Answer: Standardized FCE systems have built-in features to increase safety, validity, consistency, and inter-rater reliability. They have been researched to ensure they measure what they are intended to measure. Standardized training processes, quality assurance checks, research, and peer reviews are all elements necessary for an FCE to hold up in court. Often, when facilities start the process of creating their own FCE, they do not realize the significant amount of staff time needed. It may even be more expensive to create your own FCE. A good test must consider the following elements:

Answer: Valpar has a strong commitment to research for all of our products, including Joule. Research design was initiated even before Joule development was completed. Valpar is the only FCE developer to have a full time researcher on staff. Bryan Christopherson, Ph.D. designs Valpar’s research, manages the data collection process, then analyzes the data. Completed Joule research is published on Valpar’s web site at www.valparint.com.

To date, two inter-rater reliability studies, two outcome studies, and one normative data study have been completed. Here is the breakdown:

Inter-rater reliability: Two multi-clinic studies have been completed. Joule is proven to have excellent inter-rater reliability. Different evaluators independently assessing the same clients came to the same conclusions about their function and consistency of effort. Here are the results:

• Subjective Client Input: 84.2%
• Participation Index: 91.7%
• Terminating Factors: 93.5%
• Last Safe Weight: 96.9%
• Job Frequency Recommendations: 93.3%

Outcomes: Two studies were completed. High return to work rates are shown. 83% of clients returned to work following the FCE. Of the 17% who did not return to work following the FCE, all either were in litigation, on SSD, or were receiving ongoing medical treatment. These results indicate that the Joule FCE clarifies physical abilities and provides direction in case management and return to work. Of the clients that had returned to work and were working within FCE recommended levels, none were re-injured. That is 100% safety! High client satisfaction also was identified. Clients demonstrating inconsistent performance in the FCE were the least satisfied, and had the poorest outcome, as would be expected.

Normative Data: This study identifies FCE performance results for an uninjured population. This data serves as a point of reference for placing parameters in certain Joule protocols.

Methods-Time-Measurement (MTM) Standards: MTM standards are industry standards of productive work abilities. Our fine motor coordination test already has MTM standards built into it.

Answer: FCEs and other tests can come under a significant amount of scrutiny when they are involved in litigation. Courts look for the following elements to ensure that a test instrument is valid and reliable:

The Joule FCE contains all of the above elements. When Valpar set out to develop an FCE, we convened two separate panels of experts to create the framework for the FCE development process. Once the development was completed, the research started. Valpar utilizes independent clinics to conduct Joule research, and we make our research available to all interested parties by publishing it on our web site. In this manner, Joule has been peer-developed as well as peer-reviewed.

Answer: A peer-reviewed journal is a professional periodical with an editorial review board consisting of professionals in the field. These professionals review research that is slated for publication, and based on its contribution to the field, as well as its use of sound research techniques, it is either accepted or rejected for publication. Peer review is never an endorsement of a particular FCE system, however. Some FCE developers are misleading in their implication that the publication of an article on their FCE in a journal amounted to some kind of endorsement. It didn't.

Answer: There is no doubt that the large machines have a very scientific, polished look about them. Their measurements are exact. The problem arises when an attempt is made to compare torque measurements, foot-pounds of force, and force curve data generated by these machines to functional work activities. For example, if a client is strapped into a machine, and all movement is isolated except for trunk flexion/extension, this may give some clinical data about strength or endurance of specific trunk muscles, but it does not tell us how much the client can lift in a work situation.

The Americans with Disabilities Act states that post-offer, pre-hire tests must evaluate the critical demands of the job in order to be acceptable as measures of work ability. The only way to do that is to replicate real work situations. The evaluator must be able to observe effort, movement patterns, compensation techniques, and pace, in order to make decisions regarding safe and maximum levels of work ability. Machine-based FCEs look polished, but their application is limited. Many clinics purchase them enthusiastically, only to have them collecting dust soon after purchase.

Answer: A good FCE must not only identify maximum levels of function, but also the ability to tolerate activity over time. The work levels identified in an FCE must be safe for the client to work at all week long, including Friday afternoon, when fatigue and discomfort may affect work performance. One-day FCEs are the most cost effective, and the easiest to schedule. An individual’s abilities can be determined in one day if he/she does not have significant fluctuations in pain or endurance. A one-day FCE is often appropriate for clients who are completing a work conditioning program. The evaluator knows the client's activity tolerance, and the client has been performing demanding physical activity on a day-to-day basis.

One-day FCEs are not appropriate for individuals who have delayed physical responses to activity. A good example of this is a client with a tendonitis-type injury. He/she may be able to work at a given level one day, but inflamation and pain will most likely adversely impact abilities and activity tolerance on subsequent days. Such clients will benefit most from a two-day FCE. It is also advantageous to use a two-day testing format for clients who give insincere effort in an FCE. It gives the evaluator more information for documenting unreliable performance, and it is extremely difficult for a client to duplicate insincere efforts the second day. Workers who have very demanding jobs (such as emergency medical technicians, and construction workers) also benefit from a two-day FCE. On occasion, a multi-day FCE is also needed in determining safe work abilities. This is often the case with diagnoses such as cumulative trauma disorders, reflex sympathetic dystrophy, or multiple sclerosis, where fatigue and activity tolerance are the primary limiting factors to successful return to work.

An FCE system that is able to meet your client and referral needs should have the flexibility to accommodate one-, two-, and multi- day testing needs.

Answer: These terms refer to whether subjective or objective data is used to make determinations about abilities, and who controls the FCE. Psychophysical FCEs rely on clients to determine when they have reached the maximum of their ability in a particular test. Test results are based on the client’s subjective input. Kinesiophysical FCEs, on the other hand, utilize the objective findings from the evaluator to determine test results. The evaluator decides when an activity will be terminated. FCEs that rely on purely psychophysical or kinesiophysical approaches often miss valuable pieces of information.

The Joule FCE is unique, in that it combines both approaches. There is valuable subjective and objective information in every FCE. Joule uses a classification system to rate the quality of subjective input. Reliable subjective input is used along with objective findings to determine levels of function. The evaluator and the client work together in determining endpoints.