Determining Client Effort: Understanding Therapists' Practices

Abstract

For over 20 years occupational therapists have been using functional capacity evaluations to provide information about individuals’ ability to work after a musculoskeletal injury. An important component of these evaluations is the determination of the clients’ level of effort during the assessment. Only when a client puts forth high effort are the results considered an accurate measure of their work ability. This qualitative study explored therapists’ perception of the process of determining effort. Consistent with the literature, the results show that effort is a complex construct that is not easily defined, understood, or consistently assessed in practice. The participants in this study spoke about their own struggles defining, explaining, and assessing effort within the medico-legal context of an insurance system. The study results suggest support is needed for clinicians to navigate multiple client contexts, and the term ‘effort’ needs to be conceptualized in line with current knowledge about disability.