Questions and Answers: EPIC Lift Capacity (ELC) and ELC Certification

Questions

  1. How do I become certified?
  2. How is quality control for the EPIC Lift Capacity maintained?
  3. Why is an EPIC Lift Capacity site license necessary?
  4. Why is it necessary to buy equipment rather than make my own?
  5. Why is it necessary to get training and certification?
  6. Why is it necessary to become certified?
  7. On pages 69–71 of the manual, the case example of Mary Smith is curious to me. Everything seems to fall in line except the fact that her performance on ELC 2 is less than on ELC 3. Because ELC 3 incorporates ELC 2, one would expect this lift to be similar, if not greater, due to the range of movement being less in ELC 2. Do you see this as an inconsistency? If so, where would this be documented in the data sheet? It looks as if full effort was given based on the indicators of “+” on all three lifts.
  8. You mention that the ELC is the weight utilized to compare with the PDC chart. Was the PDC chart based off a full ROM or the floor to knuckle lift? Many systems base this off the floor to knuckle lift which in my estimation should be higher than the ELC 3 lift. What is the origin of the PDC chart?
  9. The ELC comes with 120 lbs of weight. What do we do in situations that the indicators are met and we have run out of weight?
  10. You indicate that a 25% increase in HR is suggestive of full effort on page 48 of the training manual. Is there a place to note the pre-subtest HR on the evaluation form for documentation? It seems like recording the HR pre-subtest would be better since you need to do the math to find out if max effort is given. I believe I read at one time in one of your papers that a 50% increase from resting standing HR was indicative of maximal effort and that less than 25% increase was indicative of sub maximal effort ( those giving 50% effort during testing per instructions). I have tried to follow the 50% increase rule but few people achieve this on a consistent basis that I believe to be giving full effort via other indicators such as biomechanical overload, grip strength testing etc. What supportive information should I refer to regarding the 25% increase in HR?
  11. On page 79, the 3rd paragraph indicates a PDC level of Medium for Mr. Doe. Mr. Doe lifted 80 lbs occasionally, which qualifies for Heavy (although not through the full spectrum) and 50 lbs frequently, which qualifies for Heavy. Could one clearly indicate that this patient meets the Heavy PDC level up to 80 lbs? What is the correct way to use the PDC chart?
  12. The test provides for lifting up to 120 lbs but the scoring sheet and some of the computer programs only go up to 100 lbs. How is this addressed? One evaluee met all safety checks at 100 lbs on ELC 5 (it is interesting that he did more on frequently than on his occasional). I have found that people start to get warmed up and they exceed their occasional lifting. Should I then record their occasional higher because they demonstrated a higher lift capacity in an ELC subtest (4-6)? It would not be logical to record them being able to do more frequently than occasionally.
  13. When do you record HR? Many times the HR climbs 5–10 sec after the effort that may exceed the 85%. If taken immediately after the test then the HR may be within acceptable guidelines.
  14. Upon retest, one person asked if he could wear a wrist support. He feels that if he could wear one, he would have less forearm strain and would be more comfortable. Is this acceptable for testing healthy patients? Is it acceptable for injured patients?
  15. 3 out of 4 people indicated they were feeling forearm strain, hindering their ability to lift. This occurred as early as ELC 3 and continued through ELC 4-6. Have you encountered this problem?
  16. I have noticed, particularly with females, that foot stance starts in high-risk work style 3 and ends up in 1. What do I make of this and how should I make corrective remarks? I intervened and explained what the ideal position would be and why and an effort was made to correct the high risk work style successfully.
  17. Do you correct for lifting in a kyphotic manner or do you just note it? I explain the ideal lifting technique when I see this occurring and explain why. Current thinking would suggest that kyphotic lifting is stressful to the spine, but I find no evidence of its predictive ability for injury.
  18. Question #33 on the EPIC health questionnaire is unclear to me. Some people find it difficult to find time to perform regular exercise. I am not sure whether the intent of the question is to include these people or whether it is to focus on people who have COPD or Fibromyalgia/chronic fatigue syndrome that can’t perform regular exercise.
  19. On ELC 4-6, do you ask the evaluee “can you do this 8–12 X per day?” I was thinking that this was only for the occasional lifting. Where would I find that 4 lifts in 30 secs is a frequent lift? Is this a NIOSH standard, DOT?
  20. Can you assist me with suggestions of a protocol for a carrying test? Can these be replaced or assessed from any Hanoun or EPIC results? What correlation does the Hanoun Static Pushing/Pulling testing have to dynamic lifting?

Answers

All responses by L. N. Matheson, PhD

1. How do I become certified?

Certification requires that you complete a one-day training course on use of the EPIC Lift Capacity, pass a written exam, and perform 5 test-retest exams on healthy volunteers using site-licensed equipment. The training workshops are offered frequently in various locations throughout the United States and Canada.

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2. How is quality control for the EPIC Lift Capacity maintained?

First, EPIC has a United States patent for the “evaluation of the work capacity of injured people” that covers the EPIC Lift Capacity. This patent is enforceable in Canada, the United States, Mexico, Europe, Australia and Japan. Second, if an equipment maker wants to use the EPIC Lift Capacity, it must reach an agreement with EPIC to do so. EPIC receives a license fee from the manufacturer. Without such a contract, use of the EPIC Lift Capacity is illegal.

The legal equipment manufacturers are BTE Technologies, ERGASYS, and Advanced Therapy Products. Through their equipment manufacturers, EPIC Lift Capacity purchasers are provided a site license that allows legal use of the EPIC Lift Capacity at their clinic, just like computer software is licensed. These agreements require that all EPIC Lift Capacity users become formally trained and certified.

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3. Why is an EPIC Lift Capacity site license necessary?

To provide quality control by limiting the EPIC Lift Capacity to be used only with equipment that is standardized. If an EPIC Lift Capacity provider in your area is not site licensed, contact EPIC and be sure to inform your referrers that this is not an acceptable standard of practice.

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4. Why is it necessary to buy equipment rather than make my own?

For several reasons. It is difficult to standardize equipment over several sites, which would limit the inter-rater reliability that has been established for the EPIC Lift Capacity. It is risky for the evaluee, in that a fracture in a handle or an unstable shelf can cause injury. It is also risky for the evaluator. If an injury occurs using nonstandard equipment, the plaintiff’s attorney will make that an important point of criticism.

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5. Why is it necessary to get training and certification?

Training and certification assures all clients that their evaluator is competent to perform this evaluation. Training and certification also assures purchasers of EPIC Lift Capacity services, such as physicians, attorneys and insurance carriers that the evaluator will provide a professional level of service. I also provides the evaluator his or her first line of defense in the event that a professional liability lawsuit is filed. Evaluators who cannot prove that they are competent to perform an evaluation are in difficult straits if a lawsuit were filed.

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6. Why is it necessary to become certified?

It is an important step in quality control. Evaluators routinely report that the first few times they administer the EPIC Lift Capacity, they are unsure of themselves and find it quite challenging. It is best for this to occur during the certification process with properly screened healthy volunteers, so that by the time a real client is tested, the evaluator’s skills are up to par. Also, thus far, no EPIC Lift Capacity certified evaluators have had their certificates revoked. However, it is possible for EPIC to do so, which serves to assure all of us who depend on the excellent reputation of the EPIC Lift Capacity that others who use it will not abuse it and cause difficulties for the rest of us.

If an EPIC Lift Capacity provider in your area is notcertified, contact EPIC and be sure to inform your referrers that this is not acceptable.

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7. On page 69–71 of the manual, the case example of Mary Smith is curious to me. Everything seems to fall in line except the fact that her performance on ELC 2 is less than on ELC 3. Because ELC 3 incorporates ELC 2, one would expect this lift to be similar, if not greater, due to the range of movement being less in ELC 2. Do you see this as an inconsistency? If so, where would this be documented in the data sheet? It looks as if full effort was given based on the indicators of “+” on all three lifts.

On page 69, the example of Mary Smith is based on an actual case and reflects an over-restriction in subtest No. 2. Although you will not find this when you test your healthy normal subjects for the certification program, anomalies such as this are not rare when persons have symptoms such as hers, especially on the first occasion of testing. She probably perceived the subtest No. 2 and subtest No. 5 as more challenging or more risky than subtest No. 1 or subtest No. 3, etc. Her performance on subtest No. 3 is unexpected for two reasons. First, it contains the range of subtest No. 2; in most cases the maximum acceptable weight on subtest No. 2 is an upper limit on subtest No. 3. Perhaps of more significance, subtest No. 3 relies on the ability of the evaluee to transition from one Isoinertial lifting segment to another. This transition itself is significant from a neuromuscular standpoint, requiring adjustments in posture and balance. The fact that she was able to achieve 30 pounds on subtest No. 3 tells me that she should achieve 30 pounds on subtest No. 2. Because she did not, stopping at 20 pounds on subtest No. 2, this is what I would begin working on in therapy. She may have an actual weakness due to guarding in the lumbar extension musculature, or she may simply be over protecting based on what she has been told by her physician, previous therapists, and others. Note that in the accompanying report, paragraph 2 describes symptoms that probably first came up in subtest No. 2 and may have been frightening to her, or at least a reminder of the injury. One of the key skills of an excellent therapist is to assist patients to learn when they are over protecting themselves. Using a test that is as safe as the ELC greatly facilitates this process.

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8. You mention that the ELC is the weight utilized to compare with the PDC chart. Was the PDC chart based off a full ROM or the floor to knuckle lift? Many systems base this off the floor to knuckle lift which in my estimation should be higher than the ELC 3 lift. What is the origin of the PDC chart?

The Physical Demand Characteristics of Work chart assumes a full vertical range from floor to shoulder. You are correct that the floor to knuckle lift is inherently greater than the full range lift. This has been demonstrated in all ergonomics research and is integrated in the NIOSH Action Limit approach. It is also found with the ELC normative data presented in the Examiners Manual. Look at the normative data in appendix E, compared with appendix F. Subjects are able to lift a much greater proportion of their body weight in subtest No. 2 than in subtest No. 3. Also look at the normative data presented in any of the peer reviewed published studies on the ELC. When we develop the ELC we had been using the West Standard Evaluation (WSE) for many years, a test that I developed in the late 1970s. The WSE was designed to provide information about the person’s ability to lift that would be specifically linked to the PDC chart. I originated the PDC chart in the mid-1970s based on the Handbook for Analyzing Jobs (1973) published by the United States Department of Labor. The original version of the chart had eight levels with transition levels from sedentary to light and from light to medium and from medium to heavy. In the first chart, I also included the range of MET levels based on energy expenditure studies performed by others describing typical energy expenditure of various jobs. I did a crosswalk from these jobs to the PDC chart, with the assistance of the Dictionary of Occupational Titles. Later versions of the chart contained only the five main levels but have had almost no adjustment to the energy expenditure ranges. Additional research has borne out the estimates developed many years ago. The ELC was designed to link subtest No. 3 and subtest No. 6 to the PDC chart. Research that we have done substantiates this link. For example, when you do the certification testing, one of the items in the questionnaire for each of your subjects is the Job Demands Questionnaire. Over the years, we have monitored the relationship between subjects’ scores on the ELC and their responses to the JDQ. Consistently, the relationship between Subtest No. 3 and Subtest No. 6 and the subject’s job demands has been borne out, assuming their performance on the ELC should demonstrate adequacy for their job demands.

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9. The ELC comes with 120 lbs of weight. What do we do in situations that the indicators are met and we have run out of weight?

The ELC was designed to link subtest No. 3 and subtest No. 6 to the PDC chart. Thus, the maximum weight in the test is 120 pounds, and most manufacturers limit the amount of weight provided to 120 pounds. Do not test the person’s ability above this level with the ELC.

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10. You indicate that a 25% increase in HR is suggestive of full effort on page 48 of the training manual. Is there a place to note the pre-subtest HR on the evaluation form for documentation? It seems like recording the HR pre-subtest would be better since you need to do the math to find out if max effort is given. I believe I read at one time in one of your papers that a 50% increase from resting standing HR was indicative of maximal effort and that less than 25% increase was indicative of sub maximal effort ( those giving 50% effort during testing per instructions). I have tried to follow the 50% increase rule but few people achieve this on a consistent basis that I believe to be giving full effort via other indicators such as biomechanical overload, grip strength testing etc. What supportive information should I refer to regarding the 25% increase in HR?

Using HR is difficult because it is subject to many factors. I include it in support of my opinion on global effort rating, but usually don’t do precise calcs. If the test is being videotaped for trial testimony, I’d do precise calcs, but what I usually do is monitor the HR and factors it in. Remember that the evaluator’s judgment has been shown to be the best indicator of full effort, so don’t get caught up in relying on a simple phys measure.

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11. On page 79, the 3rd paragraph indicates a PDC level of Medium for Mr. Doe. Mr. Doe lifted 80 lbs occasionally, which qualifies for Heavy (although not through the full spectrum) and 50 lbs frequently, which qualifies for Heavy. Could one clearly indicate that this patient meets the Heavy PDC level up to 80 lbs? What is the correct way to use the PDC chart?

The PDC chart defines all jobs in each category as requiring the minimum listed per frequency. Since he doesn’t meet the min, you’d need to drop back to the lighter level or qualify the recommendation. I prefer the former approach.

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12. The test provides for lifting up to 120 lbs but the scoring sheet and some of the computer programs only go up to 100 lbs. How is this addressed? One evaluee met all safety checks at 100 lbs on ELC 5 (it is interesting that he did more on frequently than on his occasional). I have found that people start to get warmed up and they exceed their occasional lifting. Should I then record their occasional higher because they demonstrated a higher lift capacity in an ELC subtest (4-6)? It would not be logical to record them being able to do more frequently than occasionally.

No, record only what you oberve. Be sure you are adequately warming up your evaluees.

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13. When do you record HR? Many times the HR climbs 5–10 sec after the effort that may exceed the 85%. If taken immediately after the test then the HR may be within acceptable guidelines.

Wait until HR peaks after the cessation of each lift. This is described in the training.

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14. Upon retest, one person asked if he could wear a wrist support. He feels that if he could wear one, he would have less forearm strain and would be more comfortable. Is this acceptable for testing healthy patients? Is it acceptable for injured patients?

This is acceptable for either.

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15. 3 out of 4 people indicated they were feeling forearm strain, hindering their ability to lift. This occurred as early as ELC 3 and continued through ELC 4-6. Have you encountered this problem?

Each lift will be limited by the weakest biomechanical segment; these peoples’ most-limiting BM segment is their forearms. I’m a bit concerned about “hindering their ability to lift.” Isn’t this just a normal and acceptable limitation, or do these people have something to prove?

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16. I have noticed, particularly with females, that foot stance starts in high-risk work style 3 and ends up in 1. What do I make of this and how should I make corrective remarks? I intervened and explained what the ideal position would be and why and an effort was made to correct the high risk work style successfully.

Follow the procedures carefully. Look in the Manual and in the audio/ PPT presentation for clarification.

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17. Do you correct for lifting in a kyphotic manner or do you just note it? I explain the ideal lifting technique when I see this occurring and explain why. Current thinking would suggest that kyphotic lifting is stressful to the spine, but I find no evidence of its predictive ability for injury.

Don’t correct for a normal lifting technique for a person unless you judge from your training and expertise that it is likely to be harmful. If you believe that it is likely to be harmful, you cannot suspend your expertise, because it’s always “Safety First.” The ELC prootocol doesn’t require you to correct for kyphosis. The evidence does not support lifting injuries due to kyphosis in otherwise healthy people.

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18. Question #33 on the EPIC health questionnaire is unclear to me. Some people find it difficult to find time to perform regular exercise. I am not sure whether the intent of the question is to include these people or whether it is to focus on people who have COPD or Fibromyalgia/chronic fatigue syndrome that can’t perform regular exercise.

Use this as an indicator of likely fitness.

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19. On ELC 4-6, do you ask the evaluee “can you do this 8–12 X per day?” I was thinking that this was only for the occasional lifting. Where would I find that 4 lifts in 30 secs is a frequent lift? Is this a NIOSH standard, DOT?

Yes, for every lift. NIOSH is a good reference for this. DOT is not focussed on frequency as this is defined, only on percent of the workday, which is not physiologic.

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20. Can you assist me with suggestions of a protocol for a carrying test? Can these be replaced or assessed from any Hanoun or EPIC results? What correlation does the Hanoun Static Pushing/Pulling testing have to dynamic lifting?

The Cal-FCP integrates the ELC with a good carry test. Visit epicrehab.com to purchase the ToolKit, which has the Cal-FCP video and protocol at no extra charge. The relationship between IM strength and lift capacity is weak but significant for vertical pulls only, not for horizontal push or pull. For the latter, there is no dependable relationship.

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