In 2004, a major automotive industry company contacted BTE Technologies to develop a reliable and non-discriminatory method for screening candidates, to determine if they were physically fit to perform work in which they have been employed in the automotive company. The company identifies six manufacturing plants to develop the Physical Assessment Test (PAT).” The plant which pre-employment testing was employed was in the Midwest United States in both urban and suburban areas of the plant” (Franzblau, 2004).
In 2006 a new Automotive Manufacturing Plant (AMP) was built and this AMC (automobile manufacturing company) was to hire new workers for the new plant in the Midwest of the USA. Approximately 3169 potential new employees were tested with the PAT between 2003 and 2006, in the number, consists of 113 transferred employees who had already worked for the company before-let call them D-; plant D subjects did not undergo PAT pre-employment testing. Plant D subjects were given a physician-administered history and physical and a six-panel urine drug testing with a brochure, and literature of correct lifting and operation hazards with incorrect postures on the job also a 2-week work hardening and work simulation program on-site at the new plant. “The age of the workers who underwent PAT pre-employment testing was between 18 years and 70 years” (Borofsky & Smith 1993).
Workers were scheduled to take a medical questionnaire at the new company upon arrival, an Informed Consent document was signed after a valid form of identification. A plant physician-administered history and a basic physical before the physical testing which included blood tests, hypertension, and blood pressure tests, and urinalysis tests (drug tests). These tests were performed to determine if the worker is capable to perform the work as per the contract between the two parties. In addition, to rule out any previous medical condition the worker has suffered in the past. Some workers were excluded from the physical test due to medical considerations including post-surgical and a history of significant heart disease. “The test was carried out and approximately 10.5% and 8.4% of the women in this study failed to meet the criteria necessary for a safe administration of the test.” (Graham 2008).
Before the test, the Human Resource Departments in the automotive company which had information for the workers transferred to the new plant: supplied injury statistics, departmental job titles, and descriptions of jobs and workstations in the plant. An independent contractor of a national rehabilitation company which included trained physical therapists, athletic trainers, occupational therapists, certified occupational therapists performed plant-wide workplace assessments to determine the essential job tasks and job demands of each worker in several of these automobile plants before testing. This information was collected and manually entered into a database of the testing equipment which was the BTE (Baltimore Therapeutic Equipment).
The auto manufacturer decided the testing protocol be automatically constructed with tests utilizing the BTE program. This included 17 different physical demand requirements which encompassed several areas specifically related to the job tasks of the automobile workers. The testing assessed every worker to determine the individual capability to perform the job demands with reasonable equivalence. Secondly, the testing goal ensured that the potential employee could perform the job duties for which they are being employed. Several tests included areas that copy both fine motor and gross motor assembly-type jobs. A specific order was given for each test component; to allow consistency between the tasks.
All tests were conducted using the Baltimore Therapeutic Evaluation and Rehabilitation System Tests (BTE):
- Seven tests required the application of force for three seconds and were repeated three times.
- Hand Grip- position 2- using the Jamar dynamometer of the BTE the wrist in a neutral position
- Hand Grip- position 2- Jamar with the hand position is in a supinated position
- Hand Grip- Position 2-Jamar with hand position –Jamar in a pronated position.
- Hand Grip-Position 3-JaMAR IN Neutral position
- Key Pinch Grip
- Tip Pinch
- One Thumb Press
- Two thumb press
- Push Strength- Hands Neutral
- Push strength –Hands Pronated 90 degrees
- Pull Strength-Hands Neutral
- Pull Strength-Hands Pronated 90 degrees
- Static Knuckle Height Lift
- Dynamic Lift 1 – Up to 40 lbs. with 3 repetitions
- Dynamic Lift 2- Up to 75 lbs. with 1 repetition
- From Upper-Level Reach (time-motion based positional Tolerance )
- From Stoop with 36-inch Horizontal Displacement Reach (Time –motion-based positional tolerance).
Dynamic lift assessments included a rest period of 15 seconds between each weight interval. Dynamic lifts i.e. lift #2 required one lift of each weight interval, commencing with a weight of fifty pounds and incremental of five pounds until a final weight reached seventy-five pounds was achieved for the lift.
Tests such as #16 and #17 items were included with the utilization of the Functional Range of motion (FROM) test. The test is a sub-component of the BTE testing equipment. This assessment puts the worker through a series and motions which are similar to activities that are replicated by their job. A portion of the Upper-Level Reach test includes an anthropometric component modification which appears to have a similar carryover to actual jobs on the assembly line. Job cycle timings which copy cycle time as seen with productivity is taken into consideration with this test and the subject is rated with these Method –Time- Measurements (MTM)
Throughout the test, the workers wear a “Polar Heart Rate Monitor” strap which allows the evaluator to monitor the subject’s heart rate. The strength portion of the testing includes a loading format which is performed closer to the end of testing to determine the endurance of the worker when performing repetitive activities.
Standardization for Testing
All workers tested were provided instructions for each test component. Instructions for each test component were taken from the BTE-ER system and protocol booklet. Instructions were given verbally and a verbal acknowledgment by the worker understood the instructions. The worker is shown the correct postures before the test component with a demonstration by the evaluator. However, body postures are not corrected during the testing. Self-selecting postures may influence testing results.
There were special procedures for isometric testing which allowed retrials on test components. Retrials were given to the worker if they perform an error, such as losing grip on the handles of the BTE, the worker starts before being told to do so.
Each individual was screened for resting heart rate and blood pressure. The highest was identified at 149/94 which resulted in 15 workers being eliminated from the testing procedure.
Hand Grip Testing
Strength testing of the wrist and hand was obtained by the Jamar Grip Dynamometer. The Jamar dynamometer was set at position 2 (second rung from the smallest handgrip position) with the cord and transducer from the BTE upright. The test was conducted with the working in a standing position with wrists in a neutral posture. Three repetitions were performed bilaterally. Workers squeezed the Jamar dynamometer for three seconds and a rest break was given of 5 seconds between each repetition. The second-hand grip test was using the Jamar dynamometer using the same setting, however, the test was conducted with the worker standing and holding the Jamar dynamometer with their wrist pronated. Three repetitions were performed bilaterally with 5 seconds between each repetition. Position three for Jamar Dynamometer grip testing used position 3 rungs from the smallest handgrip position. The same instructions were given to the worker as the two previous tests.
Utilizing the Pinch Grip Jamar Dynamometer the worker was tested in the standing position, wrist neutral holding the dynamometer using the key pinch grip also known as the lateral pinch. Three repetitions were given bilaterally with the 5-second break between repetitions. The test continued with testing the worker’s pinch grip using the pinch tip test. The operator held the dynamometer standing with wrist neutral. Three repetitions were given with 5-second rest breaks.
Tip pinch testing was conducted with the worker standing with the wrist in a neutral position, holding the dynamometer using a tip pinch grip. Three repetitions were performed with the left hand and then repeated on the right upper extremity. The test is performed by holding the pinch dynamometer and pressing it between the pad of the tip of the thumb and the pad of the tip of the index finger. “Testing is performed for three seconds on each extremity with five-second breaks between each repetition” (Harley 2004).
Knuckle Height Lift
The knuckle height lift test uses the UTM with box handles. The box handles are set to 8 inches from the center of the UTM machine with its handles in a neutral position. “The worker pulls up on the device to mimic lifting tasks. The test is repeated three times with 5-second rest breaks” (Harbin & Olson 2005).
Dynamic lifting measures individuals lifting strength with movement, the test used the Focus evaluation device; this device has a lower shelf that held a crate and weights. The lower shelf was set at 50 inches. The test started with the weight of 10 pounds with increments of 10 pounds until the final weight of 40 pounds is reached. The worker performs this test three times lifting for each weight increment. The weight is lifted from the lower shelf to the floor and back to the shelf, the heart rate was monitored and captured through the BTE software throughout the lifts and two minute recovery period is captured following completion of the test, Indication of biomechanical concerns is noted by the evaluator. During this test the worker is required to lower the crate from the shelf to the floor and then repeat picking the box from the floor to the shelf, the weights are added and the lifts are repeated until 40lbs is achieved.
The next level of lift test starts with 50 lbs increments of 5 lbs until a final weight of 75 lbs is achieved; the weight was lifted as with the same procedure with the crate being lifted from the shelf to the floor and back then back to the shelf. “The worker wore a heart rate monitor which captured heart readings through the use of Focus software throughout the lift test, and Biomechanical concerns were documented in the software program” (Jackson 1994).
Upper-Level reaching was tested utilizing the BTE functional range of motion system, the worker raise their feet flat on the floor: arms and fingers were extended to the highest level of the test apparatus while both feet remain flat on the floor. The highest row that was reached with the distal tip of the middle finger and exceeding the top of the peg hole was used as the highest row. The test requires the worker to take the peg out of the hole with the left hand, and then transfer it to the right hand while the peg is out of the hole, and then place the peg into the corresponding hole with the right hand. The test continued with the worker moving from the lowest level row. When the fifteen pegs are moved the process was repeated in reverse order until all fifteen pegs are restored to their original positions. This constituted the completion of one cycle, the test was concluded when a total of five cycles were completed.
The Displacement Reach test requires stooping to 36 inches; the test requires the placement of the 28-inch high work surface table in front of the BTE Functional Range of Motion System. The test allowed workers to lean against the table while placing the pins in the proper holes. “The worker undergoing the test is also advised that he/she may return to the erect posture after the completion of the test cycle” (Gibson 2002).
The testing process for this assessment uses five rows of pegs from panels located around the worker during testing. The worker is instructed to take a peg out of one hole with the left hand then transfer the peg to the right and then place it in a corresponding hole in a panel on the worker’s right. The test continues until the highest level of rows and lowest level rows are completed. “When 15 pegs are restored to their original position, the evaluator counts this as one cycle, the test is concluded when a total of 5 cycles are completed” (Maida & Walker 1975).
Borofsky, G. L., & Smith, M. (1993). Reductions in turnover, accidents, and absenteeism: The contribution of a pre-employment screening inventory. Journal of Clinical Psychology, 49(1), 109-116.
Franzblau, A. (2004). Preplacement Nerve Testing for Carpal Tunnel Syndrome. Journal of Occupational and Environmental Medicine, 46, 714-719.
Gibson, L. a. J. S. (2002). Expert review of an approach to functional capacity evaluation. Work, 19, 231-242.
Graham, B. (2008). The value added by electrodiagnostic testing in the diagnosis of Carpal tunnel syndrome. Bone Joint Surgery Am, 12(90), 2587-2593.
Harbin, G., MD & Olson, J. (2005). Post-offer, pre-placement testing in the industry. American Journal of Industrial Medicine, 47, 296-307.
Harley, A. A. C. J. (2004). Fire-fighters perspectives of the accuracy of the Physical Aptitude Test (P.A.T.) as a pre-employment assessment. Work, 26, 29-35.
Jackson, A. (1994). Pre-employment physical evaluation. Exercise Sports Science Review, 22, 53-90.
Maida, A.S., & Walker, R.J. (1975). The validity of pre-employment medical evaluations. Journal of Occupational Medicine, 17(11), 687-692.