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Free Online Data Collection / FCE Report Writing Template and Related Forms |
The Data Collection/FCE Report Writing Template on this page is a free service for our site visitors. It is in the MS Word Format. This document is intended to be adapted to meet your needs. You do not need to purchase our products to download and adapt the template. You may use the "Save As" option and download the forms to your own personal computer. Unless you wish to conduct the X-RTS Hand Strength Assessment, there is no need to be online when you use the templates on this page. We do not use "tracking cookies" or "spyware" on this site. None of your data entries are monitored or saved. As a condition of use of these templates, all users must agree to hold this site and the owners of this site harmless for all aspects of their FCE testing program.
The purpose of providing the Data Collection/FCE Report Writing Template is to help you maintain the critical individuality for each report while making the report writing process efficient. There are two primary ways in which this template can be used:
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Enter raw data by hand on the template and create the final version of your report at a later time. | ||
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Enter raw data onto the template while the test is being conducted, then refine and edit the report following the test. |
The template gives our site visitors the ultimate in report writing flexibility in the following ways:
| 1. | You can edit all of these forms to meet your own particular needs. | |||||||||
| 2. | Use of X-RTS products is not required. | |||||||||
| 3. | You do not need to be online when you use this page. | |||||||||
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If you use the X-RTS Hand Strength, you can enter data subsequent to test administration if you do not have Internet access in your testing area. | |||||||||
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If you have an account with our company, or if you have purchased Test Authorization Numbers, you can conduct the Hand Strength Assessment in real time. If you conduct the test in real time, the data entry fields will be seen on your monitor. A small percentage of tests (about 5%) will result in a classification of "equivocal" for consistency of effort. In such cases, you may wish to re-test. Therefore, we recommend, but do not require, the administration of the Hand Strength Assessment in real time when feasible. |
We offer technical and clinical support for our products. However, we do not offer technical support related to the use of your computer if you are using these templates. We do welcome calls if you need assistance with the wording or interpretation of test results.
While entry of raw data is an important mechanical process, it is also important to provide a brief narrative which discusses and emphasizes the most important findings and explains the rationale for your recommendations. When such a narrative is provided, your report is more likely to fulfill the primary goal of the report---communication of the findings in a clear and unequivocal manner that will expedited case management decisions and/or resolution of the case.
To make the creation a narrative for your report more efficient, we have provided 26 sample narratives, listed in the table below. They have been sorted according to the sex of the subject, the body part that is injured, and the outcome of some of the important parts of the test. These narratives can be copied and pasted into Section 2 of the template where they can be quickly edited to reflect the results of the test that you have conducted. These narratives are provided to help avoid "writer's block" and quite possibly save you time. These templates will also show you how to clearly convey the results of X-RTS sincerity of effort testing.
In addition to the templates and the sample narratives, you can download a data collection sheet for the administration of the X-RTS Hand Strength Assessment. This sheet is to be used if you do not have Internet access in your testing area. If you use this form, you will fill in the test data by hand, return to this site at a later time and access our online test to enter the data. If you have Internet access in your testing area, you do not need the list of trials because you will be entering the data at the time it is collected in the appropriate fields seen on your monitor. Regardless of which method you use for data collection, you must be a registered user. Your clinic can either purchase Test Authorization Numbers to conduct the test or establish a commercial account with our company. Details regarding our online test are found by following this link: X-RTS Online Hand Strength Assessment.
Templates
To download all of the information below in a Zip Folder, click on this sentence.
To choose specific templates found in the Zip Folder, select from the list below.
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Combined Data Collection / FCE Report Template |
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Download List of Trials / X-RTS Hand Strength Assessment |
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Download the list of trials for the X-RTS Hand Strength Assessment by clicking on the text in this sentence. You will need to be a registered user if you wish to conduct this test. Go to X-RTS Online Hand Strength Assessment for further details. |
To download any of the narratives listed below, simply click on the text in the box of your choice.
| Narratives for Male and Female Test Results, Sorted According to Diagnosis and Outcome. (Click on the number of the narrative you wish to have displayed on your monitor.) |
| No. 1 |
Male, cervical spine complaints, low back surgery, no abnormal behaviors, consistent Lever Arm Assessment |
No. 14 |
Male, multiple upper extremity surgeries, passed Hand Strength Assessment, no Lever Arm Assessment |
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| No. 2 |
Male, cervical spine, failed Hand Strength Assessment, inconsistent Lever Arm Assessment |
No. 15 |
Female, back pain, positive pain questionnaires, inconsistent Lever Arm Assessment |
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| No. 3 |
Male, low back surgery, passed cursory hand strength, consistent Lever Arm Assessment |
No. 16 |
Female, shoulder surgery, cursory hand strength Assessment, consistent Lever Arm Assessment |
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| No. 4 |
Male, cervical fusion, consistent Hand Strength Assessment, no Lever Arm Assessment |
No. 17 |
Female, elbow surgery, inconsistent Hand Strength Assessment, inconsistent Lever Arm Assessment |
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| No. 5 |
Male, mechanical instability in lumbar spine, no Lever Arm Assessment |
No. 18 |
Female, lumbar surgery, consistent Hand Strength Assessment, inconsistent Lever Arm Assessment |
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| No. 6 |
Male, multiple upper extremity surgeries, consistent Hand Strength Assessment, no Lever Arm Assessment |
No. 19 |
Female, low back pain, inconsistent Hand Strength Assessment, untestable for lifting |
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| No. 7 |
Male, low back pain, pain questionnaires negative for symptom magnification, inconsistent Lever Arm Assessment |
No. 20 | Female, low back pain, equivocal overall results, inconsistent Lever Arm Assessment | |
| No. 8 |
Male, wrist arthroscopy, inconsistent Hand Strength Assessment, un-testable for lifting |
No. 21 | Female, low back pain, no symptom magnification, consistent Lever Arm Assessment | |
| No. 9 |
Male, cervical spine fusion, symptom magnification on pain questionnaires, failed Hand Strength Assessment, failed Lever Arm Assessment |
No. 22 |
Female, multiple upper extremity surgeries, consistent Hand Strength Assessment, no Lever Arm Assessment |
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| No. 10 |
Male, "fibromyalgia" diagnosis, symptom magnification on pain questionnaires and Waddell testing, failed Hand Strength Assessment, inconsistent Lever Arm Assessment |
No. 23 | Female, low back surgery, consistent Lever Arm Assessment | |
| No. 11 |
Male, cervical fusion, passed Hand Strength Assessment, no Lever Arm Assessment secondary to special circumstance |
No. 24 | Female, mechanically unstable, no Lever Arm Assessment | |
| No. 12 |
No. 12: Male, upper quadrant injury (severe burns), consistent Hand Strength Assessment, consistent Lever Arm Assessment |
No. 25 | Female, "fibromyalgia" diagnosis, positive Waddell Tests, failed Hand Strength Assessment, failed Lever Arm Assessment | |
| No. 13 |
No. 13: Male, shoulder surgery, passed cursory evaluation of hand strength, no Lever Arm testing |
No. 26 | Female, lumbar surgery, negative Waddell Tests, no Lever Arm Assessment |
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Below, please find two Examples of Completed Reports (PDF Format, Adobe Acrobat Required). Note: These reports are actual results that have had patient identifiers removed. The Combined Data Collection / FCE Report Template is designed to allow the user a reporting mechanism that can be easily configured to resemble the two examples below. Click on the choices below to view or download these sample reports.
Valid Effort
Invalid Effort
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