November 10, 2025 • 48 mins
Functional Capacity Exams with Rob Pearse
In this episode of Comp Conversations, Shane Dawson of Dinsmore and Shohl and Jennifer White of Peterson White sit down with Rob Pearse, a clinical exercise physiologist, to demystify what makes a good FCE — and how defense attorneys can use them effectively in workers’ compensation cases. From spotting red flags to interpreting effort validity this discussion offers practical insights for lawyers, adjusters, and anyone navigating the intersection of medicine and litigation.
To learn more about DRI and the Workers' Compensation Committee visit www.DRI.org.
#DRILawyer
#DRICommunity
In this episode of Comp Conversations, Shane Dawson of Dinsmore and Shohl and Jennifer White of Peterson White sit down with Rob Pearse, a clinical exercise physiologist, to demystify what makes a good FCE — and how defense attorneys can use them effectively in workers’ compensation cases. From spotting red flags to interpreting effort validity this discussion offers practical insights for lawyers, adjusters, and anyone navigating the intersection of medicine and litigation.
To learn more about DRI and the Workers' Compensation Committee visit www.DRI.org.
#DRILawyer
#DRICommunity
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:19):
Welcome back to another episode of the Conversations podcast, a
podcast developed thir Dri where we discuss the world of
workers' compensation, exploring issues involving occupational injuries, treatment, claims, management, litigation,
as well as future trends and emerging issues in this
area of law. My name is Jennifer White and I'm
here with Shane Dawson, a partner with Dens Marshall and Ohio.
(00:41):
We are delighted to have with us today Rob Pierce.
He is a clinical exercise physiologist who focuses on performing
functional capacity evaluations. He owns his own business, peerce See
and offers employment testimony and expert witness testimony. He has
over thirty years of experience. It's in the field and
it is extremely experienced. Rob herece, Welcome to Conversations.
Speaker 2 (01:06):
Great, thanks for having me. Love being here.
Speaker 1 (01:08):
If you could just go ahead and give us I
gave some of your background, but just kind of give
a quick intro to your background, credentials and the types
of sees you perform.
Speaker 2 (01:17):
YEP, sounds good, So I like to tell people I'm
a unicorn in our field. Most fcs are performed through
physical therapy, so most services that you see offered with
fcs or usually through physical therapy companies, where I'm unique,
where I'm independent. I have worked in physical therapy for
a long time as well, but I'm completely independent. Fcees
(01:40):
are not therapy. It's an assessment, physical assessment. So but
I got into it through physical therapy. I worked for
a huge corporation in Memphis called Health South back in
the late nineties and I just got fortunate. There was
a great place to start and learn, and they had
a huge mental ship program. They are now defunct. If
(02:03):
you know the history of Health South, it's it's pretty interesting.
But I actually left Health South after four years and
went on my own. Just had a revelation that I could
do this on my own for some bizarre reason, not
knowing what had to do it. And then it was
on my own for sixteen years. Then I actually sold
my business to ATI Physical Therapy at Chicago, worked for
(02:24):
them for ten years. Now I'm back on my own.
So it's a really interesting. I can talk hours about
how I got into this and why. A lot of
it just by chance, but it's actually a perfect fit
for me.
Speaker 1 (02:40):
What type what types of SCS do you see?
Speaker 2 (02:43):
So there's different methodologies that are all extremely similar. I
use a system called ARCon. It's been around since the nineties.
It's the most I feel, it's the most objective, and
it's the best has the best data collection tools through
computer interfaces. That's the system I use. They're all very
(03:06):
similar in the type of tests they do. The difference
comes in what process they use to collect the data,
and how many pounds someone's producing, how often someone's doing
a task, how to classify repetition into occasional, frequent, constant.
That's where there's some variances between different methodologies and fcees,
(03:27):
but they're all very similar. Mine's just very computer based,
meaning all my data collection is through tools like a
hand autemometering, clinometer, goiniometers, strain gages, load cells that are
all computer interface or I'm collecting data through a computer interface,
(03:49):
not just a manual dial, if that makes any sense.
So it's way more accurate. As well. I have wireless
heart rate monitoring where I'm monitoring someone's heart rate continuously
through the valuation wirelessly. It's not with a watch, it's
not doing a pulse meter on their finger. They're actually
wear in a chestrap computer staydloading heart rate through the
(04:11):
entire evaluation, so I can look at heart rate progression
with every test, which for me was a huge relevation
in the late nineties when that became available, looking at
consistency of effort. So it's still by far the best
FC system I found, and I'm always looking at new
ones or look, there's no new ones out there, looking
at all the different ones, and it's still by far
(04:33):
the best ones. That's what I stuck with my you know,
for the last since ninety five, so it's been a while.
Speaker 1 (04:41):
I probably should have asked this before we jumped into
the technical assestause I have an SSE, but for in
our podcast goes out to a lot of different listeners
in different states, and they might not always use fcees.
Why exactly are they so critical for the return to
work puzzle?
Speaker 3 (04:58):
Can you explain that.
Speaker 2 (05:00):
The fcs are vital and it's amazing that I use more,
but it should be the final, the final tool used
in a claim to determine return to work in restrictions.
So when a patient's put at MMI, there's no further treatment,
no surgical intervention anymore, other and all the diagnostics are
done and basically the physicians getting ready to release that patient,
(05:22):
and he is the physician just needs to know I
can they return to work regular duty with no restrictions?
Do they need restrictions? What do they need to be?
So that's the value of an f C rather than guessing,
is actually objectively measuring what a person's functional abilities are
compare to the regular job demands. To do that direct
(05:44):
comparison and then see what they don't meet and then
those would be what the restrictions are. And then it
can help an employer look at placing one in a
different job position comparing job descriptions. If a job description
is accurate, that's another world to talk about. But you
can get way more objective evidence to show if someone
(06:08):
can do a job yes or no. Also if they're
giving if this is the true representation of their abilities
or not, or if they're exaggerating for whatever reason. So
it's vital. It's amazing. It amazes me that people don't
use it more in a oppositions just gas on return
to work.
Speaker 4 (06:26):
Rob Let me ask you so to get down maybe
into the weeds a little bit on how you would
evaluate a good FCE. You talk about what what are
the key elements that anyone should be looking for for
an FC it's going to be defensible.
Speaker 2 (06:45):
Yeah, so number one is determined consistency of effort. That's
by far the first thing you have to look at.
And what tools is that FC protocol using to determine
consistency of effort? If you really dove into the different methodologies,
it would be very alarming how many don't have consistency
(07:07):
of effort indicators or how few indicators they use. Really,
grip strength is the one most almost every FC protocol
relies on for consistency, but some of them that's the
only thing they have. It's just it's just grip strength.
And you know, I've had many physicians they're not physicians.
Attorney's question. He's like, Hey, the guy didn't give good
(07:29):
effort on grip strength. Does that mean they didn't give
good effort in the whole valuation? It's like no, absolutely not.
Or if they gave good effort in grip strength, does
that mean this is really what they can do with
all the other tests. It's like absolutely not. Because if
I'm an attorney, I tell my patient, hey, with grip strength,
you knock it out. You you know, you pushed that.
I don't care how much it hurts. You push it
as hard as you can. But the rest of it
(07:49):
I just fudget, And you would get away with a
lot of fcees fudging the rest of it because they
don't have enough consistency indicators. So with every test I do,
there's at least one consistency indicator from either heart rate
progression from the test, how much heart rate increased, or
(08:10):
repeated testing, doing coefficient a variation. That's not an old
school but that's a more rudimentary way to look at
consistency that you have to really understand well and be
careful of doing strength changes, the different positions, doing repeated testing,
comparing different tests, looking at quality of motion, range of motion.
(08:36):
So there's lots of stuff you have to look at
holistically in an FCEE, and you have to take all
that stuff together and paint a picture. So what I
tell people is when you throw up an FC on
a computer on a screen, basically it's a picture and
everybody needs to look at that picture and understand it.
And if you can't look at the picture and understand it,
then it's not really a very good FC report. You
(08:58):
can be a good evaluator, you can know what you're doing.
You could know the testing methodology inside and out, but
if your report doesn't say that, it basically still sucks.
Or conversely, you can make a report look really really
good and really have bad data you're using. So it
can go both ways. You know, I could. I could
(09:19):
easily take a really poor FC testing process and make
it look really good to anyone reading the report. That'd
be a piece of cake. Does it make it a really
a valid FCE No, not necessarily. You gotta be able
to back up, back it up with the bones of it,
which is a consistency data. So that's the biggest thing.
(09:39):
And you'll be shocked how many consistency measurements are used
in most fcees. It's you know, it looks bad. It
makes fcs look bad, which is part of the reason
why people don't realize their value because there's so many
bad ones out there, but a good one sticks out
like crazy when you say a good one really sticks out.
(10:01):
My fcs typically have forty to sixty consistency indicators that
I use to determine if the results are reliable. Most
would have at most eight to ten, maybe fifteen and
that's mostly just grip strength. So again there's a huge variance,
you know. And I could sit and cut apart FCEs
(10:26):
like crazy, which I do because I've been doing it
for so long, which doesn't really make sense that I'm
sort of criticizing my own profession. But there are so
many bad ones that they are still being utilized. It's scary.
And everybody thinks that Matheson is still the you know,
the gold standard of fcees. Matheson hasn't changed since nineteen
(10:49):
ninety that's the last time anything's changed with it. And
it's still done how I first started my career in
nineteen eighty three and it hasn't evolved, And it's yeah.
Leonard Mathieson, the guy that started was a psychiatrist in California.
Super smart viewed, but no one's advanced it beyond where
(11:10):
he had it. And it was very subjective, very psychological.
He really had He really looked at the psychological side,
which makes sense for his background. But once it evolved
more into the into physical therapy, which was really just
in the eighties. It was initially started back in the sixties.
Return to work after after the Wars for companying figure
(11:33):
out return to work with post war injuries. But when
it got into workers comup in the eighties, it was
still very subjective, and there's a lot of people still
use a very subjective FCE and FC evaluators if they're
not experienced. The subjectivity will eat you alive because you
(11:53):
don't know how to it. Shouldn't be using it, first
of all, should just be purely objective. I think a circle.
Speaker 5 (12:00):
But sorry, I wanted to ask you.
Speaker 4 (12:03):
I know you said something before about the job descriptions
the job, you know, so can you talk just for
a moment about the importance, as as a client, as
an employer, as an attorney, of getting that FSE evaluator
something that reasonably describes the actual job.
Speaker 2 (12:24):
Absolutely, it's the most crucial part, because that's what we're
comparison comparing the physical abilities we've determined for that individual.
We're comparing to what their job demands were at the
time of injury. If that job description isn't accurate, then
we're comparing apples and oranges. If we even have a
(12:44):
job description, it's the first thing. A lot of times
we don't even have one, so then you're stuck going
to the Dictionary of occupational titles or that's now called
the o NET, and that's the DFT and o NET
are very basic, low level descriptions of jobs, very generic.
It's better than nothing but a true job analysis, which
(13:08):
is rare. I would say I get a true job
analysis out of maybe one out of fifty FSAs that
I do that, I really feel confident that I'm comparing
to something accurate. It's vital and it's probably the biggest
stumbling block we have with determining return to work is
(13:29):
that we don't we're not comparing to something really validated
because most of them are a supervisor filling out a
job description. If it's it's amid the small company, you know,
they're not going to pay an ergonomist to go out
there and do a job analysis or anyone else. So
there's having supervisors feeling, hey, what's the lifting demand, and
(13:51):
they're guessing half the time, or they're just always putting
in fifty pounds. That's what I see now is that
everybody just puts in fifty pounds and sometimes a job
will requires fifteen pounds. So now I'm doing the evaluation
on a person and I asked, I always ask every
patient what are there. You know, what do you have
to do in your job? Describe your job to me?
How much you have to lift, what are the heights
(14:12):
you lift, what's a repetition, And then also positional wise,
how often you have to do different positional stuff. And
I've many times have a patient tell me, yeah, I
think the maximum I've ever lifted is probably ten twelve
pounds and it's only a couple times a day. And
the job description says fifty pounds. So now I'm doing
(14:34):
an FCEE and I'm comparing to the job description and
I say, no, they cannot return to work because they
can only lift thirty five pounds when the job description
says fifty. And then if I'm the patient, I just
may have lost my job because now they've got someone
giving an objective opinion that isn't accurate. You know, I
(14:56):
see that all the time, but I try not to
get into the in the middle with the employer because
then I look like the bad guy. So I just
tell the patient, Hey, just so you know, job description
says this, this is what I'm going to compare to.
If you dispute that, if you don't think that job
description is accurate, you need to talk to your guester
and the employer and get it straightened out. So I
(15:17):
put the onus on them, which I think is a
true way to do a good way to do. It
happens all the time. And then I see jobs. I
see this all the time. Construction worker maximum lifts thirty
five pounds and the guy's a framer and he's lifting
trusses and lifting well into one hundred pounds if not more.
And the job description says, oh, as to lift thirty
(15:39):
five pounds. Yes, So then okay, now I'm on the
opposite boat. I'm saying, yes, this person can do the job.
I know they can't, but based on the job description,
I have to say yes, they meet the job deman.
It's based on the job description. So I make sure
I'm very clear on that. And what I'm comparing to
(16:00):
the job description is vital. It's the most overlooked part
of workers camp that I see in the accuracy and
the value because employers, most employers don't want to pay
that money to have someone come and evaluated job. I
would think the insurance companies should be the ones that
are thinking, oh, I need to pay for this because
(16:21):
this is vital for return, you know, determining what my
pay it's going to be on our end. So you know,
I think the own is finding skilled the insurance companies
because employers won't won't pay that. It's a lot of
times they just bypassed that expense.
Speaker 4 (16:35):
Okay, So you mentioned too about the system that you
use ARCon. Are there are there other methodologies, other protocols
out there that are respected that you've seen that you know,
some of our audience they may come across and and say, okay,
well that one is at least still something that's valid
that I can trust.
Speaker 2 (16:56):
Yeah, yep, So thet if I couldn't use ar Con anymore,
the next one I would go to is BTE. It's
Baltimore Therapeutic Therapeutic Equipment. I'm pretty sure they're based out
of Baltimore. They actually purchased a system back around two
thousand ish called Hanoon, which was out of Colorado. And ironically,
(17:16):
the guys that started ARCon, there was two of them
when they developed the ARCon system. They had a disagreement
split and one guy made it went to his own
business made Hanoon, and it's essentially the same system. Henon's
actually even more advanced from a technology standpoint, and it
was a lot more expensive to purchase. But BTE is
(17:38):
a big equipment company in that we have field they
purchased hand in. It's a great system and it's it's
essentially the same as the one I use, So that's
the only other one I think is great. And then
there's a big step down. Then you get back down
to the very sort of old school ones, which are
(17:59):
matheson key. There's work well, there's all these other different
people that have started their little FC businesses that those
are all very similar. They're very manual, meaning it's a
box and put weights in a box. It's a load
cell with a dial on it, where you're doing push
pull forces with a dial. If they have a heart
(18:23):
rate monitor and maybe a chest strapp but it's with
a watch, it's not with a computer interface, or they're
using a finger pulse meter for heart rates, which is
a lot of them. It really drops down from a
technology standpoint. The protocols are all the same. They use
different niosh National introduce safety and health lift methodologies. They
(18:48):
use all the similar tests, they just do them a
little differently and some of the technology is much better
for collecting that data, if that makes sense. So like,
I feel I could do a good FCE on any
system just because of the experience I have. So I
can pretty much use anything and still be able to
(19:09):
come up with a good FCE because I'm at the
point where you use a ton of observations and common
sense as well. But a new person doing FCEs, oh,
when they when they're stuck with these rudimentary systems they are,
they're already way behind the eight ball on advancing their career.
When I was at ATI, I had about thirty people
(19:32):
that I oversaw on the East Coast and they were
all pts that have been newly trained and certified for
FCS but through Matheson and so I was supposed to
be their mentor to train them. And the first thing
I told them all the time is, unfortunately, you're stuck
with a poor FCE methodology you're using. And here's the
here's the reasons why it's poorn, here's the disadvantages you have.
(19:55):
So here's the only It's going to take you years
to figure out how to get through that and use
it effectively. And most of them after six months are
sick of it, and they so they don't do it.
So like when you're asking an fc evaluator what's your experience,
don't ask them how many years they've done it. Ask
them how many you've done? Because I see people all
(20:16):
the time. Oh, I've done f ceas for fifteen years.
How many have you done? I did two or three year?
You've never become proficient. Or I've done f ceas for
two years. How many have you done? Oh I've done
about six hundred. Okay, you're getting proficient. Because with my career,
my first five years, even though I was very well trained,
and I'm still figuring it out, like I cringe it
(20:38):
my first five years and I'm just sort of lucky
I wasn't called on any of my guests because I
was way too hard on people. But you know, it's
just like any career. You start up fresh, you do
your certifications. We all know certifications don't really mean squat,
you know, I mean you sat down for a weekend
and listened and passed the task where everybody passes. The
(21:00):
true value with your work experiences in the in the
trenches seeing people, and with fcees, you're definitely in the
middle of the trenches seeing people and that's where you
gain all your experience. It takes years. I always tell
people at least five years to become somewhat proficient.
Speaker 3 (21:17):
Okay, let me let me ask you this.
Speaker 5 (21:19):
Rob.
Speaker 1 (21:21):
We had talked a little bit about what my consistency
of effort in fcs and if they're only using that
grip strength, then that makes it.
Speaker 3 (21:30):
Possibly as suspect FCEE.
Speaker 1 (21:32):
You said you looked at over forty or other six
forty to sixty other things that you would look at.
Speaker 3 (21:38):
What were those things that you look at?
Speaker 1 (21:41):
It from our our perspective, we want to like point
that out, like if that's not occurring in other YEA.
Speaker 2 (21:47):
So heart right progression with tests is this huge one.
That's for me, that's the biggest one because it's the
easiest to explain to people that don't understand FC testing
and it makes the most sense. Okay, when I did
a dynamic Florida and knuckle lift saying how much someone
can lift in a box from Florida waste level, you know,
(22:07):
their heart rate at the beginning of the test was
eighty four weeks per minute. Before we started through the test,
their heart rate increase to one hundred and thirty four
did they give good effort. Yes, that makes sense, and
I think for most of us would think, oh yeah,
that's a pretty good increase in heart rate. For fcase,
the general rule of thumb is a twenty five percent
(22:30):
increase in heart rate determines a reliable test. I personally
don't believe that one hundred percent, but that's one thing
I do use because that's one of the sort of
standardized things that did us are there for consistency. But
you have to look at other stuff as well. So
heart rate progression from various tests is huge. From a
(22:53):
lifting strength testing standpoint, repeated testing where you're testing a task.
The grip strengths by the easiest one to explain. So
I'm testing grip strength through five positions in a hand dynamometer.
So the grip strength tool has different you can make
it smaller or bigger, and there's five different rungs you
(23:13):
go through. It's essential to test people in all five runs,
not just one, and you do at least three trials
to get a coefficient of variation. So cofisient variation is
just a statistical tool to look at what's the variance
between those three trials. So I'm asking a patient, Okay,
(23:33):
squeeze as hard as you can three times, you know,
for three your appetitions with each hand, and the result
is the first time he squeze is ten pounds, the
next time it's fifty, the next time it is two. Obviously,
that's gonna have a very high coefficient of variation. The
variance between trial the trial is very large. You can
tell it's not consistent. Or they squeeze and it's twelve pounds,
(23:57):
fourteen pounds, thirteen pounds. That's to have an acceptable coefficient variation.
It's a consistent, reliable result. So did they give good
effort with that grip test? Yes, where the first person
did two, fifty, twenty whatever, didn't give consistent effort? However,
what if pain is factored in? So it's something you
(24:19):
have to look at. Pain is part of fcees, even
though we try to ignore it as much. Some people
try to ignore it as much as possible talking about it.
But what if the first time they squeeze was with
fifty pounds and it's a thumb injury, bad thumb, and
the next time it was painful for them their pain
level went from four to eight. We do a second trial. Now,
(24:39):
they've only expez with thirty pounds, their pain level still eight.
Does that make sense? Sometimes it does because pain's factored in.
You have to be able to understand and put all
that stuff together in a big picture. If it does,
see if it makes sense. So coefficient variation alone, you
can't just the person didn't give good effort. Necessarily, you
(25:02):
could be saying someone didn't where really they did, but
pain was a limiting factor. But you've got to factor
in all the other stuff you do as well to
overall look at did they give consistent effort or not?
So I know that's getting really down in the weeds,
but you've got to really be objective and look at
(25:22):
every single aspect of what you're testing, look at what
you observe, what the patient says, what you've measured doesn't
make sense, and if it does, great, it's a reliable result.
If it doesn't, you just have to be able to
explain why it doesn't. And then with grip again, I
(25:43):
always do something called rapid exchange grip testing. So in
the second run of a hand itermometer, it's called the
standard position. That's where all the research did. Normative testing.
You see what's normal grip'strength for different genders at different ages.
It's always in position too, So we do the maximal
grip in position two for three trials in each hand,
(26:03):
and then we do something called rapid exchange where they're
doing a fast, hard squeeze. At that second level, you
can't produce as much force quickly as you can slowly
and maximally when you're squeezing. So that's another direct comparison
for consistency. So if you see an FC that didn't
do rapid exchange, it's not a thorough test because rapid
(26:26):
exchange tells you a lot. So, just to give an example,
patient's maximal grip was twenty pounds, coefficient evation, coficient of
variation was consistent. Now I did rapid exchange and the
grip was now eighty pounds. It shows me they didn't
give good effort in that maximal grip because the rapid
exchange was four times higher. And that happens a lot,
(26:50):
so more research was done. Oh can I reproduce force
submaximally consistently? Absolutely some people can, so co efficient variational
loan can't be used with grip. You have to use
rapid exchange on the top with that as well, in
(27:10):
addition to a five position curve looking at strength in
the five different positions. So just with grip strength to loan,
there should be if you're doing it properly, there should
be a six or twelve fourteen. There should be at
least sixteen consistency measurements just with grip strength testing, if
(27:30):
you're utilizing all aspects of it. Another thing I do
that not many of these do anymore is called static
strength testing. So I'm looking at their strength pulling against
a load cell or a scale essentially in different heights, low, mid,
(27:52):
high level heights, and then I test that same position
at a different distance from the gate. So as an example,
I'm doing something called a high in ear lift, which
is a shoulder lift in close pushing up with as
much force as they can, and then we double the distance.
Now they're going to be twenty inches or fifteen inches
(28:13):
from the load cell, so they're way far away. Doing
the same test, force should go down by at least
thirty three percent based on research, and if I'm going
to show someone didn't give good effort on that test,
a lot of times in the close test, they're pushing
straight up they're pushing in with say ten pounds, and
then I put them in the compromised position, and now
they're pushing in with eighteen pounds. Well, what the eighteen
(28:37):
pounds shows me is they can do way more than
that here. They should be able to do at least
thirty three percent more than eighteen in this position. That's
just another consistency measurement. A lot of FC evaluators and
protocols are afraid of static testing. They think that there's
a higher risk of injury, which is actually the exact opposite.
(28:58):
It's a lower risk of injury because we're we're testing
or testing strength with no motion. So it's like pushing
against the wall that won't move or pulling up against
something that won't move. It's a very safe way to
test strength. But a lot of people are afraid of it.
They think, oh, her needed disc. We can't do a
static floor lift. I mean absolutely you can. You know
(29:19):
I'd be more worried about doing dynamic Florida knuckle lifting
than I would a static floor lift with a her
needed disc. Anyways, just another consistency measurement. Coefficient variation is
because can be should be used, the strength of it
isn't great alone, but it's one of the tools you
(29:41):
used to sort of put the whole picture together.
Speaker 1 (29:46):
What I know, we were talking about consistency in your experience.
How how many people or what percentage are giving really
liable effort versus unreliable effort.
Speaker 2 (30:03):
This question, this is a great question because you can
answer this so many ways. So the caveat to this
is you have to look at the client tele I'm
being referred. So when someone has surgery, goes through rehab,
does well, typically those people go to work back to work,
(30:25):
don't need an f C. I see people that had,
you know, say, if it was surgical, had a surgical intervention,
didn't do well in rehab for some reason. They either
didn't try or had a poor therapist or whatever, have
a ton of comorbidities, which is a huge one that
I see. I see the people that don't do well. Right,
(30:47):
So I already have a biased referral group of people
that aren't doing well physically for whatever reason. And then
if you look at the psychological component of this, and
the psychological component never wants to be discussed and it's
the biggest part of any workers complaint. So you have
someone that their initial injury was sort of poo poo,
(31:09):
that's denied. You know, the urgent care center said, oh,
it's just a strange brain. Guy's got a huge tear.
Now he's angry. It's taken six months to see an orthopedic.
Orthopedic sees and says, oh, that urgent care play sucks.
I can't believe they miss this, and now you need surgery.
So now the guys even matter goes through surgery. He's
(31:33):
got diabetes, he's screen in fifty pairs, never exercises, his life,
alcoholic whatever. His rehab potential is extremely low. They've done
surgery now eight months late. Chances of success with that
patient extremely low. That's my FC referral. That's who I get.
(31:57):
So I have potentially someone that's very angry, a pointed
in the system doesn't do anything help themselves, so didn't
really put in the effort that should have been put
in by themselves. But the system let them down as well.
So they got that that double whammy. And then they
come to see me and they know this is the
end of the road, and a lot of people look
(32:18):
at me, Oh, you're just hired by the insurance company.
You're just here to get me out of the system.
And I get that response a lot, and I have
to sit down and tell people not, well, I'm not
hired by anybody. I may be paid by the insurance company,
but everybody is. My job is just to be objective
and tell everybody what you're safely able to do. So
(32:40):
I have to have that that FC evalue have confidence
that I'm going to be fair. And that's a huge thing,
because if they come in and they're leery of me,
they are not going to give good effort at all
because they're already leary. And I can and some people
I can't turn there's and the people I can't turn
(33:02):
actually usually do really reasonably well. Maybe they can't return
to work full duty they need restrictions, but they at
least give good effort. And a lot of people leave saying, man,
I was so worried about doing this, and I was
actually angry coming in. And I feel much better now
because now I know what I can do that makes
my life, that makes my job fulfilling. To me, it's rare,
(33:26):
you know, that's that's very rare. But that's one thing
that makes me feel good, like, yes, I finally help somebody.
But I see many people that come in and everything's
going against them and they're not doing anything to help themselves,
and they come in and give poor effort, and I
have to figure out why. You know, it's not really
(33:47):
my job to figure that out, but that's always in
the back of my mind, what's going on. How can
I get this person to give good effort? And sometimes
I have that little come to Jesus talk with them
and tell them, Hey, you know, I told you there's
lots of consistency measurements in this testing, and I've told
you have to give your best, safe effort and you're
the only one that can determine that. However, I feel
(34:08):
you're not giving your best effort. We need to really
need to push yourself as hard as you can safely
push yourself. Some people will actually turn the corner and say, Matt,
you're right, I'm just afraid. I'm like, Okay, I get it.
I understand. You know, you've been going through this a
long time and it sucks and your shoulder hurts and
you're disappointed. I get it. However, it's not helping you
(34:30):
right now. So I try my best without overdoing it
and there's a fine line because some people you do
that and they go the opposite direction and they anger
kicks in. Usually it's an older male that'll kick you in,
that has an ego, and I have to be very
I have to be gentle with those. So my job is,
(34:50):
I swear ninety eight percent psychological and trying to get
people to give good effort and trying to work around
and see the picture without knowing the picture. And that's
what a good FC valuator should be. And that's why
I think I'm good. It's because I feel confident that
I can see usually see the picture to some extent,
or at least I try to. My first five years
(35:13):
of my career, I didn't even try to. I didn't care.
My job is I'm we're gonna do these tests and
spit out the results of the tests and I either
gave good effort or you didn't, and a lot of
people it wasn't fair to that person and it didn't
really help the claim because it caused more a bigger
adversarial situation and they dug their heels in deeper. I
(35:35):
try not to get into that, but as well, I
also get to the point of I can only exhaust
telling them to give their best effort so much until
I finally will give up and say, okay, we're it's
gonna go through it now, and I know you're not
giving good effort. I'm just gonna have to unfortunately show
you didn't. Ironically, up until twenty fourteen, where the work
(35:58):
comp laws were different, the majority of my referrals were
Lombard DD, probably seventy percent of them, and almost all
of them were inconsistent, didn't give good effort. They were
trying to manipulate the system. So back then, I would say, honestly,
seventy eighty percent of my have seas were unreliable even
with me trying to coach them to give good effort.
(36:21):
Since twenty fourteen, that dynamic has changed completely. It's amazing.
So if the law changes, getting rid of a lot
of diagnoses that are compensatable in Tennessee now I see
post surgical rotator cuffs. That's eighty percent of what I see,
and most of them have tons of comorbides that diabetic, obese,
heavy smoker, alcoholic anxiety, depression, all the psychological stuff. That's
(36:48):
what I see now. So actually most of mine are consistent.
I would say eighty five percent of them are consistent.
Their restrictions aren't always limited just to the injury. There's
other reasons for it. But it's changed dramatically since the
law has changed in twenty fourteen.
Speaker 1 (37:08):
It's so tyfinicely you're referring to Tennessee because you're.
Speaker 3 (37:13):
Just for our listeners.
Speaker 2 (37:14):
Yeah, yeah, and it's so it's been amazing for me
to see the difference in my referral the types of referrals.
I'm getting what the diagnosises are like, I don't get
carpal tunnel, I don't get albleteninitis, I don't get Lombard
d D. You just don't get the common sprain strains.
They don't get to me anymore because they either get
(37:34):
denied or they get through the system faster where the
physicians release them. So I mainly see post surgical. Even
in Georgia, even Alabama, with those referrals, it's almost all
post surgical. Majority of shoulders, not many backs, not many necks.
So it has changed dramatically. So it's interesting. There's still
(37:55):
a lot of inconsistency. I can't say that there's no
as much inconsistency because I'm actually seeing people that truly
had injuries that were recognized and had surgical intervention, were fire.
I didn't see those very often. So it has changed.
Now has the psychological part changed, No, there's still a
(38:17):
lot of crazy people out there. And when you know,
I tell people that when I say I think I
see the bottom of the barrel, note the barrel just
drops and the floor it's a bottomless floor. It's crazy.
The stories I hear from people and the people I see,
it's it's absolutely amazing and it's a little bit disheartening
at times too when you see what's actually happening in
(38:39):
the world. But it so the dynamic has changed in
definitely in the last ten fifty ten years with consistency,
way more consistent, people giving good effort.
Speaker 5 (38:55):
That's good to hear. So rob let me.
Speaker 3 (38:57):
So.
Speaker 5 (38:57):
Most of our audience obviously are defense attorney.
Speaker 4 (39:00):
So if you can being give give them three things
they should look at. If they have an FSE lands
on their desk, what things should they be looking for
either to determine, hey, this is really a good FCE
or this is a poor one that's going to be
(39:21):
subject to.
Speaker 5 (39:24):
Attack on cross examination.
Speaker 2 (39:27):
Yeap hard to do in three. I would think the
first one really is can I read the report and
understand what the recommendations are? That'd be number one. So
the one thing I see and I review a lot
of competitors' fcees for physician friends that don't can't figure
out what to do with it, and a lot of
(39:47):
times the recommendations are hard to find or they don't
make sense. Every FSE has a referral question why you're
doing the FCE and then you should have your conclusion
should be an answer to the question. It's pretty straightforward,
and a lot of people don't understand that that are
FC evaluators. So if you're having a hard time understanding
what are the recommendations, that's number one. I can't even
(40:10):
find them in the report. Or are the recommendations specific
to what the referral question is, which should be tann
this person return to work as a whatever based on
this injury. So I look, I only test people specific
to an injury. I don't do global comprehensive fcs where
(40:33):
I test the entire body. I test relative to what
the injury is, because that's what we're looking at. As
an example, I never you'll never see me give a
restriction for overhead reaching for any patient. I see that
all the time in FC reports, and I see people
say this person cannot return to work because of this
(40:56):
other limitation that's not related to the injury. So that's
a huge red flag. The recommendation should be specific to
the injury as much as possible, and also specific to
the occupation, and a lot of people just don't get that.
So you got to be able to understand the report.
Number one. Number two is if they need to comment
(41:21):
is it reliable, unreliable or valid, invalid. I don't use invalid,
valid because that's not the proper terminology, but people do,
but they mean essentially the same thing to delay people
that you know, reliable means they gave valid effort. This
is really accurate or unreliable or invalid they did? This
isn't a good represent representation. What they can do. You
(41:43):
have to be able to is that indicated in the report?
And what criteria did they use to determine that? That
would be another huge one. And you know they may say, oh,
out of you know, fifteen consistency indicators, patient gave consistent effort. Well,
what really are those indicators? Are they just grip strength alone, Like,
you've got to dive a little bit deeper into it
(42:05):
to understand what are they using. Because if you're saying
the person can only lift two pounds and they didn't
look at heart rate progression or anything else in the FC,
they only use grip strength for consistency indicator, I would
question the accuracy of that FCE. So what are the
consistency indicators? You know? Does can you find their recommendations
(42:28):
in the report? And do they answer the referral question
of why you did the FCE? The third one is
it just make common sense? It does? It doesn't make
sense because you see reports, Oh I'm sure you've seen them.
This person can lift, you know, four pounds, which is
absolutely ludicrous because in our life there's so much that
(42:51):
weighs more than four pounds that we couldn't survive doing that.
So there's actually an FC protocol that if you can't
produce at least fifteen pound as a force in any test,
it's unreliable, which means it doesn't make sense because just
to live, just to build, to go from sit to stand,
to walk, to open a door, to pull a cabinet,
(43:12):
where anything requires at least fifteen pens of force. I
would never use that from a legal standpoint because I
think you could question that all day long. But there
is a protocol that uses that, which is interesting. I
think it makes sense, but it's a little bit more.
It's a little too aggressive, I think for consistency indicator.
(43:34):
But look at what are the consistent indicators? How many
were they used with every test you did? So every
test from walking, squatting, bending, reaching, handling, fingering, they should
all have some type of consistency indicator sometimes and it's
hard from attorney to look at report and understand all
(43:55):
that because how are you going to know? So that's
where maybe utilizing someone with experience to help you would
be helpful to understand these reports. There's a lot of
bad ones out there, there really are, and I hate
seeing it because it makes my profession look poor because
(44:15):
there's so much garbage out there. Fortunately for me, it
makes me look better, So I like that because it
probably makes me look better than I truly am. But
it hurts the profession. So then you get adjuster's employer's attorneys.
They see the garbage fcs out there by someone that's
just done like two in their career and they have
(44:37):
no clue what they're doing, and they throw out this
document that's being leally scrutinized, that they have no clue
what they're writing and the impact that can have, and
then every looks like it goes. No, f caes are garbage.
Look at this. That happens all the time, I guarantee you,
and it really I don't blame them, because yeah, that
(44:59):
is good garbage or a tendy garbage, but there is
very good value in it as well. With a good one.
It's just hard to find the good ones. You really
got to know where you're looking, and you can't just
rely on a work network with their pot of providers
that they really scrutinize the value. So I tell people
(45:24):
all the time. Physical therapy in general very low variance
in quality. They're all very similar. They've all been trained
the same way, they do everything very similarly, So from
company to company, from PT to PT, there's usually not
a huge variance. They're all very most are good. Some
are better than others, but most are good. They're very
(45:46):
rare to see a bad one. Fcees huge variants, enormous,
So just because you're calling a one call or a
med risk or whoever and saying, oh, they have their
providers and they you know done, uh, you know they
look at the quality of their their stuff. Now they
don't they don't even know what they're looking at either.
(46:08):
They're just signing on as many providers as they can
and then they're trying to find the cheapest provider. So
that's and that's again another can of worms that I'd
love to talk to is you know what those networks
have done to the provider pool and work cop because
the good providers are walking away. I will not get
(46:29):
involved with the with the network now, where when I
was with ATI, I had to, they signed all the contracts,
but now I refuse to because I'm not gonna, you know,
get paid fifty percent less for my service just to
get more business from you when you're not gonna send
it to me anyways, because someone's gonna undercut me and
you're just gonna send it to them. I'm sort of
(46:52):
hopefully making a smart decision on quality still does matter,
and I can prove the quality and it should hopefully
show so hopefully that my you know, my business can
be successful. But yeah, the system, the work on networks
out there are killing killing the system. Quality is going
(47:12):
through the floor, not just in FC's and PT as well,
just because the reibursements so low.
Speaker 1 (47:19):
That sounds like another topic for another podcast for us.
But yes, but it looks like we've run out of time.
But we would like to give some information to our
listeners where they can learn more or contact you.
Speaker 3 (47:33):
Where would that be.
Speaker 2 (47:35):
I'm pretty simple, don't even have a website. My email
is puerce f c E, which is p E A
R S E f c E at gmail dot com.
My cell number fourty three two eight oh seven eight
eight five. I'm currently based in Chattennigan Knoxville. I'm looking
at adding at least one more location. I'm looking at
(47:58):
either Birmingham or Murphy's Burrow in the near future. But
that's basically how to give me an email cell phone.
I try to keep it as simple as possible.
Speaker 1 (48:10):
Great, well, thank you so much. We've enjoyed our time
with you today, Rob.
Speaker 2 (48:13):
Thank you, Thank you really appreciate it.
Speaker 3 (48:15):
Thanks
Welcome back to another episode of the Conversations podcast, a
podcast developed thir Dri where we discuss the world of
workers' compensation, exploring issues involving occupational injuries, treatment, claims, management, litigation,
as well as future trends and emerging issues in this
area of law. My name is Jennifer White and I'm
here with Shane Dawson, a partner with Dens Marshall and Ohio.
(00:41):
We are delighted to have with us today Rob Pierce.
He is a clinical exercise physiologist who focuses on performing
functional capacity evaluations. He owns his own business, peerce See
and offers employment testimony and expert witness testimony. He has
over thirty years of experience. It's in the field and
it is extremely experienced. Rob herece, Welcome to Conversations.
Speaker 2 (01:06):
Great, thanks for having me. Love being here.
Speaker 1 (01:08):
If you could just go ahead and give us I
gave some of your background, but just kind of give
a quick intro to your background, credentials and the types
of sees you perform.
Speaker 2 (01:17):
YEP, sounds good, So I like to tell people I'm
a unicorn in our field. Most fcs are performed through
physical therapy, so most services that you see offered with
fcs or usually through physical therapy companies, where I'm unique,
where I'm independent. I have worked in physical therapy for
a long time as well, but I'm completely independent. Fcees
(01:40):
are not therapy. It's an assessment, physical assessment. So but
I got into it through physical therapy. I worked for
a huge corporation in Memphis called Health South back in
the late nineties and I just got fortunate. There was
a great place to start and learn, and they had
a huge mental ship program. They are now defunct. If
(02:03):
you know the history of Health South, it's it's pretty interesting.
But I actually left Health South after four years and
went on my own. Just had a revelation that I could
do this on my own for some bizarre reason, not
knowing what had to do it. And then it was
on my own for sixteen years. Then I actually sold
my business to ATI Physical Therapy at Chicago, worked for
(02:24):
them for ten years. Now I'm back on my own.
So it's a really interesting. I can talk hours about
how I got into this and why. A lot of
it just by chance, but it's actually a perfect fit
for me.
Speaker 1 (02:40):
What type what types of SCS do you see?
Speaker 2 (02:43):
So there's different methodologies that are all extremely similar. I
use a system called ARCon. It's been around since the nineties.
It's the most I feel, it's the most objective, and
it's the best has the best data collection tools through
computer interfaces. That's the system I use. They're all very
(03:06):
similar in the type of tests they do. The difference
comes in what process they use to collect the data,
and how many pounds someone's producing, how often someone's doing
a task, how to classify repetition into occasional, frequent, constant.
That's where there's some variances between different methodologies and fcees,
(03:27):
but they're all very similar. Mine's just very computer based,
meaning all my data collection is through tools like a
hand autemometering, clinometer, goiniometers, strain gages, load cells that are
all computer interface or I'm collecting data through a computer interface,
(03:49):
not just a manual dial, if that makes any sense.
So it's way more accurate. As well. I have wireless
heart rate monitoring where I'm monitoring someone's heart rate continuously
through the valuation wirelessly. It's not with a watch, it's
not doing a pulse meter on their finger. They're actually
wear in a chestrap computer staydloading heart rate through the
(04:11):
entire evaluation, so I can look at heart rate progression
with every test, which for me was a huge relevation
in the late nineties when that became available, looking at
consistency of effort. So it's still by far the best
FC system I found, and I'm always looking at new
ones or look, there's no new ones out there, looking
at all the different ones, and it's still by far
(04:33):
the best ones. That's what I stuck with my you know,
for the last since ninety five, so it's been a while.
Speaker 1 (04:41):
I probably should have asked this before we jumped into
the technical assestause I have an SSE, but for in
our podcast goes out to a lot of different listeners
in different states, and they might not always use fcees.
Why exactly are they so critical for the return to
work puzzle?
Speaker 3 (04:58):
Can you explain that.
Speaker 2 (05:00):
The fcs are vital and it's amazing that I use more,
but it should be the final, the final tool used
in a claim to determine return to work in restrictions.
So when a patient's put at MMI, there's no further treatment,
no surgical intervention anymore, other and all the diagnostics are
done and basically the physicians getting ready to release that patient,
(05:22):
and he is the physician just needs to know I
can they return to work regular duty with no restrictions?
Do they need restrictions? What do they need to be?
So that's the value of an f C rather than guessing,
is actually objectively measuring what a person's functional abilities are
compare to the regular job demands. To do that direct
(05:44):
comparison and then see what they don't meet and then
those would be what the restrictions are. And then it
can help an employer look at placing one in a
different job position comparing job descriptions. If a job description
is accurate, that's another world to talk about. But you
can get way more objective evidence to show if someone
(06:08):
can do a job yes or no. Also if they're
giving if this is the true representation of their abilities
or not, or if they're exaggerating for whatever reason. So
it's vital. It's amazing. It amazes me that people don't
use it more in a oppositions just gas on return
to work.
Speaker 4 (06:26):
Rob Let me ask you so to get down maybe
into the weeds a little bit on how you would
evaluate a good FCE. You talk about what what are
the key elements that anyone should be looking for for
an FC it's going to be defensible.
Speaker 2 (06:45):
Yeah, so number one is determined consistency of effort. That's
by far the first thing you have to look at.
And what tools is that FC protocol using to determine
consistency of effort? If you really dove into the different methodologies,
it would be very alarming how many don't have consistency
(07:07):
of effort indicators or how few indicators they use. Really,
grip strength is the one most almost every FC protocol
relies on for consistency, but some of them that's the
only thing they have. It's just it's just grip strength.
And you know, I've had many physicians they're not physicians.
Attorney's question. He's like, Hey, the guy didn't give good
(07:29):
effort on grip strength. Does that mean they didn't give
good effort in the whole valuation? It's like no, absolutely not.
Or if they gave good effort in grip strength, does
that mean this is really what they can do with
all the other tests. It's like absolutely not. Because if
I'm an attorney, I tell my patient, hey, with grip strength,
you knock it out. You you know, you pushed that.
I don't care how much it hurts. You push it
as hard as you can. But the rest of it
(07:49):
I just fudget, And you would get away with a
lot of fcees fudging the rest of it because they
don't have enough consistency indicators. So with every test I do,
there's at least one consistency indicator from either heart rate
progression from the test, how much heart rate increased, or
(08:10):
repeated testing, doing coefficient a variation. That's not an old
school but that's a more rudimentary way to look at
consistency that you have to really understand well and be
careful of doing strength changes, the different positions, doing repeated testing,
comparing different tests, looking at quality of motion, range of motion.
(08:36):
So there's lots of stuff you have to look at
holistically in an FCEE, and you have to take all
that stuff together and paint a picture. So what I
tell people is when you throw up an FC on
a computer on a screen, basically it's a picture and
everybody needs to look at that picture and understand it.
And if you can't look at the picture and understand it,
then it's not really a very good FC report. You
(08:58):
can be a good evaluator, you can know what you're doing.
You could know the testing methodology inside and out, but
if your report doesn't say that, it basically still sucks.
Or conversely, you can make a report look really really
good and really have bad data you're using. So it
can go both ways. You know, I could. I could
(09:19):
easily take a really poor FC testing process and make
it look really good to anyone reading the report. That'd
be a piece of cake. Does it make it a really
a valid FCE No, not necessarily. You gotta be able
to back up, back it up with the bones of it,
which is a consistency data. So that's the biggest thing.
(09:39):
And you'll be shocked how many consistency measurements are used
in most fcees. It's you know, it looks bad. It
makes fcs look bad, which is part of the reason
why people don't realize their value because there's so many
bad ones out there, but a good one sticks out
like crazy when you say a good one really sticks out.
(10:01):
My fcs typically have forty to sixty consistency indicators that
I use to determine if the results are reliable. Most
would have at most eight to ten, maybe fifteen and
that's mostly just grip strength. So again there's a huge variance,
you know. And I could sit and cut apart FCEs
(10:26):
like crazy, which I do because I've been doing it
for so long, which doesn't really make sense that I'm
sort of criticizing my own profession. But there are so
many bad ones that they are still being utilized. It's scary.
And everybody thinks that Matheson is still the you know,
the gold standard of fcees. Matheson hasn't changed since nineteen
(10:49):
ninety that's the last time anything's changed with it. And
it's still done how I first started my career in
nineteen eighty three and it hasn't evolved, And it's yeah.
Leonard Mathieson, the guy that started was a psychiatrist in California.
Super smart viewed, but no one's advanced it beyond where
(11:10):
he had it. And it was very subjective, very psychological.
He really had He really looked at the psychological side,
which makes sense for his background. But once it evolved
more into the into physical therapy, which was really just
in the eighties. It was initially started back in the sixties.
Return to work after after the Wars for companying figure
(11:33):
out return to work with post war injuries. But when
it got into workers comup in the eighties, it was
still very subjective, and there's a lot of people still
use a very subjective FCE and FC evaluators if they're
not experienced. The subjectivity will eat you alive because you
(11:53):
don't know how to it. Shouldn't be using it, first
of all, should just be purely objective. I think a circle.
Speaker 5 (12:00):
But sorry, I wanted to ask you.
Speaker 4 (12:03):
I know you said something before about the job descriptions
the job, you know, so can you talk just for
a moment about the importance, as as a client, as
an employer, as an attorney, of getting that FSE evaluator
something that reasonably describes the actual job.
Speaker 2 (12:24):
Absolutely, it's the most crucial part, because that's what we're
comparison comparing the physical abilities we've determined for that individual.
We're comparing to what their job demands were at the
time of injury. If that job description isn't accurate, then
we're comparing apples and oranges. If we even have a
(12:44):
job description, it's the first thing. A lot of times
we don't even have one, so then you're stuck going
to the Dictionary of occupational titles or that's now called
the o NET, and that's the DFT and o NET
are very basic, low level descriptions of jobs, very generic.
It's better than nothing but a true job analysis, which
(13:08):
is rare. I would say I get a true job
analysis out of maybe one out of fifty FSAs that
I do that, I really feel confident that I'm comparing
to something accurate. It's vital and it's probably the biggest
stumbling block we have with determining return to work is
(13:29):
that we don't we're not comparing to something really validated
because most of them are a supervisor filling out a
job description. If it's it's amid the small company, you know,
they're not going to pay an ergonomist to go out
there and do a job analysis or anyone else. So
there's having supervisors feeling, hey, what's the lifting demand, and
(13:51):
they're guessing half the time, or they're just always putting
in fifty pounds. That's what I see now is that
everybody just puts in fifty pounds and sometimes a job
will requires fifteen pounds. So now I'm doing the evaluation
on a person and I asked, I always ask every
patient what are there. You know, what do you have
to do in your job? Describe your job to me?
How much you have to lift, what are the heights
(14:12):
you lift, what's a repetition, And then also positional wise,
how often you have to do different positional stuff. And
I've many times have a patient tell me, yeah, I
think the maximum I've ever lifted is probably ten twelve
pounds and it's only a couple times a day. And
the job description says fifty pounds. So now I'm doing
(14:34):
an FCEE and I'm comparing to the job description and
I say, no, they cannot return to work because they
can only lift thirty five pounds when the job description
says fifty. And then if I'm the patient, I just
may have lost my job because now they've got someone
giving an objective opinion that isn't accurate. You know, I
(14:56):
see that all the time, but I try not to
get into the in the middle with the employer because
then I look like the bad guy. So I just
tell the patient, Hey, just so you know, job description
says this, this is what I'm going to compare to.
If you dispute that, if you don't think that job
description is accurate, you need to talk to your guester
and the employer and get it straightened out. So I
(15:17):
put the onus on them, which I think is a
true way to do a good way to do. It
happens all the time. And then I see jobs. I
see this all the time. Construction worker maximum lifts thirty
five pounds and the guy's a framer and he's lifting
trusses and lifting well into one hundred pounds if not more.
And the job description says, oh, as to lift thirty
(15:39):
five pounds. Yes, So then okay, now I'm on the
opposite boat. I'm saying, yes, this person can do the job.
I know they can't, but based on the job description,
I have to say yes, they meet the job deman.
It's based on the job description. So I make sure
I'm very clear on that. And what I'm comparing to
(16:00):
the job description is vital. It's the most overlooked part
of workers camp that I see in the accuracy and
the value because employers, most employers don't want to pay
that money to have someone come and evaluated job. I
would think the insurance companies should be the ones that
are thinking, oh, I need to pay for this because
(16:21):
this is vital for return, you know, determining what my
pay it's going to be on our end. So you know,
I think the own is finding skilled the insurance companies
because employers won't won't pay that. It's a lot of
times they just bypassed that expense.
Speaker 4 (16:35):
Okay, So you mentioned too about the system that you
use ARCon. Are there are there other methodologies, other protocols
out there that are respected that you've seen that you know,
some of our audience they may come across and and say, okay,
well that one is at least still something that's valid
that I can trust.
Speaker 2 (16:56):
Yeah, yep, So thet if I couldn't use ar Con anymore,
the next one I would go to is BTE. It's
Baltimore Therapeutic Therapeutic Equipment. I'm pretty sure they're based out
of Baltimore. They actually purchased a system back around two
thousand ish called Hanoon, which was out of Colorado. And ironically,
(17:16):
the guys that started ARCon, there was two of them
when they developed the ARCon system. They had a disagreement
split and one guy made it went to his own
business made Hanoon, and it's essentially the same system. Henon's
actually even more advanced from a technology standpoint, and it
was a lot more expensive to purchase. But BTE is
(17:38):
a big equipment company in that we have field they
purchased hand in. It's a great system and it's it's
essentially the same as the one I use, So that's
the only other one I think is great. And then
there's a big step down. Then you get back down
to the very sort of old school ones, which are
(17:59):
matheson key. There's work well, there's all these other different
people that have started their little FC businesses that those
are all very similar. They're very manual, meaning it's a
box and put weights in a box. It's a load
cell with a dial on it, where you're doing push
pull forces with a dial. If they have a heart
(18:23):
rate monitor and maybe a chest strapp but it's with
a watch, it's not with a computer interface, or they're
using a finger pulse meter for heart rates, which is
a lot of them. It really drops down from a
technology standpoint. The protocols are all the same. They use
different niosh National introduce safety and health lift methodologies. They
(18:48):
use all the similar tests, they just do them a
little differently and some of the technology is much better
for collecting that data, if that makes sense. So like,
I feel I could do a good FCE on any
system just because of the experience I have. So I
can pretty much use anything and still be able to
(19:09):
come up with a good FCE because I'm at the
point where you use a ton of observations and common
sense as well. But a new person doing FCEs, oh,
when they when they're stuck with these rudimentary systems they are,
they're already way behind the eight ball on advancing their career.
When I was at ATI, I had about thirty people
(19:32):
that I oversaw on the East Coast and they were
all pts that have been newly trained and certified for
FCS but through Matheson and so I was supposed to
be their mentor to train them. And the first thing
I told them all the time is, unfortunately, you're stuck
with a poor FCE methodology you're using. And here's the
here's the reasons why it's poorn, here's the disadvantages you have.
(19:55):
So here's the only It's going to take you years
to figure out how to get through that and use
it effectively. And most of them after six months are
sick of it, and they so they don't do it.
So like when you're asking an fc evaluator what's your experience,
don't ask them how many years they've done it. Ask
them how many you've done? Because I see people all
(20:16):
the time. Oh, I've done f ceas for fifteen years.
How many have you done? I did two or three year?
You've never become proficient. Or I've done f ceas for
two years. How many have you done? Oh I've done
about six hundred. Okay, you're getting proficient. Because with my career,
my first five years, even though I was very well trained,
and I'm still figuring it out, like I cringe it
(20:38):
my first five years and I'm just sort of lucky
I wasn't called on any of my guests because I
was way too hard on people. But you know, it's
just like any career. You start up fresh, you do
your certifications. We all know certifications don't really mean squat,
you know, I mean you sat down for a weekend
and listened and passed the task where everybody passes. The
(21:00):
true value with your work experiences in the in the
trenches seeing people, and with fcees, you're definitely in the
middle of the trenches seeing people and that's where you
gain all your experience. It takes years. I always tell
people at least five years to become somewhat proficient.
Speaker 3 (21:17):
Okay, let me let me ask you this.
Speaker 5 (21:19):
Rob.
Speaker 1 (21:21):
We had talked a little bit about what my consistency
of effort in fcs and if they're only using that
grip strength, then that makes it.
Speaker 3 (21:30):
Possibly as suspect FCEE.
Speaker 1 (21:32):
You said you looked at over forty or other six
forty to sixty other things that you would look at.
Speaker 3 (21:38):
What were those things that you look at?
Speaker 1 (21:41):
It from our our perspective, we want to like point
that out, like if that's not occurring in other YEA.
Speaker 2 (21:47):
So heart right progression with tests is this huge one.
That's for me, that's the biggest one because it's the
easiest to explain to people that don't understand FC testing
and it makes the most sense. Okay, when I did
a dynamic Florida and knuckle lift saying how much someone
can lift in a box from Florida waste level, you know,
(22:07):
their heart rate at the beginning of the test was
eighty four weeks per minute. Before we started through the test,
their heart rate increase to one hundred and thirty four
did they give good effort. Yes, that makes sense, and
I think for most of us would think, oh yeah,
that's a pretty good increase in heart rate. For fcase,
the general rule of thumb is a twenty five percent
(22:30):
increase in heart rate determines a reliable test. I personally
don't believe that one hundred percent, but that's one thing
I do use because that's one of the sort of
standardized things that did us are there for consistency. But
you have to look at other stuff as well. So
heart rate progression from various tests is huge. From a
(22:53):
lifting strength testing standpoint, repeated testing where you're testing a task.
The grip strengths by the easiest one to explain. So
I'm testing grip strength through five positions in a hand dynamometer.
So the grip strength tool has different you can make
it smaller or bigger, and there's five different rungs you
(23:13):
go through. It's essential to test people in all five runs,
not just one, and you do at least three trials
to get a coefficient of variation. So cofisient variation is
just a statistical tool to look at what's the variance
between those three trials. So I'm asking a patient, Okay,
(23:33):
squeeze as hard as you can three times, you know,
for three your appetitions with each hand, and the result
is the first time he squeze is ten pounds, the
next time it's fifty, the next time it is two. Obviously,
that's gonna have a very high coefficient of variation. The
variance between trial the trial is very large. You can
tell it's not consistent. Or they squeeze and it's twelve pounds,
(23:57):
fourteen pounds, thirteen pounds. That's to have an acceptable coefficient variation.
It's a consistent, reliable result. So did they give good
effort with that grip test? Yes, where the first person
did two, fifty, twenty whatever, didn't give consistent effort? However,
what if pain is factored in? So it's something you
(24:19):
have to look at. Pain is part of fcees, even
though we try to ignore it as much. Some people
try to ignore it as much as possible talking about it.
But what if the first time they squeeze was with
fifty pounds and it's a thumb injury, bad thumb, and
the next time it was painful for them their pain
level went from four to eight. We do a second trial. Now,
(24:39):
they've only expez with thirty pounds, their pain level still eight.
Does that make sense? Sometimes it does because pain's factored in.
You have to be able to understand and put all
that stuff together in a big picture. If it does,
see if it makes sense. So coefficient variation alone, you
can't just the person didn't give good effort. Necessarily, you
(25:02):
could be saying someone didn't where really they did, but
pain was a limiting factor. But you've got to factor
in all the other stuff you do as well to
overall look at did they give consistent effort or not?
So I know that's getting really down in the weeds,
but you've got to really be objective and look at
(25:22):
every single aspect of what you're testing, look at what
you observe, what the patient says, what you've measured doesn't
make sense, and if it does, great, it's a reliable result.
If it doesn't, you just have to be able to
explain why it doesn't. And then with grip again, I
(25:43):
always do something called rapid exchange grip testing. So in
the second run of a hand itermometer, it's called the
standard position. That's where all the research did. Normative testing.
You see what's normal grip'strength for different genders at different ages.
It's always in position too, So we do the maximal
grip in position two for three trials in each hand,
(26:03):
and then we do something called rapid exchange where they're
doing a fast, hard squeeze. At that second level, you
can't produce as much force quickly as you can slowly
and maximally when you're squeezing. So that's another direct comparison
for consistency. So if you see an FC that didn't
do rapid exchange, it's not a thorough test because rapid
(26:26):
exchange tells you a lot. So, just to give an example,
patient's maximal grip was twenty pounds, coefficient evation, coficient of
variation was consistent. Now I did rapid exchange and the
grip was now eighty pounds. It shows me they didn't
give good effort in that maximal grip because the rapid
exchange was four times higher. And that happens a lot,
(26:50):
so more research was done. Oh can I reproduce force
submaximally consistently? Absolutely some people can, so co efficient variational
loan can't be used with grip. You have to use
rapid exchange on the top with that as well, in
(27:10):
addition to a five position curve looking at strength in
the five different positions. So just with grip strength to loan,
there should be if you're doing it properly, there should
be a six or twelve fourteen. There should be at
least sixteen consistency measurements just with grip strength testing, if
(27:30):
you're utilizing all aspects of it. Another thing I do
that not many of these do anymore is called static
strength testing. So I'm looking at their strength pulling against
a load cell or a scale essentially in different heights, low, mid,
(27:52):
high level heights, and then I test that same position
at a different distance from the gate. So as an example,
I'm doing something called a high in ear lift, which
is a shoulder lift in close pushing up with as
much force as they can, and then we double the distance.
Now they're going to be twenty inches or fifteen inches
(28:13):
from the load cell, so they're way far away. Doing
the same test, force should go down by at least
thirty three percent based on research, and if I'm going
to show someone didn't give good effort on that test,
a lot of times in the close test, they're pushing
straight up they're pushing in with say ten pounds, and
then I put them in the compromised position, and now
they're pushing in with eighteen pounds. Well, what the eighteen
(28:37):
pounds shows me is they can do way more than
that here. They should be able to do at least
thirty three percent more than eighteen in this position. That's
just another consistency measurement. A lot of FC evaluators and
protocols are afraid of static testing. They think that there's
a higher risk of injury, which is actually the exact opposite.
(28:58):
It's a lower risk of injury because we're we're testing
or testing strength with no motion. So it's like pushing
against the wall that won't move or pulling up against
something that won't move. It's a very safe way to
test strength. But a lot of people are afraid of it.
They think, oh, her needed disc. We can't do a
static floor lift. I mean absolutely you can. You know
(29:19):
I'd be more worried about doing dynamic Florida knuckle lifting
than I would a static floor lift with a her
needed disc. Anyways, just another consistency measurement. Coefficient variation is
because can be should be used, the strength of it
isn't great alone, but it's one of the tools you
(29:41):
used to sort of put the whole picture together.
Speaker 1 (29:46):
What I know, we were talking about consistency in your experience.
How how many people or what percentage are giving really
liable effort versus unreliable effort.
Speaker 2 (30:03):
This question, this is a great question because you can
answer this so many ways. So the caveat to this
is you have to look at the client tele I'm
being referred. So when someone has surgery, goes through rehab,
does well, typically those people go to work back to work,
(30:25):
don't need an f C. I see people that had,
you know, say, if it was surgical, had a surgical intervention,
didn't do well in rehab for some reason. They either
didn't try or had a poor therapist or whatever, have
a ton of comorbidities, which is a huge one that
I see. I see the people that don't do well. Right,
(30:47):
So I already have a biased referral group of people
that aren't doing well physically for whatever reason. And then
if you look at the psychological component of this, and
the psychological component never wants to be discussed and it's
the biggest part of any workers complaint. So you have
someone that their initial injury was sort of poo poo,
(31:09):
that's denied. You know, the urgent care center said, oh,
it's just a strange brain. Guy's got a huge tear.
Now he's angry. It's taken six months to see an orthopedic.
Orthopedic sees and says, oh, that urgent care play sucks.
I can't believe they miss this, and now you need surgery.
So now the guys even matter goes through surgery. He's
(31:33):
got diabetes, he's screen in fifty pairs, never exercises, his life,
alcoholic whatever. His rehab potential is extremely low. They've done
surgery now eight months late. Chances of success with that
patient extremely low. That's my FC referral. That's who I get.
(31:57):
So I have potentially someone that's very angry, a pointed
in the system doesn't do anything help themselves, so didn't
really put in the effort that should have been put
in by themselves. But the system let them down as well.
So they got that that double whammy. And then they
come to see me and they know this is the
end of the road, and a lot of people look
(32:18):
at me, Oh, you're just hired by the insurance company.
You're just here to get me out of the system.
And I get that response a lot, and I have
to sit down and tell people not, well, I'm not
hired by anybody. I may be paid by the insurance company,
but everybody is. My job is just to be objective
and tell everybody what you're safely able to do. So
(32:40):
I have to have that that FC evalue have confidence
that I'm going to be fair. And that's a huge thing,
because if they come in and they're leery of me,
they are not going to give good effort at all
because they're already leary. And I can and some people
I can't turn there's and the people I can't turn
(33:02):
actually usually do really reasonably well. Maybe they can't return
to work full duty they need restrictions, but they at
least give good effort. And a lot of people leave saying, man,
I was so worried about doing this, and I was
actually angry coming in. And I feel much better now
because now I know what I can do that makes
my life, that makes my job fulfilling. To me, it's rare,
(33:26):
you know, that's that's very rare. But that's one thing
that makes me feel good, like, yes, I finally help somebody.
But I see many people that come in and everything's
going against them and they're not doing anything to help themselves,
and they come in and give poor effort, and I
have to figure out why. You know, it's not really
(33:47):
my job to figure that out, but that's always in
the back of my mind, what's going on. How can
I get this person to give good effort? And sometimes
I have that little come to Jesus talk with them
and tell them, Hey, you know, I told you there's
lots of consistency measurements in this testing, and I've told
you have to give your best, safe effort and you're
the only one that can determine that. However, I feel
(34:08):
you're not giving your best effort. We need to really
need to push yourself as hard as you can safely
push yourself. Some people will actually turn the corner and say, Matt,
you're right, I'm just afraid. I'm like, Okay, I get it.
I understand. You know, you've been going through this a
long time and it sucks and your shoulder hurts and
you're disappointed. I get it. However, it's not helping you
(34:30):
right now. So I try my best without overdoing it
and there's a fine line because some people you do
that and they go the opposite direction and they anger
kicks in. Usually it's an older male that'll kick you in,
that has an ego, and I have to be very
I have to be gentle with those. So my job is,
(34:50):
I swear ninety eight percent psychological and trying to get
people to give good effort and trying to work around
and see the picture without knowing the picture. And that's
what a good FC valuator should be. And that's why
I think I'm good. It's because I feel confident that
I can see usually see the picture to some extent,
or at least I try to. My first five years
(35:13):
of my career, I didn't even try to. I didn't care.
My job is I'm we're gonna do these tests and
spit out the results of the tests and I either
gave good effort or you didn't, and a lot of
people it wasn't fair to that person and it didn't
really help the claim because it caused more a bigger
adversarial situation and they dug their heels in deeper. I
(35:35):
try not to get into that, but as well, I
also get to the point of I can only exhaust
telling them to give their best effort so much until
I finally will give up and say, okay, we're it's
gonna go through it now, and I know you're not
giving good effort. I'm just gonna have to unfortunately show
you didn't. Ironically, up until twenty fourteen, where the work
(35:58):
comp laws were different, the majority of my referrals were
Lombard DD, probably seventy percent of them, and almost all
of them were inconsistent, didn't give good effort. They were
trying to manipulate the system. So back then, I would say, honestly,
seventy eighty percent of my have seas were unreliable even
with me trying to coach them to give good effort.
(36:21):
Since twenty fourteen, that dynamic has changed completely. It's amazing.
So if the law changes, getting rid of a lot
of diagnoses that are compensatable in Tennessee now I see
post surgical rotator cuffs. That's eighty percent of what I see,
and most of them have tons of comorbides that diabetic, obese,
heavy smoker, alcoholic anxiety, depression, all the psychological stuff. That's
(36:48):
what I see now. So actually most of mine are consistent.
I would say eighty five percent of them are consistent.
Their restrictions aren't always limited just to the injury. There's
other reasons for it. But it's changed dramatically since the
law has changed in twenty fourteen.
Speaker 1 (37:08):
It's so tyfinicely you're referring to Tennessee because you're.
Speaker 3 (37:13):
Just for our listeners.
Speaker 2 (37:14):
Yeah, yeah, and it's so it's been amazing for me
to see the difference in my referral the types of referrals.
I'm getting what the diagnosises are like, I don't get
carpal tunnel, I don't get albleteninitis, I don't get Lombard
d D. You just don't get the common sprain strains.
They don't get to me anymore because they either get
(37:34):
denied or they get through the system faster where the
physicians release them. So I mainly see post surgical. Even
in Georgia, even Alabama, with those referrals, it's almost all
post surgical. Majority of shoulders, not many backs, not many necks.
So it has changed dramatically. So it's interesting. There's still
(37:55):
a lot of inconsistency. I can't say that there's no
as much inconsistency because I'm actually seeing people that truly
had injuries that were recognized and had surgical intervention, were fire.
I didn't see those very often. So it has changed.
Now has the psychological part changed, No, there's still a
(38:17):
lot of crazy people out there. And when you know,
I tell people that when I say I think I
see the bottom of the barrel, note the barrel just
drops and the floor it's a bottomless floor. It's crazy.
The stories I hear from people and the people I see,
it's it's absolutely amazing and it's a little bit disheartening
at times too when you see what's actually happening in
(38:39):
the world. But it so the dynamic has changed in
definitely in the last ten fifty ten years with consistency,
way more consistent, people giving good effort.
Speaker 5 (38:55):
That's good to hear. So rob let me.
Speaker 3 (38:57):
So.
Speaker 5 (38:57):
Most of our audience obviously are defense attorney.
Speaker 4 (39:00):
So if you can being give give them three things
they should look at. If they have an FSE lands
on their desk, what things should they be looking for
either to determine, hey, this is really a good FCE
or this is a poor one that's going to be
(39:21):
subject to.
Speaker 5 (39:24):
Attack on cross examination.
Speaker 2 (39:27):
Yeap hard to do in three. I would think the
first one really is can I read the report and
understand what the recommendations are? That'd be number one. So
the one thing I see and I review a lot
of competitors' fcees for physician friends that don't can't figure
out what to do with it, and a lot of
(39:47):
times the recommendations are hard to find or they don't
make sense. Every FSE has a referral question why you're
doing the FCE and then you should have your conclusion
should be an answer to the question. It's pretty straightforward,
and a lot of people don't understand that that are
FC evaluators. So if you're having a hard time understanding
what are the recommendations, that's number one. I can't even
(40:10):
find them in the report. Or are the recommendations specific
to what the referral question is, which should be tann
this person return to work as a whatever based on
this injury. So I look, I only test people specific
to an injury. I don't do global comprehensive fcs where
(40:33):
I test the entire body. I test relative to what
the injury is, because that's what we're looking at. As
an example, I never you'll never see me give a
restriction for overhead reaching for any patient. I see that
all the time in FC reports, and I see people
say this person cannot return to work because of this
(40:56):
other limitation that's not related to the injury. So that's
a huge red flag. The recommendation should be specific to
the injury as much as possible, and also specific to
the occupation, and a lot of people just don't get that.
So you got to be able to understand the report.
Number one. Number two is if they need to comment
(41:21):
is it reliable, unreliable or valid, invalid. I don't use invalid,
valid because that's not the proper terminology, but people do,
but they mean essentially the same thing to delay people
that you know, reliable means they gave valid effort. This
is really accurate or unreliable or invalid they did? This
isn't a good represent representation. What they can do. You
(41:43):
have to be able to is that indicated in the report?
And what criteria did they use to determine that? That
would be another huge one. And you know they may say, oh,
out of you know, fifteen consistency indicators, patient gave consistent effort. Well,
what really are those indicators? Are they just grip strength alone, Like,
you've got to dive a little bit deeper into it
(42:05):
to understand what are they using. Because if you're saying
the person can only lift two pounds and they didn't
look at heart rate progression or anything else in the FC,
they only use grip strength for consistency indicator, I would
question the accuracy of that FCE. So what are the
consistency indicators? You know? Does can you find their recommendations
(42:28):
in the report? And do they answer the referral question
of why you did the FCE? The third one is
it just make common sense? It does? It doesn't make
sense because you see reports, Oh I'm sure you've seen them.
This person can lift, you know, four pounds, which is
absolutely ludicrous because in our life there's so much that
(42:51):
weighs more than four pounds that we couldn't survive doing that.
So there's actually an FC protocol that if you can't
produce at least fifteen pound as a force in any test,
it's unreliable, which means it doesn't make sense because just
to live, just to build, to go from sit to stand,
to walk, to open a door, to pull a cabinet,
(43:12):
where anything requires at least fifteen pens of force. I
would never use that from a legal standpoint because I
think you could question that all day long. But there
is a protocol that uses that, which is interesting. I
think it makes sense, but it's a little bit more.
It's a little too aggressive, I think for consistency indicator.
(43:34):
But look at what are the consistent indicators? How many
were they used with every test you did? So every
test from walking, squatting, bending, reaching, handling, fingering, they should
all have some type of consistency indicator sometimes and it's
hard from attorney to look at report and understand all
(43:55):
that because how are you going to know? So that's
where maybe utilizing someone with experience to help you would
be helpful to understand these reports. There's a lot of
bad ones out there, there really are, and I hate
seeing it because it makes my profession look poor because
(44:15):
there's so much garbage out there. Fortunately for me, it
makes me look better, So I like that because it
probably makes me look better than I truly am. But
it hurts the profession. So then you get adjuster's employer's attorneys.
They see the garbage fcs out there by someone that's
just done like two in their career and they have
(44:37):
no clue what they're doing, and they throw out this
document that's being leally scrutinized, that they have no clue
what they're writing and the impact that can have, and
then every looks like it goes. No, f caes are garbage.
Look at this. That happens all the time, I guarantee you,
and it really I don't blame them, because yeah, that
(44:59):
is good garbage or a tendy garbage, but there is
very good value in it as well. With a good one.
It's just hard to find the good ones. You really
got to know where you're looking, and you can't just
rely on a work network with their pot of providers
that they really scrutinize the value. So I tell people
(45:24):
all the time. Physical therapy in general very low variance
in quality. They're all very similar. They've all been trained
the same way, they do everything very similarly, So from
company to company, from PT to PT, there's usually not
a huge variance. They're all very most are good. Some
are better than others, but most are good. They're very
(45:46):
rare to see a bad one. Fcees huge variants, enormous,
So just because you're calling a one call or a
med risk or whoever and saying, oh, they have their
providers and they you know done, uh, you know they
look at the quality of their their stuff. Now they
don't they don't even know what they're looking at either.
(46:08):
They're just signing on as many providers as they can
and then they're trying to find the cheapest provider. So
that's and that's again another can of worms that I'd
love to talk to is you know what those networks
have done to the provider pool and work cop because
the good providers are walking away. I will not get
(46:29):
involved with the with the network now, where when I
was with ATI, I had to, they signed all the contracts,
but now I refuse to because I'm not gonna, you know,
get paid fifty percent less for my service just to
get more business from you when you're not gonna send
it to me anyways, because someone's gonna undercut me and
you're just gonna send it to them. I'm sort of
(46:52):
hopefully making a smart decision on quality still does matter,
and I can prove the quality and it should hopefully
show so hopefully that my you know, my business can
be successful. But yeah, the system, the work on networks
out there are killing killing the system. Quality is going
(47:12):
through the floor, not just in FC's and PT as well,
just because the reibursements so low.
Speaker 1 (47:19):
That sounds like another topic for another podcast for us.
But yes, but it looks like we've run out of time.
But we would like to give some information to our
listeners where they can learn more or contact you.
Speaker 3 (47:33):
Where would that be.
Speaker 2 (47:35):
I'm pretty simple, don't even have a website. My email
is puerce f c E, which is p E A
R S E f c E at gmail dot com.
My cell number fourty three two eight oh seven eight
eight five. I'm currently based in Chattennigan Knoxville. I'm looking
at adding at least one more location. I'm looking at
(47:58):
either Birmingham or Murphy's Burrow in the near future. But
that's basically how to give me an email cell phone.
I try to keep it as simple as possible.
Speaker 1 (48:10):
Great, well, thank you so much. We've enjoyed our time
with you today, Rob.
Speaker 2 (48:13):
Thank you, Thank you really appreciate it.
Speaker 3 (48:15):
Thanks
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