The evolving role of physiotherapists in pre-employment screening for workplace injury prevention: are functional capacity evaluations the answer?

Abstract

BackgroundMusculoskeletal injuries account for the largest proportion of workplace injuries. In an attempt to predict, and subsequently manage, the risk of sprains and strains in the workplace, employers are turning to pre-employment screening. Functional capacity evaluations (FCEs) are increasing in popularity as a tool for pre-employment screening despite limited published evidence for their validity in healthy working populations.ObjectivesThis narrative review will present an overview of the state of the evidence for pre-employment functional testing, propose a framework for decision-making to determine the suitability of assessment tools, and discuss the role and potential ethical challenges for physiotherapists conducting pre-employment functional testing.Major FindingsMuch of the evidence surrounding the validity of functional testing is in the context of the injured worker and prediction of return to work. In healthy populations, FCE components, such as aerobic fitness and manual handling activities, have demonstrated predictability of workplace injury in a small number of studies. This predictability improves when workers' performance is compared with the job demands. This job-specific approach is also required to meet anti-discrimination requirements. There are a number of practical limitations to functional testing, although these are not limited to the pre-employment domain. Physiotherapists need to have a clear understanding of the legal requirements and potential ethical challenges that they may face when conducting pre-employment functional assessments (PEFAs).ConclusionsFurther research is needed into the efficacy of pre-employment testing for workplace injury prevention. Physiotherapists and PEFAs are just one part of a holistic approach to workplace injury prevention.

Interpreting physical and behavioral health scores from new work disability instruments

“…Clinician−administered and/or performance−based functional assessments are time−consuming, costly, and impractical to implement in large programs such as the SSA’s work disability adjudication process. Comprehensive functional assessment strategies exist, but they are time-consuming to administer and are impractical for widespread use (14). Item−response theory (IRT) and computer adaptive test (CAT)−based assessment of function may be a promising means to provide the SSA with standardized functional assessment tools that are feasible for widespread implementation, and that when combined with other medical evidence and workplace information, can provide valuable information on a person’s ability to engage in substantial gainful employment activity (15–18).…”

Pre-employment functional capacity evaluations: a public health perspective

“…In the review of pre-employment screening by Legge, the author provides a much needed overview of the aspects of this practice that are of relevance to physiotherapists and employers. 1 The narrative review is neither an opinion piece about pre-employment screening nor does it provide a list of pros and cons for the reader to contemplate. It is neither a systematic review of the evidence nor a practical how-to guide.…”