functional capacity evaluation

FCE - Repeated measures

11/19/2018

Why are repeated measures critical for a valid FCE?
Repeated measures provide the necessary data to classify validity of effort. If you have one set of lifting attempts performed by an individual, how can you be certain that full effort was given? Doesn't comparing one set of lifts to another set of lifts make more sense when trying to determine if full effort was given, rather than trying to find a trend in one set of data? Of course it does.

Most FCE systems cannot determine if maximal effort was given because they don't gather enough data and are limited by subjective interference. The point here is that the basic premise of the former test approaches is flawed.

XRTS uses the client's effort compared to a repeated effort to determine if maximal effort was given. In practice, that means comparing one set of lifts to another set of lifts. Variation within an acceptable range indicates maximal effort was likely given. Variation greater that an acceptable range indicates maximal effort was likely not given.

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XRTS Material handling

11/16/2018

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The XRTS Material Handling Assessment sets this FCE testing methodology apart from all others. The material handling assessment compares a set of baseline lifts to the same lifts repeated on the XRTS lever arm and compares an individual’s reported maximum efforts with workloads of different physical appearance.

This allows for an objective measure of effort through data comparison. Other methods for measuring effort during material handling rely on an evaluator’s opinion of observed movement patterns or changes in heart rate which lack objective, data- derived criteria.

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XRTS Hand Strength Assessment

11/13/2018

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Today's topic is the XRTS Hand Strength Assessment. It is the most accurate hand test available today, detecting feigned weakness at 99.5% accuracy. This compares to 70% accuracy in the Bell Curve test.

Used in upper extremity or neck injuries, the reason for the higher accuracy is that the research methodology developed criteria for identifying feigned weakness. Criteria for identifying feigned weakness were developed by identifying measures specific to individuals known to be giving a perceived 50% effort.

The XRTS Hand Strength Assessment also incorporates simultaneous bilateral testing which is unique to this testing protocol.

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FCE - Statistical Analysis

11/13/2018

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Statistical analysis allows for FCE results to be determined by calculation, as opposed to clinician interpretation. This eliminates subjectivity or evaluator bias.

The criteria used to compare calculated results has been subject to peer review with known sensitivity and specificity measures. Sensitivity is the ability to correctly identify those giving a sub-maximal effort. Specificity is the ability to correctly identify those giving maximal effort.

The XRTS FCE has a specificity rate of 100%. This means that there are no false positives - none of the subjects are identified as giving a sub-maximal effort when they have given a maximal effort.

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FCE - distraction-based testing

11/12/2018

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What is distraction-based testing in an FCE? It is a concept where multiple inputs are utilized to minimize the ability to control the outcome of the test. In addition, it is non-hurtful, non-emotional, and non-surprising. The concept was developed by Dr. Gordon Waddell, M.D. (see reference below).

XRTS utilizes distraction-based testing to ensure that it is comparing data that has not been manipulated. Gathered data is compared to research-based criteria and this also eliminates the potential for evaluator bias or misclassification of effort.

It's not a difficult concept or difficult to implement, and the benefit is that testing data is reliable and valid.

Distraction-based testing is based on a 1980 study, "Nonorganic Physical Signs in Low Back Pain” March-April 1980, Spine, Volume 5, Issue 2 P 117-125.

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FCE and the issue with subjectivity

11/12/2018

The information in this blog expands our email series about the differences between the XRTS FCE and other testing methods.

Subjectivity in your FCE and why it is problematic.
What is a subjective FCE? It's one where the physical therapist (PT) or the client makes decisions on test performance based on their own impressions rather than the gathered data. In an FCE that is relying on subjective impression, and not data comparison, the PT has to be 'convinced' that effort was given. This is what happens in most protocols and the outcome can be easily manipulated.

The XRTS FCE uses science, not subjective impression. The PT does not have to be convinced. They merely measure the effort given and provide the results in a report. In other words, comparison of effort determines whether full effort was given, not subjective impression.

FCE - Repeated measures

XRTS Material handling

XRTS Hand Strength Assessment

FCE - Statistical Analysis

FCE - distraction-based testing

FCE and the issue with subjectivity

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