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Functional Capacity Evaluation using the Matheson System Alison Biggs, Healthywork Ltd www.healthywork.org.uk. Matheson System. Dr Leonard Matheson, Psychologist researcher. Roy Matheson, training programmes. 4 - 5 day course – then Accreditation system. Retrain after 7 years.
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Functional Capacity Evaluation using the Matheson System Alison Biggs, Healthywork Ltd www.healthywork.org.uk
Matheson System DrLeonard Matheson, Psychologist researcher. Roy Matheson, training programmes. 4 - 5 day course – then Accreditation system.Retrain after 7 years. Therapist chooses suitable tests for questions to be answered and the client’s diagnosis.
Matheson Evaluation Philosophy • Purpose of FCE – to collect reliable information about current vocational status & estimate potential vocational status. • Hierarchical Professional Value System: respect for client: Safety(Highest) - minimize re-injury Reliability – dependable test scores and test effort to ensure reliable results Validity - measure intended target task Practicality – reasonable direct/indirect costs of test procedures Utility – maximise case resolution Skilled clinical judgement to balance safety and utility issues. Change tests to get the answer rather than compromising safety
Feasibility. Acceptability of the worker generally. • Internal threats to reliability. Tell then to give full safe effort. • Stopping points determined by: Biomechanical. Psychophysical. (should be the most limiting factor, they say when they want to stop) Cardiovascular-metabolic. • Allow modifications. • Extra instruction. Yes, if this is not focus of test. Allow Trials. • Correction of body mechanics if at risk. • Psychophysical approach. Increased function + improved method = further improvement. • Pain should be treated as a tool and factual. Questionable pain behaviour – distraction and effort testing, incl HR. Replace pain behaviour with productive behaviour. Activity linked to control of symptoms.
Physical demand characteristics of work(1993 Leonard Matheson & Ministry of Labor)
Matheson FCE Content • Client info & job info. • Pain scales & standardised questionnaires. • MSE assessment. • Spinal Sort/Hand Sort. Loma Linda, West tool sort. • Jamar. • Dexterity. • Handling. • Fitness and Cardiovascular. • Mobility. • Lifting, carrying, pushing & pulling. • Review.
Pain reporting • Pain scales: Functional Pain Scale and Visual Analogue Scale. • Standardised questionnaires.
MSE and Sorts • MSE: upper, lower, cervical, thoracic, lumbar. Posture, tests (ROM, mmt /5), special tests, measurement (circum, volumetric, pre and post), palpation. • Sorts: West tool Sort, Loma Linda, PACT (Performance Assessment & Capability Testing) Spinal Function Sort and EPIC Hand Function Sort.
Hand Dynamometer Jamar grip test Grip Effort
Dexterity and upper limb tests Purdue Pegboard • Several different tests. • Timed • Distraction testing
Minnesota Test • Several tests. • Pinch gauge • Valpar 4 and 8 (assembly tests). • Crawfordsmall parts test.
Valpar 9 Whole body Range of Motion • 4 panels of shape transfer positions.
Handling • Bennett Hand tool dexterity test (Norm). • Valpar 202 (MTM).
Fitness & Cardiovascular • Intake questions for safety. • CSTF - Canadian Standardised Test of Fitness (push ups, curls, trunk flexion, aerobic). • NBFT - National Back Fitness Test (back flex, lower abdo strength, hip flexor flexib, L, R, lateral trunk muscle strength, L, R. • Aerobic – walking, jogging, jumping. • Cardiac – Bruce, Balke, Bench step test, Rockport walking test. • Bench step test. • Walking/treadmill test. • Jogging. • Jumping.
Mobility • Balance. • Crouching/squatting. • Kneeling/floor mobility. • Repetitive movement screening. • Trunk flexibility. • Crawling. • Stairs. • Ladder mobility. • West bus bench. • Work simulation.
Lifting Tests Eg Pile (frequent), Snook or Westor EPIC (Employment Potential Improvement Corporation) Lift Capacity • Tests occasional and frequent lifting. • Standardised shelf heights. • How much does this weigh? List of possible responses
Carrying, Pushing, Pulling Push/pull sled • Handle heights. • Increase weights on platform. • Measure with Force gauge.
Matheson Review • Job match table. • Physical effort. • Reliability of client reports. • Conclusions.
Points of view on Matheson • Instruments whose reliability and validity has been determined through peer reviewed research, available in the public domain. • Equipment available from a range of vendors. • Work simulation. • Weights. • Jamar. • Workday tolerances.
Assessment length. • Answering case-resolution relevant questions while adhering to the Practice Hierarchy. • Training certification/accreditation and retraining requirements. • Support.
Assessment requirements • Choose a practitioner who has attended suitable training to use standardised tests/system. • Ensure client is ready for the assessment – needs to be work ready, able to participate fully in assessment, at end of rehab not too early. Can give info more quickly in a case. • Ensure client and job is appropriate for this assessment. Good for physical jobs. Analyse effort, reliability of client reports and techniques for Manual Handling etc. • Be clear what you want to find out from Assessment. Specific information required and questions. Reason for this assessment is... Also to defend its use to the payer.
Assessment requirements cont • Tell the assessor what information you need to know. RTW yet? • Unsafe to RTW? Look at alternatives. • FCE shows they can RTW, even if they don’t think they can? • GRTW hours? Which job tasks can they do? Frequency and kg of lifting/carrying? • Other issues preventing RTW (social/psychological)?
Hierarchyof RTW Hierarchy of objectives: • Same work and same employer • Same work (modified) and same employer • Different work and same employer • Similar work with different employer • Different work with different employer • Retrain and/or re-educate the worker (Workers Compensation Board of Manitoba www.wcb.mb.ca )
Other considerations • Client travelling to assessment. • Gather detailed job info prior to the assessment, so that the testing can more accurately reflect the job demands. Ask for a Job Demands Analysis if req. • Consents and access to medical records. • Cardiac Arrest – defib requirements? Approp assessment/job? • Follow ups, next day? • Other standardized assessments can be used, eg. Numeracy tests, The Cognitive Test of Minnesota.
Links • www.roymatheson.com • www.epicrehab.com • www.khavalpar.co.uk