Functional Evaluation Unit, Workers' Compensation Board of British Columbia, Richmond, Canada.

A prospective blinded cohort study was performed in an interdisciplinary vocational evaluation program to investigate the concurrent validity of the ERGOS work simulator in comparison to current methods of evaluation. Seventy men and eight women, aged 22 to 64 years, who attended for a 2-week physical capacity assessment participated in the study. Physical activity factors as defined by the Canadian Classification and Dictionary of Occupations and the American Dictionary of Occupational Titles were assessed for all subjects under three evaluation conditions: the ERGOS work simulator, an exercise-oriented physical evaluation by a rehabilitation therapist, and performance of project-format industrial tasks. In addition, 17 men and 7 women were assessed with VALPAR standardized work sample tests. The statistical significance of the relationships between results obtained by the various evaluation methods was examined. There was a strong correlation between the ERGOS dynamometry and the clinical assessment of strength for all standard movements tested (P < .001). The Methods Time Measurement rating by the ERGOS for dexterity variables, according to industrial engineering standards, tended to rate subjects as more restricted than did the clinical evaluators. There was a significant relationship (P < .001) between the "overall physical activity rating" from ERGOS dynamometry, clinical evaluation, and performance in an industrial workshop setting. There was also a significant relationship (P < .001) between the "overall physical activity rating" for endurance of a full workday produced by the 4-hour ERGOS evaluation and by the 2-week functional capacity evaluation.

Functional Evaluation Unit, Workers' Compensation Board of British Columbia, Richmond, Canada.

A prospective blinded cohort study was performed to test for a difference in the pattern of physical activity factors measured with the ERGOS work simulator in subjects with low back injuries versus those with limb injuries. Also tested was the relationship between physical activity factors measured with the ERGOS and several psychological tests and measures of nonorganic pain behavior in subjects with low back pain. Subjects were 70 men, 22 to 64 years old, who attended a 2-week physical capacity assessment after undergoing rehabilitation for a work-related injury. In subjects with a complaint of low back pain, nonorganic pain behavior was measured with the Waddell score. In addition, two brief psychological tests, the Coopersmith Self-Esteem Inventory and analog self-rating of wellness, were administered. It was found that subjects with low back complaints underperformed globally in comparison with subjects with limb complaints. This underperformance was statistically significant (P < .05) for 7 of 13 strength variables and 2 of 7 dexterity variables. In the subjects with low back complaints, those who exhibited excessive illness behavior (Waddell score, 3 to 5) performed significantly worse on all 13 strength variables and on 3 of 7 dexterity variables. In the subjects with low back complaints, those with low self-assessment ratings were found to have a high Waddell score (P < .01) and to perform significantly worse (P < .05) on 12 of 13 strength variables and 6 of 7 dexterity variables. There were no significant relationships (P > .05) between Coopersmith Self-Esteem score and Waddell score or performance on ERGOS testing

Boadella JM, Sluiter JK, Frings-Dresen MH. Reliability of upper extremity tests measured by the Ergos work simulator: a pilot study. Journal of Occupational Rehabilitation, 2003 Dec, 13(4):219-32. [Link]

Coronel Institute for Occupational and Environmental Health, Academic Medical Center/University of Amsterdam, Research Institute for Health and Health Care Research (AmCOGG), Amsterdam, The Netherlands.

The objective of this paper was to assess the reliability of functional capacity evaluation (FCE) tests of the upper extremity in Ergos from three perspectives: human performance (in terms of a learning effect); order of the physical intensity (force) of the subtests (intensity effect); and performance in time (time of day effect). An experimental within-subjects design was performed. Twelve healthy males/females were tested in the morning or in the afternoon. The tests focused on sensibility, coordination, and strength of the upper extremity. A counterbalanced design was used for three orders of the three types of tests increasing in intensity. Each participant was tested three times over the course of 4 weeks. A learning effect was found in sensibility and coordination subtests. No order effect was observed in terms of the intensity of the subtests. A time effect was found in coordination tasks: keyboarding performance was better in the morning, and handling better in the afternoon. It was concluded that repeated upper extremity FCE testing in the present pilot study was found to be reliable over a 4-week period in healthy subjects.

The use of assessment instruments in evaluating functional capacity is an important element in the process of social-medical judgment of whether a person will likely be able to reintegrate into working life. Standardized work processes are used in simulating occupational reality over several hours, with all the requirements involved, and the performance found is contrasted with the requirements to be expected at a workplace. Time-tested in the U.S. for more than 20 years and applied throughout Germany for some two years now, the ERGOS work simulation system is presented in the article, using a case example for more detailed description. Using five different work stations, performance data are collected for job tasks such as carrying, working in kneeling position or overhead, and subjected to computer-based comparison with the job requirements information contained in relevant databases. This enables computerized identification of excessive demands, and hence may point to a need for further rehabilitative action. An important feature is objective assessment, as subjective information on the basis of observation or reports of painfulness are raised separately, hence do not influence the findings of the work simulation performed.

Coronel Institute for Occupational and Environmental Health, Academic Medical Center/University of Amsterdam, Research Institute for Health and Health Care Research (AmCOGG), Amsterdam, The Netherlands.

The objective of this paper was to assess the reliability of functional capacity evaluation (FCE) tests of the upper extremity in Ergos from three perspectives: human performance (in terms of a learning effect); order of the physical intensity (force) of the subtests (intensity effect); and performance in time (time of day effect). An experimental within-subjects design was performed. Twelve healthy males/females were tested in the morning or in the afternoon. The tests focused on sensibility, coordination, and strength of the upper extremity. A counterbalanced design was used for three orders of the three types of tests increasing in intensity. Each participant was tested three times over the course of 4 weeks. A learning effect was found in sensibility and coordination subtests. No order effect was observed in terms of the intensity of the subtests. A time effect was found in coordination tasks: keyboarding performance was better in the morning, and handling better in the afternoon. It was concluded that repeated upper extremity FCE testing in the present pilot study was found to be reliable over a 4-week period in healthy subjects.

AmCOGG, Research Institute Amsterdam Center for Health and Health Care Research, Coronel Institute for Occupational and Environmental Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.frings@amc.uva.nl

Musculoskeletal disorders often result in employee disability leaves and sickness-related absenteeism in the workplace. Professional evaluations of an employee's capacity to work require additional support by means of Functional Capacity Evaluation (FCE) methods. However, most FCE methods assess general physical capacity and, because of fixed test procedures, testing times range between 4 and 6 h for up to several days. For return to work (vocational rehabilitation), the tests need to reflect the employees' specific work demands more precisely. This study aims to develop a job-specific FCE protocol on the Ergos Work Simulator for hospital nurses. In developing the contents of this specific protocol, hierarchical task analyses were performed with 20 nurses in four departments of a university medical center. A job-specific test protocol was developed that consisted of five steps. In this process, the original test protocol was analyzed first. Secondly, categorization of physical risk factors for work-related musculoskeletal disorders revealed 16 possible combinations of activity, posture, and load. Finally, duration and frequencies during one working day of these combinations were coupled to the Ergos test panels. The nurse-specific test protocol lasts 90 min. It was possible to develop a job-specific protocol, using on-site observations as the input. Compared to the original Ergos protocol, the external validity of the new job-specific protocol has improved: it simulates the functional capacity that nurses need to perform their job in a realistic way. The testing time of the original Ergos protocol is four times longer compared to the new job-specific protocol.

Objective: To establish a comparative best effort physical performance and physio-behavioral pain component baseline for use in an evidence-based functional restoration program.

Design: Two separate prospective blinded cohort studies were conducted the first of which examined the robustness of various physical performance assessment systems and then studied 219 chronic pain subjects to compare best effort work capability [employability] to their disability impairment ratings. The second study examined 58 test subjects, including 4,795 discomfort and 3,039 behavioral test samplings, to determine how to properly classify and analyze physio-behavioral pain components.