WorkAbility.us

By: Rick Wickstrom, PT, DPT, CPE, CDMS

Traditionally, employers have limited their medical screening of new hires to persons entering physically-demanding or safety-sensitive jobs where the program is justified to prevent work injury claims in physically-demanding jobs or to protect the health and safety of the public. Employers are legally permitted to condition a job offer on the results of an employment entrance medical exam that has a similar scope for all entering employees in the same category. This is the only phase of employment when the scope of medical inquiry and tests are relatively unrestricted, provided that health-related information is maintained in a confidential record (separate from the personnel file) and that withdrawal of the job offer is based on medical information that is job-related and consistent with business necessity.

A well-designed post-offer WorkAbility Fitness Screen by a physical therapist has important benefits that justify this investment in human resources for all categories of new hires:

1. Reduces recovery time and costs of future health claims by establishing an objective, pre-injury baseline of musculoskeletal status, health and fitness.

It has been often said that anyone can slip & fall on the employer's premises, regardless of the level of work strenuousness. Having a pre-injury baseline of physical fitness helps deter inappropriate work-related injury claims, shortens recovery time, and reduces claims costs because pre-injury data may be used to determine the functional impact of injury and realistic recovery expectations. When prior health and fitness status is unknown, most of the worker's alleged problems are attributed solely to the work-related injury claim.  

2. Improves job placement safety and efficiency. 

Harbin¹ conducted a prospective 3-year study of new-hires in Food Production and Electrical Manufacturing that received a comprehensive medical history and 20 different anthropometric, isometric strength and dynamic lifting tests. Isometric strength testing alone was of no predictive value for work injury incidence. There was a strong correlation between dynamic lifting tests and physical job requirements. Well-matched workers had 3% incidence of lower back injury compared to a 33% incidence of injury if the workers did not demonstrate adequate physical capacities. Workers with history of prior back surgery or low back pain at the time of hire had a 35% incidence of back injury (these workers were analyzed separately). Cost savings of $690 per employee tested and hired were projected based on direct costs alone. The importance of physical capacity screening on job assignment was critical for Medium, Heavy and Very Heavy physical demands based on percent of physically qualified food production workers for jobs at different DOT Physical Demand Strength Categories: 

DOT level                                     Male (%)         Female (%)

Sedentary up to 10 lbs.               99                    99

Light 11-20 lbs.                            95                    90       

Medium 21 to 50 lbs.                   66                    50

Heavy 51 to 100 lbs.                    33                    10

Very heavy over 100 lbs.             10                     0

Rosenblum et al.² investigated effects of pre-employment physical ability screening in the building supply industry and found that non-screened applicants 2.38 times more likely to experience a MSD-related overexertion injury and had 4.33 times higher costs for work-related injury claims. Average direct cost for MSD injuries of $422.76 per year for non-screened workers versus $97.63 for screened workers. There was also a significantly lower cost of non-MSD claims expense among screened workers, with 10-fold reduction in average loss accident costs.

Predictive validity studies by Anderson et. al.³ on hire food distribution workers that passed physical ability test had 47% lower workers compensation injury rate and 21% higher retention.

Sluiter^4-5noted that in general, specific demands of high-demand jobs are more likely to tax capacities of older workers than younger workers, but that effect varied enormously within age cohorts. She recommended development of functional tests for high demand jobs due to such an extent of age-related diversity.

3. Raises employee awareness of interventions to maintain or improve safety, health & fitness. 

A mandatory post-offer fitness screen may be only opportunity to evaluate persons who don’t participate in health promotion programs. One of the criticisms of health promotion programs has been that program resources are largely consumed by the "worried well" who don't benefit as much from the programs. 

55% deaths strongly impacted by four modifiable behavioral factors (tobacco use, poor diet, physical inactivity, and alcohol use).⁶ These factors relate to five of most costly physical health conditions for US Employers (angina pectoris [chest pain], diabetes mellitus, acute myocardial infarction, chronic obstructive pulmonary disease, and back pain).⁷ Individuals with multiple health risks tend to be less productive than peers with better profiles, with estimated productivity impact of two times the medical costs.⁸ These risk factors can be reduced through participation in worksite health promotion interventions. Rula⁹ reported that 47.4% of workers under-reported/unaware of 3 or more risk measures…this reinforces need for objective health metrics to motivate higher risk workers to improve their health and fitness.

Soler et. al.¹⁰ identified strong evidence of effectiveness of Assessment of Health Risks with Feedback as a gateway intervention to a broader worksite health promotion program that includes health education lasting at least one hour or being repeated multiple times over one year. Evidence suggests that higher risk person have greater health gains, with more evidence of effectiveness for some outcomes and insufficient evidence for changes in body composition or intake of fruits and vegetables.

Yen¹¹ determined that excess costs related to smoking were $466 per year and for high blood pressure were $1644 per year. Schultz¹² evaluated impact of metabolic syndrome (3+ risks) and demonstrated excess costs for

1. Blood Pressure => 130/85 or meds: $2011
2. BMI > 30: $627
3. Fasting glucose => 100 or meds: $1682
4. Triglycerides => 150: $ 1474

Note: Total costs included costs for health care, pharmacy and STD for persons at risk minus costs for persons not at risk.

References

1. Harbin G, Olson J. Post-offer, pre-placement testing in industry. Am J Ind Med. 2005 Apr;47(4):296-307.
2. Anderson C, Briggs J. A study of the effectiveness of ergonomically-based functional screening tests and their relationship to reducing worker compensation injuries. Work. 2008;31(1):27-37.
3. Sluiter, JK. High-demand jobs: Age-related diversity in work ability? Applied Ergonomics. 2006; 37: 429-440.
4. Sluiter JK and Frings-Dresen. What do we know about ageing at work? Evidence-based fitness for duty and health in firefighters. Ergonomics. 2007 November; 50 (11): 1897-1913.
5. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004 Mar 10;291(10):1238-45. Review. Erratum in: JAMA. 2005 Jan 19;293(3):298. JAMA. 2005 Jan 19;293(3):293-4.
6. Goetzel RZ, Hawkins K, Ozminkowski RJ, Wang S. The health and productivity cost burden of the "top 10" physical and mental health conditions affecting six large U.S. employers in 1999. J Occup Environ Med. 2003 Jan;45(1):5-14
7. Loeppke R, Taitel M, Haufle V, et al. Health and productivity as a business strategy: a multiemployer study. J Occup Environ Med 2009; 51: 411-428.
8. Rula EY, Hobgood A. The impact of health risk awareness on employee risk levels. Am J Health Behav. 2010 Sep-Oct;34(5):532-43.
9. Soler RE, Leeks KD, Razi S, Hopkins DP, Griffith M, Aten A, Chattopadhyay SK, Smith SC, Habarta N, Goetzel RZ, Pronk NP, Richling DE, Bauer DR, Buchanan LR,Florence CS, Koonin L, MacLean D, Rosenthal A, Matson Koffman D, Grizzell JV,Walker AM; Task Force on Community Preventive Services. A systematic review of selected interventions for worksite health promotion. The assessment of health risks with feedback. Am J Prev Med. 2010 Feb;38(2 Suppl):S237-62. Review.
10. Yen L, Schultz A, Schnueringer E, Edington DW. Financial costs due to excess health risks among active employees of a utility company. J Occup Environ Med. 2006 Sep;48(9):896-905.
11. Schultz AB, Edington DW. Metabolic syndrome in a workplace: prevalence, co-morbidities, and economic impact. Metab Syndr Relat Disord. 2009 Oct;7(5):459-68.