Functional testing: Approaches and injury management integration

Functional Capacity Evaluations (FCEs) have become the standard for identifying an individual's physical abilities and/or limitations following injury or illness. While philosophies and approaches differ, the focus of most FCE systems is to identify the individual's maximum capabilities. This article will discuss the usefulness of the FCE information and how FCEs are impacted by multiple factors including APTA guidelines, machine based testing, therapist expertise, medical legal credibility and court testimony, IMEs and FCE, and return to work/return to function.     

The functional capacity of healthcare workers with history of severe acute respiratory distress syndrome (SARS) complicated with avascular necrosis--case report

Two years after the SARS outbreak in Hong Kong, 128 healthcare workers continued to present with musculoskeletal complaints and 38 workers were diagnosed with avascular necrosis (AVN) in different joints. 13 healthcare workers were referred to six designated Physiotherapy Departments of the Hospital Authority for a tailor-made standardized Functional Capacity Evaluation (FCE) from 2004 to 2005 on a voluntary basis. Job analysis, workers' self-perceived disability and functional capacity, non-material handling tests, and the cardiopulmonary fitness test were performed. Retrospective review of the FCE data showed that there were 17 AVN of hips, 16 AVN of knees, 3 AVN of shoulders. All patients had AVN of lower limb joints. Nearly full ranges of movement (ROM) were observed in the knees involved, but the hip range was decreased for most subjects suffering from hip AVNs. Most workers (n=12) could not complete the cardiopulmonary test due to intolerable joint pain. Six workers' self-perceived physical demands level (PDC) matched with the physical demands level identified by the FCE. 12 healthcare workers attained a sedentary physical demands level and were unable to match with their previous job demands. One staff was classified as light physical demands and managed his original duty. Four workers had returned to work at the time FCE was performed. The tailor-made FCE added information to facilitate the return-to-work planning for the staff. Four more workers returned to work with modified duties one year after the FCE.     

Functional capacity evaluation: An essential component of South African occupational therapy work practice services

South African occupational therapists have been involved in the delivery of work practice services since the inception of the profession in this country. Initial development in this area of practice appeared slow but following the acceptance of South Africa's first democratic Constitution in 1996, many opportunities for service delivery were facilitated by the implementation of disability equity legislation. One of the key services offered by practitioners is Functional Capacity Evaluation (FCE). Although the outcomes of FCE are many, the process in essentially the same. This entails: referral, the initial interview, evaluation of performance components and ADL, vocational evaluation, obtaining collateral and the closure interview, the work visit, hypothesis testing and reporting. This article reports on the Functional Capacity Evaluation process as followed by South African occupational therapists in various contexts.     

Expert review of an approach to functional capacity evaluation

Functional capacity evaluation (FCE) is a widely used tool in work rehabilitation, despite the limited examination of the soundness of its measurement properties. This paper outlines the development of a new approach to FCE, the GAPP FCE, and reports on the findings of an expert review of aspects of its content validity and technical adequacy and how it meets established test criteria. Five expert occupational therapists reviewed the materials of the GAPP FCE then completed a questionnaire related to the content validity, technical adequacy and safety, reliability, validity, practicality and utility of the GAPP FCE. The experts gave support to most aspects of these criteria. The main issue identified by the review was related to interpretation and extrapolation of the FCE results for return to work. This and other issues are discussed in relation to recent developments in FCE and plans for future development of the GAPP FCE.     

Explanatory models for disability: perspectives of health providers working in Malawi

Health providers’ understanding of disability determines how disabled people are treated, and hence it is imperative to address conceptualisations of disability, as this will contribute to better opportunities and realisation of human rights for disabled people. This article will use data from a qualitative study exploring conceptualisations of disability by 22 health service providers from the total health care system in Malawi, including the professional sector (e.g. medical doctors and nurses) and the folk sector (healers and indigenous practices). We will discuss how these perceptions influence the lives of disabled people, using the case of a health service user with physical and speech impairment as an example. Our data show that health providers largely conceptualise disability according to the medical model for disability, contributing to the exclusion of disabled people. The bio-psycho-social model for disability, largely absent as an explanatory model for disability among our informants, is the most inclusive and rights based.     

Doing Disability: Disability Formations in the Search for Work*

Disability theorists have spent much time discussing how disability is defined. The theoretical roots for these debates reside in the medical, structural, and minority models of disability. The medical model views disability as equivalent to a functional impairment; the minority model sees a lack of equal rights as a primary impediment to social equality between able and disabled populations; and the structural model looks to environmental factors as the cause of disability. While debates over how to define disability are informative, there is currently an insufficient amount of empirical research looking at how people come to identify themselves as having a disability. Rather than focus on how disability is (or should be) defined, herein we look at how disability identities are constructed as people search for work. We show that people's interactions with employers and employment agencies have important influences on how disability identities are constructed. We borrow from the “doing gender” and “racial formations” paradigms to introduce an interactive approach to looking at how disability identities are constructed. We introduce the concept of disability formation to highlight how disability identities are continually negotiated through interactions with employment agencies and employers. Our findings are based on focus groups with 58 people who self‐identified as having a disability and were working or searching for work.     

Test-retest reliability of a WRULD functional capacity evaluation in healthy adults

The aim of this study was to determine test-retest reliability of a Functional Capacity Evaluation for patients with non-specific Work Related Upper Limb Disorders (WRULD FCE). The study sample included 33 healthy adults, consisting of 14 males and 19 females with a mean age of 29.2 years. The WRULD FCE consisted of 8 different tests including 26 items measuring repetitive movements, duration, working in awkward positions, forceful movements and static postures. Two FCE sessions were held with a 10-day interval. Means, 95% confidence intervals, one-way random Intraclass Correlation Coefficients (ICCs), 95% limits of agreement and repeated measures were calculated. An ICC between 0.75 and 0.90 was considered as good and an ICC above 0.90 was considered as an excellent reliability. The results showed that 14 of 26 items (54%) had excellent reliability, 9 of 26 items (35%) had good reliability and 3 of 26 items (11%) had moderate reliability based on ICC values. Significant learning effects were present in the Purdue Pegboard Task and in the Complete Minnesota Dexterity Test. It is concluded that the WRULD FCE is reliable in healthy adults.     

Multiculturalism and Disability: a critical perspective

In an effort to counter discrimination and powerlessness, the disability community has espoused sociopolitical and cultural factors as defining characteristics of disability identity. This view of disability has replaced the historical medical model of disability as a deficit, and has had important implications for social action, political agendas, legislation and overall quality of life for individuals with disabilities. This article reviews current multicultural thinking, and offers a critical view of the advantages and disadvantages of positioning disability within the emergent multicultural discourse. Implications for future thinking and action to promote equal opportunity and self-determination for persons with disabilities as a cultural group with a political agenda are then advanced.     

Applying the use of activity in the assessment of malingering: A case illustration

The assessment of malingering has predominantly been considered within the domains of neuropsychologists and psychiatrists, who use consistency of performance criteria similar to those used in functional capacity evaluations (FCE). The use of activity has traditionally been used in occupational therapy as an assessment and treatment modality with goals not always considered obvious and which could easily be used for diversional reasons. The appropriate use of activity adds an additional dimension to a layered approach of using multiple data sources and methods as recommended by FCE practitioners and neuropsychologists alike. The case illustration aims to explain the above using a layered model.     

Use of functional capacity evaluations in workplaces and the compensation system: a report on workers' and report users' perceptions

Until recently, little was documented about how functional capacity evaluations (FCEs) are used by employers and workers' compensation organizations. Such information was one focus of a comprehensive research study on FCEs carried out in southern Ontario, Canada, which involved representatives from the full range of groups involved in FCEs: referral sources, assessors, return-to-work specialists, third party payers and injured workers [1]. This paper shares findings from a cohort of injured workers undergoing FCEs, and explored how their FCE results were perceived and utilized by those receiving the reports. Based on study findings, we provide recommendations as to how FCEs should be requested, undertaken, reported and particularly applied to reduce work disability among injured workers.     

Disability as a Phenomenon: a discourse of social and biological understanding

This paper addresses conceptualisations of disability and what it constitutes as a category in a social security system. It argues that the conceptualisation of disability involves a discourse about definitions. This means it is an ongoing debate about principles or which determinators to use presenting the 'correct' understanding of disability as a phenomenon. The disability discourse involves a contest between a biological and social understanding of disability. This paper discusses which domains of interest are produced by each of these understandings. They are based on empirical findings when analysing rights of entitlement to a disability programme in the Swedish social security system. The study followed documentation of the public debates for a period of 25 years and extracted what was communicated as constituting disability in these debates. Which definition to give disability by this social security programme appeared as being a continuous contest between medical and social understanding. The paper argues that, rather than approaching the biological understanding as representing an antiquated concept to disability and the social model as a modern conceptualisation, these understandings are competitive. This makes disability into a flexible and heterogeneous concept, a term difficult to give a specified and limited meaning.     

‘Is it just food?’: the social implications of celiac disease as a disability

This article focuses on the case of celiac disease, an autoimmune disease for which the medical treatment is a gluten-free diet, and the social implications of its inclusion as a disability. Under what circumstances is celiac disease a disability and what are the consequences of such considerations? The article evaluates the expansion of the definition of disability and its inclusion of individuals with celiac disease, and also considers the macro-level and micro-level consequences and social implications for both individuals with celiac disease themselves and also for the field of disability studies.     

Navigating the ethical maze in disability research: ethical contestations in an African context

Despite changes in how disability is viewed, ethical requirements for disability research have hardly changed. Some ethical clearance procedures, processes and practices still consider persons with disabilities as not able, creating unease among researchers and research participants with disabilities themselves. This paper considers five ethical contestations arising from research in the area of disability in an African context: positionality, vulnerability, signed consent, anonymity, and research committee composition. We argue that ethical requirements in practice are still largely based on a medical model of disability and propose that culturally sensitive social and human rights models should influence disability research ethics.     

Health professionals' attitudes and practices in relation to Functional Capacity Evaluations

Functional Capacity Evaluations (FCE's) are part of practice in work injury prevention and rehabilitation, and are designed to define an individual's functional abilities or limitations in the context of safe, productive work tasks. Qualitative research methodology was used to investigate the attitudes and behaviours of health professionals in relation to FCE use. The study aimed to identify why health professionals chose a particular FCE, and to identify what factors influence health professionals' clinical judgements when providing results and recommendations for the individual being assessed. Five health professionals from the Hunter Region of New South Wales, Australia, participated in semi-structured, individual interviews using a phenomenological approach. Following inductive analysis of the data, four themes reflecting participants' attitudes and behaviours of FCE use emerged: i) referrals and expectations, including why and when the assessment is completed ii) outcomes, -- what the results aim to provide iii) workplace/practice/usage issues and iv) skills of the assessor. The results indicate the need for further research on the clinical utility of FCE's. A large scale quantitative study would allow results to be generalised to a wider community of FCE users.     

How is disability understood? An examination of sociological approaches

This paper considers sociological understandings of what constitutes disability. Current meanings of disability in both disability studies and medical sociology are examined and compared, using selected articles from leading authors in each discipline as case studies. These disciplines are often represented as offering starkly contrasting approaches to disability, with their differences amounting to a disciplinary 'divide'. It is argued that, on closer inspection, common ground can be found between some writers in disability studies and medical sociology. It is suggested that this situation has arisen because, in disability studies, the social relational understanding of disability developed by Vic Finkelstein and Paul Hunt in the 1970s has been lost over time, overshadowed by the rise to prominence of its offspring: the social model of disability. The paper concludes with some reflections on the need to revive a social relational understanding of disability.     

Research on physical disability in sociological social psychology: The state of the field and future directions

We discuss the state of the research literature on physical disability in sociology, focusing particularly on social psychology. We first trace the history of treatments of disability in the field, noting a movement from a medical model that located disability in the individual to a social model that recognizes physical disability as an important social characteristic that is both produced by and has important consequences for social interactions. We then summarize contemporary research, identifying areas in which sociological research tends to be located, particularly in critical approaches, health‐related outcomes, and stigma. Finally, we discuss areas in which more research on physical disability would be fruitful. We believe that research on group processes, intersectionality, and identity would each especially benefit from greater attention to physical disability.     

Index to Volume 31

This article presents an analysis of disability theory and content in the social work curriculum and advances a theoretically expansive approach to disability that is consistent with social work’s commitment to diversity and the elimination of oppression. A careful examination of relevant social work literature reveals that disability is generally discussed and treated from a diagnostic perspective. We suggest shifting the approach to disability content in social work curricula from one that emphasizes individual deficiency to one that addresses disability as the interaction of a medical condition or diverse conditions with disabling environments.     

Disability activisms: social model stalwarts and biological citizens

The Disabled People’s Movement (DPM) in the UK rejects the view that disability is an illness. For the DPM it is the social processes of discrimination and oppression that create the material circumstances out of which solidarity and politicisation arise. The DPM has also been shy about impairment, arguing that it is generally irrelevant to the issue of disability and that a clear distinction between impairment and disability is necessary if disability is to be understood as a basis for identity politics. The biological citizens that support embodied health movements use impairment, genetic status, biomedical diagnosis and classification as calling cards that signal their claims to identity. Whilst the DPM has challenged medical hegemony and scientific ideas, many ‘biosocial’ groups embrace the specialised medical and scientific knowledge associated with their ‘condition’, particularly where it might be used to enhance their claims to citizenship. This paper argues that disability activism in the UK is bifurcating. It addresses the difference in perspective and action between the ‘social model stalwarts’ of the DPM and biological citizens that organise politically around particular diagnostic labels.     

Disability identity and attitudes toward cure in a sample of disabled activists

This study investigates the assumption that disabled people want improvements in their functional abilities, or complete cures. Contrary to this assumption, many disabled activists are found to have attitudes in which they refuse treatment that promises a cure. In order to explain this attitude, different sources of disability identity are isolated as potential predictor variables. A multivariate model reveals that self-identity related to a personal affirmation of disability is a significant predictor of refusal of treatment, as is the age of onset of disability. Implications for interactions with medical professionals and utility-based modeling of medical treatment seeking are discussed.     

Public Support for Rehabilitation Programs: The Analysis of U.S. Disability Policy

Although political scientists have displayed relatively little interest in research on disability thus far, a brief review of major issues in rehabilitation in the United States indicates the contribution that policy analysts can make to the study of this subject. This opportunity is enhanced by a recent shift in the definition of disability from a medical orientation, which emphasizes functional impairments, and from an economic approach, which stresses vocational limitations, to a socio-political perspective, which regards disability as the product of interactions between individuals and the environment. The latter definition has become the foundation for a new 'minority-group' model of disability that is challenging the traditional 'functional-limitations' paradigm and that might profitably be utilized in future research.