Heart rate zones

In our experience, we realize who created EPIC, and we know full well, that physiologically, the heart rate response is going to be the same.

The reason we have been careful is that in Philadelphia, we have heard in some cases, of shrewd attorneys, some of them who are former MD's or PT's (I think one was a previous OT) who have brought up the heart rate topic in different scenarios. They also bring up arguments against the CV and REG tests and the supporting literature.

The issues have been that they are trying to do their job which is unfortunately, to put a shred of doubt in the minds of the jury or judge. And their argument has been: the heart rate has been validated with a different lift system, how does it carry over to your evaluation which uses (put test here) system. Someone on the stand hears this and thinks "wow, this guy did their homework, Yikes" and could get someone unravelled.

When the evaluator did his/her homework and mention that the testing is very similiar and therefore, should have the same physioligc response on heart rate regardless of what system is used for testing, then, things are well. It is the case where people freeze when asked that question. Litgiousness makes us think very carefully how we do things, especially when the counsel has a strong medical background in the rehab arena. I have only heard of two or three of these scenarios in the Phila/south Jersey area through other colleagues, but it has been enough for us to remember where the heart rate zone comes from so that if asked, we can give a good rationale as to why we as testors utilize those zones. We haev been mentioning this in our reports, refering to the literature with references linked into the report, and we (knock on wood) have been lucky so far. We are actually starting a journal review meeting with all of our evaluators, so we can discuss all the supporting and critical literature behind what we do, so that we can be ready not only to be good evaluators and use the best evidence, but also to nkow what has been looked at arguing the validity of wat we do, so that we are ready for anything that may come up, and have a consistent stance if subpeonaed.

Unfortunately, regardless of how well we do our jobs, there are others who are also good at their jobs, and they know all they have to do is put some doubt into the court's mind. It's a good thing people generally have feelgood ideas about OTs and PT's :D , but boy, times are nd the limate are changing, even more so now as the economic times change. We just like to be ready. Note to self, stop drinking coffee before responding to things.

Keep in mind that the EPIC was developed by Dr. Leonard Matheson.

the article is actually in the Matheson library link and you can get the full text through Matheson's web site. It is the same article that talks somewhat about competitive test behavior. The only thing to remember, is that the heart rate zone has been utilized for a different system, so if you are using it for say, a PILE, then, out our clinic, we reference that and state that the motions and muscles used in the EPIC is similiar to the PILE which is why we use it. The heart rate zone of 1.25 versus 1.50 for effort has not been looked at for other lifting tests, and it is hard to generalizations stating that it works for PILE as well when it's a different system to a degree. Again, be careful, no what the 1.25 versus 1.50 was made for, so you can speak about it when asked by someone, say the counsel.

The use of 125% and 150% of (standing) resting heart rate comes from a year 2000 article in the journal of SPINE (Jay M, Lam JM, et. al. Sensitivity and Specificity of the Indicators of Sincere Effort of the EPIC Lift Capacity Test on a Previously Injured Population. SPINE, Volume 25 (11), June 2000, pp. 1405 - 1412). If you have access to a medical library they may be able to get a copy for you. Or you might consider contacting SPINE and request a copy of the article.
Hope this helps!
Mary