FCE Sincerity of Effort & Symptom Validity 1 — Questions and Answers
Question 1: The coefficient of variation (CV) threshold most commonly used in grip strength testing to indicate consistent, reliable effort is:
- Less than 10%
- Less than 15% (Correct answer)
- Less than 20%
- Less than 25%
Correct answer: Less than 15%
A CV of less than 15% across repeated grip strength trials is the widely accepted criterion indicating consistent, sincere effort.
Question 2: In the five-position grip strength test, a bell-shaped curve of results (low-high-low pattern) across positions 1 through 5 is considered a sign of:
- Sincerity of maximal effort (Correct answer)
- Submaximal or inconsistent effort
- Malingering confirmed
- Carpal tunnel syndrome
Correct answer: Sincerity of maximal effort
A bell-shaped curve where grip strength peaks at position 2 or 3 and tapers at the extremes is the normal pattern indicating sincere maximal effort.
Question 3: The Rapid Exchange Grip (REG) test is used in FCE primarily to:
- Measure peak grip endurance
- Detect submaximal effort by comparing REG to sustained grip values (Correct answer)
- Assess median nerve conduction velocity
- Establish a baseline for work hardening
Correct answer: Detect submaximal effort by comparing REG to sustained grip values
The REG test compares rapid-alternating grip values to sustained grip; submaximal effort is suggested when REG values are unexpectedly higher than sustained grip values.
Question 4: Waddell's non-organic signs are used in FCE to assess:
- Structural pathology severity
- Behavioral indicators that may suggest symptom magnification (Correct answer)
- Cardiovascular effort during lifting
- Joint range of motion accuracy
Correct answer: Behavioral indicators that may suggest symptom magnification
Waddell's signs are behavioral and physical exam findings that may indicate non-organic contributions to pain and disability, signaling possible symptom magnification.
Question 5: Which of the following is the MOST appropriate term for a clinical finding when an examinee performs below their actual physical ability during FCE testing?
- Malingering
- Submaximal effort (Correct answer)
- Functional overlay
- Deconditioning
Correct answer: Submaximal effort
Submaximal effort is the clinically appropriate, objective term; malingering implies intent to deceive, which FCE evaluators cannot definitively determine.
Question 6: Heart rate monitoring during FCE testing is used as a sincerity of effort indicator because:
- Maximal effort always corresponds to a heart rate above 220 bpm
- Submaximal effort typically produces a disproportionately low heart rate relative to reported exertion (Correct answer)
- Heart rate below 60 bpm confirms adequate effort
- Heart rate is used only for cardiovascular safety, not effort assessment
Correct answer: Submaximal effort typically produces a disproportionately low heart rate relative to reported exertion
When an examinee reports maximal effort and severe pain yet demonstrates a low cardiovascular response, this physiological inconsistency suggests submaximal effort.
Question 7: Which consistency criterion indicates reliable performance during range-of-motion testing in an FCE?
- All three repeated measurements within 5 degrees of each other (Correct answer)
- Any two of three measurements within 10 degrees
- All three measurements are identical
- The highest and lowest values differ by less than 30 degrees
Correct answer: All three repeated measurements within 5 degrees of each other
ROM reliability is typically established when three repeated measurements fall within 5 degrees of each other, demonstrating consistent, reproducible effort.
FCE Sincerity of Effort & Symptom Validity 1
The coefficient of variation (CV) threshold most commonly used in grip strength testing to indicate consistent, reliable effort is: