Functional testing, often referred to as functional capacity evaluation (FCE) has played a
longstanding role within return-to-work (RTW). The goal of an FCE is to measure an assess an
individual's functional capabilities (e.g., how much can the client lift? How hard can the
client push? Can the client sit for a long period of time? etc.). Historically, FCE served to
measure the degree of disability (i.e., reduction in physical capability) following a
workplace injury and also helped to match workers with meaningful work suited to their
(adapted) functional abilities. Presently, performance-based FCE, testing requiring clients
to perform movements with different weighted objects (for instance, to measure how much
someone can lift), is collected at patient intake to provide a functional capacity baseline
which, in turn, informs patient-centered rehabilitation programming. Not only does this FCE
information help support job matching when applied at the end stages of rehabilitation
(fitting clients to work based on the adapted functional capabilities), but when applied
early with the rehabilitation program, FCE also provides key insights to inform
patient-centred rehabilitative strategies and work hardening approaches. FCE plays a central
role in supporting early and safe RTW.
However, accessing in-person, in-clinic administered functional testing to provide these
important baseline insights has been a longstanding problem in remote and rural communities,
a problem now amplified by clinic disruptions and temporary closures across Ontario, Canada.
COVID-19 has intensified the problem of the in-person, in-clinic requirements for baseline
functional testing where many injured workers are unable to access or are delayed in
accessing important FCE services. The lack of patient-specific information regarding
functional abilities via baseline FCE is a direct barrier to patient-centered rehabilitation
and limits early and safe RTW. To address this problem, the investigators test the efficacy
of a remotely administered functional testing protocol as an alternative to in-person,
in-clinic baseline functional testing.
The concept of a remotely delivered baseline FCE is not new, but has been limited to
subjective self-report-based methods only (e.g., asking a client how much they think they can
lift). Gross et al., (2014) provide evidence that a functional interviewing-based FCE
(currently deployed within the Workers' Compensation Board - Alberta, Canada system) was
equivalently useful in predicting RTW outcomes relative to performance-based FCE. However,
performance-based FCE elements, such as low lifting tests also remain useful for predicting
RTW outcomes and provide objective insight about movement characteristics. Observing how a
client moves when performing a lift, for example, provides insight into their willingness to
engage, any guarding behaviours they may exhibit, any observed hesitancy to move, and also
provides insight into their coordination of movement. These insights are necessary to inform
patient centered rehabilitation programming and to ensure that the care team has the
necessary health professionals (i.e., rehabilitation to address mechanical issues relative to
psychosocial barriers). The investigators believe that a hybrid FCE including self-report to
estimate maximum functional levels combined with a safe, submaximal performance-based FCE to
assess movement characteristics can provide key insights to best optimize early and safe RTW
when using virtual FCE delivery. However, at present, no such testing paradigm exists.
To optimize remote FCE service delivery to include both self-report and performance-based
insights, the investigators aim to leverage the 2D video recording capabilities of Microsoft
Teams, the CBI Health approved software application for safely and securely engaging with
clients remotely. The investigators have demonstrated how movement data (which can be
generated using 2D video and pose estimation) and advances in computer vision can be
leveraged to generate insightful information about key movement characteristics, functional
capabilities and safety. The ability for a patient to record their performance of safe,
standardized, sub-maximal actions will generate essential and objective information to
support patient-centered rehabilitative programing, an integral requirement for early and
safe RTW.
The investigators have developed an evidence-based protocol for remote delivery of baseline
functional testing for injured workers inclusive of performance-based and self-report FCE
measures. The investigators now aim to evaluate if a remotely administered functional testing
protocol can generate treatment recommendations and RTW outcomes that are consistent with the
current status quo requiring in-person, in-clinic functional assessment. The investigators
hypothesize that the remotely administered functional testing protocol will yield similar
insight to in-person, in-clinic baseline FCE, such that RTW outcomes will be equal to or
better when using the remotely administered functional testing protocol. The investigators
also hypothesize that patient experience and satisfaction will be improved with the use of a
remotely administered functional testing protocol because time and cost intensive travel
barriers can be removed.