XRTS Protocol

Familiar tools. Unique process.

The Hand Strength Assessment

  • The XRTS Hand Strength Assessment uses the same gauges that clinicians have always used to assess hand strength. Even the directions given to the client prior to the evaluation are substantially the same. The only mechanical differences occur during the administration of the simultaneous bilateral trials.
  • The protocol is a randomized series of 66 trials of unilateral and simultaneous bilateral grip and pinch strength measurements.
  • The results are applied to 7 statistically developed criterion to assure the accuracy of the results.


Research published in the Journal of Hand Therapy has proven the XRTS Hand Strength Assessment to be:







The Material Handling Assessment

  • The XRTS Material Handling assessment uses a repeated measures protocol during the lifting assessment to maximize the objectivity of conclusions regarding validity of effort and maximum lifting capacities. This facilitates fair and legally defensible conclusions regarding functional capacity, moving each case forward in the return to work process.
  • The mechanics of using the XRTS Lever Arm are identical to the mechanics of lifting a crate or box of weights. Therefore, the directions given the patient prior to the Lever Arm testing are identical to those given during box and crate lifts. The differences between the XRTS methodology and standard testing practices occur in the selection of the workloads for the Lever Arm and the mechanical process of selecting and changing workloads on the testing device.

Published Studies

Accuracy of visual estimation in classifying effort during a lifting task

Schapmire DW, St. James JD, Townsend R, Feeler L. Work, 2011;40(4):445-457.

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.

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Simultaneous Bilateral Hand Strength Testing in a Client Population, Part I: Diagnostic, Observational and Subjective Complaint Correlates to Consistency of Effort

Schapmire DW, St. James JD, Feeler L, Kleinkort. Work, 2010;37(3):309-320.

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.

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Simultaneous bilateral hand strength testing in a client population Part II: Relationship to a distraction-based lifting evaluation

St. James JD, Schapmire DW, Feeler L, Kleinkort. Work, 2010;37(4):395-403.

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.

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Isometric Strength Assessment, Part I: Static Testing Does Not Accurately Predict Dynamic Lifting Capacity

Feeler l, St. James JD, Schapmire DW. Work, 2010;37(4):395-403.

Objective: To determine if isometric (static) strength accurately predicts dynamic lifting capacity.

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Isometric Strength Assessment, Part II: Static Testing does not Accurately Classify Validity of Effort

Townsend R, Schapmire DW, St. James, Feeler L. Work. 2010;37(4):387-94.

Objective: The purpose of this study was to determine if these two commonly-administered isometric tests are accurate indices of effort.

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Functional Capacity Evaluation Part 2: Exposing the Most Common Myths in Validity of Effort Testing

St. James JD and Schapmire D. Journal of International Association of Industrial Accident Boards and Commissions. 2011;48(1):65-93.

Abstract: Part 1 of this article described multiple variables in the Gordian Knot known as workers’ compensation. These variables included and were aggravated by functional capacity evaluation (FCE) validity of effort testing. The weaknesses in using intake interviews, pain questionnaires and various clinical tests and observations as the basis for conclusions related to validity of effort were pointed out. The remaining element of the FCE validity of effort testing, various common assessments of physical strength, were referred to as myths on the same order as the legendary Gordian Knot. The conclusion of this article discusses these myths and proposes two previously peer-reviewed distraction-based testing methods as viable alternatives to discredited testing practices.

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Simultaneous Bilateral Testing: Validation of a New Protocol to Detect Insincere Effort During Grip and Pinch Strength Testing

Schapmire D, St. James JD, Townsend R, Stewart T, Delheimer S, Focht D. Journal of Hand Therapy. 2002 Jul-Sep;15(3):242-250.

Abstract: The detection of feigned weakness in hand grip strength assessment is difficult. The authors review several proposed methods and their weaknesses. A comparison of unilateral testing and simultaneous bilateral testing with the Jamar dynamometer and the Baseline pinch gauge is demonstrated as a solution. An experiment involved 100 asymptomatic subjects who were tested twice, once under instructions to give a full effort and once under instructions to feign weakness. Seven statistical criteria of noncompliance were chosen. Defining noncompliance as failing two or more of the seven criteria, 99% of the instructed noncompliant subjects were correctly classified as noncompliant. No subjects were incorrectly classified as noncompliant during instructed compliant testing. Twelve subjects failed on a Single criterion. On retesting, all but one were correctly classified. One subject in the instructed noncompliant group passed all criteria. Accuracy was 99.5%, including retesting of the 12 “gray-zone” subjects.

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