Francisca Peydro de Moya; Mª José Vivas Broseta; Salvador Pitarch Corresa; David Garrido Jaén; Ignacio Bermejo Bosch (*); Juan Manuel Belda Lois (*); Juan Fernando Giménez Pla; Inés María Pereira Carrillo
Instituto de Biomecánica (IBV)
Universitat Politècnica de València
Camino de Vera s/n. Edificio 9C
46022 Valencia, Spain
(*) The Health Technology Group of the IBV, CIBER in Bioengineering, Biomaterials and Nanomedicine (CIBER- BBN)
The Instituto de Biomecánica de Valencia (IBV) has developed the NedLabor/IBV application that enables users to put into practice the functional capacity evaluation methodology for workers. It is the result of the joint venture with the Spanish National Social Security Institute (INSS). This program enables users to compile: 1) the worker’s specific physical job requirements; 2) the worker’s perception of the functional limitations; 3) the results of the biomechanical tests after carrying out a physical load protocol that reproduces their job requirements. As a result of this NedLabor/IBV has written a factual report on the functional capacity in which the limitations on the physical abilities concerning the job requirements are assessed and the worker’s performance level is determined. This article presents both the methodology and the operations of the software and the hardware, which are associated with this application.
INTRODUCTION
In 2008 the IBV, supported by the Spanish Ministry of Employment and Social Security, launched a project aimed at developing a methodology to objectively evaluate the functional capacity of workers that would enable experts to make decisions to improve the management of the disability resources.Initially it had the help of Mutual Insurance Companies working with the Social Security because they were potential users of this method that also adapted to the needs of the medical inspectors of the Spanish National Social Security Institute (INSS).
To this end, in 2010 a general collaboration protocol was signed onthe basis of which it started to work with the ProvincialDirectorate of the INSS in Valencia on a convergence project between the functional capacity evaluation methodology of the INSS and that of the IBV.NedLabor/IBV is the result of this joint venture.
NedLabor/IBVis a computer application that makes it easier to evaluate the functional capacity of workers.The application has the following advantages for users:
♦ It structures and homogenizes the data obtained on the workers in terms of their capacity limitations and also with regard to the job positions that they hold, taking into account the structure of the Professional Evaluation Guide of the INSS.
♦ It automatically generates valid physical load protocols to simulate the physical job requirements that could be affected by workers’ injuries.
♦ It states which biomechanical tests have to be carried out and what variables have to be recorded to evaluate the functional capacity of the affected workers pursuant to the diagnoses to be assessed.
♦ It produces objective and quantitative reports on the Functional Capacity of the workers.
This application has proved to be useful in certain evaluation processes in which there are doubts about the disparities found between the job requirements and the physical abilities, when the worker is suspected of faking or when an objective support is needed to assess the possibility of going back to work after an incident or an exacerbated feeling of the disease.
WORK METHODOLOGY
NedLabor/IBVhas included the methodology to evaluate the functional capacity, thanks to the joint project carried out between the INSS and the IBV, and it divides it into a three level process (Figure 1).
Figure 1. Process established by the INSS and the IBV to evaluate the functional capacity.
LEVEL 1: Determining DISPARITIES
It determines whether there are disparities between the physical requirements of the specific job position and the physical abilities of the worker under analysis. To this end, by using standardized questionnaires the program helps users obtain information about:
- The physical job requirements.
It uses a list of 35 requirements concerning the biomechanical load in different joints, the handling of loads, manipulating them, the sitting, the standing and the walking. Each physical requirement is evaluated by means of a three level scale (Unnecessary, Occasional or Fundamental). Data is acquired about the job task that each requirement is associated with and what percentage of the working day is used to carry out each task (Figure 2). Optionally, whenever there are doubts about the validity of the answers given by the actual worker, the application enables an expert to verify this information in the workplace. The objective is to check or correct the information given by the worker by compiling the information separately.
- The physical capacity of the worker.
It is a list of 35 physical abilities associated with the job requirements that are assessed by means of a three level scale (Normal, Limited or Can't).
Nedlabor/IBV analyzes the information acquired and identifies the possible disparities between the requirements and the abilities. This result is shown in a report that determines:
♦ Whether the source of information used to get data on the job requirements is the worker who is being assessed or whether it has been checked by an expert.
♦ The occasional or fundamental job requirements that are affected by the injury or disease to be evaluated.
♦ he requirements that are not affected by the injury or disease to be evaluated.
♦ The main tasks of the job, the percentage of time spent on each of these during the working day and the physical requirements needed to carry them out
Figure 2. Questionnaire on the job requirements in which the NedLabor/IBV software highlights (blue) those that are affected by the injury.
LEVEL 2: OBJECTIFY the disparities found
NedLabor/IBVdescribes the degree to which each physical functional capacity that is assessed to fulfill the job requirements actually changes. To this end the program continues to supply specific questionnaires that gather together more detailed information about:
- The physical job requirements with disparities.
This information is used by the application to automatically define the physical load protocol that reproduces the physical job requirements affected by the injury (Figure 3).
- The physical capacity affected.
This information is needed so that the application can automatically come up with the list of suitable biomechanical tests to assess the functional capacity that is affected by the injury.
Figure 3. Detailed questionnaire on the requirements that are affected by the injury that is needed by the NedLabor/IBV to produce the right physical load protocol.
Having gathered together all the information the evaluation process can begin, and this consists in two consecutive stages:
Simulation of the job requirements.
The physical load protocol reproduces all the physical job requirements that are said to be affected by the injury. The objective is to determine whether these real job requirements negatively affect the worker’s functional capacity or increase the amount of pain experienced thus preventing the worker from carrying out the tasks properly. NedLabor/IBV favors the application of this protocol using a work station and accessory equipment that helps reproduce the different physical requirements (Figure 4).
Biomechanical evaluation.
The biomechanical evaluation is carried out after the worker has executed the physical load protocol that simulates their physical job requirements which are affected by the injury.
Figure 4. Left: Work station and accessories for the physical load protocol. Right: The worker carrying out the tasks of the protocol.
RESULTS OBTAINED BY NedLabor/IBV
NedLabor/IBVstates what necessary information must be included so that the program prepares a final report that summarizes the functional capacity of the worker with the following information:
♦ Job requirements.It shows the list of the worker’s job requirements assessed, with a distinction between those that are affected by the injury and those that are not according to the information about the worker. It also differentiates between those requirements that are fundamental (those that take up more than 40% of the working day) and those that are occasional (less than 40%).
♦ Work capacity. It describes the degree to which each physical functional capacity that is assessed to fulfill the job requirements actually changes, and which according to the worker,is affected by the injury. It matches up with the result of the biomechanical evaluation of the work capacity after the physical load protocol concerning the job requirements has been applied (Figure 5).
♦ Physical load protocol.It describes the activities and the postures that have been simulated along with the time that each one of them takes, the reason for doing so and the amount of effort put in by the worker.
♦ Conclusions.It presents the conclusions drawn by the medical assessor on the functional capacity of the worker after analyzing all the information acquired.
Figure 5. Table summarizing the final evaluation of the functional capacity.
CONCLUSIONS
The NedLabor/IBV application is a management tool for the data about the worker who is temporarily disabled and this, together with a work station and the biomechanical tests of the functional capacity evaluation of the IBV, favor the use of the Functional Capacity Evaluation methodology for workers, which has been developed together with the INSS, and its final report also helps users make decisions on the degree of disability of the worker and their performance level.
This methodology was developed with the help of Mutual Insurance Companies working with the Social Security and the INSS itself.
The different studies carried out to validate the methodology confirm that it is useful for the medical inspectors, the Disability Assessment Teams of the INSS, the medical assessors and the experts on occupational risk prevention from the Mutual Insurance Companies. In fact, almost 80% of the files reviewed by the INSS were resolved thanks to the information supplied by the Level 0 and 1 of the NedLabor/IBV methodology and the whole protocol only had to be carried out for 20% of the remaining files.
Finally, among other important results, it should be pointed out that the workers who took part in the different validation studies considered the NedLabor/IBV methodology to be a more reliable way to evaluate functional capacity.
ACKNOWLEDGMENTS
Many thanks to the National Social Security Institute (INSS) for its support and interest in developing and validating the NedLabor/IBV methodology.
To the Mutual Insurance CompaniesUMIVALE and IBERMUTUAMUR working with the Social Security for taking part in the transfer pilot projects and their continual feedback.
