Reliability and Safety of Functional Capacity Evaluation in Patients with Whiplash Associated Disorders

Abstract

Introduction Whiplash-associated disorders (WAD) are a burden for both individuals and society. It is recommended to evaluate patients with WAD at risk of chronification to enhance rehabilitation and promote an early return to work. In patients with low back pain (LBP), functional capacity evaluation (FCE) contributes to clinical decisions regarding fitness-for-work. FCE should have demonstrated sufficient clinimetric properties. Reliability and safety of FCE for patients with WAD is unknown. Methods Thirty-two participants (11 females and 21 males; mean age 39.6 years) with WAD (Grade I or II) were included. The FCE consisted of 12 tests, including material handling, hand grip strength, repetitive arm movements, static arm activities, walking speed, and a 3 min step test. Overall the FCE duration was 60 min. The test–retest interval was 7 days. Interclass correlations (model 1) (ICCs) and limits of agreement (LoA) were calculated. Safety was assessed by a Pain Response Questionnaire, observation criteria and heart rate monitoring. Results ICCs ranged between 0.57 (3 min step test) and 0.96 (short two-handed carry). LoA relative to mean performance ranged between 15 % (50 m walking test) and 57 % (lifting waist to overhead). Pain reactions after WAD FCE decreased within days. Observations and heart rate measurements fell within the safety criteria. Conclusions The reliability of the WAD FCE was moderate in two tests, good in five tests and excellent in five tests. Safety-criteria were fulfilled. Interpretation at the patient level should be performed with care because LoA were substantial.

Assessment of Psychosocial and Functional Impact of Chronic Pain

“…There is growing research on the reliability, validity, and clinical utility of FCEs in different occupational patient populations. 25,75,213,214 For example, in a cohort of 354 patients with chronic occupational musculoskeletal disorders, FCE scores were responsive to a functional restoration program and predicted successful return to work 1 year after rehabilitation. 75 Although performance-based measures provide objective information, they do not capture one's functioning in the context of their work, home, or community environment.…”

Short-term changes in median nerve neural tension after a suboccipital muscle inhibition technique in subjects with cervical whiplash: a randomised controlled trial

“…wrist) where no tissue damage is required to provoke pain and alter functionality [9]. Grip strength has been included as a tool to measure functional capacity in cervical whiplash [10]. Entrapment of the median nerve in the carpal tunnel has been suggested as an associated component to the chronic pain of the upper limb in patients with cervical whiplash [11].…”

Systematic review of the measurement properties of performance-based functional tests in patients with neck disorders

“…Six articles address the clinical measurement properties of this FCE ranging from good to excellent quality (67%–92%). There was evidence that the FCE was stable over test-retest time of 7–14 days 31 32. These measures demonstrate longer stability over time compared with self-report measures such as the Neck Disability Index (NDI) which has demonstrated test-retest reliability within only a short period of 0–3 days 28.…”

“…The 12 articles that were included for review provided properties on the following functional based tests: functional capacity evaluations (FCE),29–34 The Baltimore Therapeutic Equipment work simulator II (BTEWS II),35 Functional Impairment Test- Hand and Neck/Shoulder/Arm (FIT-HaNSA),36 as well as items off of a physiotherapy test package including a cervical and lumbar Progressive Isoinertial Lifting Evaluation (PILE-C, PILE-L) test37–40 and 2×20 m with burden walking test (2×20M-WWB) 37–40. Descriptions of all functional-based tests and their relevant subtasks are provided in online supplementary appendix D.…”

“…Six articles reported measurement properties for an FCE battery. We identified multiple versions of the FCE in the literature with one article reporting properties on the Workwell FCE,30 two reporting on the Whiplash Associated Disorder (WAD) FCE29 31 and three reporting on the neck-FCE 32–34. These test batteries include various combinations of muscular strength, endurance and functional based tests.…”