In a lot of injury cases there can be confusion about whether or not a medical physician or a doctor of physical therapy should be giving the green light for a patient to return to work full time, part time, or with / without restrictions.
Usually, a medical exam is a general health screen consisting of range of motion measurements, strength testing, neurologic assessments, and muscular palpation. The physician or physician assistant typically see the patient every couple months for checkups throughout their case and these follow up appointments typically last just a few minutes. While these evaluative measures are helpful in determining what impairments an individual may be suffering from due to their collision, they do not paint a definitive picture of those impairments and how they affect the persons’ ability to perform work related activities.
On the other hand, the physical therapist will typically be working with the patient in the trenches 2-3 times per week for 2-3 months on average. The visits last anywhere from 30 minutes to 1 hour. During this time, the therapist is able to see how the patient is responding to functional activities and can often find other unidentified impairments that may be prohibiting optimal recovery from an injury.
Understanding this, which of these two practitioners would you ask if it were you going back to work?
This topic is further discussed by the American Medical Association who have determined that “evaluation of “ability and disability” can and should involve non-medical practitioners in such determinations: In general, “it is not possible for a physician, using medical information alone, to make reliable predictions about the ability of an individual to perform tasks or to meet functional demands…when functional ability is assessed by a standardized non-medical procedure in a vocational rehabilitation setting, the physician may have confidence in the determination.” — Guidelines to the Evaluation of Permanent Impairment (2nd Edition)
The Association then goes on to emphasize that
“impairment is defined as “a loss, loss of use, or derangement of any body part, organ system, or organ function.” Disability (activity limitation) is defined as “an alteration of an individual’s capacity to meet personal, social, or occupational demands because of impairment.” Impairment means an alteration of an individual’s health status that is assessed by medical means; disability, which is assessed by non-medical means, means an alteration of an individual’s capacity to meet personal, social, or occupational demands.” — Guidelines to the Evaluation of Permanent Impairment (3rd and 5th Editions)
According to the Guidelines to the Evaluation of Permanent Impairment (6th Edition), “Most physicians are not trained in assessing the full array of human functional activities and participations that are required for comprehensive disability determinations.” “The relationship between impairment and disability remains both complex and difficult, if not impossible, to predict…the same level of injury is in no way predictive of an affected individual’s ability to participate in major life functions (including work).”
“Physicians are concerned with the degree of medical impairment, not with the contractual determination regarding whether the individual is “disabled.” Similarly, physicians are not typically trained in making occupational determinations. It is better to state a reasonable restriction and leave the determination as to whether it prevents the performance of a main duty to the appropriate resource.” — AMA Guides to the Evaluation of Work ability and Return to Work (2nd Edition) 2011.
When physical therapists who are also certified functional capacity evaluators evaluate the client, a proper return to work schedule can safely be determined. According to the Orthopedic Section of the American Physical Therapy Association, “A Functional Capacity Evaluation (FCE) is a comprehensive battery of performance based tests that are used commonly to determine ability for work, activities of daily living, or leisure activities.”
The medical physician and doctor of physical therapy can and should work in concert together. By having the medical physician determine the clients’ impairments they can give a proper diagnosis. By having the doctor of physical therapy actually confirm the diagnosis and quantify its severity through a skilled functional capacity evaluation, you can be confident that the client’s impairments and disabilities have been properly documented as well as how they impact someone’s livelihood.
Dr. Poppie has served the legal industry as a treating clinician, damages expert, and educator for over 20 years. He specializes in the evaluation and treatment of multi-trauma injuries related to motor vehicle collisions, standard of care and malpractice claims, and as a damages expert to help educate insurance companies and both plaintiff and defense counsel to provide a viable pathway for obtaining a fair settlement based on ethics, research, and evidence-based standards of care.
As a certified functional capacity evaluator, Dr. Poppie helps to document the true objective measurements of how the impairments and disabilities that the client is suffering from impact their ability to perform work related tasks, activities of daily living, and leisure activities in an easy to understand method for the insurance company or jury members.
Dr. Poppie founded Injury Reporting Consultants to help attorneys and insurance companies resolve personal injury cases through medical analysis and reporting. Injury Reporting Consultants is a collaborative team of dedicated medical professionals using their knowledge to ensure fair outcomes for all parties in personal injury cases.
Recognized specialties include Motor Vehicle Collision, Life Care Planning, Medical Cost Projection, Functional Capacity Evaluation, Onsite Job Analysis, Functional Impairment and Disability, Workplace Injuries, Orthopedic Physical Therapy, Standards of Care, Current Best Practices, Physical Therapy Malpractice, Negligence, File and Medical Record Review, Improper Documentation, Expert Rebuttal Reports, and Expert Testimony.
If you have a client that you would like to discuss their need for an expert report, please contact me directly at 720-982-2000 or email me at: firstname.lastname@example.org
Dr. Brad Poppie, DPT, CLCP, CFCE, CSCS
Doctor of Physical Therapy Certified Life Care Planner Medical Cost Projection Specialist Certified Functional Capacity Evaluator Certified Strength and Conditioning Specialist Certified Strength and Conditioning Specialist