The return to work process of an injured worker is dependent upon matching the physical abilities of the worker with physical demands of work tasks. Functional work movements and tasks are complex. Machines, equipment and isolated musculoskeletal testing have not produced data that is broad enough to project multi-faceted work ability. Functional capacity evaluations, which are sets of dynamic work tests, have seen a growing acceptance because of their whole-worker approach. The basic items of functional evaluations (lifting, carrying, bending, reaching, climbing) are compiled into a comprehensive test which results in information about the whole of work and overall ability of the worker. Projections into an eight-hour day and comparison to physical demands of the job are included in outcome of a functional capacity evaluation. The Kinesiophysical design approach also produces information on safety, compliance, movement characteristics and physical reasons behind work limitations. Utility of functional evaluation is exemplified when employers, and physicians use it as a basis for safe work return of the employee.
Background and Purpose. The relationship between functional capacity evaluation (FCE) data and work disability has not been studied. The validity of FCE testing results in terms of subsequent return to work (RTW) was the focus of this exploratory study. Subjects and Methods. Six hundred fifty adults of working age were evaluated as part of a standardized FCE. Clients were contacted by telephone 6 months after the FCE to determine their work status. Predictor variables were gender, age, time off work, maximum safe loads during 3 dynamic lifts, and isometric grip force. Other variables measured were whether or not the client returned to work (RTW-Y/N) and level of return to work (RTW level). Results. A multivariate logistic regression analysis demonstrated that the more time a worker was away from work, the less likely was RTW. Male subjects were less likely to return to work than female subjects. The more weight lifted from floor to waist, the more likely was RTW. The logistic regression equation correctly classified 80.3% of the subjects who returned to work and 56.6% of the subjects who did not return to work. Each of the 3 lift tests was related to RTW level, whereas the grip force tests were not related to either RTW-Y/N or RTW level. Discussion and Conclusion. Time off work and gender were the strongest predictors of RTW, but certain FCE subtests of lifting were related to RTW and RTW level for people with work-related chronic symptoms. Grip force was not related to RTW. [Matheson LN, Isernhagen SJ, Hart DL. Relationships among lifting ability, grip force, and return to work. Phys Ther. 2002;82:249 -256.]
rofessional community standards mark the development of a profession and facilitate its practice. Functional capacity evaluation has been practiced for many years by physical therapists, occupational therapists, vocational evaluators, and psychologists. Each of these professions has welldeveloped standards of practice. However, none of the professions has standards for the practice of functional capacity evaluation. We believe that these standards are necessary and that they should be developed on an interdisciplinary basis.In the absence of formal standards, guidelines that we can recommend to the practicing professional have been developed. These guidelines are based on professional experience as well as a review of scientific and technical materials that have been published in the professional literature. These guidelines are offered as a starting point for the interdisciplinary development of professional standards in functional capacity evaluation. OVERVIEWFunctional capacity evaluation (FCE) is a comprehensive, objective test of a person's ability to perform work-related tasks (4). T h e evaluation of functional capacity always carries some degree of risk. Control of this risk so that the "risk-toFunctional capacity evaluation is an important and widely available service provided by rehabilitation professionals, including many physical therapists. In the absence of agreed-upon professional standards, guidelines for practice have been developed. These guidelines provide a basis for the development of standards of practice which the authors believe should be undertaken on an interdisciplinary basis. These guidelines provide a baseline level of care that should be maintained by physical therapists and others who provide functional capacity evaluation services. reward ratio" can be maximized has been a focus of study of the Ergonomic Rehabilitation Research Society, Inc., founded by the authors in 1987.Five issues must be addressed in the selection and use of any functional test in the field of rehabilitation (5,8,9,1 1). These issues, presented in hierarchical order, are: I) Safety-Given the known characteristics of the evaluee, the procedure should not be expected to lead to injury; 2) Reliability-The test score should be dependable across evaluators, evaluees, and the date o r time of test administration; 3) Validity-The interpretation of the test score should be able to predict o r reflect the evaluee's performance in the target work setting; 4) Practicality-The cost of the test procedure should be reasonable and customary. Cost is measured in terms of the direct expense of the test procedure plus the amount of time required of the evaluee plus the delay in providing the information derived from the procedure to the referral source; and 5) Utility-The usefulness of the procedure is the degree to which it meets the needs of the evaluee, referrer, and payor. These five factors relate to each other in a dynamic manner such that a decision to emphasize o r minimize one of the factors usually will affect
Occupational rehabilitation, while acknowledged as a multidisciplinary field, is only as effective as contributions of its individual disciplines. Physical therapy has been and is continuing to be an integral part of both the clinical and scientific portions of the team. Inherent in the physical therapy profession are three educational components which makes it a particularly suitable addition: movement science, pathology, and functional analysis. Physical therapists are active in each of the primary areas of occupational rehabilitation: musculoskeletal treatment, injury prevention education, functional capacity evaluation, restorative exercise, work hardening, ergonomics, and pre-work screening. Future challenges encompass increased skill in ergonomics, effectiveness in the return-to-work process, and in the scientific study of physical therapy techniques and their effectiveness.
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