Objective classification of functional capacities is a requisite for effective, fair case management of compensable injury claims. An objective and robust assessment of validity of effort must be employed during the functional capacity evaluation (FCE) to ensure the conclusions relative to a claimant's ability to return to work are legally defensible. Otherwise, the outcome of the case becomes an expensive crap shoot which benefits neither plaintiff nor defense. Unfortunately, the standard methods of assessing validity of effort (visual estimation of effort, typical hand strength assessments, the use of heart rate as an index of effort, isometric assessment and isokinetic testing) do not provide objective evidence relative to the claimant’s effort. The X-RTS FCE was developed to give the market a new option to approaching this thorny issue of assessing validity of effort. Our products are supported by the published studies found on this site.
Recently Published Studies
Schapmire DW, St. James JD, Townsend R, Feeler. Accuracy of visual estimation in classifying effort during a lifting task. Work, 2011;40(4):445-457.
Abstract
(Full Text on Published Studies Page)
Objective: The objective was to determine if visual estimation of effort (VEE) during lifting tasks is accurate in classifying relative levels of exertion or distinguishing between incomplete lifts that may be potentially unsafe and incomplete lifts of "actors" feigning weakness. Participants: A convenience sample of 117 health professionals and lay subjects participated in the study. Methods: Four actors were videoed performing four complete dynamic lifts (sets of five repetitions) of varying levels of exertion (relative to subjects' physical maximum). Subjects viewed the videoed performances, presented in no apparent order, attempting to properly classify the lifting tasks. For the four levels of exertion, participants were to judge if the lifts were 25%, 50%, 75% and 100% of each actor's maximum lifting capacity and to distinguish between an incomplete (failed) lift of 110% of maximum and a feigned failure of a lift of 25% of maximum. Results: Accuracy for in classifying all lifting activities was marginally higher than chance. There were no differences in the accuracy of health professionals or lay subjects. Conclusion: The VEE does not accurately classify relative levels of exertion or distinguish between incomplete feigned effort lifts and lifts that are potentially too heavy to safely lift.
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Schapmire DW, St. James JD, Feeler L, Kleinkort J. Simultaneous bilateral hand strength testing in a client population, Part I: Diagnostic, observational and subjective complaint correlates to consistency of effort. Work, 2010;37(3):309-320.
Abstract
(Full Text on Published Studies Page)
Objectives: 1. To determine if scores on pain questionnaires and overt behaviors during a functional capacity evaluation (FCE) were related to variability between repeated measures during a hand strength assessment. 2. To determine if failure of statistically-based validity criteria, as proposed by Schapmire, St. James and Townsend et al. [Journal of Hand Therapy, 2002] is likely to be due to pain. Participants: 200 consecutive clients presenting for an FCE. Methods: Subjects filled out pain questionnaires, were observed for various behaviors and were administered the distraction-based hand strength assessment. Results: Clients failing two or more of the statistically-based validity criteria had higher scores on most pain questionnaires, presented with a higher frequency of various pain behaviors (p <0.05 and < 0.001, respectively), and had a lower rate of relevant surgeries (p <0.001). There was no statistically significant difference in the number of failed validity criteria between this group of clients and for normal subjects feigning weakness in [Schapmire, St. James and Townsend et al., Journal of Hand Therapy, 2002] a controlled study (p > 0.05). Conclusions: Pain does not reasonably explain the failure of the statistically-based validity criteria. The protocol is appropriate for use in a client population.
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St. James JD, Schapmire DW, Feeler L, Kleinkort. Simultaneous bilateral hand strength testing in a client population, Part II: Relationship to a distraction-based lifting evaluation. Work, 2010;37(4):395-403.
Abstract
(Full Text on Published Studies Page)
Objective: To determine if passing or failing statistically-based validity criteria during a distraction-based hand strength assessment is related to test behavior during a lifting assessment. Participants: 200 consecutive clients presenting for an FCE. Methods: The two testing protocols, one involving a hand strength assessment, the other involving an assessment of lifting capacities, were administered to assess the variability between repeated measures. Results: Clients failing two or more statistically-based hand strength validity criteria had significantly more variability between repeated measures in the lifting assessment, p = 0.001 and 0.014 for right and left unilateral lifts, respectively, and p < 0.0005 for three different bilateral lifts. Conclusions: A pattern of performance related to the degree of variability in repeated measures protocols for these two distractionbased protocols is revealed. Passing or failing the hand strength assessment are each equally predictive of test outcome during the distraction-based lifting assessment. The failure of the validity criteria in these two distraction-based tests cannot be attributed to a history of surgery but, rather, is the result of abnormal test behavior.
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Testimonials
The XRTS FCE system has been invaluable to our industrial rehabilitation program. As the result of the objectivity of the system, evaluating therapists can be assured of the accuracy of their findings and their ability to legally defend conclusions drawn from the FCE. This system is unlike any other product on the market and benefits all parties with a vested interest in the outcome of the case, the most important of which is the patient."
John Kruzich, OT, E3 Work Therapy Services, Des Moines, IA.
Darrell has done great work for us on many complex cases. Dave Scott, Archer Daniels Midland, Decatur, IL
Darrell provided invaluable assistance and guidance in preparing for my deposition of an evaluator, in a large Federal jury trial. The information that Darrell provided was invaluable in establishing that the basis for the evaluator's determinations was not scientifically sound, resulting in exclusion of the opinion from the trial. Moreover, I will do a better job on every future expert deposition, thanks to the information Darrell provided.
Defense Attorney Dennis Sadler, Esq., Leitner, Williams, Dooley & Napolitan, Memphis, TN
My client underwent an FCE where the examiner alleged that she was self-limiting and the results were deemed invalid. The testing protocol that was used was mostly subjective in nature. My client then underwent an FCE that used Mr. Schapmire’s devices and methodology. The FCE results were found to be valid. At trial, I used Mr. Schapmire’s materials when I cross-examined the first FCE examiner. The trial court found the first examiner to be not credible and made an award that was favorable to my client." Plaintiff Attorney Todd Reese, Esq., Reese & Reese, Rockford, IL
Since acquiring the XRTS FCE system, we have experienced a significant increase in our FCE referrals. The research based and objective nature of the testing has made reporting validity of effort easier and has made our clinicians confident in the ability to defend their report. Doug Edwards, ATC, Athletic & Rehabilitation Centers, Kansas & Missouri
The XRTS Hand Strength Assessment and Lever Arm have been invaluable additions to my FCE testing regimen for years. This testing system is legally tested and scientifically based, focusing on the effort of the client being tested. I can be confident in the decisions I make as an evaluator and have support from XRTS if these decisions are questioned.Rachel Viel, PT, Orthopedic Rehab Specialists, Rockford, IL
Darrell is an expert in the functional testing field and always answers his phone. I cannot recommend his services enough.Pono Aiona, DC, QME, Sport Clinic, Fremont, CA