Services at Koita Pratique Médicale

We conduct a thorough history of the presenting condition (e.g.)

• Area of injury, mechanism of injury, job history, hobbies, past medical history, review of systems
• Comprehensive musculoskeletal exam with meticulous documentation
• Use of appropriate diagnostic testing
• Evidence based treatment plan with a focus on functionality
• Frequent follow up
• Patient education and expectations
• Knowledge of expected response to course of treatment and expected recovery times
• “Malingering testing” when appropriate - non-organic component

Also various other measurements, see  WHO Disability Assessment Schedule (‎WHODAS 2.0)‎ manual for measuring health and disability.

A standard functional capacity evaluation (FCE) will need to include the following 6 elements: 

1. Worker Information:  Worker subjective pain complaints, height, weight ·blood pressure, oxygen saturation, pulse, Medications taken related to injury or that will impact testing, and whether scheduled medication taken, assistive devices used during evaluation, worker’s report of functional ability in (self-care, chores, yard work, driving, shopping, recreation, exercise), and worker’s self-reported goal(s).
2. Musculoskeletal Screening:  This is determined by the evaluator on a case by case basis, and may include these areas: Balance, Posture, Range of Motion (Passive/Active), Gait Abnormalities, Sensation, Extremity Edema Measurements (Pre/Post), Strength UE/LE, Other Clinical Findings. 
3. Capacity Testing: Positional, Material Handling, Non-Material Handling, standard movements (Sit, Stand, Walk, Climb Ladders, Climb Stairs, Twist Neck, Twist Truck, Bend/Stoop, Kneel, Squat Partial/Full, Crawl, Reach forward, Reach waist to shoulder, Work above shoulders, Grasp (forceful), Handle/Grasp, Fine Manipulation, Lifting Floor to Waist, Lifting Waist to Shoulder, Lifting Shoulder to Overhead, Push, Pull, Carry. Also, additional categories if noted on any job description/analysis such as working on ladders, typing, Wrist flexion/extension, or Operate Foot controls.
4. Cardiorespiratory Endurance: Utilizing testing best practices on a case-by-case basis.
5. Level of Effort Testing: May include Observational Level of Effort (hard and soft signs), Consistency of test performance (distraction, placebo, test/retest), and Physical (Heart rate monitoring/response, Isometric grip test battery, other movement tests).
6. Musculoskeletal/Psychosocial Questionnaires: Determined on a case-by-case basis, but must include reliability as it relates to a worker’s report of pain and abilities. Example tests and questionnaires:  Oswestry (ODI) Roland (RMQ) Neck Disability (NDI) Shoulder Pain and Disability (SPADI) Patient Health (PHQ-9) Fear-Avoidance Belief (FABQ) Tampa Kinesiophobia (TSK-11) EPIC Hand Function Sort PACT Spinal Function Sort Pain Disability Index (PDI) McGill Pain Questionnaire (MPQ-SF), World Health Organization Disability Assessment Schedule (WHODAS), Dalles Pain Questionnaire Orebro Musculoskeletal Pain Questionnaire (OMPQ), Ransford Pain Drawing Injustice Experiences Questionnaire (IEQ), The Effect of Pain Scale (EOP), and MTAP EPIC/PACT.

 Our comprehensive physical exam focuses on objective measurements of functionality, such as:

• Follow recommendations in the evidence based literature, including the "Return to Work Guidelines" and official "Disability Guidelines" from the Work Loss Data Institute, AAFP, AMA, ACP American Pain Society, ACOEM, British Occupational Medicine Guidelines, Agency for Health Care Policy and Research, and NIOSH lifting limits. 
• We look for evidence of functional limitations, and Functional Capacity Evaluations may include but are not limited to: Matheson Functional Capacity Evaluation, Isernhagen Work Systems Functional Capacity Evaluation, and Blankenship Functional Capacity Evaluation.
• We apply appropriate Treatment Guidelines, and Evidence based functional guidelines, including Physical Therapy is case based, evidence based and appropriate for the patient in example, did you know bed rest > 2 days may be detrimental to recovery from low back injuries, and walking beneficial for low back injuries depending upon the condition.
• We do what is best for the patient, in accord with best practices.
• We take into consideration second opinions and other independent medical evaluations.

• We always use an evidence based approach
• We educate patients about e.g.:  anatomy, physiology, pathophysiology, treatment plan, prognosis, degenerative findings vs. acute tears in shoulder injuries such as damage “caused” by a slip-and-fall three weeks ago versus Carpal Tunnel Syndrome.
• If relevant, we evaluate and discuss risks for development of debilitating diseases, such as:  obesity, hypothyroidism, diabetes, age, wrist dimension, osteoarthritis, autoimmune disease, gout, and also normal processes of pregnancy and postpartum leave of absence from work.

• Repetitive movement injuries
• Animal / Human bites
• Toxin or pathogen exposures
• Eye injuries
• Occupational asthma
• Treating hostile / difficult patients

Physical Examinations:

• Pre-placement examination
• Cleared to work examination (able to safely perform essential duties)
• Cleared to work job with accommodations/restrictions
• Not cleared – work poses a danger to patient’s health or health of others, or need more information to make a determination
• Return to Work
• Fitness for Duty
• Medical Surveillance
• Transportation Authority and DOT
• General Wellness Exam
• IME / Workability Exam/ Disability Examination

Wellness/Health Promotion:  Health Programs or Periodic assessment such as blood pressure and cholesterol screening.

Counseling on preventive care and health maintenance:  Individual counseling and education regarding recommendations of PPE (e.g. respirators, protective eye wear, Kevlar gloves, hearing protection etc.).

• COVID testing
• Post-exposure testing
• Pulmonary Function Testing
• Laboratory testing
• X-rays
• Tuberculin Skin Testing / IGRAs
• Physical abilities testing
• Drug testing and MRO services
• Audiometric testing
• Immunizations

• Ergonomic evaluation of the work site–heavy lifting, repetitive motion, awkward positions
• Dermal exposures
• Respiratory exposures
• Use of PPE
• Chemical, physical, biologic hazards(MSDS)
• General safety - machine guards, safety showers, signs, trip hazards
• Health and medical services available  

• OSHA

–Respiratory protection programs

–Hearing conservation programs

–Surveillance for chemical and biologic hazards

–NIOSH vs. OSHA

• ADA

• DOT medical clearance requirements

• CDC / Department of Health

• Large or small component musculoskeletal injuries
• Exposures (Respiratory, body fluids, dermal, hearing)
• Exacerbation / Aggravation of preexisting conditions

Determine significant vs. non-significant exposure, (this does not imply high or low risk, it suggests whether transmission is possible based on the exposure).

• Common Blood Bourne pathogens: HIV, Hep B, Hep C
• Determine need for post exposure prophylaxis (PEP ) and offer or recommend PEP if appropriate. The risk of becoming infected with HIV after an exposure to body fluids from an HIV infected patient is low. A review of 23 studies of needlestick injuries to HCWs exposed to an HIV positive source patient found 0.33 % transmission rate for a needlestick, 0.09 % exposure (one in 1143) to mucosa, no exposures to intact skin in 2712 patients.  There have been 58 cases of occupationally acquired HIV in US history with one case since 1999

Determine significant or non significant of e.g.:

Needlestick with used needle - significant:

• If significant follow Centers for Disease Control protocol

Intact skin - non significant:

• Sputum (Saliva) to eyes - non-significant (unless visible blood)
• Vomit - non-significant
• Urine – non-significant (unless visible blood present)
• Blood to intact skin - non-significant
• If exposure type is non significant – STOP, and proceed to other relevant circumstances, concerns and evaluations.

 Establish diagnosis based on symptoms and confirm diagnosis with EMG/NCS

• Establish high repetition in work place, vibration high handgrip (forceful movements)
• Evaluate for non occupational medical contributing factors
• Assess overall picture
• Evidence based treatment approach

Follow current best practices,  identify current and pre-existing health conditions, differentiate between unrelated injuries and temporary impairment versus long-term disability.  See the  U.S. Preventive Services Taskforce occupational health recommendations for further details. 

• Screen for physical demand versus physical ability mismatch.
• Screen for physical work related risk factors.
• Screen for psychosocial risk factors.

• Conduct physical examination
• Safely preform the essential duties of the job
• Identify safety issues
• Follow American Disability Act accommodations
• Conduct drug testing
• Conduct lift testing
• Conduct Physical ability/ capability testing

• Evaluate ergonomics
• Identify personal protective equipment being used
• Identify safe versus dangerous work practices

• Identify disputed compensation claims
• Evaluate fear avoidance (fear activity will cause worsened damage)
• Evaluate job dissatisfaction - including poor rating by supervisor
• Evaluate pending or past litigation in relation to injury
• Evaluate for underlying depression or anxiety
• Evaluate treatments including reliance on passive rather than active treatments
• Identify somatization factors
• Identify prior history of another disability
• Identify the the patients prospective about returning to work or modified duty