title: A cluster randomized clinical trial comparing functional capacity evaluation and functional interviewing as components of occupational rehabilitation programs.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada, dgross@ualberta.ca.
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Gross
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Asante
authors.forename: Maxi
authors.initials: M
authors.lastname: Miciak
authors.forename: Michele C
authors.initials: MC
authors.lastname: Battié
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Carroll
authors.forename: Ambrose
authors.initials: A
authors.lastname: Sun
authors.forename: Marti
authors.initials: M
authors.lastname: Mikalsky
authors.forename: Rene
authors.initials: R
authors.lastname: Huellstrung
authors.forename: Riikka
authors.initials: R
authors.lastname: Niemeläinen
mesh_terms: D000328:Adult; D000416:Alberta; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000534:rehabilitation*; D059352:Musculoskeletal Pain / Q000534:rehabilitation; D009784:Occupational Diseases / Q000534:rehabilitation*; D010147:Pain Measurement; D062707:Return to Work; D057566:Self Report; D014938:Work Capacity Evaluation; D014942:Workers' Compensation