This research project has been presented at the MPTA 2016 on April 16, 2016 RockU's Festival of Student Achievement (FOSA) Celebration on April 21, 2016 and APTA's Combined Sections Meeting on February 18, 2017.
Institution: Rockhurst University, 100 Rockhurst Road, KCMO, 64110
Purpose: Within a functional capacity evaluation (FCE), an individual’s sincere maximal effort must be determined. Objective tools or methods such as the traditional crate lift are used to assess sincerity of effort, which gives the FCE evaluator further ability to protect patients who are sincerely participating in the FCE, while identifying those who are not. The XRTS Lever Arm replicates the biomechanics of the crate lift. The purpose of this research study is to 1) compare the maximum lifting capacities on the XRTS Lever Arm with the traditional crate lift and 2) determine the relationship of perceived exertion between the XRTS Lever Arm and the traditional crate lift. Subjects: For this pilot project, a total of 41 subjects between ages 20-40 with no upper or lower extremity injuries within the past 12 months were recruited to participate in this study. Subjects who were able to lift more than 110 pounds in the crate lift were excluded. Materials/Methods: On the first day of testing, investigators established 1RM for each subject performing a lift from 20 inches off the ground to their navel using a traditional crate. Subjects were then randomly assigned 5 weights ranging from 10-100% of their determined 1RM and asked to give a rating of their perceived exertion (RPEs) after each lift. The subjects repeated the same procedure used for the crate lift 2-5 days later using the XRTS Lever Arm. Percent difference between the traditional crate lift and the XRTS Lever Arm were calculated and the results of the lifting modes were classified as “equivocal consistency” of effort if the average variation between all lifts were < 25%. Spearman’s Correlation Coefficient was used to determine the relationship of perceived exertion between the XRTS Lever Arm and the traditional crate lift. Results: There was a statistically significant difference (p < 0.04) between maximal lift values for the two lifting modes. The % difference between the traditional crate lift and the XRTS Lever Arm was 10.5% +/- 6.4% with values ranging between .82%-23.78%. Of the 41 subjects, 38 of the subjects were below a 20% difference and 31 subjects were below a 15% difference. Additionally, there was a positive correlation between the RPE on the traditional crate lift and the XRTS Lever Arm (p=0.92). Conclusions: This validation study demonstrates that lift effort and perceived exertion are not different between lifting modes. Although the actual maximal lift values for the modes of lifting were statistically different the two modes of lifting are equivalent within the standard 20% percent difference. Clinical Relevance: It is challenging to determine an individual’s sincerity of effort based on visual observation alone during an FCE. Patients whose efforts are not sincere during physical evaluation may overuse treatment, have prolonged recovery, or increased cost of care. Ongoing research using distraction based lifting with the XRTS Lever Arm for determining patient effort during testing is needed in which data collection simulates the clinical environment by testing subjects for both modes of lifting on the same day rather than on two separate days. Further, increased scientific evidence to support objective measurement of effort will assist in eliminating clinician bias in determining functional capacity evaluation results.
References
1. Gross DP, Battié MC. Does functional capacity evaluation predict recovery in workers’ compensation claimants with upper extremity disorders? Occup Environ Med. 2006;63(6):404-410.
2. Lechner DE, Bradbury SF, Bradley LA. Detecting sincerity of effort: a summary of methods and approaches. Phys Ther. 1998;78(8):867-888.
3. Legge J. The evolving role of physiotherapists in pre-employment screening for workplace injury prevention: are functional capacity evaluations the answer? Phys Ther Rev. 2013;18(5):350-357.
4. Reneman MF, Fokkens AS, Dijkstra PU, Geertzen JHB, Groothoff JW. Testing lifting capacity: validity of determining effort level by means of observation. Spine. 2005;30(2):E40-E46.
5. Reneman MF, Kool J, Oesch P, Geertzen JHB, Battié MC, Gross DP. Material handling performance of patients with chronic low back pain during functional capacity evaluation: a comparison between three countries. Disabil Rehabil. 2006;28(18):1143-1149.
6. Schapmire DW, St James JD, Townsend R, Feeler L. Accuracy of visual estimation in classifying effort during a lifting task. Work Read Mass. 2011;40(4):445-457.
7. St James JD, Schapmire DW, Feeler L, Kleinkort J. Simultaneous bilateral hand strength testing in a client population, Part II: Relationship to a distraction-based lifting evaluation. Work Read Mass. 2010;37(4):395-403.
Key Words: Functional capacity evaluation (FCE), Effort testing, Perceived exertion
Purpose: Within a functional capacity evaluation (FCE), an individual’s sincere maximal effort must be determined. Objective tools or methods such as the traditional crate lift are used to assess sincerity of effort, which gives the FCE evaluator further ability to protect patients who are sincerely participating in the FCE, while identifying those who are not. The XRTS Lever Arm replicates the biomechanics of the crate lift. The purpose of this research study is to 1) compare the maximum lifting capacities on the XRTS Lever Arm with the traditional crate lift and 2) determine the relationship of perceived exertion between the XRTS Lever Arm and the traditional crate lift. Subjects: For this pilot project, a total of 41 subjects between ages 20-40 with no upper or lower extremity injuries within the past 12 months were recruited to participate in this study. Subjects who were able to lift more than 110 pounds in the crate lift were excluded. Materials/Methods: On the first day of testing, investigators established 1RM for each subject performing a lift from 20 inches off the ground to their navel using a traditional crate. Subjects were then randomly assigned 5 weights ranging from 10-100% of their determined 1RM and asked to give a rating of their perceived exertion (RPEs) after each lift. The subjects repeated the same procedure used for the crate lift 2-5 days later using the XRTS Lever Arm. Percent difference between the traditional crate lift and the XRTS Lever Arm were calculated and the results of the lifting modes were classified as “equivocal consistency” of effort if the average variation between all lifts were < 25%. Spearman’s Correlation Coefficient was used to determine the relationship of perceived exertion between the XRTS Lever Arm and the traditional crate lift. Results: There was a statistically significant difference (p < 0.04) between maximal lift values for the two lifting modes. The % difference between the traditional crate lift and the XRTS Lever Arm was 10.5% +/- 6.4% with values ranging between .82%-23.78%. Of the 41 subjects, 38 of the subjects were below a 20% difference and 31 subjects were below a 15% difference. Additionally, there was a positive correlation between the RPE on the traditional crate lift and the XRTS Lever Arm (p=0.92). Conclusions: This validation study demonstrates that lift effort and perceived exertion are not different between lifting modes. Although the actual maximal lift values for the modes of lifting were statistically different the two modes of lifting are equivalent within the standard 20% percent difference. Clinical Relevance: It is challenging to determine an individual’s sincerity of effort based on visual observation alone during an FCE. Patients whose efforts are not sincere during physical evaluation may overuse treatment, have prolonged recovery, or increased cost of care. Ongoing research using distraction based lifting with the XRTS Lever Arm for determining patient effort during testing is needed in which data collection simulates the clinical environment by testing subjects for both modes of lifting on the same day rather than on two separate days. Further, increased scientific evidence to support objective measurement of effort will assist in eliminating clinician bias in determining functional capacity evaluation results.
References
1. Gross DP, Battié MC. Does functional capacity evaluation predict recovery in workers’ compensation claimants with upper extremity disorders? Occup Environ Med. 2006;63(6):404-410.
2. Lechner DE, Bradbury SF, Bradley LA. Detecting sincerity of effort: a summary of methods and approaches. Phys Ther. 1998;78(8):867-888.
3. Legge J. The evolving role of physiotherapists in pre-employment screening for workplace injury prevention: are functional capacity evaluations the answer? Phys Ther Rev. 2013;18(5):350-357.
4. Reneman MF, Fokkens AS, Dijkstra PU, Geertzen JHB, Groothoff JW. Testing lifting capacity: validity of determining effort level by means of observation. Spine. 2005;30(2):E40-E46.
5. Reneman MF, Kool J, Oesch P, Geertzen JHB, Battié MC, Gross DP. Material handling performance of patients with chronic low back pain during functional capacity evaluation: a comparison between three countries. Disabil Rehabil. 2006;28(18):1143-1149.
6. Schapmire DW, St James JD, Townsend R, Feeler L. Accuracy of visual estimation in classifying effort during a lifting task. Work Read Mass. 2011;40(4):445-457.
7. St James JD, Schapmire DW, Feeler L, Kleinkort J. Simultaneous bilateral hand strength testing in a client population, Part II: Relationship to a distraction-based lifting evaluation. Work Read Mass. 2010;37(4):395-403.
Key Words: Functional capacity evaluation (FCE), Effort testing, Perceived exertion