Presentation M O26
M O26 (Oral Presentation):
A Cluster Randomized Clinical Trial Comparing Functional Capacity Evaluation and Functional Interviewing as Components of Occupational Rehabilitation Programs
- University of Alberta, Edmonton, Canada
- Alberta Health Services, Calgary, Canada
- WCB-Alberta/Millard Health, Edmonton, Canada
Functional capacity evaluations (FCE) are used to identify work abilities and have become an important component of many functional restoration and rehabilitation programs. We studied whether integrating performance-based FCE into rehabilitation leads to better outcomes for injured workers. We hypothesized: 1) claimants undergoing FCE would demonstrate higher functional work levels at time of evaluation as compared to tose undergoing functional interview; 2) claimants undergoing either FCE or functional interview would have comparable rates of RTW; but 3) claimants undergoing FCE would RTW at higher work levels.
A cluster randomised controlled trial was conducted at a workers’ compensation rehabilitation facility (registration ISRCTN61284905). Clinicians were randomised into 2 groups: 1 group used FCE while another conducted semi-structured functional interviews. Outcomes included recommendations following assessment, rehabilitation program outcomes including functional work levels and pain intensity, as well as compensation outcomes at 1, 3, and 6 months after assessment. Analysis included Mann-Whitney U, Chi square and t tests.
Subjects included 225 claimants of whom 105 were tested with FCE. Subjects were predominantly employed (84%) males (63%) with sub-acute musculoskeletal conditions (median duration 67 days). Claimants undergoing FCE had ~15% higher average functional work levels recommended at time of assessment (Mann–Whitney U = 4391.0, p<0.001) but differences at other follow-up times were smaller (0% to 8%), in favour of functional interviewing, and not statistically significant. Clinically important improvement during rehabilitation in functional work level (0.9/4, SRM=0.94), pain intensity (2.0/10 change, SRM=0.88) and self-reported disability (21.8/100, SRM=1.45) were only observed in those undergoing the functional interview.
Performance-based FCE integrated into occupational rehabilitation appears to lead to higher baseline functional work levels compared to a semi-structured functional interview, but not improved RTW rates or functional work levels at follow-up. Functional interviewing has potential for efficiency gains and higher likelihood of clinically important improvement following rehabilitation, however further research is needed.
Monday September 29
15:45 - 17:15 Afternoon Concurrent Sessions (M O25 - M O37 and Seminar 3)
Session: Long-term work disability