I had an interesting referral the other week and wanted to get some feedback from the group. Canada Post sent me letter carrier who has been at it for 30 years. His diagnosis is OA of the (L) knee. He has NOT missed any work as a result of this impairment. He was diagnosed 2 years previously with no surgical intervention. He used to play hockey and this made his knee sore and it difficult to walk his route. When he quite hockey this seemed to settle the knee and it has not bothered him much since. The referral source has asked me to comment on the "number of hours per day that Mr. XX is able to walk".

The issue is this - Mr. XX walks a route that takes him 4 hours/day. The postal service has allowed for 6 hours/day to walk this route but this fellow is rather quick. It works out well for him because he gets paid for the full day but is able to go home 1-2 hours early each day and still get full pay. He states that when he goes home and eats lunch then starts moving again his notices his knee stiffening up. He has been asked to work overtime occasionally and this sometimes involves walking an additional 1-2 hours to deliver mail. It is this request from which he has asked to be exempt. He states that he can work OT in the depot (sorting etc) but walking more worries him since his knee seems to get aggravated after 4 hours. Of interest is that he has less than 1 year left until retirement!

So, in the FCE I did a bunch of baseline measures of walking quality and speed then had him do a "delivery circuit" for about 2 hours. He was NOT overly descriptive or self-limiting in the testing. In fact, he said his knee was a 0/10 on the FPS throughout the evaluation (which is consistent from what he told me about his usual workday). There was a restriction in ROM in both flexion and extension and diagnostics demonstrate significant OA changes.

From a recommendations standpoint and to be objective (not using my crystal ball!) I based my recommendation that he should be limited to his regular 4 hour walking shift because his complaints of pain and disability were found to be reliable and he was very competitive in testing. With this, as well as the diagnostic findings, it would be reasonable that this minimal accommodation be provided to him.

I guess my dilemna is that he tested so well and he could likely walk a longer route but this would / could be uncomfortable and "put more miles on his tires". Since his complaints were found reliable, I am making the statement that increased pain in his knee when he walks farther is aggravating his OA condition and should be considered, to some extent, as a warning sign of wear and tear.

thoughts? I will answer any furhter questions to help in your deliberations.