title: Are performance-based functional assessments superior to semistructured interviews for enhancing return-to-work outcomes?
abstract: OBJECTIVE
  To examine whether use of functional capacity evaluation (FCE) leads to better outcomes for injured workers.
  
  
  METHODS
  Cluster randomized controlled trial conducted with analysis at level of claimant.
  
  
  METHODS
  Rehabilitation facility.
  
  
  METHODS
  Participants included claimants (N=203); of these, 103 were tested with FCE. Data were collected on all claimants undergoing RTW assessment at the facility for musculoskeletal conditions. Participants were predominantly employed (59%) men (73%) with chronic musculoskeletal conditions (median duration, 496d).
  
  
  METHODS
  FCEs are commonly used to identify work abilities and inform return-to-work (RTW) decisions. Therefore, FCE results have important consequences. Clinicians who were trained and experienced in performing FCEs were randomized into 2 groups. One group included 14 clinicians who were trained to conduct a semistructured functional interview; the other group (control group) continued to use standard FCE procedures.
  
  
  METHODS
  Outcomes included RTW recommendations after assessment, functional work level at time of assessment and 1, 3, and 6 months after assessment, and compensation outcomes. Analysis included Mann-Whitney U, chi-square, and t tests.
  
  
  RESULTS
  All outcomes were similar between groups, and no statistically or clinically significant differences were observed. Mean differences between groups on functional work levels at assessment and follow-up ranged from 0.1 to 0.3 out of 4 (3%-8% difference, P>.05).
  
  
  CONCLUSIONS
  Performance-based FCEs did not appear to enhance RTW outcomes beyond information gained from semistructured functional interviewing. Use of functional interviewing has the potential to improve efficiency of RTW assessment without compromising clinical, RTW, or compensation outcomes.
authors: Department of Physical Therapy, University of Alberta, Edmonton, Alberta; Workers' Compensation Board-Alberta/Millard Health, Edmonton, Alberta. Electronic address: dgross@ualberta.ca.
authors: Douglas P
authors: DP
authors: Gross
authors: Alberta Health Services, Calgary Zone, Calgary, Alberta.
authors: Alexander K
authors: AK
authors: Asante
authors: Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta.
authors: Maxi
authors: M
authors: Miciak
authors: Department of Physical Therapy, University of Alberta, Edmonton, Alberta.
authors: Michele C
authors: MC
authors: Battié
authors: School of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
authors: Linda J
authors: LJ
authors: Carroll
authors: Workers' Compensation Board-Alberta/Millard Health, Edmonton, Alberta.
authors: Ambrose
authors: A
authors: Sun
authors: Workers' Compensation Board-Alberta/Millard Health, Edmonton, Alberta.
authors: Marti
authors: M
authors: Mikalsky
authors: Workers' Compensation Board-Alberta/Millard Health, Edmonton, Alberta.
authors: Rene
authors: R
authors: Huellstrung
authors: Workers' Compensation Board-Alberta/Millard Health, Edmonton, Alberta.
authors: Riikka
authors: R
authors: Niemeläinen
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D009140:Musculoskeletal Diseases / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011379:Prognosis; D012189:Retrospective Studies; D062707:Return to Work / Q000639:trends*; D014938:Work Capacity Evaluation
keywords: Insurance, disability; Outcome and process assessment (health care); Rehabilitation; Return to work; Workers' compensation