Assessment and Goal Setting in Vocational Rehabilitation

The evaluation of the functional performance is a complex problem of our time. The definition of functional health (ICF) shows many different achievments.

It provides an academic base for the study and understanding of the state of health as well as conditions, outcomes and determinates the health.

• It is a common claim to improve the communication between healthcare experts, research, politicians and the public including persons with disability.

• It allows comparison of data between countries, disciplines of the health care system and during terms.

• It is a systematic ciphering system for all healthcare information systems.

Rehabilitation is the management of the aftereffect of disease. Therefore it concentrates more on the consequences on the functional health than the diseases.

Conceptional performance, measured by test-specific or ergonomic requirements, is facing specific requirements at the workplace.

Many workgroups are working on a solution for the loss of transfer between test and reality.

There is an algorithm with three different systems (ERGOS, EFL by Iserhagen, biomechanics functional analysis) to establish different criteria. These criteria are abstract versus concrete functional performance as well as testing and assessment of job performance.

One standardized Method to evaluate the job performance is the measurement of functional capacity with ERGOS.

Our researches for test-retest-reliability of ERGOS-systems are showing good to excellent good results and confirming the results of other workgroups.

The main focus is on integrative appraisal of performance, the complexity of the tasks and skills, hard and soft analysis of data, mechanism of compensation and the experience of the rater.

There are controversial results for evidence of the system. Goutebarge 2009 points a bad construct validity and a statistically not provable discriminative validity out. A high predicatively validity for patients with unspecific chronic back pain is found by Cheng 2010. Branton 2010 sees a usesage of predication for recovery but not for diseases consequences.

Fig. 1: The test quality of the FCE systems based on validity, reliability and objectivity, is proved in different papers (James 2011, Oesch 2011, Gibson 2010).

Fig. 2: Performance evaluation of functional disorders.

References:

[1] Branton EN (2010): A short-form functional capacity evaluation predicts time to recovery but not sustained return-to-work. J Occup Rehabil. 2010 Sep;20(3):387-93.

[2] Erbstößer S, Nellessen G, Schuntermann M: FCE Studie FCE-Systeme zur Beurteilung der arbeitsbezogenen Leistungsfähigkeit Bestandsaufnahme und Experteneinschätzung Abschlußbericht (DRV Schriften Band 44); Verband Deutscher Rentenversicherungsträger, Frankfurt am Main 2003

[3] Cheng, AS (2010): The predictive validity of job-specific functional capacity evaluation on the employment status of patients with nonspecific low back pain. J Occup Environ Med. 2010 Jul;52(7):719-24.

[4] Gibson LA. (2010): Test-retest reliability of the GAPP functional capacity evaluation in healthy adults. Can J Occup Ther. 2010 Feb;77(1):38-47.

[5] Goutebarge V. (2009): Construct validity of functional capacity evaluation lifting tests in construction workers on sick leave as a result of musculoskeletal disorders. Arch Phys Med Rehabil. 2009 Feb;90(2):302-8.

[6] James C. et al (2011): Inter- and intra-rater reliability of the manual handling component of the WorkHab Functional Capacity Evaluation Disabil Rehabil. 2011;33(19-20):1797-804. Epub 2011 Jan 19.

[7] Kaiser H, Kersting M, Schian H-M, Jacobs A, Kasprowski D (2000): Der Stellenwert des EFL-Verfahrens nach Suan Isernhagen in der medizinischen und beruflichen Rehabilitation. Rehabilitation 39, 297-306

[8] Oesch et al (2011): What is the Role of ‘Nonorganic-Somatic-Components’ in Functional Capacity Evaluations in Patients with Chronic Non-Specific Low Back Pain Undergoing Fitness for Work Evaluation? Spine (Phila Pa 1976). 2011 Aug 18.

[9] Schreiber TU, Bak P, Petrovich A, Anders C, Müller W-D, Smolenski UC (2001): Evaluation der funktionellen Leistungsfähigkeit (EFL) – Überblick über Methoden und Testsysteme Phys Med Rehab Kuror 200 (10): 108-119