PT Classroom - The “Six W’s” Of Functional Baseline Testing ׀ by Ronald W. Porter, PT, CEAS III

Ronald W. Porter is a recognized expert in the field of Occupational Safety and Health, and Ergonomics. In the past 30 years, since becoming Director of the The Back School, he has instructed over 1000 workshops and seminars on Ergonomics Awareness and Musculoskeletal Disorder Prevention to physical and occupational therapists, medical doctors, occupational health nurses, and industrial health and safety professionals. Ron has worked with over 200 industries, including Lockheed Martin Aeronautics, E.I. Du Pont, DS Waters, Shell Oil, International Paper, Cingular Wireless and the United States Navy, on the development and implementation of innovative ergonomics programs for both individual plant sites and entire corporations. He is often an featured presenter at national safety and health association conferences including the 2007 - 2010 American Society of Safety Engineers Professional Development Conferences, the 1995 - 2005 American Occupational Health Conferences, SEAK Annual National Workers' Compensation and Occupational Medicine Conferences in 2005-2007 and a March 2010 national webinar on the Aging Workforce for the ASSE Virtual Classroom. His Bachelor of Science degree is from the University of Tennessee-Knoxville and his Graduate Degree in Physical Therapy from Emory University in Atlanta, GA. He is a member of the Human Factors and Ergonomics Society, American Physical Therapy Association, American Society of Safety Engineers and the American Industrial Hygiene Association.

Functional Baseline Testing is a method by which Physical and Occupational Therapists may address functional activities with workers’ compensation patients. This testing and treatment process will enable the therapist to provide an alternative to Work Hardening Therapy, a program increasingly fraught with reimbursement issues requiring expensive equipment and excessive square footage. Here are some fast facts about Functional Baseline Testing:

WHAT IS FUNCTIONAL BASELINE TESTING?
A method to incorporate functional activities into a traditional physical rehab program:
 • Without the space and equipment expense required for Work Hardening facilities:
   - Functional Baseline Testing and Treatment equipment needs can be met for under $2500.00 (in addition to standard clinic equipment).
   - Functional Baseline Testing and Treatment can be done in a standard, already equipped PT clinic.
• A method to prepare an injured worker for return to work:
   - Every job has Material Handling and Non-Material Handling requirements. Functional Baseline Testing emphasizes job-matching and precise goal setting in these key areas of work.
• A method to increase Workers’ Compensation revenues by retaining patients formerly lost to providers with Work Hardening program.

WHY DO FUNCTIONAL BASELINE TESTING?
Decreased utilization of traditional Work Hardening.
• Provider perspective – Expensive to provide & litigious patients:
  - Equipment, space, time, and staff expense.
  - Liability concerns, “I got hurt in Work Hardening defense”.
• Payer perspective – Insurance Companies do not think Work Hardening is a good investment:
  - Work Hardening is “expensive baby-sitting”.
  - Mixed outcomes results in Work Hardening – “50-80% success” and “Outcomes are unclear” per the research.
• “Modified Duty” work + increased pressure for early return to work.
• The need to furnish the appropriate treatment pathway for workers with behavioral obstacles preventing return to normal activity.

WHEN SHOULD FUNCTIONAL BASELINE TESTING BE DONE IN A REHAB PROGRAM?
When an acute patient enters the strengthening phase of a physical rehabilitation program:
• OT/PT patient is medically stable
  - No medical or surgical contraindications for care
• OT/PT patient is ready for “conditioning”
  - Aerobic & Progressive Resistance exercise
• OT/PT patient is ready to begin at least light lifting, pushing, and pulling tasks.
• OT/PT patient is ready to begin working on required postures and positions assumed at work safely.

WHO CAN PERFORM FUNCTIONAL BASELINE TESTING?
• OT’s/PT’s should check with State Division of Professional Registration.
• OT’s/PT’s should check with State PT or OT Association.
• In general:
  - Evaluations – Licensed Physical or Occupational Therapist.
  - Treatment Planning – as above.
  - Treatment – Licensed PTA, COTA, or well-trained therapy aide with direct supervision.

WHERE CAN FUNCTIONAL BASELINE TESTING BE DONE?
Traditional therapy clinic with the proper equipment:
• Conditioning – Cardio & Progressive Resistance Equipment
• Functional activity:
  - Lifting (lift boxes, weights, lifting shelves)
  - Pushing/pulling (force gauge)
  - Climbing (sturdy ladder & stairs)
  - Positional tolerances (adequate space to allow for skills circuits – bending, squatting, crawling, kneeling tasks)
• Treatment should coordinate w/ Modified Duty Work:
  - Restricted work per the treating physician
  - Patient can work in modified duty work and attend Functional Baseline Treatment on the same day.

HOW IS FUNCTIONAL BASELINE TESTING DONE?
• Appropriate patient is determined ready for Functional Baseline Testing Program. Employer is contacted for Job Description.
• Initial Functional Baseline Test is done with appropriate patient:
  - FBT assesses material handling and non-material handling
  - FBT assesses effort and presence of non-organic signs.
• Based on the functional deficit areas, a treatment plan is written and reviewed with the patient.
  - Goals coordinate with job description – functional goal setting.
• Patient begins a goal-oriented conditioning and activity program.
  - Includes conditioning, material handling, non-material handling.
• Every week goals attainment is reviewed and new goals are set for the following week. Patient signs off on treatment plan.
• Every 2 weeks a new Functional Baseline Test is performed.
• When plateau reached, 1 of the following discharge pathways occur:
  - Goals met for return to full-duty work – Patient returns to work.
  - Goals not met for return to full-duty work – Patient undergoes a traditional Functional Capacity Evaluation to determine:
    - If restrictions are needed and what they are.
    - If non-organic pain behaviors are the obstacle to progress.
  - Workers’ Compensation Case is closed.