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Functional Capacity Evaluation using the Matheson System

Alison Biggs, Healthywork Ltd

www.healthywork.org.uk

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Matheson System

Dr Leonard 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.

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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-injuryReliability – dependable test scores and test effort to ensure reliable resultsValidity - measure intended target taskPracticality – reasonable direct/indirect costs of test proceduresUtility – maximise case resolution

Skilled clinical judgement to balance safety and utility issues. Change tests to get the answer rather than compromising safety

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• 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.

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Physical demand characteristics of work (1993 Leonard Matheson & Ministry of Labor)

Physical Demand Level

Occasional

0-33% work day

Frequent

34-66% of workday

Constant

67-100% of workday

Typical Energy Required

Sedentary 10 lbs Negligible Negligible 1.5 -2.1 METS

Light 20 lbs 10 lbs Negligible 2.2 – 3.5 METS

Medium 20-50 lbs 10-25 lbs 10 lbs 3.6 – 6.3 METS

Heavy 50-100 lbs 25-50 lbs 10-20 lbs 6.4 – 7.5 METS

Very Heavy

Over 100 lbs

Over 50 lbs

Over 20 lbs Over 7.5 METS

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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.

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Pain reporting• Pain scales: Functional Pain

Scale and Visual Analogue Scale.

• Standardised questionnaires.

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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.

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Hand Dynamometer

Jamar grip test

Grip

Effort

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Dexterity and upper limb tests

Purdue Pegboard• Several different

tests. • Timed• Distraction

testing

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Minnesota Test• Several tests.

• Pinch gauge

• Valpar 4 and 8 (assembly tests).

• Crawford small parts test.

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Valpar 9

Whole body Range of Motion

• 4 panels of shape transfer

positions.

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Handling

• Bennett Hand tool dexterity test (Norm).

• Valpar 202 (MTM).

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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.

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Mobility• Balance.• Crouching/squatting.• Kneeling/floor mobility.• Repetitive movement

screening.• Trunk flexibility.• Crawling.• Stairs.• Ladder mobility.• West bus bench.• Work simulation.

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Lifting TestsEg Pile (frequent), Snook or West or

EPIC (Employment Potential

Improvement Corporation) Lift Capacity

• Tests occasional and frequent lifting.

• Standardised shelf heights.• How much does this weigh? List of

possible responses

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Carrying, Pushing, Pulling

Push/pull sled• Handle heights.• Increase weights on

platform.• Measure with Force

gauge.

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Matheson Review

• Job match table.

• Physical effort.

• Reliability of client reports.

• Conclusions.

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Job Match TableJob Demand Demonstrated Ability Match?

Mobility

Sitting Occasional. 1-17%Admin tasksSitting on the floor whilst performing low level tasksBreaks

No limits reported or observed Yes

Static Standing Performed over 50% of day.Varies depending on task. Can be lengthy periods of time.

Demonstrated short periods of standing,Heel pain reported after 7 minutes and then increased to heel and base of foot pain.Maximum standing duration demonstrated 22 minutes before requesting to sit.Mr Stone reported that the pain in his leg when standing on it to assess his standing tolerance was 3/10 on the Functional Pain Scale (2003), where 3 = ‘Pain starting to visibly disable you, cause difficulty moving or applying strength through the painful area, affecting your productivity or performance. Causes you to take small breaks to rest or stretch’. He reported that at home he would elevate the leg to relieve the pain symptoms.

If he can vary static standing with dynamic standing and walking then this tolerance could be increased, but it is likely that tolerances will need to be broken up with sitting in order to manage the pain in the right foot. A padded in sole may ease the discomfort. Carry a small folding metal stool; possibly use this during some jobs?

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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.

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• 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.

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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)?

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Hierarchy of RTWHierarchy 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 )

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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.

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Occupational Questionnaire

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N/A 1%-17%

18%-33%

34%-50%

51%-66%

67%- 84%

85%- 100%

Additionalinformation

Lifting

Carrying

Pushing

Pulling

Drivingvehicle type:

Sitting (not driving)

Walking

Standing - static

Standing - moving

Bending/stooping

Twisting/spinal rotation

Crouching/squatting

Crawling/kneeling

Climbing stairs Is a lift available?

Climbing ladders etc

Reaching/stretching Eg overhead orhip height:

Above shoulder work

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Links

• www.roymatheson.com

• www.epicrehab.com

• www.khavalpar.co.uk