Brief History of DSI Work Solutions

A brief history of the Isernhagen-DSI Work Solutions Functional
Capacity Assessment
By Susan J. Isernhagen PT
DSI Work Solutions inc
sisernhagen@dsiworksolutions.com

Susan J. Isernhagen PT created the first functional capacity evaluation in the mid 1980’s. Referrers, physicians, employers, vocational counselors and case managers identified the needs for:

  • Objectivity of results to replace the subjective estimates that were currently being used
  • Medical base to tie the functional capacity and limitations into current diagnoses
  • Information on level of effort, to identify those who used full effort and those who did not use full effort.
  • Safety in functional tests so that this information could lead to safe return to work
  • Work relatedness to determine abilities to perform specific jobs, ability to do a category of jobs and/or ability to perform individual functions of work.

The scientific method of evaluation for Isernhagen-DSI Functional Evaluations is the "kinesiophysical" method. This was developed by Isernhagen for its objective approach and quality of education. Physical therapist or occupational therapists who undergo FCE training have the requisite education in physiology, anatomy, kinesiology and pathology to ensure a test is scored both on criteria and the particular diagnoses of the evaluee. It replaces the psychophysical method, where the evaluee is asked to be the evaluator as far as endpoints. Instead, safe endpoints and researched criteria are used.

In the 1990’s and into the 2000’s, many researchers have determined that the Isernhagen kinesiophysical model is highly reliable. It has been labeled as the most evidence based method available. (See bibliography, Innes article and Nelson article.)

In 2004, the DSI Work Solutions Functional Capacity Assessment was redeveloped. It continued the strong cornerstones of work tasks, objectivity and evidence base. The major enhancements were in work relatedness and measurement of effort

For work relatedness, the DSI FCA uses a comprehensive and repetitive mix of physical demands to identify endurance, differences in task performance and ability to sustain work activity. Its unique format is closest to actual job descriptions.

Measurement of level of effort is divided into two areas. The levels of effort proven reliable in research are used to objectively identify full effort or the lack of it. The second is ability/willingness to do repetitive items. The DSI method has a consistency checklist imbedded as each item is repeated at least twice in the one part test and four times in the two part test. To enhance the likelihood of full effort, objective criteria, and medical safety, promote willingness of the evaluee to provide full effort.

In the DSI format, referrers are asked to ask referral questions to assure maximum use of the information. The functional test results can be used to provide specific answers to questions as well as overall functional capacity levels.

The DSI FCA has three primary parts.

  1. History with medical, injury/illness and functional backgrounds
  2. Physical exam to document any motion, strength or balance/coordination deficits that would be linked to safety issues or test endpoints.
  3. The FCA non-medical form which has all areas of function tested and scores placed in each functional category according to frequency of task performance, ergonomic recommendations and referral answers.