Re-testing Level of Effort
Thu, 09/11/2008 - 4:59pm
I tested a patient who put forth less than full effort. I asked the client to return and explained that the test was invalid and that she would need to put forth better effort this time (explained the many things that can impact level of effort, blah blah blah..). I never mentioned anything about coefficients of variation and how we determined level of effort. She re-tested and performed better all the way around and produced valid scores. Does anyone know if there is any literature around this topic? A doctor on this case felt that there would be some kind of practice effect and that the second FCE still should not be considered valid. I don't think there would be because the person doesn't know what tests look at level of effort. Thanks.
Sherry in Boulder
This is a great question. I have re-tested several persons over the years and have found that this kind of situation is a great reason to believe in, and sell the Matheson System. ANYONE can read on the internet about MVE testing and grip strength dynamometry. Dr. Matheson has a great paper on disability that talks about this weakness in some FCE approaches. What sets us apart from other types of "systems" is the thinking evaluator. Skilled evaluators always look for less transparent signs of effort-things that can't possibly be feigned. Competitive test performance, consistency and increased muscle recruitment should be held in the highest regard-especially when re-testing an evaluee. I expect that everyone I have re-tested has read the previous report. As I read your question, it sounds like you have confidence in high levels of effort during the second FCE-I think you should consider speaking with the physician and explaining why you feel so-what you saw and why you came to the decision you came to. As far as I am aware, there is no published literature on re-test "validity". As far as I am concerned, everyone has a chance to have provide high levels of effort every time-regardless of suppositions by MD's, case managers or my fellow practitioner's predictions. Hope this helps!