Standardized Performance Tests and Their Impact on the Decisions Determining the Type of Rehabilitation Program

Abstract

In the health and social sectors, many diagnostic and prognostic tests are carried out without a constant watch on (1) what influence the test results have on decisions, and (2) the impact of these decisions on every day clinical work. Consequently, it is not known whether the additional information gained, if any, justifies the expenditure necessary for resources involved in a testing procedure. In fact, the net impact of testing in every day clinical work may be negative. By carrying out a testing procedure, under the before mentioned conditions, resources would be wasted. Since the early 1970's a battery of standardized performance tests have been used at the Vocational Rehabilitation Clinic in Aarhus, Denmark. Originally, the aim of the tests was to identify and give an early discharge to those clients, that were, in any case, shown to be fit for a social pre-term pension. An early discharge of these clients would enable the Clinic to counsel a greater number of clients who were suited to vocational rehabilitation. The test period lasts two weeks, and the average stay in the Clinic amounts to about 3 months. During the years 1981 to 1983, a total of 607 clients were discharged from the Clinic. Out of the 607, 379 had been given the battery of tests. Those tested stayed 16 days longer at the clinic than the rest of the clients. A few clients got an early discharge. The associations between the test results and case closure status were weak. Furthermore, these weak associations occurred in 6 out of 51 tests. On the other hand, case closure status could be predicted on the basis of already available demographic, social, and health information on the individual clients. The conclusion is, that standardized performance testing seems to have raised the resource consumption of the clinic without any demonstrable benefit in terms of client selection. The need for continuous socio-medical and epidemiological evaluation of rehabilitation tests and procedures is stressed.