“Functional” Functional activities have been defined as “those activities identified by an individual as essential to support physical, social, and psychological well-being and to create a personal sense of meaningful living”. Any movement at the level of the person that is task related, goal oriented, environmentally germane and involves the integration of multiple body systems and structures.
"Testing" is defined as a set of problems to assess the ability to determine performance abilities or limitations. A functional limitation is the inability to perform a particular activity at a normal level. Normal should be based on such factors as a client’s age, sex, body type, and occupation. They are highly dependent on the tasks specific to the sport or occupation and their associated demands or requirements. Normative values are determined via collection of data on large numbers of subjects performing a task.
Functional testing is defined as using a variety of physical skills and tests to determine:
(1) one’s ability to participate at the desired level in sport, an occupation, or recreation or to return to participation in a safe and timely manner without functional limitations.
(2) one’s ability to move through up to three planes of movement as assessed via nontraditional testing that provides qualitative and quantitative information related to specialized motions involved in sport, occupation, and exercises.
Functional performance is an aspect of everyday life, whether for the elite athlete, the industrial worker, the homemaker, or anyone else:
The commonality among all groups is that some aspect of performance is needed for them to be successful in performing their respective skills or duties. Clinicians use multiple tests depending on the set of physical attributes they need to assess to predict the level of activity at which a client can perform or to which the client can safely return. For clients who are reimbursed by third-party payers, functional performance outcome scores may provide justification for reimbursement or for the need for further rehabilitation or care, or conversely, justification that further care is not needed.
In the case of clients who have been injured, immediately after injury there is normally, at minimum, a brief period of impairment. Impairment is a dysfunction or a significant structural abnormality in a specific body part or system. It is during the immediate postinjury period that the more classical objective measures of physical function are used, such as range of motion, anthropometry, muscle strength, reflexes, and joint integrity. These clinical exam measurements are important, but do not correlate directly with actual physical function. This is the reason for functional performance testing. The lack of clinical correlation also makes it imperative that functional testing be performed to ensure the individual can safely return to a given activity.
Compared to the classical objective measures of physical function, functional performance testing more closely mimics physical activities that people wish to return to. For example, the fact that a person has full shoulder range of motion does not mean that he or she can throw a softball far enough to return to full unrestricted play. If this same person has full range of motion, full strength, and full neuromuscular control and additionally is able to achieve an excellent score on the underhandr softball throw without adverse symptoms, we are much more confident about the prospect of a safe return to unrestricted overhead throwing activities.
Physical performance tests have varying amounts of complexity and impose different levels of physical demand. The clinician ensures that testing is at the appropriate level and time for the patient. As with any objective measurement used to assess an injured client, one should carefully evaluate the appropriateness of each test before introducing it. For example, a client who is only six weeks post Anterior Cruciate Ligament reconstruction is not an appropriate candidate for performance of the single-leg hop test. This test would be far too aggressive.