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A Cluster Randomized Clinical Trial Comparing Functional Capacity Evaluation and Functional Interviewing as Components of Occupational Rehabilitation Programs

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Abstract

Purpose Functional capacity evaluations (FCE) are used to identify work abilities and are commonly integrated into rehabilitation programs. We studied whether integrating FCE into rehabilitation leads to better outcomes for injured workers. Methods 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. Results 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 = 4,391.0, p < 0.001) but differences at other follow-up times were smaller (0–8 %), 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, SRM = 0.88) and self-reported disability (21.8/100, SRM = 1.45) were only observed in those undergoing the functional interview. Conclusions 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.

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Acknowledgments

This research was supported with funds from WorkSafeBC through the Focus on Tomorrow program. WCB-Alberta Millard Health assisted with data acquisition and study implementation. The clinical trial registration number was ISRCTN61284905 and the protocol can be accessed at the following website: http://www.controlled-trials.com/ISRCTN61284905/. The authors have no competing interests or financial arrangements that would represent a conflict of interest for this research.

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Authors and Affiliations

  1. Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada

    Douglas P. Gross & Michele C. Battié

  2. Workers’ Compensation Board-Alberta Millard Health, Edmonton, AB, Canada

    Douglas P. Gross, Ambrose Sun, Marti Mikalsky, Rene Huellstrung & Riikka Niemeläinen

  3. Alberta Health Services, Calgary Zone, Calgary, AB, Canada

    Alexander K. Asante

  4. Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada

    Maxi Miciak

  5. School of Public Health, University of Alberta, Edmonton, AB, Canada

    Linda J. Carroll

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  1. Douglas P. Gross
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Correspondence to Douglas P. Gross.

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Gross, D.P., Asante, A.K., Miciak, M. et al. A Cluster Randomized Clinical Trial Comparing Functional Capacity Evaluation and Functional Interviewing as Components of Occupational Rehabilitation Programs. J Occup Rehabil 24, 617–630 (2014). https://doi.org/10.1007/s10926-013-9491-4

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