Department of Work Rehabilitation, Rehaklinik Bellikon, Suva Care, 5454, Bellikon, Switzerland,
J Occup Rehabil. 2014 Jun;24(2):361-9. doi: 10.1007/s10926-013-9470-9.
Functional capacity evaluation (FCE) can be used to make clinical decisions regarding fitness-for-work. During FCE the evaluator attempts to assess the amount of physical effort of the patient. The aim of this study is to analyze the reliability of physical effort determination using observational criteria during FCE.
Twenty-one raters assessed physical effort in 18 video-recorded FCE tests independently on two occasions, 10 months apart. Physical effort was rated on a categorical four-point physical effort determination scale (PED) based on the Isernhagen criteria, and a dichotomous submaximal effort determination scale (SED). Cohen's Kappa, squared weighted Kappa and % agreement were calculated.
Kappa values for intra-rater reliability of PED and SED for all FCE tests were 0.49 and 0.68 respectively. Kappa values for inter-rater reliability of PED for all FCE tests in the first and the second session were 0.51, and 0.72, and for SED Kappa values were 0.68 and 0.77 respectively. The inter-rater reliability of PED ranged from κ = 0.02 to κ = 0.99 between FCE tests. Acceptable reliability scores (κ > 0.60, agreement ≥80 %) for each FCE test were observed in 38 % of scores for PED and 67 % for SED. On average material handling tests had a higher reliability than postural tolerance and ambulatory tests.
Dichotomous ratings of submaximal effort are more reliable than categorical criteria to determine physical effort in FCE tests. Regular education and training may improve the reliability of observational criteria for effort determination.
功能能力评估（FCE）可用于做出与工作能力相关的临床决策。在 FCE 过程中，评估员尝试评估患者的体力活动量。本研究的目的是分析使用 FCE 期间的观察性标准来确定体力活动的可靠性。
21 名评估员在 10 个月的时间间隔内，两次独立评估了 18 个视频记录的 FCE 测试中的体力活动，每次评估均使用基于 Isernhagen 标准的四分类体力活动确定量表（PED）和二分体力活动确定量表（SED）进行评定。计算 Cohen's Kappa、平方加权 Kappa 和 % 一致性。
所有 FCE 测试的 PED 和 SED 的内部评估者可靠性的 Kappa 值分别为 0.49 和 0.68。所有 FCE 测试的第一次和第二次评估的 PED 的评估者间可靠性的 Kappa 值分别为 0.51 和 0.72，SED 的 Kappa 值分别为 0.68 和 0.77。PED 的评估者间可靠性在 FCE 测试之间的范围为 κ=0.02 至 κ=0.99。在 PED 中，每个 FCE 测试的 38%的评分具有可接受的可靠性评分（κ>0.60，一致性≥80%），SED 的评分则为 67%。与姿势耐受和步行测试相比，搬运材料测试的可靠性更高。
在 FCE 测试中，确定体力活动的二分法比分类法更可靠。定期的教育和培训可能会提高努力确定的观察性标准的可靠性。
