Should Physical Exams Be Combined with Functional Testing

16 Dec

Should a Physical Exam be Part of a Physical Abilities Test?

By Richard Bunch, PhD, PT, CBES and Trevor Bardarson, PT, OCS, CBES

The issue as to how many people are hired and become injured when performing their job duties due to inadequate job matching is becoming an increasing concern. Compensating for physical problems or poor physical fitness by using improper or unsafe body mechanics for example, can lead to an injury, or even a long-term disability.

In the past, pre-employment physicals were mainly limited to a physical exam and certain diagnostic tests such as radiographic studies (x-rays). These exams were represented as a method to identify medical problems that would make job applicants a high risk for injury on the job. However, the estimation of whether or not a person could work safely based on these early tests were often subjective. While these assessments were useful in identifying certain applicants with conditions posing medical risk, there was no research demonstrating predictive value or whether the condition presented an imminent risk of injury. With the advent of the ADA, an emphasis on physical abilities (functional) testing as a means to assess the abilities to work safely became apparent.

In order to improve the predictability of injury or determine if a condition posed imminent risk of injury, it was deemed reasonable to test a person’s physical abilities to perform job-specific simulated tasks such as lifting, carrying, pushing, pulling, climbing stairs, ladders, squatting etc. Today, a physical abilities test (PAT) is considered a medical test if heart rate and blood pressure are monitored. Therefore, ADA regulations dictate that a PAT is a medical test when it monitors vital signs for safety and can only be conducted on a post-offer basis. Therefore, it is technically incorrect today to call any medical test used to screen job applicants a “pre-employment test”. Instead, it should be referred to as a “post-offer, pre-placement” test. Another name commonly applied to this type of test is post-offer employment test (POET).

A PAT or POET is a functional-based examination that is designed to help determine whether a person with or without disability has the physical abilities to perform the minimum essential functions of a job without posing an imminent risk of injury to oneself and/or to co-workers. If such a test accurately represents true essential job functions (i.e., has “content validity”), it can be considered valid and nondiscriminatory. Since functional tests are considered forms of physical stress tests, it is prudent to conduct a detailed physical examination on the conditional new hire just before allowing that person to become engaged in physically demanding job-simulated tests. This is necessary to reduce the risk of injuries during functional testing.

Today, there are various forms of functional abilities testing being used. To be legally
performed, employers should ensure that the testing protocol is fully compliant with the federal regulations (e.g., Amended ADA) by ensuring the absence of unfair disparate discrimination in the functional test design. This is best accomplished by testing the ability of individuals to perform only the essential functions of a particular job prior to placement in that job.

When assessing if there is a gap between a person’s physical capacities and the physical demands of a job, a medical or physical examination alone, without functional capacities testing, may miss important information about abilities to work safely during physical exertion, especially when testing for labor intensive jobs. In essence, a physical examination without job-specific functional testing will many times provide only an “educated guess” as to whether or not a person can perform the essential functions of a job safely. Job-specific PATs are used to “validate” or “invalidate” an impression that a person can work safely. In this regard, job-specific work-simulated functional testing is essential.

An example of how important a PAT can be to identify a disability not picked up by a standard medical examination alone is provided by the following actual case. A 39-year-old male who applied to work for an oil industry client underwent a standard medical physical before being referred for a post-offer, preplacement PAT. He had cleared a basic medical examination that had been conducted before the post-offer, preplacement PAT with flying colors, and he appeared to be very fit. The pre-functional physical examination conducted as part of the PAT exam to ensure safety also revealed the same impression of the medical examination, that the person appeared to be physically fit. However, during the physical exertion of functional tests involving lifting, carrying and climbing stairs, the test recipient’s heart rate became highly erratic. This reaction to exertion triggered termination of the test related to obvious safety concerns. His erratic heart rate response to exertion was documented and a note was provided to the person describing the exertional dysrhythmia to bring to a doctor or hospital ER to have a more detailed cardiovascular examination. The urgency of the examination was emphasized. However, upon leaving the clinic, the person unfortunately disregarded the instructions from the evaluator and decided not to seek medical attention. Instead, he decided to apply for the same job but with a different employer who did not conduct PATs and approximately two weeks later this person suffered a myocardial infarction and died.

This tragic example describes how job-specific PATs can identify signs of a potential medical problem that may be missed during a standard physical examination alone. It should also be noted that a physical examination may identify a condition or signs of pathology that functional testing alone will not detect. Therefore, it is obvious that the best method to determine if a person can perform a specific job safely is by using a PAT that integrates a physical examination with job-specific functional capacities testing.

All WorkSaver PATs are based on validated essential physical demands of the job and integrate detailed physical examinations with job simulated functional tests. For more information, call WorkSaver at (800) 414-2174.

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