Clinical Research | Safety & Injury Evaluation Blog by Matheson

Finding Value in the AMA Chapter on Functional Capacity Evaluation

Posted on Tue, Jun 29, 2010 @ 12:35 PM

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The below post was written by James (Jim) Clouse, COTA, CWCE. Jim works at ProRehab in Evansville, IN and his professional interests include Work Conditioning, Functional Capacity Evaluations, Job Analysis/Job Description Preparation, Post-Offer/Pre-Placement Test Construction, and Workplace Injury Reduction.

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Thanks for asking me to be part of the Matheson Blog project! Aside from attending Matheson Training courses and reading "diamonds in the rough" articles, I learn the most from fellow Industrial Rehabilitation experts. We all have to be careful about how we interpret conclusions from authors, and discussing such things with my associates through RMA always leads to a deeper understanding.

One article I find myself re-reading and gleaning something new from again and again is from Dr. Leonard Matheson, and is actually part of the AMA chapter on FCE's in Disability Evaluation, 2^nd edition (2003).

Several key points I have dwelt upon include:

An excellent definition of "Functional" in Functional Capacity Evaluations
A definition of "Capacity" that we should all be ready to paraphrase in a deposition or forensic setting
A well-rounded explanation of "Evaluation" that summarizes all the key tools we use to make reliable predictions about an individual's performance
A discussion of threats to reliability, that include:

Test Reactivity: a reminder that we are all dealing with people - not doughnuts. How we interact with an evaluee will have a direct impact on the results of the evaluation. (Maybe doughnuts do respond differently to a gentle human touch, but are generally considered inanimate.)

Physical Effort: Dr. Matheson lists 11 reasons why an evaluee might not provide high levels of physical effort during an FCE - 5 of which are psychological factors outside of the area of expertise of most evaluators. (Add two more "reasons" when you include "medically determined impairments" and "fraudulent attempts to circumvent the disability determination process" and you have a baker's dozen.)

The importance of an "absence of expected relationship among related measures" (a $500 phrase!)
The acknowledgement that almost all measures of effort can be volitionally defeated and that evaluators blind to evaluee "coaching" been shown to detect less than full effort with a 94% positive predictive value
5 different purposes for FCE's and the duration of testing required
A comprehensive list of evaluation tools, and the Disability Model Level (what the tool assesses)
A comprehensive list of Manual Material Handling tests
A perspective on the future of Functional Capacity Evaluations

James Clouse, COTA, CWCE