Use of Job-Specific Functional Capacity Evaluation to
Predict the Return to Work of Patients With a Distal
Radius Fracture
KEY WORDS
 employment
 predictive value of tests
 radius fractures
 work capacity evaluation
Andy S. K. Cheng, PhD, HKROT, is Assistant
Professor, Ergonomics and Human Performance
Laboratory, Department of Rehabilitation Sciences, The
Hong Kong Polytechnic University, Hung Hom, Kowloon,
Hong Kong; andy.cheng@polyu.edu.hk
Stella W. C. Cheng, MPH, HKROT, is Department
Manager, Department of Occupational Therapy, Princess
Margaret Hospital, New Territories, Hong Kong.
The American Journal of Occupational Therapy
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Andy S. K. Cheng, Stella W. C. Cheng
OBJECTIVE. We examined the predictive validity of a job-specific functional capacity evaluation (FCE) in
relation to the return to work of patients with a distal radius fracture.
METHOD. Return-to-work recommendations for 194 participants with a distal radius fracture were based on
FCE performance. Three months after the evaluation, participants were contacted to ascertain their employ-
ment status to examine the predictive validity of each FCE-based rating.
RESULTS. The recommendation return to previous job (94.83%) was correct more often than the
recommendations do not work at the moment (60.47%), change job (52.63%), and return to previous
job with modifications (9.38%). A longer period from injury to FCE and compensable injury reduces the
predictive ability of job-specific FCE.
CONCLUSION. Job-specific FCE shows a better predictive validity in relation to the return to work of
patients with a specific injury, such as a distal radius fracture, than of patients with a nonspecific injury.
Cheng, A. S. K., & Cheng, S. W. C. (2011). Use of job-specific functional capacity evaluation to predict the return to work
of patients with a distal radius fracture. American Journal of Occupational Therapy, 65, 445–452. doi: 10.5014/
ajot.2011.001057
I n day-to-day clinical practice, occupational therapists are intensively involved
in managing upper-extremity injuries. Such injuries are common. In a terri-
torywide survey conducted from 2004 to 2006 among all the occupational
therapy work rehabilitation centers in Hong Kong, the average number of
patients referred to occupational therapy for work assessment and rehabilitation
was 3,031 per year. Musculoskeletal back injuries constituted the most prevalent
diagnosis (33%), followed by upper-limb injuries (23.4%), multiple muscu-
loskeletal injuries (15.2%), lower-limb injuries (14.6%), and others (Occupa-
tional Therapy Coordinating Committee [OTCoC], 2009). Of the different types
of upper-limb injury, distal radius fracture was the main injury, accounting for
53.4% of upper-limb injuries.
Upper-extremity injuries negatively influence the functional use of the hand
and may result in long periods of sick leave (Kasdan & June, 1993; Rusch,
Dzwierzynski, Sanger, Pruit, & Siewert, 2003; Skov, Jeune, Lauritsen, & Barfred,
1999). In general, as the duration of sick leave increases, the chances of returning
to work decrease (Post, Krol, & Groothoff, 2005). Determining whether a worker
is ready or safely able to return to work after injury remains a major challenge for
clinicians and claims adjudicators (Gross & Battié, 2006).
One clinical tool used internationally to predict whether a worker is safely
able to return to work after upper-extremity injury is functional capacity
evaluation (FCE; Lechner, Roth, & Straaton, 1991). FCE provides an objective
measurement system that matches physical abilities with essential and critical
job demands; targets short- and long-term treatment goals to justify work-
hardening therapy; identifies job modifications to enhance worker safety; and
445
 delineates functional capacities in case of litigation, im-
pairment, or disability (Isernhagen, 1988). It has become
widely used in occupational, insurance, and rehabilitation
medicine to evaluate work ability and to guide return-to-work
recommendations (Gross, Battié, & Cassidy 2004; Soer,
van der Schans, Groothoff, Geertzen, & Reneman,
2008). Occupational therapists have long been propo-
nents of functionally oriented assessments of capacity for
work (Holmes, 1985). Thus, occupational therapists have
become one of the major providers of FCE (Gibson &
Strong, 2003).
Earlier studies have reported that the predictive val-
idity of FCEs is poor (Gross et al., 2004; Gross & Battié,
2006; Lechner, Page, & Sheffield, 2008). The relatively
low predictive validity of FCE may be caused by the
problem of inconsistent terminology (Soer et al., 2008);
that is, users may not fully understand the operational
definitions of the different types of FCE. Indeed, at least
three types of FCE exist; they are distinguished by their
degree of evaluation and specificity of focus (Hart,
Isernhagen, & Matheson, 1993). Baseline capacity evalu-
ation is used to quantify worker traits in dealing with the
common physical work demands listed in the Dictionary
of Occupational Titles (U.S. Department of Labor [DOL],
1991a), such as sitting, standing, walking, balancing, climb-
ing, kneeling, stooping, crouching, reaching, lifting, car-
rying, pushing, and pulling, when there is no specific job
to which the worker will return. However, if the specific
job to which the worker is to return is known and a job
analysis has already been conducted to identify the critical
job demands, the worker should be tested using job ca-
pacity evaluation. The result of this evaluation should
include a specific match of the physical abilities of the
worker to the demands of a specific job. Work capacity
evaluation is used to determine the worker’s potential to
be able to withstand the basic demands of competitive
employment, particularly full-day workplace tolerance
and daily attendance (Matheson, 1988). Evaluation usu-
ally requires the worker to perform work simulations over
a significant time period to determine the worker’s capa-
bilities and the demands of competitive employment (Hart
et al., 1993).
FCEs can therefore be classified as either generic or job
specific. Relying solely on the use of standardized global
test batteries under a generic FCE method, however, is not
an efficient approach to predicting the ability of an injured
worker to deal with specific job demands. Pransky and
Dempsey (2004) pointed out that validity of FCE results
is optimal with accurate job simulation and detailed,
intensive assessments of specific work activities. When
test criteria are unrelated to job performance, the validity
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of results is questionable. In addition, because of the
dynamic and complex nature of most job demands, FCE
is necessarily dynamic (Pransky & Dempsey, 2004). The
evaluator should be flexible in selecting tests and should
be able to modify the test battery as required. The pre-
dictive validity of FCE should be associated with the
ability of the evaluator to identify the critical demands of
a specific job.
We previously examined the predictive validity of
a job-specific FCE in relation to the employment status of
patients with nonspecific low back pain. The results of the
study showed that for this condition, for which a cause
cannot be definitively identified and a precise pathoana-
tomical diagnosis cannot be given, job-specific FCE had
a high correct prediction rate in relation to recommen-
dations to return to the previous job or change jobs
(Cheng & Cheng, 2010). Whether these results can be
generalized to other conditions, such as those related to
specific upper-extremity injuries, is unknown.
We therefore undertook this study to examine the
predictive validity of a job-specific FCE in relation to the
return to work of patients with a distal radius fracture. We
hypothesized that job-specific FCE would have better
predictive validity in relation to the employment status of
patients with a specific injury than it would for patients
with a nonspecific injury.
Method
Design
This study used a retrospective cohort design. Data on
variables of interest were extracted from the clinical data-
bases of all designated occupational therapy work rehabi-
litation centers in Hong Kong. Since 2004, it has been
standard practice among the centers to administer only
job-specific FCEs. A unified reporting format was developed
and implemented by the OTCoC of the Hospital Authority
of Hong Kong. In addition, 3 mo after an evaluation, a
follow-up telephone interview is conducted with each pa-
tient to survey his or her employment status as a quality
measure. Occupational therapists working at the desig-
nated work rehabilitation centers have received formal
training in job analysis and FCE. This study design was
reviewed and approved by the OTCoC.
Participants
The participants were selected on the basis of the following
inclusion criteria:
• Received a medical diagnosis of distal radius fracture
from a physician
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 • Referred for FCE by a physician
• Received FCE in designated occupational therapy work
rehabilitation centers of the Hospital Authority of Hong
Kong during the period March 2004–April 2007
• Willing to cooperate by reporting personal particulars
• Willing to be interviewed by telephone 3 mo after the
FCE.
The exclusion criteria were as follows:
• Could not be contacted after discharge
• Refused to report current employment status.
Job-Specific FCE
Before the FCE, a hierarchical task analysis guided by the
modified Dictionary of Occupational Titles Physical De-
mand Questionnaire ( Jacobs & Wyrick, 1989; DOL,
1991b) was used to discuss physical work demands with
the participants. Their comments were compared with
the local job bank, which was developed by local occu-
pational therapists from previous interviews with patients
with similar job titles and a formal work site evaluation.
With this job information, we quantified the physical work
demands in terms of the duration, frequency, and intensity
of tasks and activities. Moreover, this information was used
to form the criteria by which the return-to-work recom-
mendations were made.
Next, the therapists formulated an FCE protocol,
which contained a battery of tests to determine the ability
of the participants to deal with physical work demands. In
this study, the FCE protocol to determine the work ability
of participants with a distal radius fracture included a
handgrip strength test, a dynamic bilateral lifting test at
three levels (floor to knuckle, knuckle to shoulder, and
floor to shoulder), a bilateral and unilateral carrying test,
a bilateral and unilateral pulling test, and a bilateral and
unilateral pushing test. We adopted a psychophysical
testing approach during the entire process of evaluation;
therefore, each test was stopped when a participant be-
lieved that his or her maximum level of functioning had
been reached within an acceptable pain level (Khalil et al.,
1987). The standardized FCE method used was the Bal-
timore Therapeutic Equipment (BTE) work simulator
(BTE Technologies, Hanover, MD). This system has 22
different attachments and operates in both static and
dynamic modes to replicate >300 different job tasks.
Several studies have indicated that the BTE work simulator
has high test–retest, intrarater, and interrater reliability
(Cetinok, Renfro, & Coleman, 1995; Dunipace, 1995; Fess,
1993; Innes & Straker, 1999a; Kennedy & Bhambhani,
1991; Shechtman, Davenport, Malcolm, & Nabavi, 2003)
and moderate to good construct and criterion-related
validity when used to simulate actual work demands
The American Journal of Occupational Therapy
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(Beaton, O’Driscoll, & Richards, 1995; Harvey & Gench,
1993; Innes & Straker, 1999b; Kennedy & Bhambhani,
1991).
Measures
FCE-Based Ratings. After completing the test, each
participant was given a rating that was based on his or her
performance in the FCE. A pass rating was given to those
participants who passed all the FCE tasks. A fail rating B
was given to those who failed all the tasks, and a fail
rating A was given to participants who fulfilled some of
the criteria of the tasks. With reference to these ratings,
each participant was given one of the following four
return-to-work recommendations: (1) return to previous
job, (2) return to previous job with modifications, (3) change
job, or (4) do not work at the moment. Basically, a recom-
mendation to return to the previous job was given to those
who passed all of FCE tasks. Participants who obtained
a fail rating A were recommended either to return to
their previous jobs with modifications or to consider
changing jobs. Finally, for those participants who failed all
the FCE tasks and thus obtained a fail rating B, the
therapists recommended that they should either change
jobs or not work at the moment.
Potential Confounding Variables. We selected variables
from the administrative databases that have been reported
to be predictive of recovery in previously published studies
of people with upper-extremity injuries. The variables
considered included age, gender, number of days from
injury to FCE, being the breadwinner, education level,
compensability, occupational category, and level of physical
work demands (Bernard, 1997; Bruyns et al., 2003;
Feuerstein, Shaw, Lincoln, Miller, & Wood, 2003; Filan,
1996; Gross & Battié, 2006; Himmelstein et al., 1995;
Leclerc et al., 2001; Post et al., 2005).
Outcome
All the participants were contacted for a telephone interview
3 mo after the FCE. At least three attempts were made to
contact each patient. During the telephone interview, they
were asked questions related to their current employment
status. Three months was judged to be a suitable follow-up
time because events occurring after this period were con-
sidered unlikely to be related to the FCE testing. In ad-
dition, in our experience, this time period is the optimal
follow-up time for ensuring a satisfactory response rate.
Data Analysis
Descriptive statistics were used to describe the demographic
characteristics of the participants. k coefficients were
447
 calculated to evaluate the strength of agreement, and the Table 1. Participants’ Characteristics (N 5 194)
McNemnar–Bowker test (Portney & Watkins, 2009) was Variable Details
used to test the symmetry between the return-to-work re- Age, mean (SD) 43.6 (10.11)
commendations made by the therapists and employment Sex, %
status 3 mo after the FCE as reported by the participants. Male 64.9
The percentage of correct predictions (hit rate) of each Female 35.1
Mean days from injury to FCE (SD) 221.47 (235.78)
return-to-work recommendation was measured. The rel-
Compensable work injury, %
ative percentage difference (i.e., deviation; Csuros, 1994) Yes 61.3
was used to evaluate the precision of the return-to-work No 38.7
recommendations with respect to each FCE-based rating. Occupation categories, %
To estimate the predictive validity of job-specific Agriculture, fishery, and forestry 1.5
FCE, we created a dichotomous variable for whether FCE Bench work 0.5
Clerical and sales 6.2
testing successfully predicted the return-to-work outcomes
Machine trades 6.2
of the participants (yes for an accurate prediction and no Processing 2.6
for an inaccurate prediction). Univariate logistic re- Professional, technical, and managerial 3.6
gressions were performed to examine the effect of each Service 38.7
extracted confounding variable on the predictive validity Structural work 23.7
of job-specific FCE. The confounding variables that had Miscellaneous 13.4
Unemployed 3.6
p > 5% were eliminated. The remaining variables were
Physical demand level, %
entered into a multivariate backward stepwise logistic re- Sedentary 9.8
gression to discover their contribution to the overall pre- Light 21.6
dictive validity of job-specific FCE. Finally, these significant Medium 34.1
confounding variables were put into a multivariate back- Heavy 23.2
ward stepwise logistic regression to build up a regression Very heavy 11.3
Primary wage earner, %
model for each FCE-based rating based on the correct
Yes 64.9
prediction of participants’ employment status. This mod- No 35.1
eling approach allowed for the control of those variables Education level, %
that were most likely to have a confounding influence on None 7.2
each FCE-based rating. All the statistical analyses were Primary 32.5
performed using SPSS Version 17.0 (SPSS, Inc., Chicago); Secondary 55.7
Technical school 4.1
the significance level was set at p < .05.
University 0.5
Note. SD 5 standard deviation; FCE 5 functional capacity evaluation.
Results for the recommendations do not work at the moment
A total of 229 patients with a distal radius fracture received (60.47%), change job (52.63%), and return to previous job
job-specific FCE in designated work rehabilitation centers with modifications (9.38%; Table 2).
from March 2004 to April 2007. Of these patients, 194 Table 3 summarizes the precision of the return-to-
(84.7%) were reached for a follow-up telephone interview work recommendations made according to each FCE-
and became the participants for this study. based rating. Participants who passed the FCE testing were
Table 1 shows the characteristics of the participants able to return to their previous job, whereas it was likely
in detail. After the FCEs, 63.9% achieved a pass rating that those who failed the test either had to change their job
and 36.1% a fail rating. Moderate agreement (Landis & or refrain from work at the moment. The results of the
Koch, 1977) was found between the return-to-work re- univariate logistic regressions on the confounding variables
commendations made by the therapists and the em- showed that only two variables, number of days from in-
ployment status reported by the participants at follow-up jury to FCE (crude odds ratio [OR] 5 0.561, 95% con-
(k 5 .449). A statistically significant difference (p < .0001) fidence interval [CI] 5 0.312–0.971) and compensability
was obtained from the McNemar–Bowker test, thus con- (crude OR 5 0.683, 95% CI 5 0.347–0.819), had a
firming that there was more disagreement over some cat- statistically significant effect on the predictive validity of
egories of return-to-work outcomes than others. A higher job-specific FCE. In the multivariate logistic regression
percentage of correct predictions was observed for the analysis, the following two variables continued to play a
recommendations return to previous job (94.83%) than significant role on the predictive validity of job-specific

448 July/August 2011, Volume 65, Number 4

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 Table 2. Agreement Between Therapist’s Return-to-Work Recommendations and Self-Reported Employment Status
at 3-Mo Follow-Up (N 5 194)
Return-to-Work Outcomes Therapist’s Recommendation Participants’ Actual Employment Status Hit Rate, %
Change job 20 38 52.63
Previous job 116 110 94.83
Previous job with modification 32 3 9.38
Do not work at the moment 26 43 60.47
(k 5 0.449, p < .0001)

FCE: (1) number of days from injury to FCE (adjusted
OR 5 0.498, 95% CI 5 0.263–0.819) and (2) com-
pensability (adjusted OR 5 0.549, 95% CI 5 0.398–
0.912). As a result, a 1-day increase in the number of days
from injury to FCE reduced the predictive validity of job-
specific FCE by 49.8%, and a compensable injury re-
duced it by 54.9%.
Table 4 shows the regression models for each FCE
rating in terms of correct prediction of employment status
after controlling for significant confounding variables. The
percentages of correct predictions were as follows: 85.9%
(R 2 5 20.15, sensitivity 5 87.9%, specificity 5 75.3%)
among the participants who obtained a pass rating, at a
best classification cutoff of 0.5; 62.8% (R 2 5 14.72%,
sensitivity 5 64.3%, specificity 5 69.8%) among the
participants who obtained a fail rating A because they did
not meet all the criteria of the FCE tasks, at a best clas-
sification cutoff of 0.4; and 78.5% (R 2 5 19.24%, sensi-
tivity 5 85.3%, specificity 5 72.9%) among the participants
who obtained a fail rating B because they failed all of the
FCE tasks, at a best classification cutoff of 0.4.
Discussion
The results of our study support our premise that job-
specific FCE can have better predictive validity for the
employment status of patients with a specific injury than
for that of patients with a nonspecific injury. Compared
with nonspecific injuries, such as in our previous study on
nonspecific low back pain (Cheng & Cheng, 2010), the
accuracy of the recommendation return to previous job in
the current study reached 94.83%, which is 6.47% higher
than the corresponding figures for patients with non-
specific low back pain in our previous study. Similarly,
the accuracy of the recommendation do not work at the
moment was 60.47%, which is 22.97% higher than in
our previous study (Cheng & Cheng, 2010).
For participants who passed our job-specific FCE,
a clear and distinct decision could be made to recommend
that they return to their previous jobs. If the participants
failed the test, regardless of whether it was a fail rating A or
B, three options were open to the therapists: (1) return to
previous job with modifications, (2) change job, or (3) do
not work at the moment. In our study, the return-to-work
recommendation for which job-specific FCE had the
least predictive ability was return to previous work with
modifications. The lack of available modified duties had
a significant influence on the ability of the participants
to follow the recommendation made by the therapists.
This situation was similar to that found in Lechner
et al. (2008). If modified duties had been available

Table 3. Precision of Return-to-Work (RTW) Recommendations for Participants at 3-Mo Follow-Up (N 5 194)
FCE Performance and RTW Outcomes Therapist’s Recommendation Patient’s Employment Status Relative Percentage Differencea
Pass rating
Change job 0 15 200
Previous job 116 107 8.07
Previous job with modification 8 0 200
Do not work at the moment 0 2 200
Fail rating A
Change job 3 4 28.57
Previous job 0 1 200
Previous job with modification 14 3 129.41
Do not work at the moment 1 10 163.64
Fail rating B
Change job 17 19 11.11
Previous job 0 2 200
Previous job with modification 10 0 200
Do not work at the moment 25 31 21.43
a
Calculated by dividing the difference between the two measurement values by the average of the two measurement values and multiplying by 100. 100% is
the optimum result because it indicates perfect precision.

The American Journal of Occupational Therapy 449

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 for the participants, the percentage of correct predictions
and, hence, the k coefficients may have been significantly
improved.
The importance of providing suitable duties is well
known (Brooker, Cole, Hogg-Johnson, Smith, & Frank,
2001; Shaw & Feuerstein, 2004; van Duijn, Lötters, &
Burdorf, 2005; van Duijn, Miedema, Elders, & Burdorf,
2004) and is supported by this finding. Nowadays, the
provision of modified work programs is a critical ad-
ministrative measure or organizational policy in work-
place disability management (Shrey, 1996; Shrey &
Hursh, 1999; Williams & Westmorland, 2002). Differ-
ent terms are used for these modified work programs,
although most of the programs are similar in nature. The
most frequently used terms include light duty, limited
duty work, and transitional work.
Light duty refers to any temporary or permanent ac-
tivity that is less than regular or full duty and that enables
a disabled worker to perform a job according to a set of
conditions prescribed by a health care provider. Light duty
positions are paid work and are performed in a competi-
tive work environment. They range from adaptations of
a worker’s preinjury job to working in an entirely different
job at the same or a different company; such measures can
be either preexisting or specially created for the disabled
worker (Krause, Dasinger, & Neuhauser, 1998). Limited
duty work, however, is any job that is appropriate to an
injured worker’s skills, interests, and capabilities.
New jobs are designed for workers who cannot return
to their original work area. They may be either temporary
(i.e., for a specified time, such as a few weeks or months)
or permanent (when the worker will not be able to return
to his or her original job; Randolph & Dalton, 1989).
Transitional work is any combination of tasks, func-
tions, or jobs that a worker who has functional restrictions
can perform safely for pay and without the risk of injury to
self or other workers. Transitional work options include
designated jobs or job tasks that are modified, over time, to
accommodate the injured worker during the physical re-
covery process (Shrey & Hursh, 1999).
Most employers, particularly small organizations (<20
employees), experience difficulties in providing suitable
duties for injured workers (Kenny, 1999), either because
they do not know how to modify jobs or because they
lack the flexibility to provide alternative placements.
Therefore, when occupational therapists recommend that
a worker return to his or her previous job with mod-
ifications, they should not take it for granted that all
employers can provide such facilitation. Occupational
therapists are cognizant of job analysis and workplace
modifications and can help employers to identify suitable
450
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duties for injured workers. Nevertheless, because of
workload and personnel constraints in Hong Kong, it is
uncommon for Hong Kong occupational therapists to
make on-site evaluations to determine whether a work
site needs to be modified to enable an injured worker to
perform the essential functions of his or her job. In this
regard, there is room for future improvement.
In our study, the job-specific FCE protocol was de-
veloped in such a way that it consisted of the upper-limb
functions essential for different work requirements. Given
that all the participants were suffering from a distal radius
fracture, for which a definitively identified and pathoa-
natomical diagnosis was given, the FCE testing could
focus on how their physical limitations and functional
impairments became barriers that impeded them from
performing regular work duties (rather than the primarily
pain-mediated disabilities associated with nonspecific
conditions). Nevertheless, we adopted a psychophysical
testing approach in our job-specific FCE. The assessment
results took perceived pain or pain-related fear into ac-
count. Pain-related fear is increasingly recognized as an
important contributor to disability among people, par-
ticularly those with chronic pain, because it can lead to an
avoidance of activities or situations that are expected to
produce pain (Vowles & Gross, 2003).
The results of our study contrast with the finding of
Gross and Battié (2006) that the predictive ability of FCE
was not clearly better in participants with a distinct pa-
thology, such as a fracture. This discrepancy may be because
of the FCE methods and the different testing approaches
used in the two studies. In addition, although we had a
set of standard testing items in our FCE protocol, the
position of the assessment tools and the duration set for
testing could be varied from one participant to another.
This variation embodied our hypothesis that FCE should
be job specific to increase its predictive ability. The
predictive validity of an FCE should be reflected in the
correct classification of an evaluee’s prospective employ-
ment status according to the assessment results. Within the
sample used in this study, a job-specific FCE could be
considered a valid tool for predicting the return to previous
jobs of participants with a distal radius fracture. This pre-
dictive ability, however, will be compounded by some
concurrent factors. Our results are consistent with our
previous finding that a longer period from injury to FCE
and compensable injury reduces the predictive ability of
FCE (Cheng & Cheng, 2010). Compensation benefits
and delayed management remain the major determinants
of work disability (Cheng & Hung, 2007).
The limitations of this study include its reliance on
existing administrative databases in which information on
July/August 2011, Volume 65, Number 4
 all the potentially confounding factors was not available.
This missing information influenced our selection of
potential prognostic factors and outcomes. In addition, all
the participants reported their employment status 3 mo
after their FCE, but no further follow-up was made.
Consequently, it is not known whether their return to
work was sustained. Future prospective research design
using longitudinal methodology to investigate any change
of employment status after evaluation, job sustainability
and, particularly, the reason patients did not accept or
follow the return-to-work recommendations is highly re-
commended. Last, the results of this study are generalizable
only to settings that use a BTE work simulator as the FCE
method, because our testing procedure was job specific and
based on a detailed job analysis with each patient.
Conclusion
On the basis of standard testing items in a given FCE
protocol, it is possible to develop a job-specific FCE. The
results of this study lead to the conclusion that job-specific
FCE could have better predictive validity in relation to the
employment status of patients with a specific injury than
of patients with a nonspecific injury, particularly in terms
of determining whether an evaluee can return to his or her
previous job. s
Acknowledgments
We thank all the occupational therapists and participants
in this study. Special thanks go to the clerical staff of Alice
Ho Ming Ling Nethersole Hospital, David Trench Re-
habilitation Centre, Kwong Wah Hospital, Prince of Wales
Hospital, Tuen Mun Hospital, Queen Elizabeth Hospital,
United Christian Hospital, Princess Margaret Hospital,
Pamela Youde Nethersole Eastern Hospital, and Ruttonjee
Hospital for their patience in conducting the follow-up
telephone interviews.
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