Functional testing for RTW

Functional testing spectrum

	Purpose
Functional screening	Screen group of candidates → suitable for work
Functional capacity evaluation	Determine current function of a person  For workers in the business  Track progress post-injury
Functional assessment  Part of overall functional capacity evaluation
Functional test	Specific tests to strengthen overall Ax for RTW

Definition + benefits of functional capacity evaluation

Definition:

Evaluation of capacity of the worker regarding performance of activities

—> used to make recommendations for participation in work

Benefits:

1. Good return to work process 

2. Medicolegal 

3. Good injury Mx process 

4. Good risk Mx/ rehab planning

Benefits of standardised + non-standardised functional capacity evaluation

	Benefits
Standardised	Workhab:  Direct comparison → medico-legal  Good reliability  Min equipment  Applicable in wide ranges of workplaces
Non-standardised	Scalable/ reproducible  Task specific

Contraindications to FCE

1. Unstable medical condition

2. Recent surgery/ injury 

3. Communication barriers that prevent instructions being used 

4. Non-compensable medical co-morbidities restricting performance from work 

5. Inappropriately dressed

Objective outcomes of FCE

1. BP 

2. Physical demand testing 

→ In dictionary of occupational title ( DOT ) 

→ breaks job into 20 mvmts + classify from non/ rare/ occasional/ frequent/ constant 

3. Functional Ax + tests

• Generic

→Ground-waist lvl lift 

→ Waist-overhead lift 

• Job specific → need job task analysis ( critical physical demands )

Clues for non-physical barrier to performance

1. Physiological function 

2. Distracted function 

3. Normative data 

4. ADL report e.g. can do something more strenuous ( lift luggage ) but X squat/ bend over at all

When to stop FCE testing

1. Physical/ biomechanical 

• Asymmetrical postures 

• Muscle tremors 

• Changes in cadence 

• Loss of control

2. Physiological 

• HR > 85% HR max

→ > 70% if beta blockers 

3. Psychophysical

• Pain intensity 

• Fear of mvmt

• Pain behaviours 

• Person identifies own limits

Signs of fatigue

1. Biomechanical slowing 

2. Accessory muscle usage: recruitment of accessory muscles 

3. Sliding the load over self/ using lower extremity to push/ nudge load from floor to shelf 

4. Asymmetry in mvmt 

5. Trembling of muscle fatigue