THE LOWER EXTREMITY FUNCTIONAL SCALE (LEFS) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

In Workers’ Compensation, Doctors and Medical Evaluators, in order to address matters of disability and impairment, frequently use testing. Testing can be in the form of self-reporting questionnaires filled out by Injured Workers.

Many Injured Workers have injuries to their lower extremities.  Lower extremity injuries can include the hips, knees, ankles and feet.

This article will describe the Lower Extremity Functional Scale (LEFS), what the questions are asked, how it is scored, and what it means to an Injured Worker.

What is the Lower Extremity Functional Scale?

“The Lower Extremity Functional Scale (LEFS) is a questionnaire containing 20 questions about a person’s ability to perform everyday tasks.” Honorhealth.com

What is the Purpose of the LEFS?

“The LEFS can be used by clinicians as a measure of patients’ initial function, ongoing progress and outcome, as well as to set functional goals. The LEFS can be used to evaluate the functional impairment of a patient with a disorder of one or both lower extremities. It can be used to monitor the patient over time and to evaluate the effectiveness of an intervention.” Honorhealth.com

How Are You to Answer the Questions?

When provided the LEFS, there is language on the form. It provides as follows: “We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please provide an answer for each activity.”  Honorhealth.com

“Today, do you or would you have any difficulty at all with:”

What Are the Activities That Are to Be Assessed?

There are twenty activities that are to be addressed within the LEFS:

Usual work, housework or school activities

Usual hobbies, recreational or sporting activities.

Walking between rooms

Getting into or out of the bath

Walking between rooms

Putting on shoes or socks

Squatting

Lifting an object, like a bag of groceries from the floor

Performing light activities around a home

Performing heavy activities around a home

Getting into or out of a car

Walking 2 blocks

Walking a mile.

Going up or down 10 stairs (about 1 flight of stairs)

Standing for 1 hour

Sitting for 1 hour

Running on even ground

Running on uneven ground

Making sharp turns while running fast

Hopping

Rolling over in bed

How Are the Questions Answered?

The questions are answered with respect to a level of difficulty.  The levels of difficulty are as follows: extreme difficulty or inability to perform activity, quite a bit of difficulty, moderate difficulty, a little bit of difficulty, and no difficulty.

How Is It Scored?

Each level of difficulty is assigned a number from 0 to 4.  The range being from “O” for being extreme difficulty or inability to perform to “4” being able to perform with no difficulty.

Extreme Difficulty or Unable to Perform Activity (0)

Quite a Bit of Difficulty (1)

Moderate Difficulty (2)

A Little Bit of Difficulty (3)

No difficulty (4)

What Is the Total Score?

The total score can range from 0 to 80.  The lower the score implies the greater the disability.

How Can This Scale Be Used in Workers’ Compensation?

In California, the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition, employs the use of “activities of daily living” (ADL) to address impairment.   “Activities of daily living” include the following items

Per the AMA Guides 5th Edition, Table 1-2, See Page 599, the following are the definitions of each ADL. These ADLs include standing, sitting, walking, climbing stairs, lifting, dressing oneself and bathing.

Thus, the LEFS may assist doctors and examiners as to the nature and extent of the injury’s impact on the ADLs.   The ADL assessment can impact the assignment of the permanent impairment number.

Are There Any Concerns with Respect to LEFS?

The LEFS presents problems with respect to workers’ compensation.

First, the scale is to be filled out with respect to the individual’s perception as of the day of the evaluation.  Thus, if someone’s condition gets worse during the day from prolonged weight bearing, their answer in the morning may be different from that in the afternoon. Likewise, there is the issue of the Injured Worker having good days versus bad days. Further, there is the issue of whether the assessment is made with respect to one being medicated or not.  For example, an Injured Worker may be able to perform well on activities while on narcotics but have problems without.

Second, the scale may be used for credibility issues.  Since the scale documents activities on a particular day, contemporaneous sub rosa film may show the Injured Worker performing activities either consistent or inconsistent with their answers.

Third, the scale asks a “would” question concerning the activities.  To some extent, the Injured Worker is being asked to speculate as to their ability to perform certain functions.  In workers’ compensation, speculation cannot be used as a basis for an award and is therefore problematic.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for over 28 years. Contact us today for more information.

 

NURSES: DOES YOUR WORKING SHIFT MATTER?  MUSCULOSKELETAL INJURIES, SHIFT CHOICE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Nurses are at risk for work-related musculoskeletal injuries (WMSD.)  A study addressed whether a Nurse’s Work Shift impacted WMSDs.

This article will discuss Nursing, Nursing Shifts, and how particular Shift Work may impact industrial injuries.

What Are Nursing Duties? What Makes Nurse at Risk for Injury?

Nursing Duties are physically demanding.  Patient care can require individuals to work in awkward positions and deal with individuals whose weight can shift at any moment.

“WMSDs(work-related musculoskeletal disorders) in nurses are mainly caused by shifting patients (which includes helping patients turn over or get in and out of bed), routine treatments in nursing, poorly designed work environments, and remaining active for prolonged periods of time.4 The physiological loads created by these nursing activities are all risk factors of WMSDs in nurses.” Chang WP, Peng YX. Differences between fixed day shift nurses and rotating and irregular shift nurses in work-related musculoskeletal disorders: A literature review and meta-analysis. J Occup Health. 2021 Jan;63(1):e12208. doi: 10.1002/1348-9585.12208. PMID: 33682989; PMCID: PMC7938703.

Likewise, “cllinical nurses must deal with daily routine work in busy wards, patient care and treatment, and correspondence for various matters. Their jobs are time‐consuming, complicated, and full of stress, and they are often on tight schedules, all of which are associated with WMSDs.” Supra.

What Musculoskeletal Body Parts Do Nurses Injure?

Nurses are susceptible to injury for every body part imaginable.   This includes the neck, shoulders and back.

Nurses are prone to WMSDs in the lower back, shoulders, neck, back wrists, knees, and ankles. Supra.

What are Shifts?

Hospitals and other medical facilities provide 24 hours a day service for 7 days a week.  Thus, the facilities have various work shifts.  Some facilities may have 8-hour shifts, some 10-hour shifts, and others 12-hour shifts.    

What Shifts are There?

Within an 8-hour format, there is generally a morning shift, an evening shift, and an overnight shift.

How Do Nurses’ Shifts Vary?

Nurses can have regular fixed shifts.   Also, there are Nurses who have rotating or irregular shifts.

What was the Study About?

The study focused on Nurses who worked rotating and irregular shifts. The theory of the study was that “working rotating and irregular shifts, which causes the physiological burden of disrupted circadian rhythms in the body, may also exacerbate muscle tension and pain.” Differences between fixed day shift nurses and rotating and irregular shift nurses in work-related musculoskeletal disorders: A literature review and meta-analysis. J Occup Health. 2021 Jan;63(1):e12208. doi: 10.1002/1348-9585.12208. PMID: 33682989; PMCID: PMC7938703.

What Were the Results?

The study “indicated that RS (rotating shifts) + IS (irregular shifts) nurses are more likely to experience back pain associated with WMSD than are FDS (fixed day shift) nurses.”  Differences between fixed day shift nurses and rotating and irregular shift nurses in work-related musculoskeletal disorders: A literature review and meta-analysis. J Occup Health. 2021 Jan;63(1):e12208. doi: 10.1002/1348-9585.12208. PMID: 33682989; PMCID: PMC7938703.

In sum, Nurses working irregular shift are more likely to experience musculoskeletal disorders.

As a Lawyer, Are There Any Reasons That May Cause the Higher Rate?

In my opinion, irregular shifts can include irregular routines.  Nurses who have regular shifts may have better understanding of their shift’s physical requirements.   Also, they may be more familiar with their surroundings.   Thus, they are able to take better precaution to prevent injury.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for over 28 years. Contact us today for more information.

KNEE AND HIP INJURIES, OSTEOARTHRITIS, AND WORKERS’ COMPENSATION: PHYSICAL ACTIVITIES AS RISK FACTORS FOR WORK INJURIES: WHAT YOU NEED TO KNOW

There is no requirement that the causes of a work injury has to be 100 percent industrial.

There are some medical conditions that can have a work-related component to them.  In other words, they are only partially caused by job duties.   Osteoarthritis (OA) can be that type of industrial injury.  OA is a common form of arthritis that can impact a variety of parts of the body.  The parts of the body OA can impact includes the knees.

This article will discuss OA , who Treats OA,  and how OA can be work-related.

What is Osteoarthritis?

Per the CDC, “Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees.”

“With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. OA can cause pain, stiffness, and swelling. In some cases,  it also causes reduced function and disability; some people are no longer able to do daily tasks or work.”

Note:  The term degenerative joint disease is a term that is frequently used.   It is commonly abbreviated to DJD.

What Are the Symptoms of OA?

Symptoms of OA can include pain or aching, stiffness, decreased range of motion, and swelling. CDC.

Who Treats OA, and What Treatments are Available?

OA is an interesting medical condition in that there are two medical specialties that can address the condition.   The two types of doctors are Orthopedists and Rheumatologists.

Orthopedists focus on the bones and the joints.   They can prescribe medications and perform operations.

Rheumatologists focus on internal medicine matters.  They can prescribe medications and prescribe non-surgical treatments.

How Is OA Work-Related?

OA is work-related with respect to some activities.   According to one study,  A synthesis of 69 studies from 23 countries yielded strong and moderate evidence for lifting, cumulative physical loads, full‐body vibration, and kneeling/squatting/bending as increasing the risks of developing osteoarthritis (OA) in men and women.”  Strong and moderate evidence existed for no increased risk of OA related to sitting, standing and walking (hip and knee OA), lifting and carrying (knee OA), climbing ladders (knee OA), [and] driving (knee OA.)” Men and Women’s Occupational Activities and the Risk of Developing Osteoarthritis of the Knee, Hip, or Hands: A Systemic Review and Recommendations for Further Research, Monique A.M. Gignac Emma Irvin Kim Cullen Dwayne Van Eerd Dorcas E Beaton Quenby Mahood Chris McLeod Catherine L. Backman 14 February 2019, https://doi.org/10.1002/acr.23855

Note: thus, there are activities that can increase the risk of OA and other activities which are not a causative risk factor.  Thus, an analysis of one’s work activities is important when considering to file a claim.

What is the Legal Theory for Industrial Causation?

An Injured Worker must prove that their work activities contributed to the development of the disease. South Coast Framing, Inc. v. Workers’ Comp. Appeals Bd. (2015) 61 Cal.4th 291 [188 Cal.Rptr.3d 46, 349 P.3d 141].)

What is the Analysis?

The fact that one engages in certain injurious activities does not guarantee a valid claim.  A medical opinion is required. Such a medical opinion should include a medical examination, testing, review of medical records, review of one’s past medical history, and an analysis of the physical activities the worker engaged in at work. .

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

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