Reliability of Clinician Rated Physical Effort Determination During Functional Capacity Evaluation in Patients with Chronic Musculoskeletal Pain

Abstract

Introduction Functional capacity evaluation (FCE) can be used to make clinical decisions regarding fitness-for-work. During FCE the evaluator attempts to assess the amount of physical effort of the patient. The aim of this study is to analyze the reliability of physical effort determination using observational criteria during FCE. Methods Twenty-one raters assessed physical effort in 18 video-recorded FCE tests independently on two occasions, 10 months apart. Physical effort was rated on a categorical four-point physical effort determination scale (PED) based on the Isernhagen criteria, and a dichotomous submaximal effort determination scale (SED). Cohen’s Kappa, squared weighted Kappa and % agreement were calculated. Results Kappa values for intra-rater reliability of PED and SED for all FCE tests were 0.49 and 0.68 respectively. Kappa values for inter-rater reliability of PED for all FCE tests in the first and the second session were 0.51, and 0.72, and for SED Kappa values were 0.68 and 0.77 respectively. The inter-rater reliability of PED ranged from κ = 0.02 to κ = 0.99 between FCE tests. Acceptable reliability scores (κ > 0.60, agreement ≥80 %) for each FCE test were observed in 38 % of scores for PED and 67 % for SED. On average material handling tests had a higher reliability than postural tolerance and ambulatory tests. Conclusion Dichotomous ratings of submaximal effort are more reliable than categorical criteria to determine physical effort in FCE tests. Regular education and training may improve the reliability of observational criteria for effort determination.

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.…”

Functional Capacity Evaluation in Different Societal Contexts: Results of a Multicountry Study

“…Clinicians recorded patient’s maximum weight lifted in kilograms along with HR before and after the test, patient-reported effort measured with Borg’s CR-10 scale [27], and clinician’s observed physical effort [28, 29]. In addition, the reason for ending the test was recorded [30].…”

The reliability of WorkWell Systems Functional Capacity Evaluation: a systematic review

“…Four references were excluded: one [ 21 ] because it did not report any data on the reliability of specific items, two because the investigators tested FCE systems other than the WWS FCE [ 27 , 31 ], and one because relevant statistics were not reported [ 22 ]. Our search update in February 2014 identified two potentially relevant studies [ 32 , 33 ]. We included one of the studies in our review [ 32 ].…”