Reliability and Validity of Functional Capacity Evaluations: An Update

Transition to Labor Market among Young Adults with Serious Mental Illness

Background: The research on job attainment and retention among young adults with serious mental illness (SMI) is limited. The objective of this study was to investigate the contributions of emotional, cognitive, motor, demographic, and work-related factors to the transition into supported employment (SE) and retention. Methods: This cross-sectional study included young adults with SMI involved in prevocational (N = 21) services or those who have transferred to SE (N = 21) following prevocational services. Work-related self-efficacy, executive functions, and motor skills were approached with standard and well-established tools. Results: There was a significant difference between groups in most dimensions of work-related self-efficacy, job history and experience, cognitive strategies, and general independence in daily life. The multivariate analysis demonstrates that holding a profession, experiencing self-efficacy in general work skills, cognitive strategies, and independence in living situations explained the between-group differences (χ2(4) = 34.62, p < 0.001; correct classification−90.2%). Conclusions: The study identifies the factors contributing to a sustainable transition to employment among young adults with SMI, suggesting the importance of a comprehensive approach to address a range of personal factors in an integrative way. The augmentation of prevocational training with continued employment support may be beneficial to meet the unique needs of young adults with SMI.

Towards the Use of 2D Video-Based Markerless Motion Capture to Measure and Parameterize Movement During Functional Capacity Evaluation

Purpose The objective of this study was to determine the agreement of kinematic parameters calculated from motion data collected via a 2D video-based pose-estimation (markerless motion capture) approach and a laboratory-based 3D motion capture approach during a floor-to-waist height functional lifting test. Method Twenty healthy participants each performed three floor-to-waist height lifts. Participants' lifts were captured simultaneously using 2D video (camcorder) in the sagittal plane and 3D motion capture (Vicon, Oxford, UK). The three lifts were representative of a perceived light, medium, and heavy load. Post-collection, video data were processed through a pose-estimation software (i.e., markerless motion capture). Motion data from 3D motion capture and video-based markerless motion capture were each used to calculate objective measures of interest relevant to a functional capacity evaluation (i.e., posture, balance, distance of the load from the body, and coordination). Bland-Altman analyses were used to calculate agreement between the two methods. Results Bland-Altman analysis revealed that mean differences ranged from 1.9° to 22.1° for posture and coordination-based metrics calculated using markerless and 3D motion capture, respectively. Limits of agreement for most posture and coordination measures were approximately + 20°. Conclusions 2D video-based pose estimation offers a strategy to objectively measure movement and subsequently calculated metrics of interest within an FCE context and setting, but at present the agreement between metrics calculated using 2D video-based methods and 3D motion capture is insufficient. Therefore, continued effort is required to improve the accuracy of 2D-video based pose estimation prior to inclusion into functional testing paradigms.

Translation and validation of Assessment of Work Performance (AWP) into the Icelandic language and culture

BACKGROUND

Evidence-based services in vocational rehabilitation call for valid and reliable assessments of work performance for intervention planning and safe return to work for individuals with illness or injuries. Assessments that are easy to use, culturally adapted, and in a language professionals and clients understand is important for their utility. Translation and adaption of assessments to new languages and cultures are of importance to maintain high standards of assessments and the quality of services in the vocational rehabilitation setting.

OBJECTIVE

The aim of this study was to translate and adapt the Assessment of Work Performance (AWP), into the Icelandic language and culture. Furthermore, to investigate the content validity and utility of the evaluation instrument.

METHODS

The study was conducted in two phases. The first phase, based on the Dual-Panel translation method, included two expert panels performing translation and cultural adaption of the original Swedish AWP. In the second phase field testing of the translated instrument was followed by an online survey among vocational rehabilitation professionals for content validation and utility.

RESULTS

The results of the study showed satisfactory opinions from experienced professionals toward the content validity, translation, cultural adaption, and utility of the Icelandic version of the AWP.

CONCLUSIONS

The study indicates that the Dual-Panel translation method is a valid method when translating instruments from one language and culture to another. Furthermore, the results of the study imply that the AWP can be regarded as content valid up to an acceptable degree for implementation in vocational rehabilitation services in Iceland.

Overview of reviews of standardised occupation-based instruments for use in occupational therapy practice

INTRODUCTION

Using standardised instruments is one approach to support evidence-based practice. Referring to systematic reviews is an option to identify suitable instruments. However, with an abundance of systematic reviews available, therapists are challenged to identify an appropriate instrument to use. Therefore, this overview of reviews aimed to summarise relevant systematic review findings about standardised occupation-based instruments relevant for occupational therapy practice.

METHODS

An overview of reviews was conducted. A systematic search was performed on four databases up to March 2018. Included systematic reviews were analysed for quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR).

RESULTS

A total of 2187 articles were identified after removing duplicates. Ultimately, 58 systematic reviews were identified that yielded 641 instruments. From those, 45 instruments were selected for appraisal as they met the inclusion criteria of being developed mainly by occupational therapists and were recommended in the summarised findings from the systematic reviews. The instruments were classified according to the following occupation domains: (i) multidimensional, (ii) activities of daily living, (iii) productivity, (iv) social, (v) sleep/rest, (vi) sexuality and (vii) spirituality. No systematic review was identified that specifically focussed on occupations related to school/education, leisure and play.

DISCUSSION

Certain occupation domains such as activities of daily living, social and sleep/rest received high attention amongst researchers. There is a need for systematic reviews of instruments to measure education/school, play and leisure. Limited numbers of instruments were developed by occupational therapists outside the occupation domain of activities of daily living, and in areas of practice other than children and older people. Nevertheless, this overview can give some guidance for occupational therapists in selecting a suitable occupational therapy instrument for practice.

Functional Capacity Evaluation in Different Societal Contexts: Results of a Multicountry Study

Purpose To examine factors associated with Functional Capacity Evaluation (FCE) results in patients with painful musculoskeletal conditions, with focus on social factors across multiple countries. Methods International cross-sectional study was performed within care as usual. Simple and multiple multilevel linear regression analyses which considered measurement's dependency within clinicians and country were conducted: FCE characteristics and biopsychosocial variables from patients and clinicians as independent variables; and FCE results (floor-to-waist lift, six-minute walk, and handgrip strength) as dependent variables. Results Data were collected for 372 patients, 54 clinicians, 18 facilities and 8 countries. Patients' height and reported pain intensity were consistently associated with every FCE result. Patients' sex, height, reported pain intensity, effort during FCE, social isolation, and disability, clinician's observed physical effort, and whether FCE test was prematurely ended were associated with lift. Patient's height, Body Mass Index, post-test heart-rate, reported pain intensity and effort during FCE, days off work, and whether FCE test was prematurely ended were associated with walk. Patient's age, sex, height, affected body area, reported pain intensity and catastrophizing, and physical work demands were associated with handgrip. Final regression models explained 38‒65% of total variance. Clinician and country random effects composed 1-39% of total residual variance in these models. Conclusion Biopsychosocial factors were associated with every FCE result across multiple countries; specifically, patients' height, reported pain intensity, clinician, and measurement country. Social factors, which had been under-researched, were consistently associated with FCE performances. Patients' FCE results should be considered from a biopsychosocial perspective, including different social contexts.

Updating the Evidence on Functional Capacity Evaluation Methods: A Systematic Review

Objectives To synthesize the evidence on the psychometrics functional capacity evaluation (FCE) methods. Methods A systematic literature search in nine databases. The resulting articles were screened based on predefined in- and exclusion criteria. Two reviewers independently performed this screening. Included studies were appraised based on their methodological quality. Results The search resulted in 20 eligible studies about nine different FCE methods. The Baltimore Therapeutic Equipment work simulator showed a moderate predictive validity. The Ergo-Kit (EK) showed moderate variability and high inter- and intra-rater reliability. Low discriminative abilities and high convergent validity were found for the EK. Concurrent validity of the EK and the ERGOS Work Simulator was low to moderate. Moderate to high test-retest, inter- and intra-reliability was found in the Isernhagen Work-Systems (IWS) FCE. The predictive validity of the IWS was low. The physical work performance evaluation (PWPE) showed moderate test-retest reliability and moderate to high inter-rater reliability. Low internal and external responsiveness were found for the PWPE, predictive validity was high. The predictive validity of the short-form FCE was also high but need to be further examined on several psychometric properties. Low discriminative and convergent validity were found for the work disability functional assessment battery. The WorkHab showed moderate to high test-retest, inter- and intra-rater reliability. Conclusion Well-known FCE methods have been rigorously studied, but some of the research indicates weaknesses in their reliability and validity. Future research should address how these weaknesses can be overcome.

Association between social factors and performance during Functional Capacity Evaluations: a systematic review

Purpose: Determine the association of different social factors with Functional Capacity Evaluation (FCE) performance in adults. Materials and methods: A systematic literature search was performed in MEDLINE, CINAHL, and PsycINFO electronic databases. Studies were eligible if they studied social factor's association with the performance of adults undergoing FCE. Studies were assessed on methodological quality and quality of evidence. The review was performed using best-evidence synthesis methods. Results: Thirteen studies were eligible and 11 social factors were studied. Considerable heterogeneity regarding measurements, populations, and methods existed among the studies. High quality of evidence was found for the association of FCE performance with the country of FCE and examiner's fear behavior; moderate quality of evidence with previous job salary; and low or very low quality of evidence with compensation status, litigation status, type of instruction, time of day (workday), primary or mother language, and ethnicity. Other social factors were not studied. Conclusions: Evidence for associations of various social factors with FCE performance was found, but robust conclusions about the strength of the associations cannot be made. Quality of evidence ranged from high to very low. Further research on social factors, also within a biopsychosocial context, is necessary to provide a better understanding of FCE performance. Implications for Rehabilitation Research on Functional Capacity Evaluation (FCE) performance and its association with biopsychosocial factors have scarcely addressed the impact of social factors, limiting full understanding of FCE results. The social factors, healthcare (examiner's fear behavior and type of instruction), personal or cultural systems (country of FCE, primary or mother language, and ethnicity), workplace system (previous job salary, time of day (workday)), and legislative and insurance system (compensation and litigation status), have a bearing in FCE performance. Better understanding of factors associating with functional capacity provide insights in FCE, allowing clinicians to improve the evaluations and interpretations of the assessment and better design the rehabilitation program. Better understanding of factors that influence FCE performance, and of unstudied factors, will allow researchers guidance to further investigate the construct of functional capacity.

Survey of kinesiologists' functional capacity evaluation practice in Canada

BACKGROUND

In Canada, functional capacity evaluations (FCEs) are commonly administered by several health care professions including kinesiologists. Kinesiologists have been recently regulated as health care professionals in Ontario and we know little about their demographics, the frequency of FCE administration, or the types of FCEs used by this group.

OBJECTIVE

The purposes of this study were to identify: 1) the demographic characteristics and FCE education of kinesiology FCE practitioners; 2) the FCE systems most used by these practitioners and 3) the constructs from assessments used to determine functional capacity.

METHODS

A survey was distributed to members of the Canadian Kinesiology Alliance. Descriptive statistics and frequency distributions were calculated from the survey responses (n = 77).

RESULTS

FCE practitioners were represented by kinesiologists (79%) practicing more than 15 years and 1-5 years, who received FCE training from a certification course. ARCON (23%) was the most common FCE system used. Low-level lifting (43%), mid-lift (38%), pulling (38%) and walking (38%) are the most common FCE task components used to assess functional capacity. Although kinesiologists consider multiple factors when making decisions about task component endpoints, biomechanical observations/body mechanics are the primary methods used.

CONCLUSIONS

Kinesiologists are conducting FCEs for the primary purpose of preparing return-to-work or workplace accommodation recommendations. Although functional capacity is determined using multiple factors, there is an emphasis on biomechanics and body mechanics. Focusing FCE training and research on these constructs may provide opportunities to further strengthen the reliability and validity of FCE outcomes.

Development and Validation of a Pain Behavior Assessment in Patients with Chronic Low Back Pain

PURPOSE

High levels of pain behavior adversely affect the success of multidisciplinary rehabilitation of patients with chronic nonspecific low back pain (CNSLBP). Functional capacity evaluation (FCE) assessment should detect high levels of pain behavior to prevent the inclusion of unsuitable patients to functional rehabilitation programs. The aim of this study was to develop a Pain Behavior Assessment (PBA) and to evaluate its construct validity.

METHODS

The PBA was developed by experts in the field and is literature-based. Inclusion criteria for participants of the validation study were: CNSLBP, age 20-60 years, referral for fitness-for-work evaluation. The PBA was applied by physiotherapists during FCE. Rasch analysis was performed to evaluate the construct validity of the PBA. Internal consistency was indicated by the person separation index (PSI), which corresponds to Cronbach's alpha.

RESULTS

145 male (72.5%) and 55 female patients were included. Rasch analysis removed 11 items due to misfit and redundancy, resulting in a final PBA of 41 items. Item mean fit residual was -0.33 (SD 1.06) and total item Chi square 100.39 (df = 82, p = 0.08). The PSI value was 0.83. DIF analysis for age and gender revealed no bias.

CONCLUSIONS

The PBA is a valid assessment tool to describe pain behavior in CNSLBP patients. The high PSI-value justifies the use of the PBA in individuals. The PBA may help to screen patients for high levels of pain behavior.

Functional Capacity Evaluation Research: Report from the Second International Functional Capacity Evaluation Research Meeting

INTRODUCTION

Functional capacity evaluations are an important component of many occupational rehabilitation programs and can play a role in facilitating reintegration to work thus improving health and disability outcomes. The field of functional capacity evaluation (FCE) research has continued to develop over recent years, with growing evidence on the reliability, validity and clinical utility of FCE within different patient and healthy worker groups. The second International FCE Research Conference was held in Toronto, Canada on October 2nd 2014 adjacent to the 2014 Work Disability Prevention Integration conference. This paper describes the outcomes of the conference.

REPORT

Fifty-four participants from nine countries attended the conference where eleven research projects and three workshops were presented. The conference provided an opportunity to discuss FCE practice, present new research and provide a forum for discourse around the issues pertinent to FCE use. Conference presentations covered aspects of FCE use including the ICF-FCE interface, aspects of reliability and validity, consideration of specific injury populations, comparisons of FCE components and a lively debate on the merits of 'Man versus Machine' in FCE's.

FUTURE DIRECTIONS

Researchers, clinicians, and other professionals in the FCE area have a common desire to improve the content and quality of FCE research and to collaborate to further develop research across systems, cultures and countries.

Construct Validity of Functional Capacity Evaluation in Patients with Whiplash-Associated Disorders

PURPOSE

The construct validity of functional capacity evaluations (FCE) in whiplash-associated disorders (WAD) is unknown. The aim of this study was to analyse the validity of FCE in patients with WAD with cultural differences within a workers' compensation setting.

METHODS

314 participants (42% females, mean age 36.7 years) with WAD (grade I and II) were referred for an interdisciplinary assessment that included FCE tests. Four FCE tests (hand grip strength, lifting waist to overhead, overhead working, and repetitive reaching) and a number of concurrent variables such as self-reported pain, capacity, disability, and psychological distress were measured. To test construct validity, 29 a priori formulated hypotheses were tested, 4 related to gender differences, 20 related associations with other constructs, 5 related to cultural differences.

RESULTS

Men had significantly more hand grip strength (+17.5 kg) and lifted more weight (+3.7 kg): two out of four gender-related hypotheses were confirmed. Correlation between FCE and pain ranged from -0.39 to 0.31; FCE and self-reported capacity from -0.42 to 0.61; FCE and disability from -0.45 to 0.34; FCE and anxiety from -0.36 to 0.27; and FCE and depression from -0.41 to 0.34: 16 of 20 hypotheses regarding FCE and other constructs were confirmed. FCE test results between the cultural groups differed significantly (4 hypotheses confirmed) and effect size (ES) between correlations were small (1 hypothesis confirmed). In total 23 out of 29 hypotheses were confirmed (79%).

CONCLUSIONS

The construct validity for testing functional capacity was confirmed for the majority of FCE tests in patients with WAD with cultural differences and in a workers' compensation setting. Additional validation studies in other settings are needed for verification.

The reliability of WorkWell Systems Functional Capacity Evaluation: a systematic review

Background

Functional capacity evaluation (FCE) determines a person’s ability to perform work-related tasks and is a major component of the rehabilitation process. The WorkWell Systems (WWS) FCE (formerly known as Isernhagen Work Systems FCE) is currently the most commonly used FCE tool in German rehabilitation centres. Our systematic review investigated the inter-rater, intra-rater and test-retest reliability of the WWS FCE.

Methods

We performed a systematic literature search of studies on the reliability of the WWS FCE and extracted item-specific measures of inter-rater, intra-rater and test-retest reliability from the identified studies. Intraclass correlation coefficients ≥ 0.75, percentages of agreement ≥ 80%, and kappa coefficients ≥ 0.60 were categorised as acceptable, otherwise they were considered non-acceptable. The extracted values were summarised for the five performance categories of the WWS FCE, and the results were classified as either consistent or inconsistent.

Results

From 11 identified studies, 150 item-specific reliability measures were extracted. 89% of the extracted inter-rater reliability measures, all of the intra-rater reliability measures and 96% of the test-retest reliability measures of the weight handling and strength tests had an acceptable level of reliability, compared to only 67% of the test-retest reliability measures of the posture/mobility tests and 56% of the test-retest reliability measures of the locomotion tests. Both of the extracted test-retest reliability measures of the balance test were acceptable.

Conclusions

Weight handling and strength tests were found to have consistently acceptable reliability. Further research is needed to explore the reliability of the other tests as inconsistent findings or a lack of data prevented definitive conclusions.

Quantification of the safe maximal lift in functional capacity evaluations: comparison of muscle recruitment using SEMG and therapist observation

INTRODUCTION

This study aimed to identify any correlation between muscle activity using surface electromyography (SEMG) and therapist determined safe maximal lift (SML) during the bench to shoulder lift of the WorkHab FCE. This would support construct (convergent) validity of SML determination in the WorkHab FCE.

METHOD

An experimental laboratory based study design was used. Twenty healthy volunteers performed the bench to shoulder lift of the WorkHab FCE whilst SEMG of upper trapezius, mid deltoid, thoracic, brachioradialis and bicep muscles were recorded. A summary of the data is presented using descriptive statistics and differences between groups were tested using generalised linear mixed models.

RESULTS

Results showed a significant difference in activity and duration of muscle activation with increasing weight lifted [p = 0.000 and p = 0.024 (brachioradialis)]. There was a significant difference between the up lift (bench to shoulder) and the down lift (shoulder to bench) for all muscles (p = 0.000) except the brachioradialis (p = 0.819). No significant change was found in muscle activity before or after the SML.

CONCLUSION

Convergent validity of the bench to shoulder lift of the WorkHab FCE was not established as no relationship between the muscle recruitment using SEMG and SML, as determined by therapist observation was identified during this lift.

Comparison of two methods for interpreting lifting performance during functional capacity evaluation

BACKGROUND

Functional capacity evaluation (FCE) requires determination of effort by observation of effort indexes for performance interpretation. Waddell signs have been shown to be associated with decreased functional performance. Whether determination of effort by observational criteria and Waddell sign testing can be used interchangeably to interpret lifting performance is unknown.

OBJECTIVE

The purposes of this study were to assess the concurrent validity of submaximal effort and Waddell signs and to determine whether these contribute independently to lifting performance.

DESIGN

This investigation was an analytical cross-sectional study.

METHODS

A total of 130 people who had chronic nonspecific low back pain and were referred for fitness-for-work evaluation were included. Physical effort was determined on the basis of observational criteria for lifting from floor to waist, lifting from waist to shoulder, and horizontal lifting during FCE. A second assessor conducted Waddell sign testing. The concurrent validity of Waddell signs and submaximal effort was assessed by calculating sensitivity and specificity. Hierarchical regression analysis was used to determine the contributions of Waddell signs and submaximal effort to lifting performance. Age and sex were covariates.

RESULTS

The FCE assessor found a low sensitivity of Waddell signs for submaximal effort determination. Between 53% and 63% of the participants who were classified as showing submaximal effort had Waddell signs. Waddell signs and submaximal effort were independent contributors to lifting performance. The contribution of submaximal effort was larger than that of Waddell signs, as shown by 20% to 29% higher explained variance in lifting performance when submaximal effort was added to the model first versus 3% to 6% higher explained variance when Waddell signs were added first.

LIMITATIONS

Assessor variability could have influenced the study results.

CONCLUSIONS

In people with chronic nonspecific low back pain, Waddell sign testing and determination of physical effort by observational criteria should not be used interchangeably to interpret lifting performance during FCE.

What is the role of "nonorganic somatic components" in functional capacity evaluations in patients with chronic nonspecific low back pain undergoing fitness for work evaluation?

STUDY DESIGN

Analytical cross-sectional study.

OBJECTIVE

To assess the association of "nonorganic somatic components" together with physical and other psychosocial factors on functional capacity evaluation (FCE) in patients with chronic nonspecific low back pain (NSLBP) undergoing fitness-for-work evaluation.

SUMMARY OF BACKGROUND DATA

Functional capacity evaluation is increasingly used for physical fitness-for-work evaluation in patients with chronic NSLBP, but results seem to be influenced by physical as well as psychosocial factors. The influence of nonorganic somatic components together with physical and other psychosocial factors on FCE performance has not yet been investigated.

METHODS

One hundred twenty-six patients with chronic NSLBP referred for physical fitness-for-work evaluation were included. The 4 FCE tests were lifting from floor to waist, forward bend standing, grip strength, and 6-minute walking. Nonorganic somatic components were assessed with the 8 nonorganic somatic signs as defined by Waddell and were adjusted for age, sex, days off work, salary in the previous occupation, pain intensity, fear avoidance belief, and perceived functional ability in multivariate regression analyses.

RESULTS

Between 42% and 58% of the variation in the FCE tests was explained in the final multivariate regression models. Nonorganic somatic components were consistent independent predictors for all tests. Their influence was most important on forward bend standing and walking distance, and less on grip strength and lifting performance. The physical factors of age and/or sex were strongly associated with grip strength and lifting, less with walking distance, and not at all with forward bend standing. The influence of at least 1 other psychosocial factor was observed in all FCE tests, having the highest proportion in the 6-minute walking test.

CONCLUSION

Nonorganic somatic components seem to be consistent independent predictors in FCE testing and should be considered for interpretation of test results.

Inter- and intra-rater reliability of the manual handling component of the WorkHab Functional Capacity Evaluation

The WorkHab Functional Capacity Evaluation (FCE) is widely used in Australian workplace injury management and occupational rehabilitation arenas; however, there is a lack of published literature regarding its reliability and validity.

PURPOSE

 This study investigated the intra- and inter-rater reliability of the manual handling component of this FCE.

METHOD

 A DVD was produced containing footage of the manual handling components of the WorkHab conducted with four injured workers. Therapist raters (n = 17) who were trained and accredited in use of the WorkHab FCE scored these components and 14 raters re-evaluated them after approximately 2 weeks. Ratings were compared using intraclass correlation coefficients (ICCs), paired sample t-tests (intra-rater), chi-squared (inter-rater) and percentage agreement.

RESULTS

Intra-rater agreement was high with ICCs for the manual handling components and manual handling score showing excellent reliability (0.94-0.98) and good reliability for identification of the safe maximal lift (ICC: 0.81). Overall inter-rater agreement ranged from good to excellent for the manual handling components and safe maximal lift determination (ICC > 0.9). Agreement for safe maximal lift identification was good.

CONCLUSIONS

 Ratings demonstrated substantial levels of intra-rater and inter-rater reliability for the lifting components of the WorkHab FCEs.

Test-Retest Reliability of the GAPP Functional Capacity Evaluation in Healthy Adults

Background. Functional capacity evaluations are commonly used in work rehabilitation practice to assess a person's capacity to perform work-related activities. Purpose. This study examined the test-retest reliability of participants' performance and administrator ratings using the Gibson Approach to Functional Capacity Evaluation (GAPP FCE). Methods. Forty-eight healthy adults were evaluated twice on 12 recommended core items of the GAPP FCE and rated for overall performance. Findings. The ICCs and 95% CIs for the Physical Level of Work and Alternative Physical Level of Work Ratings were 0.93 (0.87-0.96) and 0.86 (0.72-0.93) respectively. The ICCs for the core item-level ratings ranged from 0.15 to 0.94, and the ICCs for the actual loads handled in the manual handling items ranged from 0.88 to 0.95. Implications. The stability of an overall physical level of work rating shows potential for use in functional capacity evaluation practice and research. Further research is needed to investigate other measurement properties of the GAPP FCE using populations with injury or disability.

Health professional's perceptions and practices in relation to functional capacity evaluations: results of a quantitative survey

INTRODUCTION

This study investigated the perceptions and practices of Australian health professionals in relation to the use of functional capacity evaluations (FCE's).

METHODS

A quantitative cross-sectional study design was used to survey health professionals who conduct FCE's and who were working for one of 219 rehabilitation providers in NSW, Australia. Seventy seven returned surveys were eligible for inclusion.

RESULTS

Eleven different FCE's were being utilised with many health professionals using more than one FCE. The most commonly used FCE was non-standardised (56%, n = 43) followed by 52% (n = 40) using the Workhab, and 18% (n = 14) using Valpar. Both non-standardised and standardised assessments were being used by 90% (n = 69) of respondents. Health professionals reported using all or parts of the FCE, and indicated identical FCE's are not always conducted, with adaptation of the FCE, due to client injury (82%, n = 62) and job (80%, n = 43) occurring. About 60% of respondents had no choice in the type of FCE they conducted, and of the 40% with a choice, this was not influenced by other stakeholders in the process. Accreditation and training, characteristics of assessment tasks, standardisation, reliability, cost, length and flexibility were all identified as factors affecting the selection of an FCE.

CONCLUSIONS

This study demonstrated that health professionals in NSW Australia, are not routinely using standardised tools for FCE's. Health professional perceptions suggest accreditation, training and the characteristics of the FCE were important factors in FCE selection. In practice, participants tended to use parts of an FCE rather than the whole FCE. Adaptation of FCE's was common, due to client injury and specific job requirements.