) and physical strength have been extensively studied in health care professionals, little attention has been paid to health care support staff, such as patient care assistants and operation patient assistants, whose jobs are physically demanding. The purpose of this paper was to examine the musculoskeletal symptoms and physical strength of newly recruited health care support staff.
Method
Convenience sampling was conducted on 111 newly employed health care support staff in a public hospital. A custom-made pre-placement examination was performed. Data were analysed using descriptive, correlation, and regression analyses.
Results
Nearly one-third (32%) of the newly recruited health care support staff had experienced musculoskeletal symptoms in at least one body part during the preceding 12 months. Two-thirds (68%) of subjects were physically inactive, and sixty percent was overweight or obese. Handgrip strength was weaker than the local norm. The subjects’ dominant handgrip strength, bilateral lifting, pushing, and pulling force were significantly correlated. Only bilateral lifting was significantly associated with MSD among the newly recruited health care workers.
Conclusions
This study reports the baseline prevalence of MSD symptoms in the newly recruited health care support staff. Their sedentary lifestyle and suboptimal physical strength may render them susceptible to occupational injuries and disease. An effective occupational health programme that provides periodic health surveillance should be considered for high-risk health care workers to allow proper interventions in a timely manner.
... Grip strength (GS) is utilized for specific purposes in ergonomics, as well as medicine and rehabilitation (Bao & Silverstein, 2005;MacDermid, 2005;Uğurlu, Özkan, & Özdoğan, 2008). In ergonomics, it is used for quantifying force exertion levels required for a specific task (Bao, Spielholz, Howard, & Silverstein, 2009), deciding on the suitability of a worker for a particular job (Harbin & Olson, 2005), evaluating the effectiveness of worksite health promotion interventions (Sertel, Üçsular, & Uğurlu, 2016), and designing hand tools (Cakit, Durgun, Cetik, & Yoldas, 2014;Kong & Lowe, 2005), work methods (Chaffin, 1997;Finneran & O'Sullivan, 2010) and workstations (Bhatt & Sidhu, 2012;Hallbeck et al., 2010). ...
Grip strength (GS) variability due to positional changes in the upper extremity joints is of importance while designing workstations and work methods. This study was conducted to analyze the GS variations due to positional changes at shoulder joint when some important variables were under control. The GSs of dominant and nondominant hands were measured in eight shoulder (0°, 45°, 90°, and 135° of flexion and abduction) and standard test positions (STP). One hundred and thirteen subjects 20–30 years old completed the study. At the dominant side, no significant difference was observed in the pairwise comparisons between STP and the others. Maximum and minimum GSs were obtained in 0° abduction and 45° flexion and abduction, respectively. At the nondominant side, GSs were significantly lower (p < 0.001) in the corresponding test positions and demonstrated more variability. The findings of this study can contribute to the available knowledge to guide occupational ergonomists in their practices.
... 4 Fitness testing protocols are well developed in police and fire departments and the military, all of which require candidates to pass fitness tests, but less well developed for other jobs. 5 Fitness testing might be most appropriate for heavy labor jobs including construction, manufacturing, agriculture, and other blue collar jobs but may also be relevant for jobs that require excessive walking, standing, or even sitting. Employers who use the fitness test as a method to not hire people who are overweight may be subject to discrimination claims. ...
... However, job matching can also be applied as a form of primary prevention. When potential employees demonstrate adequate capacities, they are less likely to suffer injury (Harbin and Olson, 2005;Legge et al., 2013). Job matching should not supersede the traditional ergonomics approach of "fitting the task to the worker".; however, job matching does provide a mechanism to recruit workers with sufficient capacity to tolerate unavoidable physical demands (Petersen et al., 2016) that cannot be easily reduced using traditional ergonomic approaches. ...
Public safety related occupations including police, fire and military commonly apply physical employment standard (PES) to facilitate job matching, an approach to evaluate if candidates demonstrate acceptable physical capabilities as required to perform the job safely and effectively. In Canada, paramedics remain as one of the few public safety occupations without an evidence-based, validated PES. The purpose of this study was to document and describe the physical demands of paramedic work and to identify the most physically demanding tasks. These outcomes are essential to inform the design and development of an evidence-based PES for the paramedic sector.
... Manual materials handling is a high risk work activity for the occurrence of low back pain and injury (L€ otters et al., 2003). This injury risk is increased if personnel are not physically capable of safely performing set tasks (Harbin and Olsen, 2005;Rosenblum and Shankar, 2006). To reduce the likelihood of these injuries occurring, commensurate levels of muscular strength and endurance relative to task demand are necessary. ...
The risk of low back pain and injury during manual materials handling is increased if personnel are not physically capable of safely performing such tasks. To establish predictive relationships and develop a test cut-score, 69 participants performed a critical military lifting task to a 1.5-m platform (pack lift) and two task-related predictive tests (box lift to 1.5 m and 1.3 m). The pack lift was strongly correlated with both the 1.5-m (R² = 0.85) and 1.3-m box lifts (R² = 0.82). Both tests had similar sensitivity (range 0.85–0.94) with the 1.3-m test having higher specificity when compared with the 1.5-m lift. Increasing the test cut-score with the application of a safety factor increased the number of false positives and true negatives for both tests. Organisations must carefully assess their risk acceptance when applying safety factors to test cut-scores as the classification (pass/fail) of personnel may be affected.
... Despite these studies, POPP screens continue to be widely promoted by healthcare providers and device manufacturers. 11,[14][15][16][17][18][19][20][21] The purpose of this study was to determine the predictive validity of a POPP screen using nerve conduction velocity studies to detect future cases of CTS among newly-hired workers in a manufacturing facility. We hypothesized that workers with abnormal nerve conduction values at the time of hire would be more likely to develop CTS than workers with normal values. ...
Objective:
We determined the predictive validity of a postoffer pre-placement (POPP) screen using nerve conduction velocity studies (NCV) to identify future cases of carpal tunnel syndrome (CTS).
Methods:
A cohort of 1648 newly hired manufacturing production workers underwent baseline NCS, and were followed for 5 years.
Results:
There was no association between abnormal POPP NCV results and incident CTS. Varying NCV diagnostic cut-offs did not improve predictive validity. Workers in jobs with high hand/wrist exposure showed greater risk of CTS than those in low exposed jobs (relative risk 2.82; 95% confidence interval 1.52 to 5.22).
Conclusions:
POPP screening seems ineffective as a preventive strategy for CTS.
... Personnel are often required to demonstrate specified levels of physical capability for job selection, placement and/or retention. [1][2][3][4][5][6][7][8] There are two primary types of physical capability tests. One type, known as, a 'criterion task' or 'contentbased' performance test uses standardised job-task simulations, such as lifting and carrying a mannequin a specific distance. ...
... Personnel are often required to demonstrate specified levels of physical capability for job selection, placement and/or retention. [1][2][3][4][5][6][7][8] There are two primary types of physical capability tests. One type, known as, a 'criterion task' or 'contentbased' performance test uses standardised job-task simulations, such as lifting and carrying a mannequin a specific distance. ...
Physically demanding occupations (ie, military, firefighter, law enforcement) often use fitness tests for job selection or retention. Despite numerous individual studies, the relationship of these tests to job performance is not always clear.
This review examined the relationship by aggregating previously reported correlations between different fitness tests and common occupational tasks.
Search criteria were applied to PUBMED, EBSCO, EMBASE and military sources; scoring yielded 27 original studies providing 533 Pearson correlation coefficients (r) between fitness tests and 12 common physical job task categories. Fitness tests were grouped into predominant health-related fitness components and body regions: cardiorespiratory endurance (CRe); upper body, lower body and trunk muscular strength and muscular endurance (UBs, LBs, TRs, UBe, LBe, TRe) and flexibility (FLX). Meta-analyses provided pooled r's between each fitness component and task category.
The CRe tests had the strongest pooled correlations with most tasks (eight pooled r values 0.80–0.52). Next were LBs (six pooled r values >0.50) and UBe (four pooled r values >0.50). UBs and LBe correlated strongly to three tasks. TRs, TRe and FLX did not strongly correlate to tasks.
Employers can maximise the relevancy of assessing workforce health by using fitness tests with strong correlations between fitness components and job performance, especially those that are also indicators for injury risk. Potentially useful field-expedient tests include timed-runs (CRe), jump tests (LBs) and push-ups (UBe). Impacts of gender and physiological characteristics (eg, lean body mass) should be considered in future study and when implementing tests.
... The development of physical and physiological employment standards (PES) is based on the premise of matching an employee's physical attributes with the physical demands of their job. The implementation of PES can lead to increased capability and productivity in the workplace (Taylor and Groeller, 2003) and have been shown to significantly reduce injuries across a range of occupations (Harbin and Olsen, 2005;Larsson and Harms-Ringdahl, 2006;Rosenblum and Shankar, 2006). ...
Physical employment standards (PES) are developed with the aim of ensuring that an employee's physical and physiological capacities are commensurate with the demands of their occupation. While previous commentaries and narrative reviews have provided frameworks for the development of PES, this is the first systematic review of the methods used to translate job analysis findings to PES tests and performance standards for physically demanding occupations. A search of PubMed and Google Scholar was conducted for research articles published in English up to and including March 2015. Two authors independently reviewed and extracted data.
The search yielded 87 potentially eligible papers, including 60 peer reviewed journal articles and 17 technical reports. 57 papers were excluded leading to a final data set of 31 papers, representing 22 studies. Job analysis was most commonly conducted through subjective determination of job tasks followed by objective quantification and validation. Determination of criterion tasks was evenly distributedthrough subjective and objective methods with criterion tasks being defined most commonly as most demanding, critical and/or frequent. Generic predictive and task-related predictive tests were more commonly observed in isolation or in combination when compared to task simulation tests. Performance standards were more commonly criterion-referenced than norm-referenced with a variety of statistical methods utilised. This review provides recommendations for researchers when developing physical employment standards for a variety of occupations.
... Application of these legal requirements or similar requirements in other countries applied to physically demanding occupations especially in which "ineffective job performance can result in loss of life or property" [32] have been the subject of various articles and reports throughout the years (e.g., [33][34][35][36][37][38][39]; Canada [40][41][42]; Australia [43]; Britain [29,44]). In addition to military focused assessments (e.g., [23,29,[45][46][47][48][49]), perhaps even a greater number of studies have addressed other physically demanding occupations such as firefighters [43,50,51] as well as police/correctional/peace officers [32,42,[52][53][54]. ...
... Physical employment standards are developed with the aim of ensuring that an employee's physical and physiological capacities are commensurate with the demands of their occupation. The implementation of scientifically-rigorous physical employment standards can lead to a workforce with increased capability and productivity (Taylor and Groeller, 2003) and have been shown to significantly reduce injuries across a range of occupations (Harbin, 2005;Larsson and Harms-Ringdahl, 2006;Rosenblum and Shankar, 2006). In occupations where tasks may be time-critical, such as military, fire, ambulance and emergency rescue, physically capable employees are paramount in ensuring that such tasks are performed effectively and efficiently. ...
Carrying a casualty on a stretcher is a critical task within military and emergency service occupations.
This study evaluated the impact of manipulating carry speed and the object type in bilateral carries on
the ability to predict performance and reflect the physical and physiological requirements of a unilateral
stretcher carry. We demonstrated that three task-related predictive tests; a jerry can carry performed at
4.5 km/h or 5.0 km/h� and a kettle-bell carry performed at 5.0 km/h� were strongly predictive of the
physical and physiological demands of an individual participating as part of a four-person stretcher carry
team. Therefore, bilateral predictive assessments have the utility for predicting the suitability of employees
to effectively and safely conduct a four-person unilateral stretcher carry.
... The maximum acceptable weight of lift is thought to represent a tolerable limit, integrating both biomechanical and physiological feedback to favour the safety of the individual worker (Ayoub and Dempsey 1999;Ciriello et al. 1990;Dempsey and Ayoub 1996;Harbin and Olson 2005). We reported strong and consistent correlations between maximal lifting capacity and the maximum acceptable weight of lift across a large range of military-specific standing lifting tasks (Savage et al. , 2015. ...
This study investigated the effect of posture on lifting performance. Twenty-three male soldiers lifted a loaded box onto a platform in standing and seated postures to determine their maximum lift capacity and maximum acceptable lift. Lift performance, trunk kinematics, lumbar loads, anthropometric and strength data were recorded. There was a significant main effect for lift effort but not for posture or the interaction. Effect sizes showed that lumbar compression forces did not differ between postures at lift initiation (Standing 5566.2 ± 627.8 N; Seated 5584.0 ± 16.0) but were higher in the standing posture (4045.7 ± 408.3 N) when compared with the seated posture (3655.8 ± 225.7 N) at lift completion. Anterior shear forces were higher in the standing posture at both lift initiation (Standing 519.4 ± 104.4 N; Seated 224.2 ± 9.4 N) and completion (Standing 183.3 ± 62.5 N; Seated 71.0 ± 24.2 N) and may have been a result of increased trunk flexion and a larger horizontal distance of the mass from the L5-S1 joint.Practitioner Summary: Differences between lift performance and lumbar forces in standing and seated lifts are unclear. Using a with-in subjects repeated measures design, we found no difference in lifted mass or lumbar compression force at lift initiation between standing and seated lifts.
... [59,60] Preplacement strength testing as a screening method and physical examination for back disorders are controversial; even radiological screening has added no significant predictive value to screening for future back pain. [61][62][63][64][65][66][67][68][69][70] Furthermore, abdominal belts have been proven by randomized clinical trials to be ineffective at preventing back pain. No definitive conclusion has been reached on the clinical significance of back schools (an educational program that teaches practical information about back care, posture, body mechanics, back exercises, and how to prevent chronic back). ...
This paper reviews scientific research on occupational back pain and focuses on prevention of this problem. It discusses some of the challenges of translating the evidence of this multi-factorial condition into policy. Medical science is currently unable to clearly distinguish between back pain caused by work and that possibly due to other causes but which affects the individual's capacity to work. Back pain affects the vast majority of people at some point in their lives and is very costly to both the health care system and the industry. Evidence suggests that heavy lifting, driving, and vibration of the whole body are linked to occupational back pain. Once the risk factors for occupational back pain are identified, an otherwise chronic and disabling condition can be prevented in the majority of patients. As explained in this article, three levels of prevention for occupational back pain have been reported as effective. Failure to implement preventive measures may lead to a high incidence of occupational back pain.
... Archaic worker placement techniques such back x-rays and subjective estimates of strength have been shown to be ineffective at reducing low back pain claims (Snook et al., 1978). While there are some promising exceptions (Harbin and Olson, 2005), in general, placement techniques have failed to demonstrate a proven benefit (Waddell and Burton, 2001;Hamberg-van Reenen, et al., 2007). While a history of back pain is the best predictor of a future episode of back pain, there is strong evidence that use of MRIs (and x-rays) and "back function testing machines (isometric, isokinetic or isoinertial measurements) have no predictive value for future LBP [Low Back Pain] or disability" (Waddell and Burton, 2001). ...
... As a consequence, empirical validation studies of physical ability predictors for safety forces remain infrequent in the literature, despite concern about the paucity of this work raised by the editor of the Journal of Applied Psychology (Campbell, 1982). Although criterion-based validation research on safety forces is relatively sparse, the importance of physical abilities in both job performance (e.g., Arvey, Nutting, & Landon, 1992; Blakley, Quinones, Crawford, & Jago, 1994; Hoffman, 1999; Hogan, 1991a; Sothmann, Gebhardt, Baker, Kastello, & Sheppard, 2004) and in the reduction of job-related injuries (e.g., Beaton, Murphy, Salazar, & Johnson, 2002; Harbin & Olson, 2005; Jackson, 1994; Stevenson, Weber, Smith, Dumas, & Albert, 2001) has received substantial recent attention. Hogan (1991a) summarized 14 studies that correlated various physical ability measures with training time, ratings of job performance, and work simulations in a variety of physically demanding jobs. ...
Recruits from 9 consecutive fire academy classes were assessed on a battery of strength and endurance measures at Weeks 1, 7, and 14 of training. Regression analyses using Week 1 measures indicated that strength variables were the primary predictors of performance on physically demanding firefighting tasks assessed at the completion of training. Incremental validity was obtained with the addition of aerobic capacity, which produced more accurate performance distinctions among recruits with high strength levels. Results showed predictive validity and linearity throughout the upper range of strength and endurance levels, but evidence of an increased drop-off in performance for recruits with strength levels below the male 25th percentile. Structural equation modeling, a more powerful and comprehensive approach to validation than traditional regression, provided strong support for the construct validity of general strength and endurance as predictors of firefighter performance on physically demanding fire suppression and rescue tasks.
Introduction
Little is known about the relationship between the types of grip strength, functional range, anthropometric measures, and function in the home and workplace. The study aimed to determine their relationships and explore their contributions to performing usual work duties and overall function in participants with and without hand and wrist injury.
Method
Forty-four participants were measured on Maximal Voluntary Isometric Grip Strength, Rapid Exchange Grip Contractions and Isometric Endurance, Forearm Length and Volumetry, and the Dart Thrower’s Motion (DTM) measure. They completed the Patient Rated Wrist and Hand Evaluation and the Disabilities of the Arm, Shoulder and Hand Work Module.
Results
The grip measures significantly correlated with Volumetry (r = 0.62–0.74) in participants with and without hand and wrist injury. The Isometric Endurance and DTM measure of the non-injured hand were found to be contributing factors for participants with hand and wrist injury when returning to usual work duties and overall function.
Conclusion
The non-injured hand function plays a role in the overall function for participants with hand and wrist injuries. Isometric Endurance and DTM measure could assist clinicians in determining suitable rehabilitation targets, resulting in a better function required for occupations in the home or workplace.
The hand grip strength is an important performing characteristic that can increase the efficiency of workers. The hand tools should be designed in such a manner that the workers can easily perform operations with sufficient grip on it. This study was conducted to measure and compare the grip strength of the carpenters of age between 19 and 60 years. The hand grip strength of 112 carpenters was determined in different postures. The carpenters were selected from the population of Jaipur district of Rajasthan (India) and all were male and native of Rajasthan. Grip strength of dominant hand of each participant was recorded with digital dynamometer. An indirect moderate correlation was observed between age and grip strength. The hand grip strength of first group (19–32 years) was observed more compared to the other two groups (33–46 and 47–60 years). The findings of such research studies may be useful for product designers while designing products targeting a particular age group.KeywordsCarpenterCorrelationGrip strengthHand tools
Background:
Extremity strength testing is used to determine the ability of industrial employees to perform a physically demanding occupation safely, evaluate post-injury impairment, and monitor return to function after injury. There is an unmet clinical need for a robust and granular source of normative reference values to serve as a resource for baseline data on upper extremity isometric strength.
Objective:
Develop normative reference data for upper extremity strength among industrial employees and investigate associations between strength and physical job demands.
Methods:
Upper extremity strength data from 107,102 industrial employees were collected post-hire. In this study, isometric tests for pinch; hand grip; wrist pronation and supination; and flexion of the wrist, elbow, and shoulder strength were retrospectively analyzed in relationship to sex, age, and job level. Associations between strength scores and five levels of work, defined the United States Department of Labor's Dictionary of Occupational Titles by level of physical difficulty (1-5), were determined.
Results:
Higher strength scores were positively associated with more physically demanding job levels (P < 0.001), and there was a progressive increase in strength scores with increased physical job demands for both sexes (P = 0.0002). All strength scores differed significantly by decade of age (P < 0.001). All scores except for pinch strength demonstrated a moderate or high positive correlation with job level (r≥0.50).
Conclusions:
The normative reference upper extremity strength data collected in this study for industrial employees may be useful for evaluating rehabilitation and recovery following injury or illness. In order to utilize normalized strength data as a post-injury reference, it is important to consider job level in addition to age and sex, as these variables are highly correlated with baseline upper extremity strength.
The ability to work is not only an important reflection of a person’s functional capacity but can also impact their sense of self-worth, independence, purpose and calling. An individual’s employment status is meaningfully linked to both one’s financial security and long-term health. The inability to attain, maintain, or return to gainful employment may cause hardship to the physical and psychosocial aspects of a person’s life. Therefore, society and the health care community together have a role in optimizing the work environment to safely accommodate people with a diverse range of abilities. When work-related injuries or illnesses occur, Occupational Medicine and Vocational Rehabilitation are instrumental in addressing the needs of our workforce. From prevention to treatment and functional assessment to restoration, these two interrelated disciplines provide a comprehensive approach to preserve job performance respectful of any limitations. This chapter introduces key concepts in the fields of Occupational Medicine and Vocational Rehabilitation, presents epidemiology of work-related hazards with evidence-based strategies for prevention and accommodation, highlights a biopsychosocial model approach to work disability, and describes rehabilitative interventions to maximize return to work.
Background:
Pre-Employment Functional Assessments (PEFA) are increasingly used in an attempt to obtain objective information on a potential employee's functional capabilities. In rural and remote communities, there is typically reduced access to qualified therapists to perform these assessments, in part attributable to the time and costs associated with travelling to training courses. One potential method of providing the relevant training to conduct PEFAs is through the use of technologies such as videoconferencing or internet-based modules.
Objective:
The purpose of this project is to investigate the effectiveness of training therapists and therapy students in performing JobFit System PEFAs via technology when compared with a face-to-face control group.
Methods:
Fifty-three participants, consisting of 28 professional physiotherapists and occupational therapists, and 25 final year University of Queensland (UQ) physiotherapy and occupational therapy students, underwent JobFit Systems International PEFA training via one of four intervention groups: face-to-face, realtime videoconferencing, group-based online module and individual online module.
Results:
Of the 53 participants, 49 achieved the minimum competency level of 75% in post-training competency assessments. No significant difference was found in training levels between intervention groups.
Conclusions:
The results of this study suggest that technology, such as real-time videoconference and online learning modules, can be used to train both therapists and students in how to perform JobFit System PEFAs.
Background
Physicians have difficulty predicting patients’ occupational limitations, abilities, and success from clinical evaluation (CE) of pathology and impairments, especially in the presence of chronic pain. Additional information from a functional capacity evaluation (FCE) may improve the accuracy of their physical capacity assessments. It is not known whether FCE information will change these assessments. No such study has been published using Veterans or non-Veterans.
Objective
To determine the influence of FCE data on the physician’s assessment of the US Department of Labor’s Dictionary of Occupational Titles (DOT) work capacity levels of Veterans with chronic moderate-intensity pain.
Design
Retrospective analysis.
Setting
Tertiary care medical center.
Participants
Veterans aged 18-60 years with moderate chronic musculoskeletal pain who were seeking employment.
Methods
Two kinesiotherapists performed FCEs on all participants, namely, the lumbar protocol of the EvalTech Functional Testing System (BTE, Inc, Hanover, MD). One physiatrist performed CEs in all participants. Two other physiatrists assessed DOT physical capacity levels using CE data alone and later using combined CE and FCE data.
Main Outcome Measurements
DOT physical capacity level (sedentary = 1, light = 2, medium = 3, heavy = 4, very heavy = 5).
Results
Of 55 charts reviewed, 27 met inclusion/exclusion criteria. The mean age was 38 years, and there were 25 male and 2 female participants. The predominant pain location was the lower back. DOT scores for 2 physicians were averaged. The mean ± SD DOT scores for CE only and CE+FCE conditions were 2.04 ± 0.33 and 2.40 ± 0.90, respectively. In all, 65% of DOT scores changed (17% decreased and 48% increased at least 1 level) after FCE data were considered. A 1-sample t test revealed that the mean CE+FCE DOT score was significantly greater than the mean CE-only score (by 20%, P = .02). Interrater agreement (weighted κ) for CE+FCE-based DOT scores was much higher than for CE alone (0.715 versus 0.182).
Conclusion
The addition of FCE data to CE changed the majority of physician-assigned DOT levels. FCE significantly increased the mean DOT physical work capacity level provided by the physician to Veterans with chronic moderate-intensity pain, especially if the initial assessment was designated as “light.” FCE may facilitate a more objective and accurate determination of Veterans’ work capacity.
Level of Evidence
III
A mismatch between physical ability and task requirements can increase the risk of on-the-job injury. Therefore, understanding key anthropometric characteristics associated with job performance is important in developing targeted training programs and selecting employees in physically demanding occupations. The aims of this study were to understand which anthropometric and demographic (age, sex) characteristics were associated with performance in a unilateral stretcher carry and bilateral jerry can and kettle bell carries. Sixty-seven (46 males and 21 females) enlisted Australian Army soldiers participated in this investigation. Body composition was quantified using dual energy x-ray absorptiometry (DXA). Univariate and multivariable regression techniques were used to quantify correlations between anthropometric characteristics and carry performance. Median carry distance was 650 m (inter-quartile range (IQR): 425-1025 m) in the stretcher carry, 300 m (IQR: 215-445 m) in the jerry can carry and 265 m (IQR: 200-400 m) in the kettle bell carry. Univariate analyses demonstrated that whole body, trunk, upper arm, forearm and leg lean mass, as well as stature and body mass, were associated with performance across the three carry tasks. Of these, leg lean mass was shown to be a key characteristic associated with carry performance. Subsequently, it is suggested that training programs focus on whole body lean mass with a specific emphasis on leg lean mass. Additionally, we demonstrated that age and sex were not significantly associated with carry performance when controlling for leg lean mass, indicating that modifiable factors can be targeted in training programs to improve job performance.
As will be discussed in this chapter, functional capacity evaluations (FCEs) are often relied upon by employers, physicians, insurance agencies, and benefits adjudicators to determine an individual’s musculoskeletal capacity to do physical labor, many times with legal and/or occupational consequences. We will also review a number of issues related to FCEs. For example, even though FCEs have been widely used for several decades, scientific, legal, and practical skill concerns remain. Because FCEs are based on a theoretical model of comparing physical job demands to worker capabilities, valid FCE results tend to be optimal when jobs are well defined and present constant, rather than varying, physical demands; work simulation is practical and valid; and serial examinations are employed. Validity of results is questionable when the FCE criteria are unrelated to the job-specific activities or actual job requirements and flexibility are poorly represented. We will also point out that, to date, the evidence concerning the practical reliability of FCE results is limited. Moreover, the evaluation of sincerity of effort, ability to perform complex or variable jobs, and prediction of injury based upon FCE data can also be problematic. Finally, it will be concluded that more research is needed in order to better define the appropriate role for these evaluations in clinical and administrative settings, especially studies linking FCE results to occupational outcomes.
Background:
Many employers and other stakeholders believe that health examinations of job applicants prevent occupational diseases and sickness absence. This is an update of the original Cochrane review (Mahmud 2010).
Objectives:
To evaluate the effectiveness of pre-employment examinations of job applicants in preventing occupational injury, disease and sick leave compared to no intervention or alternative interventions.
Search methods:
We searched CENTRAL (the Cochrane Library), MEDLINE, EMBASE, CINAHL, PsycINFO and PEDro (up to 31 March 2015). We did not impose any restrictions on date, language or publication type.
Selection criteria:
We included randomised controlled trials (RCTs), controlled before-after (CBA) studies, and interrupted time-series (ITS) studies of health examinations to prevent occupational diseases and injuries in job applicants in comparison to no intervention or alternative interventions.
Data collection and analysis:
All five review authors independently selected studies from the updated search for inclusion. We retrieved two new studies with the updated search from 1 April 2008 to 31 March 2015, resulting in a total of eleven studies.
Main results:
We included two RCTs, seven CBA studies and two ITS studies. Nine studies with 7820 participants evaluated the screening process of pre-employment examinations as a whole, and two studies with 2164 participants evaluated the measures to mitigate the risks found following the screening process. The studies were too heterogeneous for statistical pooling of results. We rated the quality of the evidence for all outcomes as very low quality. The two new CBA studies both used historical controls and both had a high risk of bias.Of those studies that evaluated the screening process, there is very low quality evidence based on one RCT that a general examination for light duty work may not reduce the risk for sick leave (mean difference (MD) -0.09, 95% confidence interval (CI) -0.47 to 0.29). For army recruits, there is very low quality evidence based on one CBA study that there is a positive effect on fitness for duty after 12 months follow-up (odds ratio (OR) 0.40, 95% CI 0.19 to 0.85).We found inconsistent evidence of an effect of job-focused pre-employment examinations on the risk of musculoskeletal injuries in comparison with general or no pre-employment examination based on one RCT with high risk of bias, and four CBA studies. There is very low quality evidence based on one ITS study that incorporation of a bronchial challenge test may decrease occupational asthma (trend change -2.6, 95% CI -3.6 to -1.5) compared to a general pre-employment examination with lung function tests.Pre-employment examinations may also result in a rejection of the applicant for the new job. In six studies, the rates of rejecting job applicants increased because of the studied examinations , on average, from 2% to 35%, but not in one study.There is very low quality evidence based on two CBA studies that risk mitigation among applicants considered not fit for work at the pre-employment examination may result in a similar risk of work-related musculoskeletal injury during follow-up compared to workers considered fit for work at the health examination.
Authors' conclusions:
There is very low quality evidence that a general examination for light duty work may not reduce the risk for sick leave, but may have a positive effect on fitness for duty for army recruits after 12 months follow-up.There is inconsistent evidence of an effect of job-focused pre-employment examinations on the risk of musculoskeletal injuries in comparison with general or no pre-employment examination. There is very low quality evidence that incorporation of a bronchial challenge test may decrease occupational asthma compared to a general pre-employment examination with lung function tests. Pre-employment examinations may result in an increase of rejecting job applicants in six out of seven studies. Risk mitigation based on the result of pre-employment examinations may be effective in reducing an increased risk for occupational injuries based on very low quality evidence. This evidence supports the current policy to restrict pre-employment examinations to only job-specific examinations. Better quality evaluation studies on pre-employment examinations are necessary, including the evaluation of the benefits of risk mitigation, given the effect on health and on the financial situation for those employees who do not pass the pre-employment examination.
Although medical care delivery by one's personal physician is the paradigmatic American healthcare arrangement, in the workplace setting, many Americans undergo medical evaluations to assess their fitness for duty or degree of impairment. This Article explores the complex and evolving legal status of occupational medical evaluations. Beginning with the legal and ethical frameworks of occupational medical practice, the Article then examines the effects of increasingly detailed legal regulation under the Americans with Disabilities Act and the Genetic Information Nondiscrimination Act on employees, employers, and physicians.
Medical providers make recommendations every day to employers regarding employee medical fitness. These recommendations are based on the practitioner's clinical training and experience; however, there is often insufficient objective information available about the workers' physical ability to perform those requirements, thereby reducing the effectiveness and efficacy of the medical providers' recommendations. Chevron has developed a process for more accurately assessing medical fitness-for-duty based on the objective and specific physical requirements of individual jobs. The process includes job evaluation, medical exams, functional capacity evaluations (FCE), remedial action plans, and program evaluation that are applied to medical fitness determinations. This process will be described, followed by results-to-date and lessons learned from the implementation of twelve programs from 1997 - 2007 at Chevron. Additionally, several case examples including an analysis of the risks and costs will be presented from the files of ISR Institute, one of Chevron's key vendors in its medical fitness-for-duty programs. Finally, the paper will present Chevron's global health strategy, focusing on the specific programs and processes for the implementation of globalized best practice standards for medical fitness for duty.
Background: The Occupational Health Special Interest Group of the Orthopaedic Section of the American Physical Therapy Association has championed the role of physical therapy in the area of occupational health in the United States. Objective: This article is a brief review of the role physical therapists play in occupational health, competencies for professional development in this practice area, and efforts to achieve physical therapy specialization in the United States through petition to the American Board of Physical Therapy Specialties. Major Findings: Physical therapists have an important role to play in the health, wellness, and sustained function of the working population based on the numbers and types of injuries sustained in the workplace, and chronic problems common to working age adults. Physical therapists can help prevent injury and promote return to work through interventions including ergonomics, job modifications and transitional duty programs, functional testing, case management and communication, and care coordination with workers and other stakeholders. Practice analysis competencies are discussed as the foundation of professional development in the field of occupational health. This article also overviews petitioning materials for specialization. Conclusion: Physical therapist specialization in occupational health may benefit workers and employers through injury reduction and improved or sustained abilities of the workforce following injury. Specialization will help to promote consistency within the field of physical therapy for external stakeholder recognition of skills, while also promoting knowledge transfer and diffusion of best practice. The specialization petition has not been approved; however the process is ongoing.
Introducing valid physical employment tests requires identifying and developing a small number of practical tests that provide broad coverage of physical performance across the full range of job tasks. This study investigated discrete lifting performance across various platform heights reflective of common military lifting tasks. Sixteen Australian Army personnel performed a discrete lifting assessment to maximal lifting capacity (MLC) and maximal acceptable weight of lift (MAWL) at four platform heights between 1.30 and 1.70 m. There were strong correlations between platform height and normalised lifting performance for MLC (R(2) = 0.76 ± 0.18, p < 0.05) and MAWL (R(2) = 0.73 ± 0.21, p < 0.05). The developed relationship allowed prediction of lifting capacity at one platform height based on lifting capacity at any of the three other heights, with a standard error of < 4.5 kg and < 2.0 kg for MLC and MAWL, respectively.
Ergonomic injuries in the oil industry can occur when there is a gap between employee physical capacities and the physical demands of the job. Improper matching of the employee to the job can be prevented with job-specific functional testing. This paper describes the effect of new-hire functional capacity testing on injury reduction and wellness in an oilfield services company after 2 years of program implementation.
Data analysis revealed a 96% pass rate among a random sample population. A detailed investigation was conducted among the 4% of the sample who failed to meet the essential functional demands because of insufficient physical capacities or existing medical conditions. The results of the analysis of safe maximum lift capacities were used to develop ergonomic and behavioral-based intervention strategies to reduce the gap between the worker's physical capacities and the required job demands. Estimates related to direct and indirect costs for each applicant who failed were analyzed and compared to the program administration cost. The return on investment was 13:1.
The results show that improper matching of the employee to the job can be effectively prevented with job-specific functional testing. Post-offer new-hire functional testing is shown to be highly effective in preventing injuries, avoiding aggravation of preexisting medical conditions, educating new hires about specific needs for improved wellness, improving productivity, and reducing medical costs.
Discussion will include how some medical conditions can be identified effectively in the functional capacity examination. Data concerning human performance capacities is important in developing strategies that further reduce the risk of ergonomic injuries among an aging work force plagued by a growing epidemic of obesity and reduced fitness capacities.
Firefighters from 1 academy training class were observed for 23 years, beginning with their selection test consisting of a g-saturated written exam (GCA) and firefighting simulations loaded on a strength/endurance (SE) factor. Operational validity coefficients for both GCA and SE were high for training success and remained consistently high for job performance ratings throughout the study. The operational validity for combined GCA and SE predictors was .86 for a composite job rating measure covering 21 years of service. A structural model produced similar results for more broadly defined GCA and SE latent variables. Both analyses suggested approximately equal weighting for GCA and SE for a fire service selection test. Results indicate considerable latitude in choosing cognitive and physical predictors for firefighter screening if the predictors are highly loaded on GCA and SE.
The aim of this study was to assess the reproducibility (i.e., agreement and inter-rater reliability) of two task-specific functional capacity evaluation protocols meant to simulate the daily workload of collectors using either two-wheeled waste containers or bags.METHODS: A within-subjects design was used to assess reproducibility in terms of agreement and reliability. Twenty-one household waste collectors were assessed twice with both task-specific protocols with a time interval of seven days. Agreement was assessed using the Standard Error of Measurement (SEM), and inter-rater reliability was assessed using the Intra-Class Correlation Coefficient (ICC).
For the task-specific protocol for waste collection using two-wheeled containers, agreement was excellent (SEM=0.9 points; 0-340 scale; mean score 339), but inter-rater reliability was poor (ICC=0.22). For the task-specific protocol for bag collection, agreement was acceptable (SEM=53 s; continuous scale; mean time 779 s), and inter-rater reliability was good (ICC=0.79).
Reproducibility of the task-specific protocol for bag collection is acceptable to good, while the task-specific protocol for waste collection using two-wheeled containers has an excellent agreement but a poor reliability. Although face and content validity have been covered within the development of both protocols, further studies should evaluate the construct and criterion-related validity of both task-specific protocols.
Medical providers make recommendations every day to employers regarding employee medical fitness. These recommendations are based on the practitioner's clinical training and experience; however, there is often insufficient objective information available about the workers' physical ability to perform those requirements, thereby reducing the effectiveness and efficacy of the medical providers' recommendations. Chevron has developed a process for more accurately assessing medical fitness-for-duty based on the objective and specific physical requirements of individual jobs. The process includes job evaluation, medical exams, functional capacity evaluations (FCE), remedial action plans, and program evaluation that are applied to medical fitness determinations. This process will be described, followed by results-to-date and lessons learned from the implementation of twelve programs from 1997 – 2007 at Chevron. Additionally, several case examples including an analysis of the risks and costs will be presented from the files of ISR Institute, one of Chevron's key vendors in its medical fitness-for-duty programs. Finally, the paper will present Chevron's global health strategy, focusing on the specific programs and processes for the implementation of globalized best practice standards for medical fitness for duty.
Definitions:
– Job evaluation – documentation of a job's physical requirements and working conditions – Remedial action plans – recommended exercises and activities to enable an individual to pass the FCE; also includes consideration of work accommodations and / or alternate work – Program evaluation – collection of date to assess program compliance, evaluate consistency of testing application and quality of provider services, documentation of testing outcomes and analysis of the potential financial impact on the company
Objectives:
to explore to what extent the standardized Isernhagen Work Systems Functional Capacity Evaluation (IWS FCE) can be matched with observed work demands in workers with chronic low back pain, and, secondly, to explore whether this match can predict sick leave in the year after rehabilitation treatment.
Methods:
An explorative prognostic cohort study with a one-year follow-up (four, eight and twelve months after baseline) was performed (n = 18). Demographics, back complaints and FCE performance were assessed at baseline. In addition, a workplace assessment (WPA) was performed. Eleven FCE activities were matched with work demands. Sick leave associated with low back pain and physical and psychosocial work demands were assessed during follow-up.
Results:
Seven activities could be directly matched with WPA data. (Carrying, pushing, pulling, crouching, kneeling, static forward bending, and dynamic bending and rotating.) For some workers, difficulties existed in matching three of the activities (pushing, pulling and crouching). One activity (lifting) could indirectly be matched with WPA data. One activity (walking) could not be matched with WPA data. Two activities (sitting, standing) were excluded from analyses due to practical limitations. No relation was found between FCE performance, work demands, and sick leave during follow-up.
Conclusions:
Seven FCE activities could be directly matched with work demands. However, not all observed work demands could be matched with IWS FCE activities in the eighteen occupations studied. This quantitative and standardized way of assessing work-related disability is not sufficient to predict work ability and sick leave at the present time.
This investigation was conducted to evaluate the practicality and potential effectiveness of preemployment strength testing in reducing the incidence and severity of musculoskeletal and back problems in materials handling jobs. Prior to assignment to new jobs, 551 employees in six plants were given a series of strength tests and then monitored for approximately 18 months. During this time, all medical incidents were documented. An analysis of these incidents revealed that a worker's likelihood of sustaining a back injury or musculoskeletal illness increases when job lifting requirements approach or exceed the strength capability demonstrated by the individual on an isometric simulation of the job. Because strength was found to be weakly correlated with other individual attributes (e.g., gender, age, weight, and stature), the authors conclude that industry should implement specific employee selection and placement programs using a strength performance criterion.
Manual materials handling tasks are inherent to many different jobs in industry today. The performance of such tasks exposes the worker to a variety of biomechanical hazards. This paper proposes a formalized algorithm for evaluating such hazards, and demonstrates the use of the algorithm in four different jobs. Medical data from these jobs are presented which serve to confirm the types of biomechanical stresses quantified by the biomechanical evaluations.
A review of the biomechanics of weight lifting as it relates to low-back stresses is presented first. This serves as the basis for the development of a Lifting Strength Rating (LSR) methodology. Then a study is reported wherein the LSR methodology is used to evaluate 103 jobs having various amounts of required two-handed load lifting. The 411 people populating these jobs were also evaluated. For a period of one year following their evaluation, any low-back pain problems in the group were noted. The primary result of the field study is that the incidence rate of low-back pain is correlated with higher lifting strength requirements as determined by assessment of both the location and magnitude of the load lifted. It is, therefore, recommended that load lifting be considered potentially hazardous, and that the LSR methodology be used to guide corrective actions.
This study was performed to develop and evaluate a scheme for matching the strength of workers to the strength demands of their jobs. Biomechanical analyses were performed on production jobs in an aluminum reduction plant to identify and quantify strength demands. These data were used to design a set of nine strength tests which simulated job activities with the greatest strength requirements. A cross section of plant employees assigned to these jobs was strength tested and monitored for medical incidents for a period of over two years. Significant relationships were found among job strength requirements, worker strengths, and medical incidents. Workers with strength abilities (as determined by the tests) less than job strength requirements suffered a higher rate of medical incidents than workers whose strength abilities matched or exceeded job demands. It was concluded that strength testing can be used to identify workers who would be at increased risk of suffering medical incidents if placed on jobs which exceeded their strength abilities.
Risk factors for work-associated strain or sprain back injuries were investigated in a cohort of 31,076 material handlers from 260 retail merchandise stores in the United States. The workers studied were those with significant material-handling responsibilities--daily lifting and movement of merchandise. Workers in jobs with the greatest physical work requirements had an injury rate of 3.64 per 100 person-years versus 1.82 in workers with lesser work requirements. The unadjusted injury rate for males was 3.67 per 100 person-years compared with 2.34 per 100 person-years for females, but the excess for males was confounded by higher physical work requirements for men in the stocker/receiver job category. The injury rate ratio for short versus long duration of employment was 3.53 (95% confidence interval: 2.90, 4.30); for medium versus long duration of employment, it was 1.38 (95% confidence interval: 1.18, 1.62). The elevated rate ratios were maintained when the data were stratified by subsets with different rates of turnover. The results suggest that workers with the greatest physical work requirements and those with the shortest duration of employment are at the highest risk of back injuries. However, selection forces causing worker turnover within this cohort of active workers are not well characterized and have the potential to bias the measures for time-related factors such as duration of employment.
The objectives of this study were to establish test-retest reliability of lifting and carrying of a functional capacity evaluation (FCE) on two consecutive days and to verify the need for a 2-day protocol. A cohort of 50 patients (39 men, 11 women) with nonspecific low back pain were evaluated using a 2-day FCE protocol. Intraclass correlation coefficients (ICC) were calculated for weight lifted and carried. Predictive relationships between test and retest were explored by means of a regression analysis. The results of ICC were lifting low 0.87, lifting overhead 0.87, and carrying 0.77. Performances on day 2 were on an average 6-9% higher. Other than the amount of weight handled on day 1, no variable was found to predict performance on day 2. It was concluded that test-retest reliability of lifting and carrying was good, and the need for a 2-day protocol could not be confirmed.
A well designed post offer screening program including PDA, clear acceptable criteria, physical screening, standardized objective tests, and occupational and job specific tests can substantially decrease the number of injuries and resulting costs. The results of a study suggest post offer screening makes a difference on post hire injury and resulting costs. These findings are consistent with the literature reviewed. Occupational health professionals are key to the development, implementation, and evaluation of such a program and can directly affect the company's bottom line when employees are accurately matched to their job requirements.
Background Loss of productive life among injured workers potentially could be prevented by clearer knowledge of disability risk factors. Despite the number of studies that have examined predictors of disability, there have been no systematic literature reviews integrating multiple risk factor domains. Such a synthesis could help to define important gaps in knowledge, inform future study designs most likely to successfully address these gaps, and highlight the importance of secondary (disability) prevention to public health policy. A systematic synthesis of the literature on risk factors for chronic or recurrent disability in injured workers was performed to meet this need. Methods Articles were identified through a MEDLINE search, personal file searches, and requests to experts. information concerning study methods and results was abstracted from 20 articles that met the inclusion criteria (population-based or prospective cohort studies). Results The most frequently identified predictors of prolonged disability were older age and greater baseline pain and functional disability. Lumbar symptoms, smaller company size, and construction work were significant predictors in several, but not all, studies. Risk factors did not appear to differ for back versus mixed injuries. Conclusions Several risk factors for prolonged disability were identified Research is needed to develop and test multivariate models of worker; workplace, health care, and administrative risk factors for prolonged and recurrent disability in order to refine and target interventions. Am. J. Ind. Med. 38:707-722, 2000. (C) 2000 Wiley-Liss, Inc.
Study Design. Randomized control post-test only.—
Objectives. To investigate the reliability and validity of the EPIC Lift Capacity test’s indicators of sincere effort.—
Summary of Background Data. The EPIC Lift Capacity test (ELC) (Employment Potential Improvement Corp., Santa Ana, CA) is a functional evaluation tool used to identify physical limitations involved in lifting and manual materials handling. Identification of insincere effort is an integral component of such functional testing because of the potential secondary gain issues surrounding the various populations typically involved in this form of testing. The purpose of this study was to determine the sensitivity and specificity of the “indicators of sincere effort” of the EPIC Lift Capacity test when used on a previously injured population typical of subjects for which the test is designed.
Methods. Subjects consisted of 41 volunteers (age 22 to 58 years) with a previously diagnosed musculoskeletal pathology of the spine or extremities. Volunteers were randomized into either the control group, instructed to give a sincere maximum effort, or the experimental group, instructed to give an insincere effort at 50% of their perceived maximum effort. All tests were administered by certified clinical evaluators according to the standardized EPIC Lift Capacity test protocol.—
Results. Overall accuracy in identifying participants’ level of effort was 86.84%. The indicators of valid effort exhibited both high positive (94.44%) and negative (80.00%) predictive values. The indicators of valid effort accounted for 94.9% of the total variance in the determination of the subjects’ overall effort level. Interrater reliability for agreement of subjects’ overall effort was good (interclass correlation coefficient = 0.82).—
Conclusions. Through use of standardized indicators of sincere effort, certified EPIC Lift Capacity test evaluators were able to predict sincerity of effort with a highdegree of reliability and validity. The rater’s systematicobservational evaluation of effort was shown to be the single best indicator of sincere effort.
It is estimated that at least one quarter of all worker’s compensation injuries in U.S. industry is a direct result of overexertion. 11 The direct costs associated with work place injuries is estimated at $140 billion per year. 9 Further, one of the primary precipitating factors of back injuries is job-related lifting tasks. 12,13 The increase in frequency and severity of injury caused by lifting tasks has led to the need for objective measures of function to determine the levels of an individual’s physical capability both before placement in a job as well as after recovery from injuries. Lifting capacity is a “whole body activity” that it is a synthesis of a worker’s biomechanical, cardiovascular, metabolic, and psychophysical systems. 5,6,8
Assessing a worker’s functional lifting capacity determines the point at which they can safely return to an appropriate level of employment and may reduce the risk of recurrent low back injuries. 1,18 To obtain a meaningful evaluation, an assessment of lifting capacity should mimic the dynamic sequence of events involved in a lifting task. One such functional dynamic evaluation tool is the EPIC Lift Capacity test (Employment Potential Improvement Corp., Santa Ana, CA), also known as the ELC (see Figure 1). As previously described, the ELC is “a method to evaluate lift capacity based on isoinertial strength…” The ELC is a progressive lift test that uses a standard 10-lb starting load and 10-lb load increments for males and females in a manner to which the evaluee is blinded through the use of color-coded weight canisters placed by the evaluator in a 33-cm × 33-cm crate. The plastic crate has a steel liner to which are attached 5-cm diameter lightly knurled cylindrical handles. These handles are attached 23 cm from the crate bottom. Through the use of a spacer on the handles, an across-crate span of 48 to 50 cm is achieved from center to center of the evaluee’s hands. Load is increased by the evaluator, with neither the starting load nor the increments known to the evaluee. In the standard ELC battery, the evaluee receives progressive challenge within each of six subtests to a maximum acceptable weight before being tested on the next subtest, which is itself more demanding. Occasional lift capacity (one repetition per cycle) is measured in three subtests: knuckle to shoulder, floor to knuckle, and floor to shoulder, in that order. Subsequently, frequent lift capacity (four repetitions per cycle) is measured using the same vertical ranges. Gender differences are attenuated by use of vertical ranges for lifting that are linked to the evaluee’s height. In keeping with legal requirements for the use of employment tests in the United States, however, the same test protocol is used without regard to the gender of the evaluee. 2 Heart rate, posture and body mechanics, and psychophysical response are collected in a structured manner and are used to determine maximum acceptable load. The instructions to the evaluee include a psychophysical performance target definition as the load that can be lifted “safely and dependably 8–12 times a day.”7
A protocol is described to determine whether a medical preemployment evaluation can be predictive for attendance or work performance. In addition, the dollar benefit and the cost of such a program is assessed. The present analysis is based on 4,936 men and women, who were processed as prospective hires into non-hazardous job assignments. A medical preemployment evaluation was performed on all applicants, identifying factors which could influence attendance or work performance. Sixty-nine per cent of the examined applicants were hired. During the employment process, all applicants were randomly assigned to a control or trial group. Those in the trial group were hired by the employment office without knowledge of the results of the medical preemployment evaluation, whereas these results were fully disclosed for applicants in the control group. Three months after hire, supervisors answered a detailed questionnaire relating to absence and work performance for each hire. No differences were identified between control and trial groups for overall job performance, appropriateness of the job match and work force losses. A small but significant difference, on the other hand, was identified for sickness absence in the trial group between medical evaluation category A (normal risk) and category R (increased risk identified). Omission of a preemployment medical evaluation, as simulated by the trial group, increased the absence cost for the company by $2.30 per year for each new hire. Compared to a $17.50 cost per preemployment health evaluation, the average length of service of new hires would have to exceed 7.6 years to realize a dollar benefit from the medical examination. Examinations performed on applicants who were never hired further increases the cost of a medical preemployment examination program.
The costs and circumstances of low-back strains, low-back impact injuries, and non-low-back injuries among field employees of an offshore petroleum drilling company, 1979-1985, were compared. The objectives were to identify worker and workplace factors associated with low-back injuries, to identify factors differentially associated with lost-time injuries, and to formulate recommendations for the control of low-back injuries. Low-back-impact injuries resulted largely from falls. Efforts to prevent falls would have a potential to reduce other serious consequences as well as back injuries. Workers performing the heaviest physical labor were at highest risk of low-back strains. Based on activities precipitating the injury, modifications of work site, equipment, and procedures to help reduce low-back strains are recommended. Only job was a predictor of whether a low-back strain was likely to be associated with lost time. Even this association was lacking for low-back impact injuries. Cost control by preventing the small proportion of high cost injuries may not be feasible. Rather, subsets of low-back injuries defined, for example, by work site or activity can suggest options for intervention.
To evaluate the impact of back injuries on industry, the authors conducted a retrospective analysis of injuries occurring among a group of 31,200 employees of The Boeing Company, a large industrial manufacturer in Western Washington. They analyzed 4,645 injury claims (including 900 back injuries) made by 3,958 different employees. Two previous articles give an overview of the study, provide a detailed analysis of the costs associated with these back injuries, and analyze the characteristics of the injury. This article focuses on employee-related factors associated with back injuries. Claims were categorized according to severity, as indicated by total incurred cost (TIC), the sum of the medical costs, and indemnity costs. High-cost claims were defined as those with a TIC greater than $10,000 and low-cost claims as those with a TIC less than $10,000. Employees younger than 25 years of age had a statistically significant increased risk of back injury, although their claims tended to be low-cost ones. This finding tends to discredit the premise that back problems are related to aging of the lumbar spine. While older employees had a lower injury rate, they did have a significantly increased risk of incurring high-cost back injury claims. The 31-40-year age group was the most susceptible to high-cost back injuries. Newer employees tended to have a significantly increased risk of back injury. The data show that women had fewer injuries than men but a statistically significant increased risk of becoming a high-cost injury claim.(ABSTRACT TRUNCATED AT 250 WORDS)
Two different but dependent strategies must be developed to prevent low-back pain in industry. One is of an administrative nature and is concerned with whether the worker who performs activities that stress back tissues is appropriately evaluated and trained for such work. The second strategy is of an engineering type, dealing with methods to assure that the workplace and work tasks are specified in ways that minimize injurious stresses to the low back. Both of these strategies rely on knowledge of the biomechanical requirements of a job. These must be carefully evaluated by informed observers using prescribed measurement and analysis procedures. The fundamental biomechanics of heavy lifting and observational procedures developed by an expert panel for NIOSH are described. The procedure rates the difficulty of a lifting task and then recommends whether administrative or engineering controls are warranted to reduce low-back stresses. Some suggestions for preventing excessive low-back stress by redesigning the workplace are presented also.
Of all 30-, 40-, 50-, and 60-year-old inhabitants of Glostrup, a suburb of Copenhagen, 82% (449 men and 479 women) participated in a general health survey, which included a thorough physical examination relating to the lower back. The examination was constituted of anthropometric measurements, flexibility/elasticity measurements of the back and hamstrings, as well as tests for trunk muscle strength and endurance. The reproducibility of the tests was found to be satisfactory. Twelve months after the physical examination 99% of the participants completed a questionnaire sent by mail concerning low back trouble (LBT) in the intervening period. The prognostic value of the physical measurements was evaluated for first-time experience and for recurrence or persistence of LBT by analyses of the separate measurements and discriminant analyses. The main findings were that good isometric endurance of the back muscles may prevent first-time occurrence of LBT in men and that men with hypermobile backs are more liable to contract LBT. Recurrence or persistence of LBT was correlated primarily to the interval since last LBT-episode: the more LBT, the shorter the intervals had been. Weak trunk muscles and reduced flexibility/elasticity of the back and hamstrings were found as residual signs, in particular, among those with recurrence or persistence of LBT in the follow-up year.
This investigation was performed to determine if isometric strength tests can be used to select workers for strenuous jobs and to reduce occupational injuries which are caused by a mismatch between worker strength and job strength requirements. Twenty jobs in a tire and rubber plant were studied biomechanically to identify critical strength-demanding tasks. Four strength tests were designed to simulate these tasks, and performance criteria were established for passing the tests. New applicants were administered the tests during their preplacement examinations to determine if they possessed sufficient strength to qualify for the jobs. The medical incidence rate of employees who were selected using the strength tests was approximately one-third that of employees selected using traditional medical criteria. It was concluded that isometric strength tests can be used to reduce occupational injuries and should be considered for implementation in industries with strenuous jobs.
Effectiveness of a pre-employment worker fitness evaluation in a sample of grocery warehouse order selectors was studied retrospectively. Implementation of the program began in March 1990 and as of September 10, 1993, 1100 prospective employees have been tested.
Identification of prospective employees with the necessary job specific physical requirements was conducted with a standardized test protocol based on job analysis and normative data. Follow-up injury rates and costs for this department were supplied by the company for statistical analysis.
To establish normative data for minimum standards of job performance, a control group of current, uninjured and experienced order selectors was evaluated in respect to job requirements and isokinetic variables. In the control group, 17 variables were identified including one each from two 5-minute repetitive lifting tasks with weighted crates and 15 isokinetic trunk function and lifting variables. Prospective employees were required to successfully complete at least 15 variables for hire as an order selector.
The t-test for significance of difference between two proportions was used to compare injury rates in 1989 to those reported in 1990, 1991, 1992, and 1993.
Statistically significant differences were found between the unimplemented comparison year of 1989 and the 4 years post-implementation.
Preliminary data suggests that a worker fitness evaluation using the above methodology may be an effective method of reducing injuries and subsequent costs.
There is a growing trend toward using preemployment tests to select employees for physically demanding jobs. Women are, in increasing numbers, entering physically demanding occupations that were traditionally dominated by men. Under current Federal employment law, it is illegal to disqualify an employee for a job because of race, color, religion, sex, national origin, and with the recent passage of the American Disabilities Act (ADA), handicap. Because of gender differences in strength, body composition, and VO2max, preemployment tests for physically demanding jobs tend to screen out more females than males. Employers are using preemployment tests not only to enhance worker productivity, but also to minimize the threat of litigation for discriminatory hiring practices and to reduce the risk of musculoskeletal injuries. The primary ergonomic methods used in industry to reduce the risk of back injuries are preemployment testing and job redesign. When a test results in adverse impact, the validity of the test must be established. Validity in this context means that the test represents or predicts the applicant's capacity to perform the job. Criterion-related, content, and construct validation studies are the means used to establish validity. The validity of preemployment hiring practices for physically demanding jobs has been decided in the courts. The most common reason for ruling an employment practice invalid is the failure to show that the test measured important job behaviors. Much of this litigation has involved height and weight requirements for public safety jobs. The courts have generally ruled that using height and weight standards as a criteria for employment is illegal because they were not job related. If fitness tests comprise part or all of the preemployment test, it is essential to demonstrate that the fitness component is related to job performance. Although there are many factors to consider when establishing a cut score, there is a growing trend toward establishing the cut score on the basis of the job's physical demands, defined by VO2max and strength. This literature is limited because most validation studies are not published. They more typically take the form of a technical report to the governmental agency or company that funded the project. There are published preemployment validation studies for outdoor telephone craft jobs involving pole-climbing tasks; firefighters; highway patrol officers; steel workers; underground coal miners; chemical plant workers; electrical transmission lineworkers; and various military jobs.
Strength testing of lumbar extensors of shipyard workers without back injury claims was accomplished to compare isolated lumbar strength with the severity of their workplace physical demands and the incidence of workplace back injury during a 2-year period.
To determine if strength is a predictor of workplace injury and if there is a relationship between the physical demands of the job and strength.
The role of preplacement strength testing has not been clarified as a potential means for predicting workplace injury. It has not been clarified whether work activity affects the strength of the worker.
One hundred fifty-two shipyard workers were strength tested for isometric lumbar extensor strength. They had been classified as to the severity of their job demands according to the Physical Demand Characteristics. All workers at this industry were likewise classified. Those workers who were tested were followed for 2 years to evaluate for claims of back injury.
There was a higher incidence of low back injuries in the heavy and very heavy classification. There was, however, no difference in strength among those workers classified in medium, heavy, and very heavy work. Nine percent of those workers tested had back pains during the following 2 years. All but two had higher-than-average strength.
There is no evidence that preplacement back strength testing would predict workplace claims of injury.
The data in this study were gathered retrospectively after the progress of program development in terms of employee outcomes within an organization. This design characterizes a retrospective longitudinal study.
To determine whether prework functional screens are effective in lowering the incidence of work-related back sprains or strains, related medical costs, and lost work days within an organization.
Musculoskeletal injuries are considered the leading cause of disability for people during their working years. Back injuries are the most common reason for workers' decreased work capacity and reduced leisure time. The increased rate of injury and escalating workers' compensation costs are are a major force motivating companies to implement a tool that can be effective in lowering back sprain or strain injuries and containing their workers' compensation costs. The U.S. Department of Health and Human Services reports a major objective of increasing the number of companies offering back injury prevention programs by the year 2000.
The study follows the effects realized when a medical center institutes close case management, early return to work policies, and prework functional screens in three stages over the course of 10.5 years.
The severity of back sprains or strains, related medical costs, and lost work days were significantly lower with the use of prework functional screens on all new employees hired into physically laborious jobs.
This study offers employers a proven effective tool that can be used to help lower the severity of on-the-job back sprains or strains, resulting medical costs, and lost work days in their organization.
Over the past 25 years, the preplacement evaluation has undergone considerable evolution under the influence of regulatory and economic pressures. Formally used by some employers to screen out applicants who might have represented the mere possibility of a future work-related injury, the modern-day preplacement evaluation is legally restricted to only two determinations: (1) whether the individual can perform essential job functions with or without accommodation and (2) whether the individual represents a direct threat to himself or herself or others. Truly enlightened companies also recognize that other benefits accrue from a properly designed, conscientiously performed preplacement evaluation, perhaps the most important of which is to promote worker health, in the certain recognition that healthy employees are more productive ones. This benefit may be the true purpose of the preplacement evaluation and its most enduring, tangible benefit.
Prospective analysis of relationship between lifting capacity and multiple anthropometric variables.
To determine the relationship between lifting capacity and anthropometric variables and to model this relationship quantitatively.
Low-back injuries commonly occur in individuals who perform lifting tasks. Objective data are needed to determine preinjury lifting capacity that, in turn, might be used to guide decisions during rehabilitation of these injuries.
We recorded age and sex and measured the following variables for 35 men and 23 women between the ages of 22 and 40: height, weight, percentage of body fat, torso height, pelvic width, pelvic girth, arm length, thigh girth, and calf girth. Variables were selected for the study on the basis of theoretical modeling or previous research regarding the relationship between study variables and lifting capacity. Subjects also were tested to determine their maximum lifting capacity by using a lordotic lumbar spine lifting technique.
Stepwise regression analysis indicated that the combination of sex, age, thigh girth, pelvic girth, and percentage body fat was significantly related to maximum lift capacity (multiple R2 = 0.76). The mean absolute difference (+/- SD) between lifted amount predicted by the regression model and the actual amount lifted was 118.6 +/- 86 N (26 +/- 19.3 lb), which corresponded to an average absolute error of 16% (SD = 14%) of the actual weight lifted.
The results may be useful in estimating 1 aspect of preinjury lifting capacity. Similar studies are needed to model the requirements of frequency of lift, duration of lifting efforts, variety of hand-object coupling, and combined lifting and reaching.
A cohort of 307 nonsymptomatic workers and another cohort of 123 workers with previous episodes of low back pain were followed up for 2 years. The outcomes were measured by symptoms, medical consultations, and sick leaves due to low back disorders.
To study the predictive value of a set of tests measuring the physical performance of the back in a working population. The hypothesis was that subjects with poor functional capacity are liable to back disorders.
Reduced functional performance has been associated with back pain. There are few data to show whether reduced functional capacity is a cause or a consequence of pain.
Mobility of the trunk in forward and side bending, maximal isokinetic trunk extension, flexion and lifting strength, and static endurance of back extension were measured. Standing balance and foot reaction time were recorded with a force plate. Clinical tests for the provocation of back or leg pain were performed. Gender, workload, age, and anthropometrics were managed as potential confounders in the analysis.
Marked overlapping was seen in the measures of the subjects with different outcomes. Among the nonsymptomatic subjects, low performance in tests of mobility and standing balance was associated with future back disorders. Among workers with previous episodes of back pain, low isokinetic extension strength, poor standing balance, and positive clinical signs predicted future pain.
Some associations were found between the functional tests and future low back pain. The wide variation in the results questions the value of the tests in health examinations (e.g., in screening or surveillance of low back disorders).
Ensuring that employees are both physically fit for work by matching their capabilities with the physical requirements of
their job, and physically fit for life by promoting health-related physical activities, are important and under-utilized tools
in a company's arsenal for reducing absence and ill-health retirement (IHR). Both the Health and Safety at Work Act (1974)
and the Disability Discrimination Act (1995) require evidence-based approaches to setting physical and medical employment
standards. Proven fitness-related strategies include redesigning the most demanding tasks, selecting and training personnel
who possess the necessary physical attributes, and assessing and redeploying personnel to jobs within their capability. An
essential precursor to pursuing these strategies is to conduct a job analysis to quantify the physical demands of the job.
Functional testing has evolved to a new sophistication, and is currently used in a variety of situations to assist the employer and physician in safely placing an individual at the job site. The functional capacity evaluation can be employed in several ways, not only to place individuals safely in jobs, but also to monitor their progress throughout recovery from an injury or illness and aid in the establishment of vocational counseling and planning. Many legal issues now alter employer techniques for hiring and assigning people to jobs. This state of affairs places increasing importance on functional testing.
Loss of productive life among injured workers potentially could be prevented by clearer knowledge of disability risk factors. Despite the number of studies that have examined predictors of disability, there have been no systematic literature reviews integrating multiple risk factor domains. Such a synthesis could help to define important gaps in knowledge, inform future study designs most likely to successfully address these gaps, and highlight the importance of secondary (disability) prevention to public health policy. A systematic synthesis of the literature on risk factors for chronic or recurrent disability in injured workers was performed to meet this need.
Articles were identified through a MEDLINE search, personal file searches, and requests to experts. Information concerning study methods and results was abstracted from 20 articles that met the inclusion criteria (population-based or prospective cohort studies).
The most frequently identified predictors of prolonged disability were older age and greater baseline pain and functional disability. Lumbar symptoms, smaller company size, and construction work were significant predictors in several, but not all, studies. Risk factors did not appear to differ for back versus mixed injuries.
Several risk factors for prolonged disability were identified. Research is needed to develop and test multivariate models of worker, workplace, health care, and administrative risk factors for prolonged and recurrent disability in order to refine and target interventions.
This study investigated the influence of manual stone and brick handling and psychosocial work factors on the risk of chronic low-back pain and describes the impact in terms of risk advancement period.
The Hamburg Construction Worker Study included a longitudinal study among 488 male construction workers. Adjusted prevalence ratios (PR) of chronic low-back pain (>3 months during the last 12 months) according to self-reported worktasks in the baseline survey were estimated with the Cox proportional hazards model.
The 1-year prevalence of chronic low-back pain was 15.4%. Workers with chronic low-back pain in the baseline survey had a higher risk of such pain during the follow-up (PR4.07,95% CI 2.18-7.59). The prevalence in association with laying large lime sandstones for >2 hours per shift (PR 1.80, 95% CI 1.04-3.14) further increased after adjustment for job category (PR 2.69, 95% CI 1.25-5.78), and it advanced the risk by a risk advancement period of 18 years (95% CI 4-39). Workers with low satisfaction with their work achievements had a higher prevalence of chronic low-back pain (PR 2.07, 95% CI 1.10-3.88). Similar risk estimates were observed in the subgroup without chronic low-back pain in the baseline survey. A strong effect of time pressure wasonly present for these workers (high: P R 6.30,95% CI 1.41-28.21).
The results suggest that repetitive work involving bent positions and the manual manipulation of heavy stones increases the risk of future chronic low-back pain. For risk communication, the notion that a 40-year-old construction worker laying large sandstones has the same risk as an unexposed 58-year-old construction worker may be more informative.
Medical case management of musculoskeletal injuries can be facilitated when objective testing of the physical demands of the job can be compared to the functional capabilities of the individual. When the job analysis is appropriately sectioned into the separate physical demands, the physician can use information about specific job demands to maximize the likelihood of a safe return to regular duties. The response in the physical abilities in the worker can then be again functionally evaluated, leading to increased confidence in the process.
First, to identify what physical performance differences existed between a group of disabled individuals with chronic pain and a control group of pain-free individuals with comparable disabilities; and second, to test a psychosocial model designed to evaluate which psychosocial constructs were predictive of performance in disabled individuals with chronic pain.
Case-comparison study.
Ambulatory university laboratory.
A community sample of 62 individuals with lower limb amputations or paraplegia, 31 with chronic pain and 31 pain-free.
Standardized lifting and wheel-turning tasks.
Static strength, endurance, lifting speed, lateral and anterior-posterior sway, and multidimensional psychosocial measures. RESULTS Disabled individuals with chronic pain had decreased endurance for both the lifting (p <0.001) and the wheel-turning (p <0.05) tasks. A psychosocial model of physical performance also was evaluated. Using confirmatory factor analysis, 31 measures were used to validate 8 theoretical constructs: emotional functioning, pain intensity, pain cognitions, physical functioning, social functioning, task-specific self-efficacy, performance outcome, and performance style. Regression analyses indicated that more than 90% of the variance in performance was predicted by psychosocial factors, with self-efficacy, perceived emotional and physical functioning, pain intensity, and pain cognitions showing the highest associations.
Chronic pain was found to significantly reduce the performance in individuals with lower limb amputations and paraplegia. A strong association was found between performance and psychosocial factors in disabled individuals with chronic pain. These findings extend the existing literature by validating that psychosocial models of chronic pain can be applied to the disabled population, with results similar to those of other chronic pain samples.
Back injuries in industry: A retrospective study—employ related factors
- Bigos Sj
- Spengler
- Dm
- Na Martin
Bigos SJ, Spengler DM, Martin NA. 1986. Back injuries in industry: A retrospective study—employ related factors. Spine 11:252–256.