Like other FCEs, Joule can be adapted to various work injury management (WIM) needs of industrial clients such as: pre-placement screening, return-to-work testing, work hardening, and software support for job analysis.
Valpar commissioned a design team of therapists to develop Joule, working under Mary Ruprecht, OTR, with nine years WIM experience including clinic management. Following four-plus years of design and testing, Valpar is now shipping the complete package that includes computer, software and equipment.
The design team was not charged with the task of integrating Joule into Valpar's product line for vocational evaluation, Ruprecht said. Joule (a physics term for a precise unit of energy) is a new Valpar product line focused on therapists. Even so, some cross-pollination with other Valpar products appears evident.
The company's line of component work samples, for example, was launched in 1973 and now includes more than 20 samples. Work samples focus on capabilities needed for common tasks in specific job categories, and they have been used by vocational evaluators and therapists to evaluate and treat workers in transition. Of the more than 20 work samples, two focus on range of motion, one on dynamic physical capacities, and nearly all are oriented to objective measurable function.
With content and uses similar to the work samples, the Joule FCE also has the same cover-the-waterfront approach: it includes specific testing protocols for 20 job categories. The categories are based on definitions in the Dictionary of Occupational Titles (DOT), Bureau of Labor Statistics and other sources. This could shorten the learning curve for providers that must bring expertise on-line quickly.
In addition, the Joule testing format imitates the work samples in their attempt to build in procedures or basic formats that are engaging to clients. The FCE's rack system is adjusted to fit the anatomical dimensions of clients, and clients adjust the color-coded weights as they move through weight-lifting progressions. Such things help build trust and a sense of ownership.
These and other family ties to vocational rehabilitation may be important in serving SSA disability clients in the near future. Pending legislation posed to pass in Congress (the Work Incentives Improvement Act, see cover article) will make alliances with vocational rehab providers a key element in accessing these disability markets.
Joule uses three weight progressions to solve a common problem: many FCEs take a client through a lengthy weight progression before testing maximum strength limits. This means that weaker clients quickly reach their maximum, while stronger clients suffer more fatigue due to repetitions before they reach their maximum. Joule begins a client in one of three shorter weight progressions that is most appropriate for his/her strength. As a result, the client more quickly reaches an accurate maximum.
A safety issue arises, however; the therapist must select the right weight progression for each client. This decision is based on anticipated approximate weight capacities, relevant medical and work history, functional history questionnaire responses, and performance in the musculoskeletal examination. In short, the Joule systems requires thorough pre-testing as do many FCEs.
In another fatigue-related issue, the Joule system also combines all three core lifts (waist-to-waist, waist-to-mid-shin, and waist-to-eyes) into a single sequence. Many FCEs would break these out into three shorter lifting sequences, thus fatiguing the client during the first two so that she/he scores an inaccurately low maximum on the final sequence. The unified Joule protocol minimizes this problem.
Like many FCE systems, Joule offers the flexibilty to conduct testing in one day (requiring about four hours), two days (about five hours total) or more. Ruprecht feels two-day testing can help in some cases: to determine if a client is intentionally under-performing, or to gauge a client's inflammation response to functional activities, or to help a client get past fear of pain or injury.
The Joule software also has task sequencing logic and other assists to help a clinician design a custom FCE protocol for an individual or job category.
The $64,000 question in every FCE is: does it accurately measure what this client can safely do for a specified period of time? In some systems the client controls the test, while in others the evaluator does. Joule attempts to blend these approaches, with the therapist retaining final control.
During testing, a therapist observes client posture and other physical behavior, and elicits client responses regarding symptoms, perceived exertion and perception of safety at predetermined points (exam start, during subtests, and at completion of subtests). The therapist compares the client's responses with data from observation, client diagnosis, history and recovery patterns during treatment. Based on these comparisons, the therapist assigns individual responses to one of three categories:
These responses become the foundation for a Participation Index score that grades the client's sincerity of effort.
When clients have a high performance of meaningful reports as the exam progresses, the final FCE outcome is described as a consistent result that is a valid and reliable representation of safe work abilities. When a client's reports are primarily relevant, the final FCE outcome is described as a marginally consistent result that contains occasional inconsistencies in representing safe work levels, while some of the client's abilities may actually be higher than demonstrated. When extraneous reports predominate, the FCE outcome is inconsistent, and is not considered a valid representation of the client's functional work abilities.
Like most other FCE systems, Joule leaves the therapist to rely on professional judgment to answer tough questions. How to identify a client who pushes the envelope too hard and performs at an unsafe level? How to identify clients who perform at their approximate maximum, but have poor communication skills or cannot assess their own state? How to confirm that a client is not gaming the system? Joule can help, but professional skills are still necessary.
The Joule FCE system sells for $25,995 plus shipping, and includes the following: the system itself, initial training, and the Level II annual service fee for the first year. The list of additional accessories needed is fairly short; a stable ladder and a grip dynamometer. The system includes:
Annual support contracts are available.
Like other systems in its price category, Joule will include access to a proprietary user database; this capability is under development now for full release in about a year. Database services usually come at extra cost, and it remains to be seen what fee structure and incentives Valpar will offer. Standardized databases may become more important as an SSA disability market emerges. If so, FCEs may become a sub-category of vocational rehab in this particular market, rather than a primary service category. In that case, Valpar's experience could be an advantage.
For technical information about the Joule FCE, contact Mary Ruprecht at 763/755-9144, or visit the Valpar website at www.valparint.com. For product and sales support contact Neal Gunderson at 800-633-3321.