All responses by L. N. Matheson, PhD
The resting blood pressure and heart rate values are taken from the American College of Sports Medicine guidelines for non-physician supervised tests. They are presented in the document from the ACSM that describes their guidelines. I believe the most recent version of this document is (c) 1993. I don’t have an address for them, but I would expect they are on the Web.
In our clinic at the University, I find that approximately 10 to 15 percent of our referrals are unable to be tested because their blood pressure is too high. This is unfortunate, but considering that the risk for a cardiac event or stroke is significant for people who are hypertension performing a physically demanding task, we decided to integrate this restriction as a standard part of the EPIC Lift Capacity protocol. The ACSM considers this level of pre-test screening a necessary safety restriction, as do we.
Of course, how the case is handled when an evaluation cannot be conducted is crucial. In the first place, I make it clear that hypertension is an important health concern that the person needs to take seriously. Secondly, I communicate with the referring physician or other health care professional that the protocol requires that we not go forward with the test due to the evaluee’s hypertension, and that if this can be controlled, the test can be undertaken.
Keep in mind that if the controls involve medications that stop the heart from adapting to increased load, such as beta blockers, it still may not be possible to perform the test without physician supervision and the immediate ability to respond to a cardiac emergency. There is no doubt in my mind that these are necessary restrictions; other tests that do not include them are placing the evaluee at an unnecessarily increased risk of serious injury or death.
As an aside, when I hear about people using physically demanding to test protocols that do not include cardiac and blood pressure guidelines, I always point out that the cardiac demands of lifting are substantial and must be considered to be a significant safety issue. When we began to develop the EPIC Lift Capacity, we rejected the order of testing of the PILE for this reason, recognizing that evaluees we tested with the PILE who were older or unfit frequently were exposed to increased cardiac risk early in the test experience.
The safety issue is not sufficiently emphasized in most of the test protocols that have been developed. The inadequacy or absence of cardiac guidelines in a test protocol is an important deficiency. Although the incidence of claimed injury during a functional capacity evaluation is low, it is not zero. There has never been a claim of injury with the EPIC Lift Capacity or the Cal-FCP.
I use the same reasoning for the EPIC Lift Capacity as I do for the carrying, climbing and push-pull tests, since these are also physically demanding. The carrying test and climbing test use the person’s performance on the EPIC Lift Capacity sub test No. 3 as a starting point. Therefore, if the person cannot be safely tested on the EPIC Lift Capacity, the carrying test cannot be performed.
Yes. Use a job analysis to determine the manual material handling job demands, then use the sub-tests of the EPIC Lift Capacity that are content-valid for that job, following the guidelines in the EPIC Lift Capacity Evaluation Manual. You also need to perform a validation study, which requires more explanation than I can provide here. Feel free to contact me for further information on this topic.
There is a standardized extension of the EPIC Lift Capacity that can be performed after the standard six-test EPIC Lift Capacity is concluded. It uses results of the standard EPIC Lift Capacity to select a safe range of work demand for measurement of the evaluee’s constant lift capacity. Because this is so demanding and expensive, it is rarely undertaken, although it is readily available.
First use a job analysis to determine the vertical range of lift or reach and the upper end of that range, then conduct the standard six-test EPIC Lift Capacity. After the evaluee has rested, administer EPIC Lift Capacity test #3 with these ranges, but do not exceed 75% of the load achieved in the standard EPIC Lift Capacity test #3.
On page 69, the example of Mary Smith is based on an actual case and reflects an over-restriction in subtest No. 2. Although you will not find this when you test your healthy normal subjects for the certification program, anomalies such as this are not rare when persons have symptoms such as hers, especially on the first occasion of testing. She probably perceived the subtest No. 2 and subtest No. 5 as more challenging or more risky than subtest No. 1 or subtest No. 3, etc. Her performance on subtest No. 3 is unexpected for two reasons. First, it contains the range of subtest No. 2; in most cases the maximum acceptable weight on subtest No. 2 is an upper limit on subtest No. 3. Perhaps of more significance, subtest No. 3 relies on the ability of the evaluee to transition from one Isoinertial lifting segment to another. This transition itself is significant from a neuromuscular standpoint, requiring adjustments in posture and balance. The fact that she was able to achieve 30 pounds on subtest No. 3 tells me that she should achieve 30 pounds on subtest No. 2. Because she did not, stopping at 20 pounds on subtest No. 2, this is what I would begin working on in therapy. She may have an actual weakness due to guarding in the lumbar extension musculature, or she may simply be over protecting based on what she has been told by her physician, previous therapists, and others. Note that in the accompanying report, paragraph 2 describes symptoms that probably first came up in subtest No. 2 and may have been frightening to her, or at least a reminder of the injury. One of the key skills of an excellent therapist is to assist patients to learn when they are over protecting themselves. Using a test that is as safe as the ELC greatly facilitates this process.
The Physical Demand Characteristics of Work chart assumes a full vertical range from floor to shoulder. You are correct that the floor to knuckle lift is inherently greater than the full range lift. This has been demonstrated in all ergonomics research and is integrated in the NIOSH Action Limit approach. It is also found with the ELC normative data presented in the Examiners Manual. Look at the normative data in appendix E, compared with appendix F. Subjects are able to lift a much greater proportion of their body weight in subtest No. 2 than in subtest No. 3. Also look at the normative data presented in any of the peer reviewed published studies on the ELC. When we develop the ELC we had been using the West Standard Evaluation (WSE) for many years, a test that I developed in the late 1970s. The WSE was designed to provide information about the person’s ability to lift that would be specifically linked to the PDC chart. I originated the PDC chart in the mid-1970s based on the Handbook for Analyzing Jobs (1973) published by the United States Department of Labor. The original version of the chart had eight levels with transition levels from sedentary to light and from light to medium and from medium to heavy. In the first chart, I also included the range of MET levels based on energy expenditure studies performed by others describing typical energy expenditure of various jobs. I did a crosswalk from these jobs to the PDC chart, with the assistance of the Dictionary of Occupational Titles. Later versions of the chart contained only the five main levels but have had almost no adjustment to the energy expenditure ranges. Additional research has borne out the estimates developed many years ago. The ELC was designed to link subtest No. 3 and subtest No. 6 to the PDC chart. Research that we have done substantiates this link. For example, when you do the certification testing, one of the items in the questionnaire for each of your subjects is the Job Demands Questionnaire. Over the years, we have monitored the relationship between subjects’ scores on the ELC and their responses to the JDQ. Consistently, the relationship between Subtest No. 3 and Subtest No. 6 and the subject’s job demands has been borne out, assuming their performance on the ELC should demonstrate adequacy for their job demands.
The ELC was designed to link subtest No. 3 and subtest No. 6 to the PDC chart. Thus, the maximum weight in the test is 120 pounds, and most manufacturers limit the amount of weight provided to 120 pounds. Do not test the person’s ability above this level with the ELC.
Using HR is difficult because it is subject to many factors. I include it in support of my opinion on global effort rating, but usually don’t do precise calcs. If the test is being videotaped for trial testimony, I’d do precise calcs, but what I usually do is monitor the HR and factors it in. Remember that the evaluator’s judgment has been shown to be the best indicator of full effort, so don’t get caught up in relying on a simple phys measure.
The PDC chart defines all jobs in each category as requiring the minimum listed per frequency. Since he doesn’t meet the min, you’d need to drop back to the lighter level or qualify the recommendation. I prefer the former approach.
No, record only what you oberve. Be sure you are adequately warming up your evaluees.
Wait until HR peaks after the cessation of each lift. This is described in the training.
This is acceptable for either.
Each lift will be limited by the weakest biomechanical segment; these peoples’ most-limiting BM segment is their forearms. I’m a bit concerned about “hindering their ability to lift.” Isn’t this just a normal and acceptable limitation, or do these people have something to prove?
Follow the procedures carefully. Look in the manual and in the audio/PPT presentation for clarification.
Don’t correct for a normal lifting technique for a person unless you judge from your training and expertise that it is likely to be harmful. If you believe that it is likely to be harmful, you cannot suspend your expertise, because it’s always “Safety First.” The ELC protocol doesn’t require you to correct for kyphosis. The evidence does not support lifting injuries due to kyphosis in otherwise healthy people.
Yes, for every lift. NIOSH is a good reference for this. DOT is not focussed on frequency as this is defined, only on percent of the workday, which is not physiologic.
The concern stated by the physician is understandable, but unavoidable because the safety and reliability and validity studies have been based on the protocol that you are learning, which includes psychophysical limits. Thus, you are bound to stick to these limits and the other limits as described in the ELC Manual.
Some physicians and physical therapists do not include psychophysical limits in their list of legitimate reasons for stopping a full-effort test. However, they are mistaken; there are decades of research on the safety and reliability and validity of psychophysical test performance.
I would suggest showing the physician the ELC Manual in which the various limits are discussed, and pointing out the Test Factors Hierarchy, which is a frame of reference of which he may no be aware. Also point out that you use more than psychophysical limits and explain the various limits and guidelines that you use in the ELC, along with methods to check for less than full effort and retesting, if necessary.
Finally, take a look at the YouTube video that describes my doing an ELC in the context of the Cal-FCP many years ago.