Industrial Rehabilitation
George T. Edelman MPT, MTC
Rick Hayward MPT, OCS, OMPT
Scope of the Problem
5.7 Million injuries and illnesses reported
in private industries in 1999
Of those, about 2.7 million were lost
workday cases
Of those 5.7 M, 5.3 million were accidents
Injury rates higher for those mid-sized
companies employing 50-249 workers.
INJURY COSTS
Medical Costs
Employee Wages
Benefit Package Payments
Salary of Replacement Personnel
Training of Replacement
Personnel
Overtime Payments for Current
Personnel
What do I need to know?
Acute care management of
patients with musculoskeletal
dysfunction
Functional Capacity Evaluation
Job Demands Analysis
Ergonomics, hazard identification
and abatement
Pre-employment Screening
Information management
What do I need to know?
Work conditioning
Work simulation
Injury Prevention Education
Fitness
Governmental agencies
Regulatory issues
Reimbursement issues
Marketing
Players
Worker/patient
Employers
Physician
PTs/OTs/ Exercise physiologist
Vocational Rehab consultant
Psychologist
Attorney
Case manager
Scope of Practice
Most Common
Treating acutely injured workers in outpt
setting
Return to Work Screens (mini-FCE)
Functional Capacity Evaluation (FCE)
Job Demands Analysis (JDA)
Post-Offer / Pre-Placement Screens
Worker Education
Ergonomics
Fitness/Wellness
Overview of Lecture
History, Regulations, and Agencies
The Continuum of Care and Services
Functional Capacity Evaluation: The
Well Designed Test
Job Demands Analysis
Post Offer Screening
Marketing & Selling Your Services to
Business & Industry
History,
Regulations,
and
Agencies
History - 3 Major Areas
Workers Compensation
Social Security
Employment Selection
History: Workers’
Compensation
Early 1900’s - trend toward
awareness of rehab of physically
disabled
Prior to 1910 the only recourse to
bring a suit against their employers
in court to claim damages for work
related injuries
Workers’ Compensation Law
Early 1900’s increasing number of
claims being settled in favor of plaintiff
but many did not have resources to go
to trial
only 6% workers received financial relief
employers risk of liability in isolated
cases was astronomical - out of
business in single claim
History - Workers’
Compensation
State Workers Compensation Law
– 1910 New York
– 1911 Wisconsin
mandated employer-financed insurance
programs
created a “no fault system” where workers gave
up right to sue and employers accepted limited
liability
purpose was prevention of poverty, not disability
prevention
Workers’ Compensation Law
varies from state to state
costs are paid by employer to
state fund or insurer
each state determines specific
benefits received
History: Workers’
Compensation
By 1920, 42 out of 48 states & DC had WC
laws
has been called the “most dramatic event in
20th century of American civil justice”*
for 25 years was the only social disability
income program in the US
*Darling-Hammond L, Keisner TJ: The law
and economics of workers’ compensation,
Santa Monica CA, 1980, Rand Publications.
Understanding Workers Comp
Who pays and why?
– Every employer except
family business, only family employees
self-insured
– Point is to spread risk
riskier industries pay more
higher injury rates pay more
Who is Covered
Everyone except
– Baby-sitters
– Temporary agriculture
– Religious school teaching
– Part-time domestic help
– Family members in family business
What is Covered?
Work-related injuries or illnesses
– must “arise out of and in the course of
employment
Includes
– organized recreational functions
– travel
– homework
– unauthorized presence in workplace
Pre-existing Conditions:
Pre-disposing to Injury
If it occurs at work, it arises out of
employment as far as the law is concerned
does not matter if the injury occurs during
an activity that would not have been
injurious but for the preexisting sensitivity
Employers must “take employees as they
find them”
Pre-existing Conditions:
Causing Injury
When cause is unclear, law will not
attribute it to work unless evidence points
in that direction
King v. TTC Illinois Inc., Montana, 2000
– Truck driver, smoker, HBP, high cholesterol
– died in cab of truck after handling tarps
– medical examiner concluded death caused by
preexisting heart condition
– court sided with med examiner
History - Workers’
Compensation
1920’s saw decline in the workers
compensation system
Disputes arose over whether injuries were
work-related and the extent of disability
By mid-1930’s debate began over whether
to add disability to the social security
system
History: Social Security
Disability
Social Security system added disability
coverage in increments:
–
–
–
–
–
–
‘54 disabled exempt from making social security
payments
‘56 disability benefits began for those between 50 and 65
were unable to work due to disability
‘58 monthly benefits paid to dependents
‘60 age limitation of 50 years removed
‘65 12-month requirement added
‘72 benefits increased & Medicare benefits available to
those whose disability lasted for at least 2 years
SSA’s Definition of Disability
The inability to do any substantial gainful
activity (SGA) by reason of any medically
determinable physical or mental
impairment which can be expected to
result in death or which has lasted or can
be expected to last for a continuous period
of not less than 12 months.
SSA’s Definition of Disability
Impairment must be so severe that person
is not only unable to do past work but
considering age, education, and work
experience engage in any other
substantial gainful work which exists in the
national economy
Five Step SSA Disability
Determination Process
Is the individual engaged in SGA?
Does the individual have a severe
impairment?
Does the impairment meet the listings?
Can the individual do past relevant work?
Can the individual do other work?
History - Rehabilitation
World War I - disabled veterans’ vocational
needs
1920 - Passage of Vocational Rehab Act Provided funds for vocational rehab
–
–
veterans WWI
industrially injured
Amendments in 1943 & 1954
History - Employment
Selection
Americans with Disabilities Act (ADA)
July 26,1992
–
–
–
extended legal protection from employment
discrimination to handicapped Americans
goes beyond traditional equal employment
law and affirmative action by requiring
individualized treatment on a better-thanequal basis
tests cannot be used to screen out disabled
individuals unless they are job-related
ADA
All employers of 15 or more people
protects “qualified persons with a disability”
–
physical or mental impairment substantially limits
one or more major life activities
“record of”
“regarded as having”
–
–
has requisite skills, experience, education, &
other job-related requirements
able to perform essential functions with or without
reasonable accommodations
ADA - Substantial Limitation of
Major Life Activity
–
–
–
–
–
–
–
–
–
–
Caring for self
Performing manual tasks
Walking
Seeing
Hearing
Speaking
Breathing
Learning
Working
Participating in community affairs
ADA - Essential Functions
Job function considered essential if:
–
–
–
reason job exists is to perform function
limited number of employees available
among whom performance of function
can be distributed
highly specialized so that the incumbent
is hired for the ability to perform the
function
ADA - Reasonable
Accommodations
modifications or adjustments to job
to enable impaired person to enjoy
equal employment
–
–
–
job application process
work environment
benefits & privileges
ADA - Undue hardship
If necessary modifications create “undue
hardship” employer does not have to
provide
Factors considered:
–
–
–
nature and cost
financial resources of employer
effect on the operation of the
facilities/business
History - Injury Prevention
Williams-Steiger Occupational Safety &
Health Act 1970
–
–
–
assure safe and healthful working
conditions for men and women
no specific ergonomic standards
ergonomic considerations covered under
the general duty clause
employers responsible for furnishing
employees a place of employment free from
recognized hazards that are likely to cause
death or serious physical harm to employees
OSHA
Regulatory body
Employers of 11 or more people
Reduce hazards/comply with
standards
Conducts inspections
Issues fines
No ergonomic standards per se
History - Injury Prevention
1991 - OSHA published “Ergonomics
Program Management for Meatpacking
Plants” covering primary components of
an effective ergonomics program:
Worksite Analysis
–
–
–
Hazard Prevention & Control
Medical Management
Training & education
NIOSH
set up by same act that established OSHA
directed by Secretary of Health & Human
Services
authorized to develop standards & conduct
research
Work Practices Guide for Manual Lifting
including formula for calculating
recommended weight limit for lifting tasks
Governmental agencies
Department of Labor
–
description/classification of work
Social Security Administration
–
disability determination
NIOSH
–
research
OSHA
–
regulatory
Overview of Course
History, Regulations, and Agencies
The Continuum of Care and Services
Functional Capacity Evaluation: The
Well Designed Test
Job Demands Analysis
Post Offer Screening
Marketing & Selling Your Services to
Business & Industry
The BIG PICTURE...
Continuum of Care
– Medical Model vs Work Recovery Model
– Acute, Subacute, Chronic
medical management
work recovery management
Role of assessment
Importance of function
Continuum of Care
Medical Model
Work Recovery Model
– Acute
– Sub-acute
– Off Work
– Transitional modified
duty
– Chronic
– Return to full duty
– Permanent modified
duty
– New permanent
position
– Disability
Acute Care: Medical Side
Acute
– promote healing of tissue
– minimize symptoms
– maximize function
Important to begin asking about job tasks and
demands early!
– usually patient or employer self-report
– can explore occupational information
DOT
Job Exploration Software
Work Related Function
Early emphasis on work-related
function is one of the hallmarks of a
holistic clinician!
Acute Care: Work Recovery
Acute- Off work – Begin by asking about
home function
– Be specific
activity
duration
– performing functional activities at home
sitting
standing
walking
lying
light materials handling
Acute Care: Work Recovery
Aim for graded progression of home
function
Scheduled and structured
As a measure of outcome
Set stage for
– problem solving
– pain management
exercise
positioning
Work Function
Based on demands of job
– Work simulation
– Work conditioning exercises
– Graded with specific goals
Acute Care: Work Recovery
Acute -Transitional modified work
– original job
– new temporary job
meaningful work is optimal
– guided by functional testing
– communication with supervisory personnel is
essential
– progression
Importance of Function
Only way we have of knowing whether
we are making a significant difference in
the lives of the patients we treat is to
find out about function of patient & work
demands
– self-report
accuracy
motivation
– observational measurement is
preferable
Importance of Work-Related
Functional Assessment
Only objective means of determining
whether patient abilities meet functional
demands of work is to evaluate
– asking patient to perform functional task
– measuring physical demands of work
– match?
yes
no
return to work
further treatment or modified work
Appropriate Measurement for
the Acute Stage
Not full blown FCE
Not formal job demands analysis
Instead:
– informal visit to the job site
– observe the job
– use the information to develop a brief screen
of the most demanding aspects of the job
What does the informal job site
visit accomplish?
Increases your
– comfort level with the industrial environment
– credibility in the eyes of your patient
– patients’ level of trust
– ability to market other industrial services
– value in the scheme of treatment
physicians
case managers
To maximize effectiveness
in treating work-related
injuries -get out of the clinic
and into the work place!
Acute Management
Hands-on does not preclude
patient participation
– Self mobilization
– Home program
– Home administration of modalities
– Home positioning
– Functional activity
Patient should have goals related
to function
Example: Home Program
for Acute Back Patient
– Spend five 20-minute sessions in side lying
with towel roll between iliac crest and rib cage
– Perform 10 reps of extension exercise every
hour
– Apply ice pack for 20 minutes twice a day
– Walk for 15 minutes 5 times per day
– Stand for 15 minutes 5 times per day
– Perform 10 reps of stretching exercises 2
times per day
What Don’t Want...
Inactivity!
Unstructured daily regimen
Because...
promotes the sick role
encourages
– Disuse atrophy
– De-conditioning
– Decreased mobility
Essential Elements of
Success
Program should be regimented with
patient keeping a home program log
Set specific measurable goals
Begin return to work/modified work
discussions early
Demonstrate interest and knowledge
regarding functional/work activities
Knowledge of Work-Related
Function
Therapist knowledge regarding work
function
– creates face validity for worker
– builds trust
– improves quality of treatment
work simulation
work conditioning
transitional duty
Subacute: Medical
Management
Subacute - Shift toward more
–
–
–
–
–
work simulation
work conditioning
work recovery/transitional duty
posture/body mechanics training
functional testing
By the end of the sub-acute phase, should
know whether the patient can return to former
work.
Subacute: Work Recovery
Transitional modified duty
– duration increases
– duties increase
Work conditioning
– job specific
– strengthen, stretching, endurance
Work simulation
– to assist with progression to next
stage of transitional work/full duty
Chronic: Medical
Management
Shifts more toward
– pain management
– psychological interventions
– coping with residual functional
capacity
Chronic: Work Recovery
Former job with modifications
Placement in same line of work,
different job
– same employer
– different employer
Vocational assessment, exploration,
counseling, retraining for new work
The Functional Foundation
Matching the Worker to the Work
Pre-Work
Screens
Return to Work
Work Simulation /Conditioning
Transitional Modified Duty
Job Demands Analysis // Functional Assessment
Traditional Return-to-Work
Disability Decision-Making
Client self-report
• Do you think you are ready to go back to work?
• Do you think you are able to work?
Impairment/diagnosis-based decision
• Imaging studies
• Range of motion
• General impressions
No objective information regarding job
demands or patients’ functional abilities
The Well-Designed FCE
Comprehensive
Standardized Yet Flexible
Clear Report Format
Safe
Practical
Objective
Reliable
Valid
Comprehensive
Covers all physical demands
defined by DOL in the Dictionary
of Occupational Titles
Does not focus exclusively on
materials handling
Standardized Yet Flexible
Procedures
Equipment
Verbal Instructions
Scoring System
Ability to chose individual items
for job-specific testing
A Clear FCE Report
Overall level of work (Sedentary, Light,
Medium, Heavy, Very Heavy)
Percent of day individual demands
can be performed (Constantly, Frequently,
Occasionally, Never)
Tolerance for the 8 hour day
FCE
Summary
Report
A Clear FCE Report
# of tasks with self-limiting behavior
Inconsistencies in performance
Interpretations/Conclusions
– Major areas of dysfunction
– Factors underlying limitations
– Discrepancy between job demands
& pt abilities
If indicated:
• Job Specific Testing
• Job/Occupation Comparisons
• Recommendations
Safe
Minimize chance of injury during
FCE
– Heart rate monitor
– Allow patient to stop if need arises
– Therapist observing body
mechanics/alignment
– Well-defined safe stopping points
– Clear contraindications and precautions
Objective Projections
Minimize clinical “guesswork”
Projecting to 8-hour day
The Common FCE Scoring
?
t
E en
FC sm
s
se
As
?
?
?
FCE
Clinician’s
Report
Protocol
Observation
Generation
Examiner Bias
The “Gray” Zone
The PWPE Scoring System
Scoring System
t
E en
FC sm
s
se
As
Directs Therapists Observations
Classification System for Documenting
FCE
Protocol
Formulas for Combining Multiple
Observations
FCE Report
Formulas for Projecting Performance to Generation
8-Hour Day
Overall
Sincerity of
Tolerance
Work Level
Effort
8 hour Day
Rating
Rating
Rating
What is Reliability?
Reliability = Consistency
• If different therapists administer
an FCE to the same patient,
will they obtain the same
results?
What is Validity?
Validity = Accuracy
• Can the FCE accurately predict a
safe maximum level of work?
Reliability and validity are critical
to trusting FCE results!
Why Are Reliability and Validity Important?
Without proven reliability and validity, you
and the patient do not know if test results
are accurate
Legal defensibility: Daubert v. Merrill Dow
Pharmaceuticals 1993 Supreme Court
Ruling
If testimony does not meet standards FCE
results may be considered inadmissible
Reliability and Validity of FCE
Smith et al: Am J Occup Ther, 1986
Dusik et al: J Occup Med, 1993
Saunders et al. Physical Therapy, 1997
Alpert et al. J Occup Rehab, 1991
Matheson et al. Spine, 1995
Summary of Research
All of these studies made important
contributions to the literature
However, limitations include:
– Many studies focused primarily on the manual
materials handling aspect of FCE
– Many studies addressed either reliability or
validity but not both
– Methodological flaws with several of the
studies
Interrater Reliability and
Concurrent Validity
Lechner et al: Journal of Occupational
Medicine, 1994
Two therapists evaluated the same 50
patients for reliability using a new FCE
protocol, Physical Work Performance
Evaluation (PWPE)
Concurrent validity: PWPE (FCE)
predictions were compared to actual work
status
Reliability & Validity
Reliability: Kappa for Test as whole = .83 Almost Perfect
0.9
0.8
0.7
Dynamic Strength
0.6
0.5
0.4
0.3
0.2
0.1
Position Tolerance
Mobility
Overall Level
0
Kappa
Validity: 86% agreement between PWPE and actual work
Predictive Validity
Lechner, Page, Sheffield: (abstract)
Physical Therapy 1996
Study conducted at Baptist Medical Center
Montclair, Birmingham, AL
30 Workers Compensation patients who
were admitted to a interdisciplinary work
hardening program using PWPE (FCE)
protocol
Compared PWPE recommendations to
actual return to work level
Predictive Validity
Recommendations based on discharge
PWPE:
• RTW - full duty
• RTW - modified duty
• No RTW
Substantial agreement between
recommendations and:
• Initial RTW
• 3 month follow up
• 6 month follow up
Kappa of .74
Kappa of .69
Kappa of .71
Contributions of PWPE Research
These studies are the only ones that
have examined both reliability and
validity of a comprehensive test
published in the peer-reviewed medical
literature
Common Misuse of FCE
“Can’t Catch the Faker, Why Not? ”
Many of the traditional tests used to “catch the
faker” have not been adequately researched
It is impossible to infer motivation from these
tests, in a legally defensible way
Clinicians who are marketing their services and
making this claim are misrepresenting
themselves
Sincerity of Effort
Any statement that implies decreased
motivation
“symptom magnification”
“exaggerated pain behavior”
“invalid or conditionally valid FCE”
“malingerer”
Sincerity of Effort
“Measures” typically used to justify statements
about sincerity of effort
Coefficient of Variation (CV, COV)
Waddell’s Non-Organic Signs (NOS)
Bell-shaped curve
Rapid exchange grip
Correlation of heart rate to pain scores
Correlation of pain scale to behavior
Correlation of impairment measures (ROM, MMT, etc.)
to function
“Validity scales”
Sincerity of Effort
If any of these measures are used to justify
accusations of a lack of sincere effort or
motivation…
Problem:
Research supporting the reliability and
validity if these protocols for the purpose of
detecting sincerity of effort/motivation is
lacking…not defensible
The Good News
We can document self-limiting behavior (stopping
before maximum effort is reached)
We know the extent of self-limiting behavior in
motivated patients
We can document inconsistent performance
New research-based protocols becoming
available that allow us to link inconsistencies
with non-compliance
We can document atypical performance
Sincerity of Effort
Test results need to be expressed very
carefully
“Patient self-limited on…”
“Patient demonstrated the following functional
inconsistencies”
“Patient’s test results were similar to a research
group who were instructed to intentionally
withhold.”
The Challenge
To distinguish between appropriate and
inappropriate tests of sincerity of effort
Not overstate test results and increase
exposure to litigation
Additional Information
Lechner et al. Detecting Sincerity of
Effort : A Summary of Methods and
Approaches. Physical Therapy, July
1998.
Review article: Discusses in detail the
problems with commonly utilized
methods for evaluating sincerity effort.
Additional Information
Schapmire et al: Simultaneous Bilateral
Testing: Validation of a New Protocol to
Detect Insincere Effort During Grip and Pinch
Strength Testing. Journal of Hand Therapy,
Vol 15, No. 3.
Research supporting new sincerity of
effort testing.
What Is Job Demands Analysis?
Job Demands Analysis defines:
– essential functions or tasks of the job
– physical demands of those functions
– percent of day spent performing the physical
demands
– forces being exerted
– environmental conditions
– equipment used
Difference Between JDA and
Hazard Identification
JDA
– defines the essential physical demands of the
job
Hazard Identification
– identifies physical demands that exceed safe
limits
Can the two overlap? Yes, one can lead to
the other but need to know the employer’s
purpose for analysis.
How are the Results of Job
Demands Analysis Used?
ADA job descriptions
Pre-Work screening
Transitional duty
Return-to-work decisions
Setting pay rates
Matching worker abilities to job demands!
The Importance of
Job Classification
Report the results of JDA by using a
classification system defined by the
DOL
Provide additional information
–
–
–
Climbing (stairs & ladder)
Reaching (Overhead & forward)
Lifting (above vs. below waist)
Classification of Job Demands
Defined in DOT, SCO, & COJ
Classifies manual materials handling
demands:
–
–
–
–
–
Very Heavy
Heavy
Medium
Light
Sedentary
* negligible weight
Occasional
Frequent (50%)
Constant (20%)
> 100 lb.
51 - 100 lb.
21 - 50 lb.
11-20 lb.
1 -10 lb.
> 50
25 - 50
10 -25
1 - 10
> 20
10 - 20
1 - 10
*
*
*
Classification of
Physical Job Demands
Non-materials handling demands
–
–
–
–
–
–
standing
walking
sitting
reaching
crouching
stooping
–
–
–
–
–
–
kneeling
crawling
climbing
handling
fingering
balancing
Classification of
Physical Job Demands
Non-materials handling tasks classified
according to duration of demand within
the work day
– Constantly
– Frequently
– Occasionally
– Never
2/3 to the full day
1/3 to 2/3 of day
up to 1/3 of day
not required
Classification of
Physical Job Demands
Dexterity Demands
– classified as an aptitude by the DOT
– Rated on a 1 -5 scale
1 = top 10% of population
2 = highest 1/3, exclusive of top 10%
3 = middle 1/3
4 = lowest 1/3, exclusive of bottom 10%
5 = lowest 10% of population
Classification of
Physical Job Demands
Two types of dexterity
– Manual:
“Ability to move hands easily and skillfully. To
work with hands in placing and turning.”
– Finger:
“Ability to move fingers and manipulate small
objects with fingers, rapidly or accurately.”
Classification of
Physical Job Demands
Shortcomings with DOT classification system:
– Very general
climbing - ? ladder Vs stairs
reaching - ? overhead, forward, backward
– Categories very broad
1/3 to 2/3 of day
21 - 50 lb.
Reliability
Pilot studies showed that when therapists
perform JDA without a structured format,
it was not very reliable
Two therapists analyzing the same job
had different results
REQUIRES STANDARDIZED PROCESS
TO ACHIEVE CONSISTENCY AND
ACCURACY
Basic Steps of Job Analysis
Determine the tasks of the job
Determine the frequency & duration of
each task
Determine % day task is performed
Observe/videotape the tasks
Measure forces and distances
Basic Steps of Job Analysis
Determine the percent of task each
demand is performed
Determine the adjusted percent of day
each demand is performed by:
–
multiplying the task % x demand %
Sum the adjusted percentages to
determine the total percent of day each
demand is performed
Basic Steps of Job Analysis
Translate the % into:
–
–
–
–
Constantly
Frequently
Occasionally
Never
Determine the highest weight/force handled
for each type of lift to classify the job Sed to
V. Heavy
Contents of Report
Tasks
Environment
Tools/equipment
Protective equipment
Overall level of work
Percent of day performing each demand
– C,F,O,N
Force demands
Distance over which forces applied
Optional Aspects of Report
Comparisons to patient abilities
Recommendations for transitional duty
Recommendations for post-offer screening
Areas for further hazard assessment
Selection of these components will depend
on what the employer wants.
The Functional Foundation
Matching the Worker to the Work
Pre-Work
Screens
Return to Work
Work Simulation /Conditioning
Transitional Modified Duty
Job Demands Analysis // Functional Assessment
Why Preemployment
Screening ?
The Promise:
Decrease injuries
Decrease injury-related
expenses
Improve productivity
Improve profit margin
Maximize Effectiveness:
One Element
of a Comprehensive Program
Pre-employment screening
Graded work entry
Education and training
Hazard prevention and control
Fitness/wellness
Post-injury management
Three MUSTS for
Preemployment Screening
JOB RELATED
JOB RELATED
JOB RELATED!
DOCUMENT
DOCUMENT
DOCUMENT!
FOLLOW-UP
FOLLOW-UP
FOLLOW-UP!
Important Considerations
Americans with Disabilities Act
(ADA)
Test only the essential
functions of the job!
Optimal Sequence
Interview
Conditional offer
Post-offer/ screen
– medical screen
– physical abilities testing
– drug screening
Traps to AVOID!
Pre-offer testing
Predicting future injury
General strength testing
Making comparisons to normative data
Adverse impact
ADA
EEOC
PROBLEMS with Pre-Offer Tests
Safety Issues
Cannot perform medical screening
Cannot monitor physiological responses to
testing
PROBLEMS with
Pre-Offer Testing
As a health care professional,
your pre-offer exam may be
considered medical just
because it was administered by
a health professional
Predicting Future Injury
Consensus among the medico-legal
community:
Virtually impossible to deny
employment based on pre-offer
testing that predicts future injury
Predicting Injury
Based on speculation
Applicant perceived as person with a
disability
Must make reasonable
accommodation
PROBLEMS!
LITIGATION!
INSTEAD...
DETERMINE WHETHER PHYSICAL
ABILITIES MEET JOB DEMANDS
AVOID PROBLEMS!
AVOID LITIGATION
Avoid Causing Adverse
Impact
Adverse impact
–selection rate for any race, sex,
or ethnic group less than 80% of
rate for the group with the
highest selection rate.
Example of Adverse
Impact
Example:
– 60% of male applicants pass postoffer screen but only 15% of female
applicants pass (.15 /.60 = .25)
– Considered adverse impact: the pass
rate for women is only 25% of the
pass rate for men.
General Strength Testing
Faculty at Washington University;
Dueker JA, Ritchie SM, Knox TJ, Rose
SJ in JOM, Jan ‘94:
“isokinetic trunk evaluation
was of no value in employee
selection”
General Strength Testing
Faculty from the Department of Orthopaedic
Surgery, Glasgow, Scotland; Newton M &
Waddell G in Spine ‘93:
“...inadequate scientific evidence
to support the use of iso-machines in
pre-employment screening ...or
medico legal evaluation.”
Litigation Against General
Strength Testing
1982 New York City firefighter case
– Berkman v. City of New York
– physical agility test items defined by Fleisheman
– None of women passed, 46% of men did
Ruling: “Nothing in the concepts of dynamic
strength, gross body equilibrium, stamina, and the
like, has such a grounding in observable behavior
of they way firefighters operate that one could say
with confidence that a person who possesses a
high degree of these abilities as opposed to others
will perform well on the job.”
Traps to AVOID!
Comparison to normative database
Percentile rankings of physical
abilities are useless !
ADA
EEOC
Compare Abilities to Job
Demands
After Conditional Offer
Abilities match job demands
HIRE AND PLACE
Compare abilities to job demands
After Conditional Offer
Abilities do not match job demands
– Qualified person with disability
reasonable
accommodation
– Non-disability
-do not hire
-alternative placement
-job modification
-applicant remediation
Policy for Handling Test
Failures
Discuss and encourage the company
to establish written policy for handling
test failures with the employer prior to
initiating screening
Do not become involved in
implementing policy - leave it to the
company’s HR department
Two Possible Legal
Challenges
Test items do not reflect relevant
physical duties and performance
requirements adequately
Sample of incumbents tested was not
sufficiently large or did not represent the
population of workers
Job demands analysis and incumbent
testing can go a long way toward
refuting
Steps of the
Post-Offer Screening Process
Focusing the Post-Offer screening
Determine physical demands
Customize screening
Establish Procedures
Test incumbents
Modification
Implementation
The Details of this lecture were
provided by:
Deborah E. Lechner, PT, MS
President, ErgoScience, Inc.