Defining Normative Upper Limb Kinematics during Functional Capacity Evaluation (FCE) Task Performance
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The Functional Capacity Evaluation (FCE) is an evaluation tool used in the return to work process to guide treatment and decision making. An FCE involves testing the functional abilities of an individual to determine their return to work readiness. A patient’s maximum capacity and functional abilities are determined either through subjective measures of exertion or visual observations of mechanics. Even though the observational method is more objective and reliable, descriptions of kinematics to guide evaluations are limited. Therefore, the main purpose of this investigation is to provide a comprehensive description of the kinematics of the upper extremity of a healthy population during upper extremity focused FCE tasks. Upper limb and torso kinematic data were collected on 30 young, healthy participants as they performed five FCE tasks (repetitive reaching, fingertip dexterity, hand and forearm dexterity, waist to overhead lift, and overhead work). Kinematic profiles were created for all clinically relevant angles of the torso, shoulder, elbow, and wrist. Segment velocities were also calculated for each task. Sex did not influence kinematics or segment velocity, but intensity changes resulted in significant differences for both measures. For example, in the waist to overhead lift, maximum torso extension increased by 10.44° and minimum humeral flexion decreased by 11.35° and 12.07° for the right and left arm, respectively. During the overhead work task, mean torso extension increased by 6.90° and mean internal rotation of the right and left humerus increased by 13.58° and 14.26°, respectively. Segment velocities also increased by up to 50% during the waist to overhead lift and up to 82% in the overhead work task. The results of this study indicate many of these tasks require large ranges of motion and high demand postures for the upper limb, specifically for the shoulder and wrist. The reaching and dexterity tasks often required up to 60° of arm elevation, while the overhead tasks required arm elevation consistently greater than 90°. Additionally, for several tasks in this investigation, wrist extension and ulnar deviation angles remained around 20°, which is a large portion of the available range of motion of the wrist. Conversely, torso postures were almost always less than 30° away neutral and the elbow often remained within 60°-100° of flexion, the strongest elbow position, indicating the FCE tasks may not be as useful for evaluating these angles, but they should still closely monitored for potential compensations used by injured patients. The typical torso and upper limb kinematic profiles provided in this investigation is largest dataset of its kind to date. Clinicians and scientists will find the profiles useful because they provide a baseline to which motion can be compared to in order to better evaluate FCE performance. These data also improve the identification of a safe maximum capacity for overhead lifting and prolong overhead work tasks, allowing evaluators to better understand each patient’s abilities. This work supports the more ambitious future clinical goal of being able to identify people who are at risk of further injury or disability if returned to work too early.