Hello, I have rec'd a referral for a FCE with a focus on cardiac function. Does anyone have any suggestions as to what protocols to include for such an assessment? Thanks
I forwarded your question on to our clinical advisor and he responded with the following:
First I would start with a thorough medical chart review to see if there are any concerns/diagnoses regarding this particular client's cardiovascular function. It may be that the evaluator needs to seek medical clearance from the referring physician and/or the treating cardiologist. A clearance form would make it clear that the client is cleared to perform tasks that could potentially involve heavy lifting, pushing and pulling. You might also throw in static isometric strength testing (grip strength testing) if applicable. Safety is always our first "step". I would, as always, make sure the referrer and the evaluator have established the referral questions-what about cardiac function? Are there guidelines the employer requires? Is there a job match? What type of tasks are we being asked to evaluate? Are there concomitant diagnoses (diabetes, back pain, an active disc, previous heart attack, etc.). What medications is the client currently taking (beta blocker's are known to skew heart rate). Are there guidelines the referring MD/cardiologist would like you to observe ("no lifting more than job requirement-if possible, heart rate not to exceed____", etc.)? Cover all the bases and get answers to all of the relevant questions before the client appears for the test. In addition to standard cardiac tests usually performed in an FCE, I would also try to come up with a work simulation that would simulate applicable job demands as safely and accurately as possible.
I recently saw a UPS Package Car Driver for an FCE. Although his MET testing revealed he has a capacity for Meduim work (match per job description), during a work simulation circuit where he worked at the pace (mobility/lifting 22 lbs. repetitively from low levels, step climbing), he frequently exceeded his max safe heart rate. This was due to a disparity between material handling "guidelines" and what he actually does at work, and the fact that he is taking beta blockers for hypertension. I will see him for work conditioning for two weeks to improve his cardiac endurance and he will return to work!
I hope this helps! Let us know if you need anything else.
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Hello!
I forwarded your question on to our clinical advisor and he responded with the following:
First I would start with a thorough medical chart review to see if there are any concerns/diagnoses regarding this particular client's cardiovascular function. It may be that the evaluator needs to seek medical clearance from the referring physician and/or the treating cardiologist. A clearance form would make it clear that the client is cleared to perform tasks that could potentially involve heavy lifting, pushing and pulling. You might also throw in static isometric strength testing (grip strength testing) if applicable. Safety is always our first "step". I would, as always, make sure the referrer and the evaluator have established the referral questions-what about cardiac function? Are there guidelines the employer requires? Is there a job match? What type of tasks are we being asked to evaluate? Are there concomitant diagnoses (diabetes, back pain, an active disc, previous heart attack, etc.). What medications is the client currently taking (beta blocker's are known to skew heart rate). Are there guidelines the referring MD/cardiologist would like you to observe ("no lifting more than job requirement-if possible, heart rate not to exceed____", etc.)? Cover all the bases and get answers to all of the relevant questions before the client appears for the test. In addition to standard cardiac tests usually performed in an FCE, I would also try to come up with a work simulation that would simulate applicable job demands as safely and accurately as possible.
I recently saw a UPS Package Car Driver for an FCE. Although his MET testing revealed he has a capacity for Meduim work (match per job description), during a work simulation circuit where he worked at the pace (mobility/lifting 22 lbs. repetitively from low levels, step climbing), he frequently exceeded his max safe heart rate. This was due to a disparity between material handling "guidelines" and what he actually does at work, and the fact that he is taking beta blockers for hypertension. I will see him for work conditioning for two weeks to improve his cardiac endurance and he will return to work!
I hope this helps! Let us know if you need anything else.
Regards,
Jenn