XRTS Myths and Facts

Myth: Everybody fails the XRTS validity (Too many patients fail XRTS validity). Fact: In the published, peer reviewed study of the XRTS Hand Strength Assessment, participants who were instructed to give submax effort was identified (100%). When they were instructed to give full effort, the chance of them failing all of the validity tests were 1 in 25,000,000,000,000. The chance of them failing 4 of the 7 criteria is greater than 25,000,000. The peer reviewed study of the XRTS Material Handling Assessment to be published in January 2017, everyone who was instructed to give full effort when identified as valid 100% of the time. (1,2,3)

 

Myth: Evaluators pass or fail patients based on visual effort.

Fact: In the XRTS validity testing, the patient’s scores are analyzed statistically. The evaluator does not decide the outcome. This eliminates any biases based on interpreting effort level (visually). In fact, a recent study indicates determining effort based on observation was flawed. (4)

 

Myth: Evaluators pass or fail patients based on interpreting of other factors.

Fact: In the XRTS validity testing, the patient’s scores are analyzed statistically. The evaluator does not decide the outcome. This eliminates any biases based on interpreting force curves, heart rate changes, personality, appearance, pain reports or any other attributes.

 

Myth: Evaluators pass or fail patients based on a correlation between static testing and dynamic lifting.

Fact: The XRTS validity testing is based on published, peer-reviewed studies. Static (or “isometric”) testing has been proven to be highly inaccurate, failing to detect feigned weakness approximately 50% of the time (5).

 

Myth: The XRTS protocol is a litigation tool and has been recognized as such by the Commission. See Mendez v. Wal-Mart, I.C. No. 493394 & 671580.

Fact: The term “litigation tool” is a purposely-provocative term, inasmuch as every legal proceeding, including depositions could be called a “litigation tool.”  The FCE used in the above case was the Work Steps protocol performed by an evaluator who did not administer the XRTS FCE during the Mendez case.  Although her facility also administered the XRTS FCE, she was not a certified user.  The plaintiff attorney in this case has wrongly conflated the WorkSTEPS and XRTS FCEs which are two entirely different testing approaches.

 

Sources

 

  1. Schapmire D, St James JD, Townsend R, Stewart T, Delheimer S, Focht D. Simultaneous Bilateral Testing: Validation of a New Protocol to Detect Insincere Effort During Grip and Pinch Strength Testing. Journal of Hand Therapy 2002 Jul-Sep; 15(3):242-50.

  2. Schapmire D. W., St James J. D., Feeler L., Kleinkort J. (2010). Simultaneous bilateral hand strength testing in a client population, Part I: diagnostic, observational and subjective complaint correlates to consistency of effort. Work. 37(3):309-320

  3. Townsend R., Bell S., Harry J., Schilling B. (2015) Accuracy of Distraction Based Lifting Criteria for the Identification of In-Sincere Effort Utilizing the Under Loading Method. Scheduled for publication in January 2017.

  4. Schapmire D., St. James J. D., Townsend R., Feeler L. Accuracy of Visual Estimation of Effort During a Lifting Task. Work. In Press.

  5. Feeler L, St James J. D., Schapmire D. W. (2010). Isometric strength assessment, Part I: static testing does not accurately predict dynamic lifting capacity. Work. 37(3):301-308.

 

 

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