**2.4. Importance of functional capacity evaluations in vocational rehabilitation**

one step to the next according to the needs of the individual [12]. These practices are a very important step for participation in social life again for people with disabilities who have not been able to enter the education system for various reasons; who are disconnected from this system at any stage, disabled while working; or who want to change their occupation [6]. Vocational rehabilitation practices involving individuals who lose their jobs, employers, family members and related persons cover procedures that can help them to easily reach and

In vocational rehabilitation, the person's disability, cause, nature and age do not matter [6]. What is important is whether the disability situation creates a barrier from a professional point of view [6]. If the present obstacle situation is a real problem for the present or future

Like all other rehabilitation services, vocational rehabilitation will continue to be a developing field based on the evidence gained through research. Described by H. Kayıhan in 2009 [17], vocational rehabilitation includes steps of assessment, guidance, training, placement, protection and monitoring. In the assessment, an analysis of the physical, mental and vocational abilities of a person who is injured or remains after the disease is made. During this analysis, it is very important for the evaluator to evaluate the findings effectively and efficiently and to know that the findings can vary according to personality traits during this process [11]. Proposals are made in the field of guidance for vocational education and employment opportunities. In the training section, the person is trained and prepared for the job. The next step is to help the person find a suitable job. Special arrangements make it easier for the recruited person to work. In the last step, the person is followed until the full adaptation to the job is secured [17].

In vocational rehabilitation, the cause of disability, the nature of disability and the age of the disabled person do not matter. The important thing is whether there is an obstacle to work. If the physical and/or mental disability of the person is an obstacle to the current or future work, then professional rehabilitation is needed [18, 19]. People with disabilities should be assessed on the basis of their capacities, competencies, potential and relevance before starting vocational training. Akel et al. [19] reported that even adolescents with chronic diseases should be educated about possible future occupations. Functional and work capacity of the people is investigated. Parallel to the results obtained, training is provided to increase the work potential of the person and to prepare him to the activities. Vocational rehabilitation team includes people from professional groups such as doctors, physiotherapists, occupational therapists/ergotherapists, psychiatrists, psychologists, course teachers, social workers,

professional advisers and some other professionals as architects or engineers [17].

The 'International Classification of Functioning, Disability and Health' (ICF), created by the World Health Organization in 2002, classifies health and health-related areas by defining body functions and structure, activities and participation [11, 20]. These areas are categorized by physical, personal and social aspects. Since the function and disability of the subject are in the same context, ICF also includes environmental factors [11]. The social model and ICF are the models that professional rehabilitation practitioners can use. Even if the content of the

work, it indicates the need for vocational rehabilitation [6].

**2.3. The scope of vocational rehabilitation**

74 Occupational Therapy - Therapeutic and Creative Use of Activity

continue these programs.

Functional capacity evaluations are an objective measurement method that evaluates the activity status, activity limitations, physical requirements of the work and the general work situation of people with disabilities and those who have experienced work injury and gives suggestions for ultimately taking part in the job-related and participatory role [24–27]. These assessment methods have been used in North America since the early 1980s [13]. This term coincides with the time when ergotherapy is developing rapidly. The desire to find valid data in order to increase the return of persons to safe work has increased the importance of functional capacity evaluations. For the last 40 years, with the development of technology, more objective and computerized measures began to be used, resulting in healthier work choices and successful job placements [27–29]. Functional capacity evaluations are implemented by physiotherapists, occupational therapists, physicians, occupational rehabilitation consultants and many other professional occupations [9]. It is stated that the person who made the measurement should be trained in this subject [9, 11].

For people with physical disabilities to be employed, functional capacity needs to be evaluated first and then placed in appropriate jobs [8, 9, 30, 31]. Functional capacity evaluations can be made from medical, functional, psychological, physical and occupational aspects. Following the determination of the functional capacity, it is stated that the work analysis should be carried out at a later stage to assess the requirements of the work and the functional capacity should be adjusted to meet the needs of the job [4]. The decision should be made to place the person with disabilities in the work course or job [4]. As a result of the functional capacity evaluations, it is aimed to determine the capacity of the person to meet the demands of the job and the appropriate jobs [8–10]. If there is a problem to continue to work, an action plan should be made [10]. This plan should be to place the person in a modified job, to train the person about job demands, to direct the person to a treatment center when there is a medical problem, or to prepare the person for a new job with vocational rehabilitation if it is not possible to return to the previous job [10].

The purpose is very important when choosing a functional capacity evaluation method [24, 31]. If it is the intention to return to the old job, job requirements should be determined by job analysis [24]. Functional capacity evaluation results should be compared with the physical requirements of the job [24]. A more general and comprehensive assessment should be done if the person is to be placed in a new job [24]. The physical condition is investigated from many directions and the most appropriate ones are identified from the various types of job opportunities available [24]. If the objective assessment of the functional capacity is to determine the disability status, then an evaluation method should be chosen where the evaluator can collect the desired information [24].

It is also stated that these evaluations are more suitable to be applied in the clinical environment instead of the business environment because they include equipment such as lifting units, weights and power measuring unit [30]. Because of these equipment, it is stated that the establishment of functional capacity evaluation units is almost as costly as the imaging

Employment of People with Disabilities and Ergonomic Risk Factors at Workplace

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The main components of functional capacity assessments can be summarized as data collection, physical assessment, physiological assessment and functional performance measures [24]. In the data collection section, file scans, interviews with people, or surveys are conducted [24]. Physical evaluations are performed to determine clinical findings related to the disease [24]. As a result of these findings, it is determined if there is inconvenience for physiological and functional evaluations to be done properly or if the person should be followed during evaluations [24, 30]. Physiological evaluations include sections such as assessment of

The business factors specified in the 'Job Titles Dictionary' (DOT) indicate both the physical requirements of the job and the capacity of the employee to fulfill those requirements [24]. These 20 physical requirements are used by rehabilitation specialists and business consultants to classify jobs [24, 26]. Functional performance assessments measure the physical requirements of this work [24, 26]. The lift capacity test is the most commonly used functional work measurement in the DOT [24]. However, it is stated that the measurement of lift capacity in different situations and in different positions is very important in terms of reliability of the test [24].

The study of ergonomics and work posture in workplaces has gained importance in recent years. Ergonomics is an interdisciplinary scientific discipline that scientifically examines and relates the relationship between people, the equipment and working environment they use to the field of application [41]. In order to harmonize the person, machine and work with each other in the best way, it examines the physiological, biological, anatomical and other specialties of the human being and enables the machine and work to be designed according to these characteristics [41]. This science helps to understand how human abilities and limitations are understood and how it can bring about performance in a safe, effective, comfortable and healthy way in relation to the environment [42, 43]. If a building is anthropologically, physiologically, sociologically and psychologically compatible, it must be able to perform daily activities [42, 44]. Effective and successful 'harmonization' guarantees high productivity, avoidance of disease and injury risk and increased satisfaction in the work [44]. In order

to achieve these, technical and health teams must be in a successful cooperation [44].

Ergonomists should consider the special requests of the persons who will use the building during the construction, arrangement, or repair of a building, so that the space is useful, safe and effective [42]. Factors such as lighting, heat, noise, ventilation, cleanliness, humidity, as well as working hours and break times are examined in the field of ergonomics [11]. While arranging the environment of a disabled or elderly person, ergonomists find solutions by

methods at diagnostic centers [30].

muscle strength or cardiovascular endurance [24].

**3. Ergonomic regulations at workplace**

Functional capacity evaluations, such as all other tests performed in the field of rehabilitation, are generally planned according to the test and measurement standards established by the American Physical Therapy Association [32]. Functional capacity assessments are crucial to ensure reliable and valid results and to be safe and practical in practice [24, 30]. Reliability is stated as the most important factor that evaluations are standardized [24, 30]. Reliability studies of functional capacities for many different purposes have been accelerated after 1990, and clinicians have drawn attention to the importance of reliable assessment methods [33]. Reliability studies of newly produced evaluation methods continue at a rapid pace [33].

Lechner et al. [34] and Brouwer et al. [35] found that functional capacity evaluation protocols were reliable for people with low back pain and other musculoskeletal disorders. Lechner et al. evaluated 50 persons aged between 18 and 65 who had musculoskeletal discomfort and who spent at least 20 hours per week with the so-called Physical Work Performance Evaluation [34]. The reliability of interpersonal reliability when using the evaluation method of 11 physical therapists was found to be very high [34]. Gross and Battie [36] found that test–retest reliability of the results of functional capacity evaluation during lifting was high in people with low back pain. An evaluation system called 'Isernhagen Work System' was used in this study [36]. The authors state that when evaluating the operational definition, the safe and maximum performance detection is reliable when well explained to the evaluators [36].

Many types of validity were tested in the field of functional capacity assessments [30, 33]. Less validity studies were conducted compared to reliability studies [37]. The first study to question the validity of functional capacity assessment studies was conducted by Smith et al. [38]. In this study, 125 prisoners in prison were evaluated by 'Smith Functional Capacity Assessment Method', medical history was taken, and 'Patient Activity Questionnaire' was applied. According to these test results, the chances of returning to work were determined. One year after being released from prison, a questionnaire was sent to these persons, and their employment status was questioned. From the responses, it was determined that the results of the tests in the prison estimated the work situation to be 86%. Matheson et al. [39], who tested the predictive validity of functional capacity assessments, attempted to determine the return to work after 6 months without evaluating the individuals with chronic musculoskeletal system. In this study, a low lift was tested, and a 2% chance of returning to work for each added pound weight was found to increase by 2%. Lechner et al. [40] also tested the predictive validity of the 'Physical Business Performance Assessment', a functional capacity evaluation method, on 30 people with musculoskeletal dysfunction. As a result of this study, the results of functional capacity assessment were well validated in determining the chances of returning to work after vocational rehabilitation [40].

Compared to other assessments, functional capacity evaluations take longer [24, 30]. This can vary from a few hours to a few days, depending on the measurement protocol used [24, 30]. It is also stated that these evaluations are more suitable to be applied in the clinical environment instead of the business environment because they include equipment such as lifting units, weights and power measuring unit [30]. Because of these equipment, it is stated that the establishment of functional capacity evaluation units is almost as costly as the imaging methods at diagnostic centers [30].

The main components of functional capacity assessments can be summarized as data collection, physical assessment, physiological assessment and functional performance measures [24]. In the data collection section, file scans, interviews with people, or surveys are conducted [24]. Physical evaluations are performed to determine clinical findings related to the disease [24]. As a result of these findings, it is determined if there is inconvenience for physiological and functional evaluations to be done properly or if the person should be followed during evaluations [24, 30]. Physiological evaluations include sections such as assessment of muscle strength or cardiovascular endurance [24].

The business factors specified in the 'Job Titles Dictionary' (DOT) indicate both the physical requirements of the job and the capacity of the employee to fulfill those requirements [24]. These 20 physical requirements are used by rehabilitation specialists and business consultants to classify jobs [24, 26]. Functional performance assessments measure the physical requirements of this work [24, 26]. The lift capacity test is the most commonly used functional work measurement in the DOT [24]. However, it is stated that the measurement of lift capacity in different situations and in different positions is very important in terms of reliability of the test [24].
