Posted on Fri, Aug 06, 2010 @ 06:00 PM
I'd like to introduce you to blog team member MaryBeth Plummer, PT. MaryBeth has been a licensed Physical Therapist for 25 years. She owns MBPT, LLC in Albuquerque, NM which specializes in Functional Capacity Evaluations and ergonomics. For MaryBeth's full bio, please check out our Matheson Blog Team page. We're excited to have her on board and here is her first post - and it's a thought-provoking one!
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There are numerous articles, books and internet sites regarding pain. It is somewhat easy to define pain into chronic and acute stages, but more difficult to define the cause of chronic pain. Acute pain is considered a natural and “healthy” pain as a result of trauma or injury. Chronic pain has no specific etiology thus making it poorly understood. Most chronic pain clients that present for Functional Capacity Evaluation (FCE) testing have not had a good response to therapy or invasive procedures, and sometimes continue with prescription medications that are not beneficial.
When a client presents for a Functional Capacity Evaluation, the clinician has about a 4 hour time-frame to assess this person’s ability to perform his/her pre-injury job or if they can perform any other occupation. There is a need to address a client’s perceived level of ability as well as their perceived level of pain as it relates to function for daily tasks and thus incorporate job tasks. There are a number of tools used in the Matheson system for aiding the clinician in assessing pain and a client’s perceived ability to perform functional activities.
As a thinking evaluator, one can assess a person’s predicted ability based on their diagnosis, observation of gait and ability to change positions, as well as performing a musculoskeletal evaluation to determine some baseline predictions for a client undergoing an FCE.
It is sometimes difficult to assess a person’s true abilities if the client is convinced that their pain limits most, or in some cases, all of their activities. This is where compassion meets the need for educating a client on safety during the evaluation and guiding them to try simple activities that encourage increased activity as well building confidence to perform tasks. Therefore, it is important to let a client speak about the emotional trauma of their injury and what they have been through professionally, personally and financially. This can establish a better rapport and a sense of trust in order to try lifting activities or other postural activities to build confidence in the client’s perceived ability instead of a perceived inability.
Our job is not to judge whether or not a person’s pain complaints are true or authentic, but to encourage and perhaps educate them about performing tasks in a modified manner to accommodate for their pain complaints.
There is a mind and body connection which is evidenced by the effect of depression in the mind affecting symptoms of pain and dysfunction in the body (muscle aches and pains, skin and hair problems, sleep disorders, etc). A paper in Spine, Vol 17, No 6, supplemental pages 138-144 (1992) showed correlation in the success of spinal surgery patients as it related to childhood traumas. This study indicated that the outcome of spinal surgery could be predicted based on whether a client had suffered any of five possible traumatic situations in their childhood. These included: physical abuse, sexual abuse, emotional neglect/abandonment, loss of one or both parents (divorce, death, etc.), drug abuse at home (alcohol, prescription drugs, etc.). As indicated in this reference, “The result of surgery and postoperative pain have little to do with the surgical procedure itself but largely depend on factors that date back to the childhood of the patient.”
There are many research articles and reference books on the subject of pain and its neurophysiology. This type of information gives the clinician a more scientific approach to understanding the cause and effect of acute and chronic pain. It may also allow us to venture into another scope of practice besides treating an orthopaedic or neurological diagnosis while still focusing on a client’s function.
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Posted on Tue, Jun 08, 2010 @ 11:49 AM
First things first: We want to give you our most sincere apologies for the fact that we have not posted in three weeks! I (Jenn) got married May 22 and was on my honeymoon for almost two weeks, but now we are getting back in the swing of things and will be posting blog articles more regularly. Our intention is to post an article every Tuesday and Friday afternoon, so we truly hope that you come visit us to check out what's new in our world and to get your bi-weekly fix of interesting and helpful industrial rehab articles.
Second: We want to give you a formal introduction to our blog team! Visit our "Matheson Blog Team" page for a list of team members and their biographies.
Over the next several blog posts we'll be introducing members individually and the first team member to be introduced today is Jonathan (Jon) Harrison, MBA, OTR/L, CWCE, CEES, CPAM, owner of Northwest Work Options. Jon received Matheson's Functional Capacity Evaluation Certification training originally in 2002 and again in 2008, and took Matheson's Ergonomic Evaluation Certification training in 2002 and again in 2009. He obtained certification from Matheson in both FCE and Ergonomic Evaluation and has also taken our Post-Offer Testing & Job Analysis and Work Hardening-Work Conditioning courses.
Jon has authored articles for publication on the subjects of work conditioning, work hardening, and returning the "older worker" to work. He has served as a resource to OT faculty lecturing nationally and serves as a resource to many of his peers across the country.
When Jon emailed us his bio (read the full version here) he also shared with us the following:
Thanks for allowing me to be a part of the Matheson Blog. I was doing a search on FCEs and came across this article: "Pain Response of Health Workers Following a Functional Capacity Evaluation and Implications for Clinical Interpretation." in the Journal of Occupational Rehabilitation (2008) 18:290-298. It was a great read and what they found was that the pain response in 99% of the subjects after an FCE was considered "normal". Pain and discomfort can be expected after an FCE. I always thought so, but now it is there in the research in black and white.
We hope you find his article helpful and interesting. I am not a clinician, but have gained an understanding of FCEs over the past 3 years working at Matheson, and I found the article to be very insightful!
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