ISR Institute’s Clinical Services
• WorkSaver Post-Offer Pre-Placement Functional Evaluations (ADA Compliant) for New Hires
• WorkSaver Fit-For-Duty Evaluations for incumbent employees returning to Work After Injury or illness
• WorkSaver Employee Fitness Evaluations
• Functional Capacity Evaluations (FCE)
• Comprehensive Back and Neck Examinations
• Proactive Physical Therapy Services
• Post-Surgical Stabilization and Functional Restoration
• Work Conditioning

WorkSaver Post-Hire Pre-Placement Screenings

Post-Offer Pre-placement screenings provided by ISR Institute are valid, job-specific evaluations of the abilities of the conditionally hired employee to perform the essential functions of the job safely and efficiently. Compliant with ADA guidelines, the ISR Institute provides multiple testing sites with a proven standardized protocol based on job descriptions provided by the employer. If the employer lacks the critical information related to physical demands of essential tasks, then the ISR Institute can conduct physical demands analysis to provide this information for inclusion in the existing job descriptions. This service can help reduce serious injuries by determining if an employee is capable of performing the job he/she was hired for in a safe and efficient manner. The screening can also help determine whether or not any type of accommodation may be needed to reduce risk of future injury. This is a nation-wide service offered by ISR Institute.

WorkSaver Fit-For-Duty Evaluation

After an employee becomes injured or ill there can be consequential impairments or deconditioning that render the person unfit for job-specific tasks and prohibit safe return to work. This can lead to serious injury to the individual or even co-workers. A fit-for-duty evaluation consisting of detailed physical examinations and job-specific functional capacities tests is designed to determine the employee’s ability to return to his/her job safely with or without restrictions. Each employee is tested for cardiovascular status, flexibility, strength, and coordination. This is a nation-wide service offered by ISR Institute.

WorkSaver Fitness Evaluations of Incumbent Employees

Fitness evaluations of incumbent employees can be conducted in order to provide a motivating stimulus for employees to take responsibility for their own health. It also informs the employer of any health change that places the employee at increased risk for job performance. This allows the employer certain options that include accommodating the employee in order to reduce the risk of future injury. Each employee is tested for cardiovascular status, body fat/lean mass ratio, flexibility, strength, and coordination. A report with recommendations on improving their fitness level as determined during the examination is provided to the employee and employer.

Worksaver Functional Capacity Evaluation(FCE)
The WorkSaver FCE is performed to determine the functional capabilities of the injured employee. It is a systematic, scientifically based test usually requiring 4-8 hours. The FCE is used to determine feasibility of return to work, occupational disability, and/or if additional rehabilitation is needed. This evaluation also determines whether illness behavior is organic or non-organic in nature, and if the employee is motivated to return to work and in what capacity. Illness behaviors can be detected by objective means using this systematic testing format. This comprehensive examination system is extremely valuable to the physician and employer when a proper course of action is being sought for the injured employee who just does not seem to get better despite all efforts of medical treatment and appropriate intervention.

WorkSaver FCE Introduction
A functional capacity evaluation, or FCE, is used to assess disability and to assist in the determination of ability to return to work with or without restrictions. The WorkSaversm FCE is a proprietary medical-based functional capacity evaluation developed by Richard Bunch, PhD, PT (CEO of ISR Institute) and Trevor Bardarson PT, OCS, MDT (Senior Vice President, ISR Institute). More descriptively, The WorkSaversm FCE is an advanced systematic evaluation consisting of a battery of peer-reviewed clinical-based assessment methodologies that are consistent with both American Medical Association (AMA) and American Physical Therapy Association (APTA) Guidelines.

The WorkSaver FCE evaluation is customized to the specific needs and medical impairments of the person being evaluated with the primary emphasis placed on safety. The examination typically requires 6 – 8 hours to perform but 2-day WorkSaver FCEs or extended multiple day WorkSaver FCEs can be conducted when requested. The results of a WorkSaver FCE provide the referral source with very useful information to assist in determinations related to return to work with or without restrictions, or to assist in determinations related to any need for further rehabilitation or diagnostics.

The WorkSaver FCE - Performed Only by Licensed, Qualified Clinicians
The WorkSaver FCE is designed for the experienced, thinking clinician and is not offered as a canned, computerized system that generates automatic reports independently of clinical expertise. The design of the WorkSaver FCE protocol, requiring physical, behavioral, and functional examination skills, dictates administration by only experienced and qualified clinicians. The WorkSaversm FCE is performed by highly qualified, experienced physical therapists that are trained, certified, and licensed by ISR Institute.

Non-clinicians should not perform FCEs as a FCE is a complex clinical examination that must be administered safely, correctly, and skillfully. A skillfully performed FCE must be able to provide an accurate and valid report of disability. Referral sources should always consider what type of FCE is being rendered and the qualifications of the person who is conducting the FCE. In other words, all FCEs are not created equal.

Worksaver FCE Safety
A FCE referral never guarantees that a person will be administered a WorkSaversm FCE.
At ISR Institute, we accept the responsibility of assessing the person very carefully before proceeding with functional assessments. We realize that a person’s medical condition can change from the time of referral to the time of the actual application of the WorkSaversm FCE . We feel it is our professional and ethical obligation to protect the safety of the client at all times and to protect the trust rendered to us by the referral source to ensure that the client will not become injured in the testing process. Therefore, each WorkSaversm FCE is preceded by a detailed cardiovascular, neurological and musculoskeletal examination to ensure that the person being tested is safe to undergo the examination. If a person’s condition has changed since the time of referral and is deemed to be unsafe for functional testing, the WorkSaversm FCE is not conducted, the medical doctor or referral source is contacted, and the person is referred for medical examination with a medical release required to return.

When the WorkSaver FCE is conducted, there are numerous methodologies used to ensure safety. Persons undergoing the FCE are not tested while under the influence of alcohol, mind-altering drugs, or pain medications. Any test conducted during the WorkSaversm FCE that either produces or aggravates symptoms is immediately terminated. Body mechanics (kinesiological approach), vital signs (heart rate, blood pressure and respiration), perception of effort (psychophysical approach) and a client’s report of symptoms are continuously monitored during the WorkSaver FCE for safety. Consequently, there has never been a valid injury to occur as a result of undergoing a WorkSaver FCE.

Worksaver FCE Validity and Reliability – The Hallmarks of the WorkSaver FCE
The WorkSaver FCE has received considerable praise and respect from medical physicians, case managers, administrative judges, and attorneys for its unbiased, objective, and qualitative approach to assessing disability. The WorkSaver FCE is a valuable tool for determining organic versus non-organic illness behavior. For clarification, organic illness behavior has an identifiable physiological basis whereas non-organic illness behavior does not. In fact, it is essential that a FCE differentiates between organic and non-organic illness behavior in order to determine the degree of confidence that the disability demonstrated by a person is actually representing maximum safe residual functional capacities rather than just what the person is willing to do at the time.

Certainly, no FCE is a lie-detector test but a properly performed FCE, such as the WorkSaversm FCE, is highly effective in assessing physiologically based disability versus non-physiologically based disability. Positive signs of non-organic illness behavior represent red flags that signal a need for further investigation such as clinical psychological examinations to assess psychological overlay or malingering behaviors.

People who exhibit non-organic illness behavior and go undetected are very costly to society. If the nature and cause of non-organic illness behavior is not properly addressed, people with non-organic illness behavior often require more unnecessary diagnostic procedures, medical treatment, and physical rehabilitation. People who exhibit non-organic illness behavior are also less likely to return to gainful employment and are more likely to become involved in costly litigation.

Approximately 56 physical and functional cross-references are conducted in the WorkSaversm FCE to determine validity of effort and to assess organic versus non-organic illness. Psychological overlay or malingering behaviors can present significant functional barriers for return to work. These non-organic illness behaviors are effectively identified (not diagnosed) by the WorkSaver FCE using our extensive clinical and functional cross-referencing system.

Comprehensive Back and Neck Examinations – The McKenzie Approach

Detailed mechanical evaluation of the spine, especially with complex conditions, requires and experienced and highly skilled clinician. ISR Institute embraces the McKenzie concept for spinal evaluations. This methodology empowers the patient to become responsible for treatment of the spinal injury and for preventing reoccurrences. The information derived from a McKenzie evaluation permits a very diagnostic-specific approach to rehabilitation. As a result, the patient recovers from injury/trauma quickly and with maximum efficiency.

Proactive Physical Therapy Services
www.isrphysicaltherapy.com

The Institute offers the most modern, diagnostic-specific methods of physical therapy which empowers the patient to control pain and regain maximum functional abilities independently. ISR Institute has a high success rate with rehabilitation of patients with various problems of the spine including serious disc disorders. All patients are treated using a highly effective clinical approach which includes McKenzie concepts of mechanical evaluation of the spine, manual therapy and stabilization exercise principles. Rehabilitation of the injured patient also involves behavioral modification techniques and ergonomic education. The Institute’s proactive physical therapy program has been so effective that most patients require less than six weeks of therapy.

Post-Surgical Spinal Stabilization and Functional Restoration

Based on the type of surgical procedure performed, consultation with the referring surgeon, and a careful evaluation, a comprehensive treatment plan is created. Assessment of the patient provides the basis by which rehabilitation can best address the post-surgical status of strength, flexibility, and mechanical characteristics of spinal function. All deficits are identified, reported to the referring physician and the plan of treatment is conducted progressively based on the stage of healing, degree of any complications, patient response and current functional capacity. Spinal stabilization exercises are conducted specifically on target muscle groups identified during the initial assessment. Strengthening is conducted along with stretching and joint mobilization in order to restore muscle balance of the shoulder girdle, spine and pelvic regions. Functional restoration involves training the patient to actively utilize spinal stabilization techniques while performing activities of daily living and/or specific work-simulated tasks. Each patient is taught basic ergonomic principles and how to prevent re-injury to the spine.

Work Conditioning

Work conditioning involves physical therapy procedures directed toward improving the individual’s physical capacity to perform job-specific functions. Work conditioning is rehabilitation focused on job-simulated tasks based on the patient’s job description. Unlike work hardening, which is multi-disciplinary, costly, and often unnecessary, work conditioning is a cost-effective, streamlined method focused on correcting impairments for the sole purpose of rapid, safe return to work and avoidance of re-injury.