A Critical Review of Functional Capacity ... - Physical Therapy

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Table 1. Continued Train-the- Norm or Criterion Port- Trainer Train-the-Trainer Equipment Costs,' FCE System Referenced able Training Costsf Options Costs' Including Software Licensing Costs' Ongoing Costs' Blankenship Both Yes One rofessional Yes Cost depends on time $1 9,950-$75,000 . . . Data access charge of $25 per incruded in required evaluation purchase rice. additionafstaff' trained for $1,500 IWS Criterion (some normative . . . $3,500 for training Yes $550 per erson or a $1,000-$2,000 $8,000 ($4,500 for None data available for specific (included in cost rou of5-9 for manual and test items) of FCE) $2,7%0 (total) $3,500 for tra~n~ng) PWPE Criterion (some hand Yes $1,800 for first Yes Approximately $600 $3 500 without software, $3,000 Pack of 50 evaluations=$75 + dexterity normative data person; $400 for to train trainer; $5,500 with software shipping used) additional royalties of $300 (maximum of 6 per person trained Per group] externally go to Ergoscience WEST-EPIC (Cal-FCP) Predominant1 criterion, No For WEST-EPIC 1 . . . ... $23,530 Included in None WEST-EPI~ 1 (lift (lift capacity), equipment costs capacity) is normative included in equi ment price for fstaff, training in San Diego only; training for remaining modules via manuals and videos WorkAbility Mark Ill Criterion Yes $1,711 Yes No extra cost if $10,400 None None program is accredited; accreditation fee $1,120 (for2 people) WorkHab Criterion Yes $850 per person Negotiable . . . Computer package= $75 yearly licensing None $1,500 fee AssessAbility Criterion Yes None Yes None $400 plus computer None $30 per client ARCON Both Yes None Yes None $40,000 None None ERGOS Criterion Yes Included in Yes None $20,000-$100,000; Included in purchase None purchase price depends on number of price modules Key Both Yes $400 per day per Yes $1 5,000 $20,000, includes None $60 per assessment; $10 per job ~ndividual software placement analysis . . . . . . . . . . . . . . . "Responses from a slllvey completed by FCE designers in March 1997. Ellipsis indicates no conrment. 'Cooke C, Dusik I., Menard M, et al. Relationship of performance on the ERGOS Work Simulator to illness behavior in a Workers' Compensation population with low back versus limb illjury. J Orcup Mpd. 1994;36:757-762. "Dusik I., Menard M, Cooke C, et al. Concurrent validity of the ERGOS Work Simulator versus conventional functional capacity techniqlles in a Workers' Compensation population. J Orcup Mpd. 1993;35:759-767. 'Waite H. Use a/ n Nm Physiral Capacities A~se.~.sml Method to Aulsf in Vocalional Rehnbililnlion oJ'Injurrd Wmh. Thesis submitted to the Faculty or the Graduate School of the University or Colorado for the degrce of Master of Science in Public Health. 'Monetary values are in US dollars. CosB are determined from May 1997 data.
Table 2. Types of Functional Capacity Evaluationso I Actual Simulation Predicts Ability I - - - - - - - - - - - - - - - - Controlled Authors' instruction in process Authors' instruction in process Tests are actual simulations of phys~cal demands Tests simulate components of physical demands and predict physical demands Uncontrolled Instruction may be by test authors, self-taught, or by Instruction may be by test authors, self-taught, or by others who have others who have been instructed been instructed Tests are actual simulation of physical demands Tests simulate components of physical demands and predict physical demands "Reprinted from Tramposh%ith permission from Hanley & Belfus Inc, Philadelphid, Pa Table 3. Advantages and Disadvantages of Various Types of Functional Capacity Evaluationsa Type Advantages Disadvantages Examples "Controlled" (Actual Reasonable chance of inter/intra-rater Evaluator lacks flexibility to simulate a lsernhagen FCE Simulation) reliability specific iob Content validity easy to show Easy to use in court due to standard protocol Patients see job-relatedness "Controlled" (Predicts Best change of inter/intra-rater reliability Evaluator lacks flexibility to simulate a ERGOS system Ability) Easier standardization of test specific job Easy to use in court due to standard protocol Relies on construct validity Easiest to research due to control and More difficult for patients to see iob- standardization relatedness Tends to be the most expensive (for therapists to purchase) "Uncontrolled" (Actual Content validity easy to show Inter/intra-rater reliability difficult to Blankenship FCE Simulation) Flexibility to simulate a specific job control Clients see lob-relatedness More difficult to use in court-lack of Most accessible for therapists protocol control Hardest to research due to lack of standardization and protocol control "Uncontrolled" (Predicts Easier standardization of test Inter/intra-rater reliability difficult to Isometric/isokinetic Ability) control equipment Relies on construct validity More difficult to use in court-lack of protocol control More difficult for patients to see lob- relatedness "Reprinted from Tramposh5 with permission from Hanley & Belfus Inc, Philadelphia. Pa. details the 2 categories, and Table 3 describes some of the advantages and disadvantages of both categories. The comparison of uncontrolled versus controlled FCEs deals with issues such as type of training for FCE administration, degree of work simulation, ability to alter the test design, and generic versus job-specific testing. The classification into controlled and uncontrolled categories focuses on different aspects of these issues, but the classification is arbitrary and overlapping. A new classification system is needed, one that further defines the methodological differences among the various types of FCEs. The commercially available FCEs and those developed within individual clinics all share the common goal of attempting to measure work-related functional performance objectively. Whether they accomplish this objec- tive can be answered only with research. The differences in FCEs revolve around the way they assess cooperation and sincerity of effort and safety, determination of end points for stopping clients during performance of manual material-handling tests, use of isometric testing, training processes, degree of work simulation, ability to alter the test design, generic versus job-specific testing, expense of equipment, use of algorithms for scoring, methods of projecting endurance to an 8-hour workday, 856 . King et al Physical Therapy . Volume 78 . Number 8 . August 1998
Page 1 and 2: A Critical Review of Functional Cap
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Page 9 and 10: Table 4. Common Components of Funct
Page 11 and 12: and the musculoskeletal system, inc
Page 13 and 14: Currently, there is no infallible m
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