Dr David Hartshorn
Occupational Medicine Specialist
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Clinical assessment and treatment of work
related illness or injury.
Health surveillance within the work place.
Illness and injury prevention programmes.
Rehabilitation and return to work planning.
Health risk assessment within the workplace.
Development of workplace policies and
procedures.
Assessment of medical work fitness.
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In safety critical roles- transport, emergency
workers.
Pre- employment and during employment.
As part of return to work or rehabilitation.
As part of the insurance sector including ACC.
In practical terms is central in Income
Protection and TPD claims.
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The assessment requires detailed knowledge
of;
1. The functional requirements of the job.
2. The functional level of the person.
And…
An assessment of whether they match up.
Are any mis-matches important?
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Needs to be functional.
What precisely is done, where, how often, who by,
and for how long.
What is the environment and what are the hazards.
Quantify if at all possible.
Work site visit or assessment very useful.
Should be able to explain the job and the
environment to someone else.
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Physical capacity.
Cognitive capacity.
Endurance.
Consistency/lapses.
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Diagnosis does not dictate function.
Impairment does not reliably predict function
or disability.
Neither diagnosis nor impairment, in themselves, accurately predict work involvement.
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Self report- context important.
Medical assessment.
Functional Capacity Evaluation- FCE.
Exercise programme reports- functional.
OT programme reports-functional.
Work trial reports-functional.
Surveillance.
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Self report < physician < FCE in terms of
estimate of level of function within the
disability assessment framework.
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3 Questions to ask once the job and functional
level are clear.
1. Can they perform the tasks required in the
job? (physical/cognitive).
2. Can the job be performed safely without risk
to self or others? (sudden
incapacity/judgement)
3. Can the job be sustained for the duration of
hours required? (fatigue/pain/stamina)
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What is current medical work fitness?
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What is the likely future medical work fitness?
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This does require diagnostic informationknown tissue pathology and expected course of
a defined illness or injury.
More difficult in conditions of uncertain cause
or variable course.
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Desirable features of medical work fitness
assessments within the insurance industry?
Reliable- in other words does the process
produce consistent results across assessors and
claimants?
Validity- in other words does the assessment
reflect reality in terms of actual work capacity?
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Overseas studies suggest wide inter-assessor
variability in assessment of work disability.
Evidence suggests some of this is due to
differing patterns of information received.
The disconnect between diagnosis, function,
disability, and work involvement also a likely
factor.
This may be particularly true for subjective
complaints such as pain and fatigue.
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There is no “gold standard” for disability
assessment.
In the ACC sector many of those found to be “fit
for work” move across to a sickness or invalids
benefit. Fitness vs skills?
Many of those on a sickness benefit do not have
illness that precludes safe work.
Difficulty is that a return to work relates to more
complex processes than just medical fitness for
work.
Successful and sustainable return to work is best
validation but this doesn’t help to validate “unfit”
findings.
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Consistency in protocol for FFW assessments?
Seek a range of functional information sources?
Psychology assessment as part of process for
pain and fatigue related cases?
Expert panel assessments?
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Questions-Discussion.
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