Predicting Return-To-Work Using Functional Capacity Evaluation

Workers with chronic musculoskeletal disorders (MSDs) are often unable to return-to-work (RTW) at the full capacity required by the job. A multidisciplinary approach to rehab is often helpful. Physical therapists use a special test called Functional Capacity Evaluation (FCE) to figure out what form of therapy is best.

FCE is a group of 25 standardized tests including lifting weights, bending, and carrying objects. This battery of tests is designed to assess an individual's capacity to work. For example, does the person have the physical strength and mobility to do the job? Does the job have to be modified for the worker? Does the worker need lifting or weight restrictions?

The main question addressed by this study was: can the Isernhagen Work System Functional Capacity Evaluation (ISW-FCE) be used to predict who will be able to get back to work? The Isernhagen Work System FCE was developed, tested, and standardized by a physical therapist. It is a widely known and accepted FCE test around the world.

The ISW-FCE can assess functional capacity and guide therapists in setting up rehab programs. The target group consists of workers with chronic musculoskeletal disorders. But can the ISW-FCE be used to predict return-to-work (RTW) status? Right now, studies have shown that patients self-report of pain intensity and expected disability in the job are pretty good predictors of success in returning to work. The authors asked, if those two factors were taken out of the FCE, would the battery of tests given really add any additional information about the worker's likelihood to return-to-work?

A total of 145 blue-collar workers from northern Germany with musculoskeletal disorders (MSDs) were involved in this study. Each one filled out a survey that measured their general health and the effect of MSD on general health. The survey was done before and after FCE testing or rehab. Each person was followed for one full year using these measures.

The therapists administering the ISW-FCE compared each worker's functional capacity with the demand of their individual jobs. The data was also compared to self-report measures usually used to predict the estimated time until the patient's successful return-to-work. Successful return-to-work was defined as full-time employment by a worker in good health who had used low levels of sick leave because of pain from musculoskeletal disorders. Low levels of sick leave use was considered six weeks or less off work in a one-year period of time.

One year after the FCE testing and rehab there were slightly less than two-thirds of the 145 workers (62.1 per cent) successfully back on the job. For the remaining 37.9 per cent, the FCE results showed a lower work capacity and higher level of work-related deficits. The more tests failed on the FCE, the less likely it was that the worker would return-to-work. Five or more failed tests in the FCE battery were significant.

Despite that information, the FCE really didn't add any additional information to predict a worker's return-to-work that couldn't be obtained from the already successful method of assessing pain levels and workers' own predictions about work-related disability. However, the information from this study did help the researchers identify and then test a clinical prediction rule (CPR).

CPRs are a popular and effective way to take results from a study like this and put together a formula that can be used to categorize patients. In the case of blue-collar workers with musculoskeletal disorders, the CPR was used to identify people who were likely to be returners and those who would be nonreturners.

The CPR was defined as follows: returners would be patients who had low rates of sick leave before entering rehab. They also had a positive expectation that they could handle the job if they returned. And they failed five or fewer parts of the FCE. Nonreturners were defined by the CPR as having a high rate of musculoskeletal-related sick leave, an expectation of disability at work, and failure of more than five tests on the ISW-FCE.

Applying this CPR to the 145 workers, the authors reported it was possible to accurately predict returners from nonreturners for three out of four workers when the potential status of workers was unclear. Combining the already used and accurate self-report model with the FCE can help improve the success of the clinical prediction rule.

This information may help physical therapists identify patients who won't make it back to work despite completing a rehab program. The next step in research is to find ways to create a rehab program that would increase the number of workers who do return-to-work successfully.

Reference: 

Marco Streibelt, PhD, et al. Value of Functional Capacity Evaluation Information in a Clinical Setting for Predicting Return to Work. In Archives of Physical Medicine and Rehabilitation. March 2009. Vol. 90. No. 3. Pp. 429-434.

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