Rehabilitation of Hands and Hand Strength Testing

Reducing Workers Comp Cost Using Rehabilitation Assessments for Hands

Employers have a vested interest in evaluating injured workers as they make the transition from recovery at home to a transitional duty assignment and return to full duty. There may be a number of elements to consider such as the workers’ psychological disincentive to return to work after an injury, making more money to stay out of work and return and, of course, outright fraud.

Part of assigning an injured worker to transitional duty is the factor of “medical readiness” to assume a modified duty job. Thus, it is important to know an injured worker’s physical capabilities and strengths.

Let’s look at the first area of significant physical assessment.

1. Hand Strength
2. Isometric Leg Lift and Arm Lift
3. Visual Estimation of Effort

Hand Strength Assessments

Hand strength testing is one type of assessment used to classify validity of effort during functional capacity evaluation (FCE). But the hands have extremely dense populations of pressure and stretch receptors and a high number of motor nerves involved in gripping and pinching. These anatomic facts create a biofeedback loop allowing submaximal effort to often go undetected. In fact, “cheating” is undetected at least 30% of the time in “standard” testing protocols using the COV, Bell Curve and Rapid Exchange Grip testing as indices of effort.

To further complicate a “valid” test it’s often proposed non-cooperation can be detected during the (FCE) by quantifying variation between repeated measurements of strength. Typically, the statistic to evaluate variation is the coefficient of variation (COV). The logic starts with a bit of truth: Maximal efforts during strength testing should be highly reproducible. Unfortunately, some are led to believe only maximum efforts are highly reproducible – – simply not true.

There is a one hand strength assessment on the market using standard mechanical gauges shown in controlled study to be highly accurate in classifying good effort as well as in classifying poor effort.

This protocol includes the standard one-handed grip and pinch trials, but has trials involving simultaneous testing of both hands. This is a “distraction-based test” which makes cheating extremely difficult.

Statistical analysis holds up in court, regardless as to the test outcome. The application, available on the Internet, is 99.5% accurate (199 proper classifications in 200 tests). All 100 test sessions in the study with cooperating subjects were properly classified.

In test sessions involving feigning of weakness, 99 out of 100 “cheats” were properly classified.

Study Reference: D. Schapmire, J.D. St. James, R. Townsend, T. Stewart, S. Delheimer, D. Focht. Simultaneous bilateral testing: validation of a new protocol to detect insincere effort during grip and pinch strength testing. J Hand Ther. 2002;15(3):242-50. Schapmire and St. James teamed up with Larry Feeler (Work STEPS) and Joe Kleinkort (Joe Kleinkort, PC), to demonstrate that the hand strength assessment is applicable to a patient population in an article recently accepted for publication.

Author: Darrell Schapmire, MS of X-RTS Software Products & Testing Devices develops distraction-based tests for use in functional capacity evaluations. He can be reached at dschapmire@yahoo.com or http://www.xrts.com/

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