RESEARCH REPORT PLATFORM PRESENTATION

VALIDATION OF A SHORT-FORM FUNCTIONAL CAPACITY EVALUATION: RESULTS FROM A CLUSTER RANDOMIZED CONTROLLED TRIAL. Gross D^1,2, Battie M¹, Asante A³; ¹Department of Physical Therapy, University of Alberta, Edmonton, Canada. ²Workers’ Compensation Board Alberta/ Millard Health, Edmonton, Canada. ³Foothills Hospital, Calgary, Canada

PURPOSE: Functional Capacity Evaluations (FCE) are used for making return-to-work decisions. FCE is a burdensome clinical tool in terms of time and cost, yet predictive validity is modest. A short-form FCE with comparable predictive accuracy would be beneficial. Our objective was to evaluate a short-form FCE. RELEVANCE: Physical Therapists often perform fitness-for-work assessments using FCE, however, it is unknown which form of assessment is most effective or efficient for promoting return-to-work and making clinical decisions. PARTICIPANTS: Participants included twenty-six Physical, Occupational and Exercise Therapists employed at the Workers’ Compensation Board-Alberta’s rehabilitation facility who were trained and experienced with FCE administration. Data was collected on all workers’ compensation claimants undergoing FCE at the rehabilitation facility over the trial period. Subjects included 552 claimants (265 tested with short-form FCE) who were predominantly employed (58%) males (72%) with chronic musculoskeletal conditions (mean duration 709 days). METHODS: Four region-specific FCE protocols were created from items within the full Isernhagen Work Systems’ FCE protocol. To test the utility and effectiveness of the short-form FCE protocols, a cluster randomized controlled trial was conducted. Fourteen FCE clinicians were randomized to an intervention group while the remainder formed a control group. Clinicians in the intervention group were trained to conduct the short-form FCE and used these protocols through the trial’s duration. Clinicians in the control group continued routine FCE procedures. All injured workers seen for FCE at the rehabilitation facility were therefore entered into clusters based on whether they were assessed using the short-form or routine FCE. Data on subject characteristics, return-to-work outcomes and claimant satisfaction with care were extracted from the WCB-Alberta computer databases. Clinicians logged amount of time during the assessment. Focus groups were held with clinicians using the short-form to determine their satisfaction with the protocol’s clinical utility. ANALYSIS: Analysis included examining differences between groups on baseline characteristics and on indicators of fitness-to-work, efficiency, and claimant and clinician satisfaction. Multivariable regression was used to evaluate differences in outcomes between groups while controlling for potential confounders. We accounted for within-cluster dependence using a small inflation factor (intra-cluster correlation = 0.05) as claimants were assigned to therapists in a non-systematic, relatively random fashion. RESULTS: No significant differences were observed between the intervention and control groups on baseline characteristics including age, sex, duration of injury, employment status, pain intensity, or self-rated disability. No adverse consequences or complications from FCE testing were observed. The distribution of return-to-work determinations were similar between groups as were claimant satisfaction ratings (∼90% satisfied with the process). Focus groups with participating clinicians indicated adequate satisfaction with the short-form FCE’s clinical utility. A 57% efficiency gain in time of functional assessment was seen, whereas overall efficiency gain was 24%. One-year follow-up on administrative return-to-work outcomes is nearing completion. CONCLUSIONS: A short-form FCE appears to have adequate clinical utility while not affecting clinician return-to-work decisions when compared to routine FCE administration. Further evaluation of return-to-work outcomes is underway. IMPLICATIONS: Short-form FCEs may be a cost-effective option for Physical Therapists performing fitness-for-work assessments. KEYWORDS: Occupational Health; Musculoskeletal; Measurement in Practice. FUNDING ACKNOWLEDGEMENTS: Funding was received from the Clinical Research Partnership Fund sponsored by the Alberta Physiotherapy Association and University of Alberta’s Department of Physical Therapy. WCB-Alberta assisted with data acquisition. CONTACT: dgross@ualberta.ca

ETHICS COMMITTEE: University of Alberta’s Health Research Ethics Board