Burden of proof in detection of submaximal effort

Abstract

The recent increase in workers' compensation litigation and the escalating costs of healthcare have created a need for accurate identification of individuals who put forth submaximal effort during functional capacity testing. This paper reviews methods healthcare professionals can use to prove submaximal efforts and specifically addresses the importance of test reliability, subjective and objective measures of submaximal effort (including the DASH questionnaire, 5-rung and rapid exchange grip strength measures, forced-choice testing and the MMPI), techniques used to elicit maximal effort and test accuracy and patient motivations and examiner biases. Use of these methods will contribute to the establishment of a functionally sound healthcare system.