May 2017 Issue: The “Who”, “Why” and “How” of kinesiologists’ practice related to Functional Capacity Evaluations -Kathryn Sinden, RKin., PhD

Posted May 2nd, 2017 in KineKT

A functional capacity evaluation (FCE) is an important clinical tool used to assess individuals’ ability to perform tasks that are linked to job duties such as lifting, walking, pulling / pushing, carrying and manual handling. The information and recommendations from FCEs are often used in litigation related to disability and to support the rehabilitation of injured and/or ill workers (1,2). 

Multiple factors influence the way FCEs are administered including the skills and attributes of the assessor (3,4) as well as the tools or approach used to implement the FCE protocol(5). FCEs are administered by various allied health care professionals including kinesiologists and are often implemented using component-based systems such as the Metriks and BTE systems. Although FCEs are a service provided by kinesiologists, there was little information about the way they implement and interpret these clinical assessments.

To better understand these issues, we surveyed members of the Canadian Kinesiology Alliance (CKA) through an “e-blast” to identify the: a) characteristics of kinesiologists as FCE administrators, b) type of FCEs implemented and c) constructs used by kinesiologists to determine functional capacity. We asked questions in three categories: general information (i.e., demographics of the respondents), general functional testing usage (i.e., identifying when FCEs were administered in the rehabilitation context) and application of functional testing protocols (i.e., the administration of specific FCE components and task endpoint determination). 

We found that 80% of FCE practitioners were kinesiologists who had either several years of practice experience (i.e., more than 15 years) or were new practitioners (i.e., 1-5 years); these kinesiologists reported receiving their FCE training through a formal certification course as might be offered through an established approach such as Metriks or BTE. FCEs were primarily referred to assist return-to-work planning or to identify workplace modifications.  Kinesiologists reported that the most frequently administered FCE components were lifting, pushing / pulling and walking protocols. Kinesiologists used a combination of factors when determining endpoints; however, biomechanical observations and/or body mechanics were the primary factors considered.

The study provided important insights into the demographic characteristics of kinesiologists administering FCEs and how FCEs are administered.  For example, kinesiologists on both ends of the practice continuum are performing FCEs which suggests opportunity for mentorship particularly since only 20% of kinesiologists receive formal FCE training.  Furthermore, our survey results identified that a small percentage of kinesiologists receive FCE training during their formal academic training which may be an important consideration for academic institutions when reviewing kinesiology curriculum. Our finding that kinesiologists rely on biomechanical and/or body mechanics when determining task-based endpoints has important implications for training FCE assessors. Developing an evidence-based process to determine signs related to biomechanical fatigue during a functional task such as lifting may improve some of the measurement properties associated with FCEs. In summary, this study provided interesting insights into the who, why and how FCEs are conducted amongst kinesiologists that may inform both future education, research and practice.

Want to read more? Here is the full Reference:  Sinden KE, McGillivary TL, Chapman E, Fischer SL. Survey of kinesiologists’ functional capacity evaluation practice in Canada. Work (2017); 56(4):571-580. 

Funding: Queen’s University Senate Advisory Research Council grant (Dr. S.L. Fischer, RKin)

About the Author:  Kathryn Sinden RKin., PhD is an Assistant Professor in the School of Kinesiology at Lakehead University, Thunder Bay, Ontario (kathryn.sinden@lakeheadu.ca).

References

1.          Pransky GS, Dempsey PG. Practical aspects of functional capacity evaluations. J Occup Rehabil. 2004;14(3):217–29.

2.          Gibson L, Strong J. A review of functional capacity evaluation practice. Work. 1997;9(1):3–11.

3.          Smith RL. Therapists’ ability to identify safe maximum lifting in low back pain patients during functional capacity evaluation. J Orthop Sports Phys Ther. 1994;19(5):277–81.

4.          Trippolini MA, Dijkstra PU, Jansen B, Oesch P, Geertzen JHB, Reneman MF. Reliability of clinician rated physical effort determination during functional capacity evaluation in patients with chronic musculoskeletal pain. J Occup Rehabil [Internet]. 2014;24(2):361–9.

5.          James CL, Reneman MF, Gross DP. Functional Capacity Evaluation Research: Report from the Second International Functional Capacity Evaluation Research Meeting. J Occup Rehabil. 2016;26(1).

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