A conceptual framework of functional capacity evaluation for occupational therapy in work rehabilitation

Functional capacity evaluation (FCE) is commonly used in work rehabilitation to assess the capacity of the injured worker for return to work. Occupational therapists are major providers of FCE, especially in Australia. Despite a history of involvement in the functional assessment of clients for work, occupational therapy has few theoretical models for work assessment in general, and for FCE in particular. This may account for some of the confusion that exists about the conceptual basis of FCE in occupational therapy practice. This paper presents a framework for FCE that parallels occupational therapy's occupational performance model and the World Health Organisation's International Classification of Functioning, Disability and Health. The framework is used to clarify some of the confusions that exist in FCE research and practice, particularly the issue of measuring a client's function versus impairment. A redefinition of FCE for occupational therapy practice in the work assessment continuum is presented that supports occupational therapy practice and research in the area.     

Reliability of occupational therapists in determining safe, maximal lifting capacity

Determination of an individual's lifting capacity is an important component in Functional Capacity Evaluation, which is widely used to delineate potential for work. Despite a recent surge in the number and types of Functional Capacity Evaluations, and therefore in approaches to determining lifting capacity, there has been limited research to support the reliability and validity of their use. This study evaluated the inter-rater reliability of five occupational therapists in determining safe maximal lifting capacity using a biomechanical approach. In addition, the use of an operational definition of a safe lift was examined to determine its effect on therapists' decision-making process and therefore the reliability of their ratings. The use of an operational definition was found to significantly affect therapists' decision-making process in differentiating safe from unsafe lifts, with all raters showing highly significant improvements in their ability to determine the safety of lifts from pre- to postdefinition ratings, according to McNemar's χ ² statistic. The provision of a definition also enhanced therapists' reliability of ratings, with kappa values that ranged from 0.47 to 0.74 predefinition changing to 0.56–0.82 postdefinition. Possible explanations for the change in decision-making are discussed and the need for ongoing evaluation of procedures used in Functional Capacity Evaluation, particularly with regard to the determination of lifting capacity, are highlighted.     

Test-retest reliability of lifting and carrying in a 2-day functional capacity evaluation

The objectives of this study were to establish test-retest reliability of lifting and carrying of a functional capacity evaluation (FCE) on two consecutive days and to verify the need for a 2-day protocol. A cohort of 50 patients (39 men, 11 women) with nonspecific low back pain were evaluated using a 2-day FCE protocol. Intraclass correlation coefficients (ICC) were calculated for weight lifted and carried. Predictive relationschips between test and retest were explored by means of a regression analysis. The results of ICC were lifting low 0.87, lifting overhead 0.87, and carrying 0.77. Performances on day 2 were on an average 6–9% higher. Other than the amount of weight handled on day 1, no variable was found to predict performance on day 2. It was concluded that test-retest reliability of lifting and carrying was good, and the need for a 2-day protocol could not be confirmed.     

Dynamic low back functional motion capacity evaluation

Most current functional capacity evaluations focus on range of motion and strength as measures of Wellness. The goal of this study was to evaluate the dynamic functional motion capacity of controls (those without low back pain) and low back pain patients in the three cardinal planes of the body. The hypothesis was that injury would not only affect sagittal motion but also lateral and twisting motion that would load the spine in a different manner. Twenty-six age and gender matched controls and low back pain patients were tested. Trunk motion parameters of range of motion (ROM), velocity, and acceleration were measured in all three planes of the body as subjects performed three separate tasks eliciting motion in each of the three cardinal planes of the body. Controls exhibited significantly higher performance than low back pain patients in all three planes of the body for velocity and acceleration but not ROM. Single parameter discriminant function models indicated that the velocity and acceleration motion parameters distinguished between LBP patients and the control group more effectively than ROM in the cardinal planes. Multiple parameter discriminant function demonstrated that coupled motion models further increased the ability to distinguish between the control and patient groups. These results provide insight into new methods of evaluating functional capacity using velocity, acceleration, and coupling which may provide valuable information in determining the recovery of a patient.     

Upper Lifting Performance of Healthy Young Adults in Functional Capacity Evaluations: A Comparison of Two Protocols

The objectives of this study were to explore the concurrent validity of test results of upper lifting tasks of the Ergo-Kit FCE and the Isernhagen Work Systems (IWS) FCE. Seventy-one healthy young adults performed 5 upper lifting tests with at least 5 min of rest in between. The lifting tests included 3 standard protocols and 2 modified protocols. Three criteria for concurrent validity were established: 1) Pearson correlation higher than .75, 2) nonsignificant two-tailed t test, and 3) mean difference smaller than 5 kg. The results showed that none of the criteria were met for the standard protocols. For the modified protocols criteria 2 and 3 were not met. Individual differences larger than 10 kg were found for both standard and modified protocols. It was concluded that the standard protocols for upper lifting tasks of the Ergo-Kit FCE and the IWS FCE do not meet the criteria for concurrent validity and can, therefore, not be used interchangeably.     

Development and Validation of a Short-Form Functional Capacity Evaluation for Use in Claimants with Low Back Disorders

Objectives: Functional Capacity Evaluations (FCE) are used for making return-to-work decisions, yet FCE's modest predictive ability is currently outweighed by the administrative burden of testing. We attempted to develop a short-form FCE while maintaining comparable predictive ability. Methods: Three databases previously created for evaluating FCE predictive validity were used. Subjects were compensation claimants with low back disorders. FCE measures included items in the Isernhagen Work Systems’ FCE. Days until benefit suspension served as an indicator of return-to-work. Analysis included Cox regression. Results: Three items, floor-to-waist lift, crouching, and standing, were maintained in the short-form FCE. The short-form FCE was found to predict comparably to the entire FCE protocol in two validation cohorts (R ² difference<3%). Subjects meeting job demands on all three items consistently experienced faster benefit suspension. Conclusion: A short-form FCE for determining future work status in claimants with low back disorders was developed. A substantially abbreviated FCE may offer an efficient alternative.     

Functional capacity evaluation reports for clients with personal injury claims: A content analysis

Functional capacity evaluations (FCEs) for personal injury claimants are rigorously scrutinized by the stakeholders because of their financial implications. This study examined 51 medico-legal FCE reports for clients all of whom suffered with spinal pain attributed to a motor vehicle accident. The FCEs were completed by 14 occupational therapists. Content analysis of the FCE reports identified categories and sub-categories of objective and subjective information on which occupational therapists reported. They included employment, activities of daily living, pain, functional physical capacities and job demands. Recommendations included the suitability of current and future jobs. However, the reasoning behind occupational therapists' recommendations in the FCE reports was frequently not stated. This content analysis demonstrated that these detailed FCE reports had a consistent focus on work capacity; further, the researchers suggest refinements to FCE reporting practices so that findings, recommendations and predictions about work outcomes for clients are interpreted clearly and realistically.     

运用百分比CPD法综合评价医院医疗质量

目的：对医院各年度质量指标进行综合评价。方法运用百分比CPD法,确定标准值,计算所选7项指标的CPD、S、U、P等值,将计算结果进行排序分档和显著性检验。结果在0.05显著性水平意义下,2004年,2009至2013年明显优于其它年份;最好是2009年,最差是2006年。结论百分比CPD法是针对相对数或可转换为相对数形式的指标而言,计算过程简便易懂,是一种简单有效的综合评价方法。     

江西省村卫生室服务能力综合评价

目的对江西省11个地市村卫生室的服务能力进行综合评价,了解江西省各地市村卫生室服务能力状况。方法于2010年10月,以江西省11个地市所有26 287个村卫生室为评价对象,采用层次分析法(analytic hiererchy process,AHP法)确立指标权重,运用TOPSIS法和秩和比法(Kank-sun ratiio,RSR法)综合评价各地市村卫生室服务能力。结果一级指标的权重依次为服务功能(0.509 4)、卫生人力(0.234 3)、经费(0.131 8)、设备(0.084 9)和房屋(0.039 6);村卫生室服务能力TOPSIS法排序中鹰潭市排名第一(C_i值为0.806 7),新余市排名最后(C_i值为0.337 7);分档排序中,鹰潭市、吉安市较好(R?R值≥0.634),萍乡市、宜春市、景德镇、九江市、抚州市、南昌市和上饶市中等(0.366≤R?R值<0.634),赣州市、新余市相对较差(R?R值<0.366)。结论江西省11个地市村卫生室服务能力总体水平尚可,但有待于进一步提高。     

Mapping capacity in the health sector: a conceptual framework

Capacity improvement has become central to strategies used to develop health systems in low-income countries. Experience suggests that achieving better health outcomes requires both increased investment (i.e. financial resources) and adequate local capacity to use resources effectively. International donors and non-governmental agencies, as well as ministries of health, are therefore increasingly relying on capacity building to enhance overall performance in the health sector. Despite the growing interest in capacity improvement, there has been little consensus among practitioners and academics on definitions of 'capacity building' and how to evaluate it. This paper aims to review current knowledge and experiences from ongoing efforts to monitor and evaluate capacity building interventions in the health sector in developing countries. It draws on a wide range of sources to develop (1) a definition of capacity building and (2) a conceptual framework for mapping capacity and measuring the effects of capacity building interventions. Mapping is the initial step in the design of capacity building interventions and provides a framework for monitoring and evaluating their effectiveness. Capacity mapping is useful to planners because it makes explicit the assumptions underlying the relationship between capacity and health system performance and provides a framework for testing those assumptions.     

Assessment of Functional Capacity of the Musculoskeletal System in the Context of Work,Daily Living,and Sport: A Systematic Review

The aim of this systematic review was to survey methods to assess the functional capacity of the musculoskeletal system within the context of work, daily activities, and sport. The following key words and synonyms were used: functional physical assessment, healthy/disabled subjects, and instruments. After applying the inclusion criteria on 697 potential studies and a methodological quality appraisal, 34 studies were included. A level of reliability > 0.80 and of > 0.60 resp 0.75 and 0.90, dependent of type of validity, was considered high. Four questionnaires (the Oswestry Disability Index, the Pain Disability Index, the Roland–Morris Disability Questionnaire, and the Upper Extremity Functional Scale) have high levels on both validity and reliability. None of the functional tests had a high level of both reliability and validity. A combination of a questionnaire and a functional test would seem to be the best instrument to assess functional capacity of the musculoskeletal system, but need further examined.     

The utility of Functional Capacity Evaluation: the opinion of physicians and other experts in the field of return to work and disability claims

Objectives: This qualitative study explored how Dutch experts perceive the utility of functional capacity evaluation (FCE) for return to work (RTW) and disability claim (DC) assessment purposes. Methods: Twenty-one RTW case managers and 29 DC experts were interviewed by telephone using a semi-structured interview schedule. Results: The RTW case managers valued the utility of FCE on a scale of 0–10. Their mean valuation was 6.5 (SD 1.5). The average valuation for DC experts was 4.8 (SD 2.2). Arguments in favor of FCE were (1) its ability to confirm own opinions and (2) the objectivity of its measurement method. Arguments against FCE were (1) the redundancy of the information it provides and (2) the lack of objectivity. Indications for FCE were musculoskeletal disorders, a positive patient self-perception of ability to work, and the presence of an actual job. Contraindications for FCE were medically unexplained disorders, a negative patient self-perception of ability to work, and the existence of disputes and legal procedures. Conclusions: The responding RTW case managers perceived FCE to be more useful than the responding DC experts. The question of whether the arguments presented for and against the utility of FCE are valid is one that should be addressed in a future study.     

Psychosocial Factors and Functional Capacity Evaluation Among Persons with Chronic Pain

Psychosocial factors have been found to have a significant impact on functional activity, particularly among persons with chronic pain. While various systems have been developed to assess functional limitations through functional capacity evaluation (FCE), assessment of psychosocial factors that may impact function have been largely ignored. This paper examines the existing literature on psychosocial factors and FCE performance. Given that there are few studies that have directly addressed this issue, the paper also examines psychosocial factors that have been found to influence function in persons with pain. The results of the literature review indicate that few psychosocial factors have been found to be directly associated with FCE and functional measures, although many are related to various measures of disability. The strongest evidence that psychosocial factors are related to functional performance is based on the studies examining the association between functional activity and pain-related fear, self-efficacy, and illness behavior. Psychosocial factors have also been shown to influence measures of sincerity of effort often obtained during FCE. Proposals for modifying FCE assessment are given based on the available data, as well as suggestions for future research.     

Measurement Properties of Performance-Based Assessment of Functional Capacity

Performance-based functional assessments, including standardized functional capacity evaluation (FCE) batteries, are commonly used to determine the physical work abilities of individuals who have sustained musculoskeletal injury. The purpose of this paper is to critically examine research pertaining to the measurement properties of performance-based FCE, along with the theoretical bases for such measurement. While rater judgments of maximum performance during FCE appear reliable, FCEs do not appear to be purely tests of physical capacity as performance during assessment is influenced by multiple personal and environmental contextual factors. FCEs are more accurately considered behavioural tests influenced by multiple factors including physical ability, beliefs, and perceptions, and should be interpreted with in the subject's broader personal and environmental context.     

Safety Issues in Functional Capacity Evaluation: Findings From a Trial of a New Approach for Evaluating Clients With Chronic Back Pain

Although safety is recognized as a critical issue in functional capacity evaluations (FCEs), it has rarely been investigated. This paper reports on the findings of a study which examined safety aspects of a new approach to FCE. Fourteen rehabilitation clients with chronic back pain participated in the study. Aspects examined included the pre-FCE screening procedures, the monitoring of performance and safety during the FCE, and the end of FCE measures and follow-up procedures. Support was found for the screening procedures of the approach, particularly blood pressure measurement, and for the combined approach to monitoring of the persons performance from biomechanical, physiological and psychophysical perspectives. Issues for FCE safety in general are identified and discussed, including the importance of screening procedures to determine readiness for FCEs and the issue of load handling in FCEs, especially in relation to clients with chronic back pain.     

Relationships among age,body weight,resting heart rate,and performance in a new test of lift capacity

This study measured the relative contributions of age, gender, body weight, and resting heart rate to lift capacity in 531 healthy employed males and females in a cross-sectional model. The objectives of this study were to measure the contributions to lift capacity that are made by these variables and to develop an appropriate means to express the results of a new test of lift capacity. A formal training program was developed and administered to 110 health care professionals. Subsequently, each trained evaluator performed five tests on healthy volunteers. The effect of the independent variables were studied through the use of multiple regression and analysis of variance procedures. Results indicate that age, resting heart rate, and body weight are significant predictors of performance, with the last variable being the most important. A method to normalize lift capacity is presented in which the maximum acceptable weight lifted is divided by the evaluee's body weight to derive relative acceptable weight, a variable which is normally distributed. Those who use measures of lift capacity to describe performance must consider the effect of these variables in order to make valid interpretations of lift capacity test performance.     

广东省餐饮监管能力评价指标体系构建

目的 建立广东省餐饮监管机构餐饮监管能力的综合评价方法.方法 对入选的24位专家进行2轮德尔菲(Delphi)专家咨询,构建餐饮监管能力评价指标体系,层次分析法确定各指标的权重,综合评分法建立综合评价模型,对东莞市20个公共卫生监督小组的餐饮监管能力进行评价;运用折半信度和克朗巴赫信度系数(Cronbach's α),以及方差分析和相关性分析对综合评价模型的信度效度进行检验.结果 建立了包括7个1级指标、30个2级指标、60个3级指标的餐饮监管能力评价综合评价模型;综合评价模型整体的Cronbach'sα系数为0.81,Spearman-Brown折半信度系数为0.86,等级分类具有较好的区分度,且包含指标的独立性较好.结论 所建立的综合评价模型,可较好的区分广东省餐饮监管机构餐饮监管能力强弱,具有较好的适应性和较高的可信度.