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Chronic Pain Abilities Determination (CPAD) Focus 10 September2015

Chronic Pain Abilities Determination (CPAD) Focus 10 September2015. Functional Capacity Evaluations (FCE). Definition

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Chronic Pain Abilities Determination (CPAD) Focus 10 September2015

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  1. Chronic Pain Abilities Determination (CPAD) Focus 10 September2015 www.formhealth.com

  2. Functional Capacity Evaluations (FCE) Definition “The FCE is a comprehensive objective physical evaluation of an individual’s current capabilities to perform work-related tasks in order to determine whether or not they meet the demands required to undertake either their own or alternative forms of employment” www.formhealth.com

  3. Claims Manager/Underwriter Sitting Standing Cervical Range of Movement (ROM) Wrist ROM Reaching Walking Stooping Climbing Stairs Manual Dexterity Gripping Pinching Lifting Carrying www.formhealth.com

  4. Measuring Function 1. Range of Movement (ROM) Inclinometry/Goniometry www.formhealth.com

  5. Measuring Function 2. Endurance Methods-Time-Measurements (MTM) www.formhealth.com

  6. Work Day Tolerances www.formhealth.com

  7. Measuring Function 3. Strength Gripping, Pinching, Carrying, Lifting, Pushing/Pulling www.formhealth.com

  8. Work Day Tolerances www.formhealth.com

  9. Measuring Function 4. Cardiovascular Heart Rates Blood Pressure www.formhealth.com

  10. Home Visits Exactly the same tests are undertaken at home Gather vital information on home environment (adaptations, interactions with family) Often more relaxed at home Individuals not required to travel long distances, which they often cite as a reason for re-injury and poor performance. Required for individuals who report not being able to leave the home or travel Ooops………. www.formhealth.com

  11. FCE Validity • Validity of the FCE is essential in order to be able to rely on the objective results to make an informed decision on whether an individual is able or unable to RTW • A significant number of validity criteria are incorporated within the FCE • Validity is based on standardised, peer-reviewed procedures for administrating and scoring tests www.formhealth.com

  12. Validity Examples Grip Testing • Bell-shaped 5-position Grip-Strength Graphs • Rapid Exchange Grip Testing (REG) • Coefficient of Variation (CV) • Distraction observations – walking stick, door handle, stair rail www.formhealth.com

  13. Bell-shaped 5-position Grip-Strength Graphs - Valid www.formhealth.com

  14. Bell-shaped 5-position Grip-Strength Graphs - Invalid www.formhealth.com

  15. Validity Examples Grip Testing • Bell-shaped 5-position Grip-Strength Graphs • Rapid Exchange Grip Testing (REG) • Coefficient of Variation (CV) • Distraction observations – walking stick, door handle, stair rail www.formhealth.com

  16. Rapid Exchange Grip Testing (REG) and CV - Valid www.formhealth.com

  17. Rapid Exchange Grip Testing (REG) and CV - Invalid www.formhealth.com

  18. Validity Examples Grip Testing • Bell-shaped 5-position Grip-Strength Graphs • Rapid Exchange Grip Testing (REG) • Coefficient of Variation (CV) • Distraction observations – walking stick, door handle, stair rail www.formhealth.com

  19. Validity Examples Pinch Testing • Tip v Palmar • CV • Distraction – Fine Dexterity Test, Handling Test, holding a mug Other • Reaching • Cervical ROM • Lumbar ROM www.formhealth.com

  20. Validity Examples - Pain Levels www.formhealth.com

  21. Validity Examples - Self-Perceived Exertion Levels v HR www.formhealth.com

  22. Validity Examples - Self-Perceived Exertion Levels v HR *Borg G. Borg's Perceived Exertion and Pain Scales. Human Kinetics. 1998

  23. Outcomes, Conclusions and Recommendations Good Reliability, No Symptom Exaggeration Compare demonstrated physical capabilities with Job Demands/Description • Able to RTW • Cannot RTW – Rehab/Ergonomic Adaptations • Cannot RTW – No recommendations • Cannot RTW – Baseline physical capabilities for alternative forms of employment www.formhealth.com

  24. Outcomes, Conclusions and Recommendations Provided Poor Reliability, Symptom Exaggeration • Cannot compare demonstrated physical capabilities with Job Demands/Description • Do not know true working capabilities • No Recommendations other than IME/Surveillance (telephone call) www.formhealth.com

  25. Insurance Policies • IP • EL • Critical Illness/TPD • Mortgage Protection • WOP add-on • Motor www.formhealth.com

  26. Reasons for FCE Referral • Diagnosis vs Function - Accept the diagnosis (musculo-skeletal or other), but can the individual work in either their own or any other occupation? • Recommendations for Rehab/Ergonomic Adaptations For RTW • TPD/EA Claims • Stand Above Report – Conflict of medical evidence • Identification of “Red Flags” - Level of disability does not correlate with diagnosis, Lack of Definitive Diagnosis, “Tip Offs”, Frequent flyer to GP, Lack of response to numerous forms of treatment • Sparse medical evidence or no updated reports/treatment for years • Baseline Measures For Alternative Work (Any Occ) www.formhealth.com

  27. CPAD is a protocol for objective testing, designed to determine the working capabilities of individuals who suffer from various chronic disabling conditions, the outstanding prototypes of which are Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM). CPAD is the only assessment to objectively determine whether an individual is able or unable to RTW and is used extensively as the first “port of call” in addressing this issue. Chronic Pain Abilities Determination (CPAD) www.formhealth.com

  28. FCE/IME 1. The “good day- bad day” issue present with CFS and FM individuals. 2. Assessments do not focus on sustained work or predict what a person can do over an 8-hour work day. 3. Appropriate questionnaires are in most cases not completed 4. Pain and exertion responses are not monitored prior to and post exercise to evaluate the effects of fatigue 5. Cognitive testing is in most cases not performed or benchmarked History and Development of the CPAD Protocol www.formhealth.com

  29. Two-year extensive literature search, the most appropriate, peer-reviewed and researched components of current methods for assessing physical and cognitive abilities were incorporated into the protocol, specific to the individual’s required job demands. CPAD undertaken over 2 days, with a rest day in between Testing time lasts around 3-4 hours per day CPAD focuses on specific RTW issues (job specific, any suited) Physical and cognitive tests incorporated, with the same assessor undertaking both components The same tests are repeated on day 2 to monitor effects of pain, and fatigue both physically and cognitively Fatigue and pain questionnaires Validity from both a physical and cognitive perspective Addressing the Issues www.formhealth.com

  30. The CNSVS Neurocognitive Assessment is a researched, peer-reviewed battery of tests which provides precise, objective, valid, reliable and standardized baseline measures in the evaluation, diagnosis, and management of an individual’s neurocognitive health. The core domains tested are memory, processing speed, executive function, psychomotor speed, reaction time, complex attention and cognitive flexibility. CNSVS Computerised Tests assess poor concentration, poor memory, learning difficulties, “brain fog”, and poor problem-solving capabilities. Reliability and Symptom Exaggeration crosschecks CNSVS www.formhealth.com

  31. CPAD Validity • Validity within CPAD is essential in order to be able to rely on the objective results to make an informed decision on whether an individual is able or unable to RTW • A significant number of validity criteria are incorporated within CPAD • Validity is based on standardised, peer-reviewed procedures for administrating and scoring tests • Validity of physical component – See “FCE” www.formhealth.com

  32. CPAD Validity - Cognitive Valid - No Impairment www.formhealth.com

  33. CPAD Validity - Cognitive Valid - Impairment www.formhealth.com

  34. CPAD Validity - Cognitive Invalid – Symptom Exaggeration Scores are comparable to individuals suffering with severe brain injury, mental retardation and early dementia www.formhealth.com

  35. CPAD Conclusions Good Reliability, No Symptom Exaggeration Compare demonstrated physical work-day tolerances and cognitive capabilities on day 2, with Job Demands/Description • Able to RTW • Cannot RTW – Rehabilitation Options (physical and/or cognitive)/Ergonomic Adaptations • Cannot RTW – No recommendations • Cannot RTW – Baseline capabilities for alternative employment www.formhealth.com

  36. CPAD Conclusions Poor Reliability, Symptom Exaggeration • Cannot compare demonstrated physical and cognitive capabilities with Job Demands/Description • Do not know the individual’s true/actual working capabilities www.formhealth.com

  37. Reasons for CPAD Referral • Diagnosis vs Function - Accept the diagnosis, but can the individual work in either their own or any other occupation? • Recommendations for Rehab/Ergonomic Adaptations For RTW • Stand Above Report – Conflict of medical evidence • Identification of “Red Flags” - Level of disability does not correlate with diagnosis, Lack of Definitive Diagnosis, “Tip Offs”, Frequent flyer to GP, Lack of response to numerous forms of treatment • Sparse medical evidence or no updated reports/treatment for years • Baseline Measures For Alternative Work www.formhealth.com

  38. 1. Validation The Team assembled had significant experience with rehabilitation and work capacity issues specifically relating to individuals with CFS and/or FM Peer-reviewed Paper in the IMJ Co-authors: Dr M Kelly (rheumatologist) Dr D Trail (International Fibromyalgia Association) Dr Gualtieri (neuro-psychiatrist) D Newman C Olney (physiotherapist) R Gagne (software/hardware developer) CPAD Genesis www.formhealth.com

  39. 2. Recognition The impact of CPAD as a work-ability assessment for individual’s suffering with CFS and FM was recognised with a “highly commended” award at the Rehabilitation First Awards in 2009. CPAD Genesis www.formhealth.com

  40. 3. High Court Acceptance (Dublin) – May 2014 “The Court must accept the CPAD assessment as a recognised and effective tool to assess someone's physical and cognitive ability.” “The Court accepts the validity of CPAD test process…” CPAD Genesis www.formhealth.com

  41. 4. Evolution CPAD is also being undertaken on individuals suffering from the following conditions: MS Parkinson’s Migraine Cancer Brain Injuries Stroke Chronic Pain Narcolepsy / Cataplexy The outstanding reported symptoms are fatigue/pain which are preventing the individual from a RTW CPAD Genesis www.formhealth.com

  42. Contact David Newman (Director) 00447866573731 davidnewman@formhealth.com Questions? www.formhealth.com

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