Fitness For Work

The Role Of Physical Demands Analysis And Physical Capacity Assessment

T. M. Fraser

• Publisher: CRC Press
• Year: 1992
• eBook ISBN:
  9781135751258
• Topic: Medizin
• Subtopic: Personalmanagement

Offers an occupational ergonomic analysis of medical selection procedures for disabled and able-bodied labour-market entrants. The book re-examines the concept of fitness for work and emphasizes humanitarian and legislative factors.

Chapter 1
History and development

Background

Recently increasing awareness of social issues has led in various jurisdictions in the USA, Canada, Australia, New Zealand, Great Britain, Scandinavia and some European countries to the enactment of legislation for the employment of the handicapped. This in turn has led to the recognition of the inadequacy of the procedures used for the medical evaluation of potential employees, whether handicapped or not. In some respects the procedures are misleading or even useless, as they are often based on a form of physical or medical examination which pays scant attention to the needs of the workplace. The laying on of hands has been a medical ritual at least since the days of Hippocrates. Physicians have dutifully applied stethoscope to chest and hands to belly, regardless of whether the subject was sick, well, wanting insurance, seeking employment or returning to work after illness or injury. Usually the questions, examinations and objects have been the same, namely, to compare the status of the person being examined against some vaguely defined concept of clinical perfection.

The potential employer, equally, has paid little attention to the actual requirements of the job or tasks and, with due regard to the ‘bottom line’, has often been more concerned with ensuring that his future compensation costs would not increase than with determining who would be most appropriate for the task at hand. In consequence, situations have sometimes arisen where employees have been hired whose physical and mental capacities exceed or fall short of the demands of the job, or perhaps worse, potential employees who could have performed specific tasks have been rejected because of failure to meet some ill-defined standard.

Out of these and related considerations has arisen a new approach to the evaluation of potential employees based on the concept of job matching, that is, comparing the functional capacities of the individual against the physical demands of the job. Although the concept is beginning to be appreciated, and the approach applied, there is little in the way of definitive knowledge among those most in need of it. There is, however, an increasing demand in industry, in the teaching institutions and within the health professions for information as to the nature of the concept and the methodology of its application. The sparse literature available is widely distributed in journals about industrial psychology, occupational health, rehabilitation, ergonomics, kinesiology and personnel and human resources research, along with occasional articles in trade and business magazines, and even more esoterically in the limited publications of sundry institutes, government departments and the like.

It is the intent of this book to bring this material together in readable form and to provide an understanding of how to use the methodology in actual practice and what might be expected from its use.

Origins of occupational medical examinations

The earliest known practice of physical examination of the person would appear to have been undertaken by the Ancient Egyptians, as illustrated in their hieroglyphic records. By the time of Hippocrates, who even advocated consideration of potential industrial exposure, it was well established. Knowledge of what happened about physical examinations between the time of the Egyptians and Hippocrates, however, is scant. It is clear that in the 400 years between Hippocrates in Greece and Galen in Rome much of what had been developed was again lost, and that physicians, perhaps like some of their telephone-oriented counterparts today, tended to evaluate the health of their patients in the absence of any direct contact. Indeed, the whole art and practice of medicine largely disappeared into a haze of herbal mysticism on the one hand and barbaric surgery on the other until well into the 15th century when, spurred by new ideas infiltrating from the highly developed systems of Arabic medicine, the great medical schools of Western Europe began to be formed and dispense their new ideas of scientifically based medicine. It took another 50 years, however, for that bizarre genius Paracelsus to appear on the scene and once again orient medical thought to direct observation of nature and the patient, and to insist that the key to evaluation of sickness and health lay in examining the person, and not in mere theoretical speculation. Although despised and ultimately condemned by his peers, his influence has been profound and many of his concepts remain today.

By the end of the 18th century a new influence was making itself felt, this time on the other side of the balance, as it were. The Industrial Revolution, which began in England in the late 1700s, was pulling thousands of previously agricultural workers or minor craftsmen into new and burgeoning industrial workplaces where little concern was felt or expressed for their health, safety or social conditions. The machine was sacrosanct; the worker was expendable. Little or nothing was done to evaluate their fitness for work other than establishing their willingness to do the task demanded and the apparent absence of any limiting disability.

Medical significance of 19th century social reform

The early 19th century in Britain saw the introduction of the British Factory Acts under the direction of the great humanitarian statesmen and industrialists Sir Robert Peel and Robert Owen, along with the physicians Sir John Simon and Thomas Southwood Smith. The Factory Acts, of which there was a series beginning in 1833 and continuing through until 1867, as well as the writings of such authors as Charles Dickens and Charles Kingsley, drew attention to industrial working conditions and mandated at least the beginnings of control programmes. Indeed, by the Act of 1844 the requirement for physcial examinations of workers was initiated in selected industries.

However, despite the undoubted reforms brought about by the Factory Acts, physical examination of the potential worker was still rudimentary, when it occurred at all. Other than in the specific legislated industries, any physical examination tended to be a cursory inspection by the employer or his representative and was largely limited to determining whether a potential worker, impaired or not, appeared to have sufficient capacity to do the job at hand. Furthermore, if a worker became injured or sick because of the nature of his work or working conditions he had no recourse except through the civil courts, a route that was rarely available to an impecunious and out-of-work employee.

Role of social insurance and workers’ compensation

At the end of the 19th century following the development of social insurance schemes by Bismarck in Germany, a new piece of legislation was introduced in Britain which ultimately influenced the entire industrial world, and, perhaps unwittingly, determined the future needs for physical examination of the person. This was the Workmen’s Compensation Act of 1897 which provided for automatic compensation to an injured worker except in the case of wilful misconduct. The original Act was limited in scope to a few industries and situations, but was expanded in 1907 and ultimately became a world model. New Jersey and Wisconsin were the first American states to follow, and Ontario became the first in Canada in 1920. The other English speaking countries, along with Japan, the Scandinavian countries, and ultimately the whole industrial world, developed similar schemes of government funded workers’ compensation or private no-risk insurance until the concept became virtually universal in industrialized countries. Recently the scope of the concept has expanded to include certain occupational sickness as well as injury.

While workers’ compensation acts and equivalent insurance schemes were a great step forward in social legislation, their presence introduced a new and unexpected problem for the worker, and particularly the impaired or handicapped worker. The funds to provide the compensation are derived from a levy on employers based on the relative expected risk of work in a given industry, and the injury record of the specific employer in that industry. Thus, employers with a high injury record are required to pay at a higher rate than employers with a low injury record. Recognition of this differential led some unscrupulous employers in the early part of the 20th century to attempt to exclude from their employment any employee who was impaired, incapacitated in any way, or who had a record of sickness or chronic illness, regardless of whether or not it had or would have any effect on his/her capacity to work. Indeed, the pre-employment physical (medical) examination was initiated in reality for this purpose. Because of the demand on the part of these employers to minimize the financial burden of workers’ compensation, the emphasis of the examination in these situations became one of definition of problems, diagnosis of sickness and incapacity, exclusion of contagious disease, and rejection of all but the fit. As a result, many potential workers who could have made valuable contributions to the work-force were excluded, to become a burden to themselves, their families and the social services.

This approach continued at least for the first few decades of the 20th century, although Mock (1920) showed an early recognition of greater responsibilities when he wrote: ‘Every applicant for work should be thoroughly examined by the medical staff in order to prevent the introduction of contagious diseases into the plant and to provide for the proper selection of work for every man according to his physical and mental qualifications’ (present author’s italics).

Development of systematic health-oriented medical examinations

The beginning and development of World War II from 1939 and into the 1940s, with its concomitant need for fit and healthy members of the armed services, saw a focused entry or re-entry into the civilian work-force of females, as well as workers who were older and less fit. Even then, however, little provision was made for their evaluation. In the case of the military services, at least initially, very little more was required than to be in an eligible age group, without chronic disease or obvious impairment, before some placement could be found, while for civilian work in most cases all that was required was a demonstrated willingness to work.

The American Medical Association was one of the first groups in organized medicine to recognize the need for a systematic approach to physical examinations in industry. In 1944 a special report on such examinations was submitted to the Association’s governing body. In this report it was noted that health examinations should be considered as a means towards achieving the promotion and maintenance of the physical and mental health of workers in industry, and that unjust exclusion from work, or exclusion on doubtful grounds through the improper application of findings from such a health examination, was against public welfare and contrary to sound industrial health principles.

These considerations and others resulted in the formation of the (US) War Manpower Commission, also in 1944, whose role was to plan programmes to use workers effectively through the appropriate allocation of people and skills. During and preceding this period the U.S. Civil Service Commission had made a classification of all disabling conditions and paired these states with compatible positions available in federal employment. The initial classification of these positions ultimately became the Dictionary of Occupational Titles (US Department of Labor, 1977).

The method initially used by the Commission in the implementation of its mandate was to compare each of 493 positions in a Richmond, California, shipyard against a checklist they had devised. The checklist was intended to encompass the type of generic activities that would be encountered in the course of various tasks, and indeed represented the first attempt at defining work activities on the job. The descriptors included definition of the requirements for standing, crouching, sitting, walking, climbing or throwing, as well as sensory demands such as feeling, hearing and colour vision, and the need for speech. No consideration was given at that time however to visual disabilities, nor was any accommodation made for workers in wheelchairs. The checklist was further developed later to include consideration of adverse environments.

Further extension of the concept by the US Department of Labor, as mentioned earlier, led to the analysis of a very wide variety of jobs in terms of strength requirements, ranging from sedentary to very heavy, and including a significant need for climbing or crawling, a significant need for reaching, handling, fingering and feeling, as well as for talking, hearing and seeing.

Definitive work, however, is associated with the name of Dr B.Hanman (1945, 1946, 1948, 1958) at the Kaiser shipbuilding facility in San Francisco and the US Naval Air Station in Alameda, California. In a series of papers beginning over 40 years ago, the importance of which was then underestimated, Hanman pointed out many of the limitations that can arise from the use of the traditional approach to medical (physical) examinations as a means of determining the fitness of a worker to work, and initiated many of the concepts of physical demands analysis and functional capacity assessment which are considered in this text. Hanman’s work is discussed in detail in a later chapter.

It is useful to recognize that Hanman classified the traditional approach in two categories, namely the ‘rating method’ and the ‘disability method’. In the rating method, which is the most common, adjectives and adverbs are used to describe the extent of a person’s ability to undertake activity, such as good/better/best, little/moderate/great, and occasionally/frequently/constantly, or as another example, ‘no heavy lifting’. He notes, however, that while these phrases may have specific meaning to the originator, they may have a different meaning to the employer, or even the patient. Does the phrase ‘no heavy lifting’ mean moderate or little lifting, and if so what is meant by moderate or little. Does it refer to the weight, the frequency, the duration of holding and carrying, or what? Even vaguer examples occur such as ‘fit for light work’, or ‘light duties only’. Indeed, Hanman (1958) points out that according to how one interprets the scale definitions developed by the US Civil Service Commission, a worker classified as ‘fit for little lifting’ could be required to lift 40 lb at a time for 3 h per day, while a person classified as ‘fit for moderate lifting’ would not have to lift more than 15 lb for 3 h, and a person classified for ‘great lifting’ would not have to lift over 45 lb per day.

He describes the disability rating method as occurring when jobs and tasks are defined as being suitable for persons with specific disabilities, such as the absence of a limb, or chronic asthma, in the belief that since disabled persons in any specific disability group are alike in their disabilities they are also alike in their abilities—a belief which of course is erroneous since disabled persons vary in their capacities just as much as those who are not disabled. A second error occurs when a disability group is considered in terms of ‘average’ performance, which ignores the actual capabilities of the individual person. The disability rating method thus accentuates the negative aspects of work capacity instead of determining the positive aspects of the worker’s ability.

Recognizing the limitations of each of these methods Hanman (1958) continues:

Through subjectivity and misunderstanding, the lives of certain persons will be unduly restricted because they avoid activities and others restrict them from activities that they very well could perform with safety. To thousands of people this kind of misunderstanding means the difference between getting a suitable job or not and between living a more enjoyable life of retirement or not. But, still worse, certain other persons will themselves undertake activities, and will be allowed by others to undertake activities, that they cannot perform with physical safety.

Hanman goes on to define what he calls the specific method for medical evaluation which is the foundation of functional capacity assessment, and will be examined later.

Echoing Hanman’s comments, and in the light of her own experience, Slavenski (1986) outlines some of the reasons for failure of the traditional selection process as follows:

• it is not based on an analysis of job requirements;
• rather than being structured and systematic, it is informal and inconsistent, making it difficult to compare and evaluate candidates;
• it may involve irrelevant, and sometimes illegal, questions;
• it allows candidates little opportunity to demonstrate actual skills;
• it may be based on poor observation and documentation and usually relies on the interviewer’s ability to recall complex information about a number of candidates.

Furthermore, as Abt Associates (1984) point out in their study, candidates and their families can be affected economically and emotionally by adverse findings. Workers barred from the workplace by reason of alleged unfitness cannot contribute to the productivity of society, while society may spend substantial sums on rehabilitation, insurance benefits and compensation, based on what may be an inadequate assessment of their capacity to work. Thus, in considering fitness for work, one has not merely to recognize whether an applicant is ‘normal’ or not, but whether in fact an abnormality constitutes an impairment or handicap.

It becomes necessary, then, to define the terms impaired, disabled and handicapped. The World Health Organization in its International Classification of Impairments, Disabilities and Handicaps (WHO, 1980) defined them as follows:

Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function.

Disability: In the context of health experience, a disability is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.

Handicap: In the context of health experience, a handicap is a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfilment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual.

While these definitions may be valuable from a conceptual viewpoint, it is desirable for practical purposes to have a more operationally oriented definition. According to the US Department of Labor Regulations, a handicapped individual is defined as one who:

1. has a physical or mental impairment which substantially limits one or more major life activities;
2. has a record of such impairment;
3. is regarded as having such impairment.

In this connection, physical or mental impairment is considered to mean (a) any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological, musculoskeletal, special sense organs, respiratory, including speech organs, cardiovascular, reproductive, digestive, genito-urinary, haemic and lymphatic, skin and endocrine; and (b) any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities.

The term ‘physical or mental impairment’ is considered to include, but is not limited to, such diseases and conditions as orthopaedic, visual, speech and hearing impairments, cerebral palsy, epilepsy, muscular dystrophy, multiple sclerosis, cancer, heart disease, diabetes, mental retardation, emotional illness and drug addiction and alcoholism.

The term ‘substantial limits’ is considered to refer to the degree that the impairment affects an individual becoming a beneficiary of a programme or activity receiving federal assistance or affects an individual’s employability.

Bearing these considerations in mind it should be recognized that in most industrialized societies management is no longer permitted to discriminate in recruitment, hiring, compensation, job assignment and classification, and fringe benefits, against any applicant for employment on the grounds of impairment, or because the applicant’s condition might lead to a shortened working life, premature retirement on grounds of disability, early death, or a drain on a life insurance programme, or excessive need for medical care in the workplace. As will be discussed later, the employer in fact is required to make ‘reasonable accommodation’ on behalf of such applicants unless it can be demonstrated that the accommodation would impose an undue hardship on the employer. Indeed, again in the more advanced jurisdictions, not only do all testing procedures need to be job related, but pre-placement examinations must also be oriented to the job or jobs available.

Job matching

From the foregoing then it must become evident that some form of specific job matching is desirable for the needs of both society and the worker. As a member of the Ontario Human Rights Commission has remarked (Ramanujam, 1988):

To this day, some employers seek to establish an extensive profile on individuals, especially in ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Preface
• Chapter 1: History and development
• Chapter 2: Traditional approach to medical examination
• Chapter 3: Job evaluation and analysis
• Chapter 4: Physical demands analysis
• Chapter 5: Physical abilities analysis
• Chapter 6: Functional capacity assessment
• Chapter 7: Accommodations, restrictions and the handicapped
• Chapter 8: Job matching
• Chapter 9: Some legal considerations
• Appendix A: Physical demands job analysis
• Appendix B: Rating schemata for WCAM/WPAM analyses
• Appendix C: Physiological and biomechanical techniques for work capacity measurement
• Appendix D: Physical demands and work capacity
• Appendix E: GULHEMP Scale
• References and bibliography
• Glossary