Value of functional capacity evaluation information in a clinical setting for predicting return to work

Comprehensive Physical Work Capacity Evaluations for Korean Farmers Assessed in Healthy Volunteers

OBJECTIVE

To establish the lower limits of normative values of the physical work capacity for Korean farmers in healthy working individual.

METHODS

We developed a comprehensive set of physical work capacity evaluation items that encompass common farming tasks. These items include measurements of trunk flexion/extension angles, strength (hand grip, trunk flexion/extension, leg/back lifting, and pushing/pulling), and positional tolerances. We calculated the normative values for the items and defined the normal range in 124 healthy volunteers aged 20-79 years. We calculated the intraclass correlation coefficient (ICC) to validate the test-retest reliability of the measurements protocol.

RESULTS

The normal values for each measurement item were as follows: trunk flexion and extension angle (65.3°±11.6° and 29.6°±6.6°), dominant hand grip strength (32.2±10.5 kgf), trunk flexion and extension strength (288.4±119.0 N and 297.3±129.9 N), leg and back lifting strength (452.9±233.5 N and 349.2±166.7 N), pushing and pulling strength (214.7±75.1 N and 221.7±63.3 N), and positional tolerance time (squat: 76.8±9.0 seconds, front: 73.8±7.7 seconds, twist: 82.2±8.8 seconds, upward: 71.9±11.3 seconds). Regarding test-retest reliability, all strength measurements demonstrated excellent absolute agreement (ICC, 0.91-0.96). However, positional tolerance showed poor-to-moderate absolute agreement (ICC, 0.37-0.58).

CONCLUSION

We conducted measurements of muscle strength and positional tolerance in healthy participants of various ages, focusing on tasks commonly performed by Korean farmers. The outcomes hold significant value as they offer a pertinent instrument for assessing the appropriateness of workers, thereby carrying implications for rehabilitation objectives, legal evaluations, and work capacity assessments within the agricultural domain.

Matching Perceived Physical Capacity and Work Demands: A New Classification of the Modified Spinal Function Sort (M-SFS)

Purpose The aims of this study were (1) to develop a new classification for the scores of the Modified Spinal Function Sort (M-SFS) which is related to the level of physical work demands and (2) to test the predictive value of the M-SFS classification. Methods The classification was carried out in 194 subjects with musculoskeletal disorders (MSD) attending a work-related medical rehabilitation from four rehabilitation centers. External criterion was a Functional Capacity Evaluation (FCE)-based work capacity estimation according to the classification used in Germany ("REFA") which differentiates between light, light to medium, medium and heavy work. The optimal cut-offs for the M-SFS were allocated using the Youden index. Logistic regression models were calculated based on 147 subjects who participated in the follow-up survey to evaluate the predictive validity of the M-SFS classification with regard to sustainable return to work (RTW; employment at the 3-month follow-up combined with a low level of sick leave). Results Cut-offs for M-SFS scores were 44 (light work), 54 (light to medium work), 62 (medium work) and 73 (heavy work). A match between the M-SFS category and the level of physical work demands was associated with a more than threefold higher RTW chance compared to subjects with a negative discrepancy. In case the M-SFS category was above the physical demand level the RTW-chance was more than 13-fold higher. Conclusions M-SFS scores can be classified into four levels of physical work demands. If the perceived work capacity matches or exceeds the level of physical work demands patients with MSD have a substantially higher probability to return to work after rehabilitation. More studies are needed to confirm or reject our findings and overcome some of the weaknesses of this study.

Do patient characteristics affect the predictive validity of Functional Capacity Evaluations?

Purpose

The aim of this study was to identify patient-related characteristics that affect the predictive validity of the FCE assessment ELA.

Methods

A prospective multicenter study was conducted on 303 patients with musculoskeletal disorders (MSD) recruited from eleven rehabilitation centers. The ELA-based estimation of the participants' ability to cope with physical work demands was considered valid if RTW was paired with a positive ELA outcome (≥ moderate) as well as if non-RTW was accompanied by a negative ELA outcome (rather or very poor). In the remaining cases, the ELA result was judged as non-valid. To reduce the risk of false conclusions, the rating was performed inversely in participants that (1) reported severe limitations regarding their productivity at work, (2) attributed RTW to a change in job resp. a reduction of their physical work demands and in those that (3) attributed non-RTW to non-physical reintegration barriers only. Using questionnaires, 28 patient-related characteristics were collected. Logistic regression models were calculated to identify characteristics that affected the predictive validity of ELA.

Results

ELA was considered valid in 208 of 303 (69%) participants. A moderate and strong pain-related disability at work were associated with a 0.15-fold (95% confidence interval (95% CI) 0.05–0.46), respectively, 0.19-fold (95% CI 0.05–0.72) chance for a valid outcome. In addition, a negative influence was found in participants that reported psychosocial distress (odds ratio (OR) 0.35; 95% CI 0.15–0.82), a native language different from the national language (OR 0.16; 95% CI 0.05–0.56) as well as in those that expected to return to work, but not within one month (OR 0.17; 95% CI 0.06–0.46). Further variables—including age, employment status, fear-avoidance beliefs and the level of physical work demands—did not affect the predictive validity of ELA.

Conclusions

The results suggest that the predictive validity of ELA is primarily limited by patients that report a moderate or strong pain-related disability at work, psychosocial distress as well as the expectation to return to work, but not within one month. Furthermore, a negative influence can be assumed for language barriers.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01807-7.

Understanding the Process and Challenges for Return-to-Work Post-Hematopoietic Cell Transplantation from a Musculoskeletal Perspective: A Narrative Review

The current paper seeks to inform healthcare professionals on how adapting various components of return to work (RTW) programs that are already in use by other musculoskeletal rehabilitation settings can help optimize return to work process for patients with or without musculoskeletal manifestations, posthematopoietic cell transplantation. Since there is no universally agreed RTW structure for hematopoietic cell transplant patients, a narrative approach has been taken utilizing evidence from the existing musculoskeletal return to work assessment publications to help draw parallel for the hematopoietic cell transplant patients. Databases were searched including PUBMED, CINHAL, AMED, SCOPUS, and Cochrane using keywords RTW, functional restoration program, hematopoietic cell transplant, bone marrow transplant, stem cell transplant, and musculoskeletal functional assessment. The authors have managed to outline and propose a structured RTW assessment and monitoring program which can aid in getting patients back to employment by utilizing the functional capacity and job evaluation to help hematopoietic cell transplantation patients reintegrate socially. Patients undergoing hematopoietic cell transplant require additional support and a robust assessment system to allow safe RTW. The proposed model of RTW assessment can prove to be beneficial in helping patients return to work safely. Clinical Significance. To acknowledge the individuality in functional limitation is important in determining not only the rehab needs but also the RTW capabilities. The proposed RTW plan not only promotes an individualized approach to patients but also provides a structure for return to work assessments for hematopoietic cell transplantation patients, thus, eliminating the need for guess work by healthcare professionals. In line with the International Classification of Functioning, Disability, and Health (ICF) recommendations, a RTW assessment combined with a job evaluation helps healthcare professionals and stakeholders to understand the unique challenges and strengths of a patient and thereby design an individualized therapy approach.

Impact of Functional Capacity Evaluation on Patient-Reported Functional Ability: An Exploratory Diagnostic Before-After Study

Introduction Work capacity in patients with orthopedic trauma and long-lasting inactivity is significantly reduced. Functional capacity evaluation (FCE) is a diagnostic approach for developing recommendations for a return to work and further occupational rehabilitation when the ability to carry out previous job demands is uncertain. However, FCE may also have direct effects on the patients' appraisal of their functional ability. Our study therefore evaluated the change in patient-reported functional ability after the performance of an FCE. Methods We performed a diagnostic before-after study in 161 consecutively recruited patients with trauma who were referred for FCE at the end of an interdisciplinary inpatient rehabilitation program in Austria. Patients completed the Spinal Function Sort to assess patient-reported functional ability both prior to the FCE and after completing it. Results Patient-reported functional ability (0-200 points) improved by 14.8 points (95% CI 11.3-18.2). The number of participants who rated their functional ability below their functional capacity as observed by the FCE decreased from 82.6 to 64.6% by about 18 percentage points. Conclusions The performance of the FCE in patients with trauma was associated with an improvement of patient-reported functional ability. The performance of an FCE in trauma rehabilitation may possibly have a direct therapeutic effect on the patient by allowing a more realistic appraisal of the ability to perform relevant work activities.

WITHDRAWN: Functional capacity evaluations for the prevention of occupational re-injuries in injured workers

This review did not find any studies to include in 2010. Systematic searches have not revealed any new studies having been published up to November 2015. As the current author team cannot commit to updating the review and as we haven’t found new authors keen to take on the task, we decided to withdraw this review.

The editorial group responsible for this previously published document have withdrawn it from publication.

Experts opinion on the use of normative data for functional capacity evaluation in occupational and rehabilitation medicine and disability claims

PURPOSE

Application of normative values for functional capacity evaluation (FCE) is controversial for the assessment of clients for work ability. The objective of this study was to study when clinicians and researchers consider normative values of FCE useful or of no use for their purposes.

METHODS

A focus group meeting was organized among 43 FCE experts working in insurance, occupational and/or rehabilitation medicine from eight countries during the first international FCE research meeting on October 25th, 2012 in the Netherlands. Participants were asked to rate to which degree they agree or disagree with a statement concerning their position toward normative values for FCE on a 10 cm VAS ranging from 0 (completely disagree) to 100 (completely agree) at T0 and T1. Arguments for aspects that are useful and of no use for normative values were systematically collected during the meeting and afterwards independently clustered by two researchers in higher order topics.

RESULTS

Baseline opinion of participants on their position toward normative values was 49 ± 29 points. After the meeting, mean VAS was 55 ± 23 (p = 0.07), indicating that participants did not significantly change their opinion toward normative values. Based on arguments provided by the experts, seven higher order topics were constructed namely 'Comparison with job demands or treatment goals'; 'Comparison with co-workers physical ability'; 'Sincerity of effort'; 'Validity for work ability and return to work'; 'Experience of referrer with assessment method'; 'Clinimetrics compared to alternative assessment methods or reference values'; and 'Ease of use for clinician and stakeholders'.

CONCLUSIONS

Although experts state useful aspects for the use of normative values of FCE for these assessments, it may also lead to over-interpretation of results, leading to dualistic statements concerning work ability, with potential harmful consequences for work ability of patients.

A cluster randomized clinical trial comparing functional capacity evaluation and functional interviewing as components of occupational rehabilitation programs

PURPOSE

Functional capacity evaluations (FCE) are used to identify work abilities and are commonly integrated into rehabilitation programs. We studied whether integrating FCE into rehabilitation leads to better outcomes for injured workers.

METHODS

A cluster randomised controlled trial was conducted at a workers' compensation rehabilitation facility (registration ISRCTN61284905). Clinicians were randomised into 2 groups: 1 group used FCE while another conducted semi-structured functional interviews. Outcomes included recommendations following assessment, rehabilitation program outcomes including functional work levels and pain intensity, as well as compensation outcomes at 1, 3, and 6 months after assessment. Analysis included Mann-Whitney U, Chi square and t tests.

RESULTS

Subjects included 225 claimants of whom 105 were tested with FCE. Subjects were predominantly employed (84 %) males (63 %) with sub-acute musculoskeletal conditions (median duration 67 days). Claimants undergoing FCE had ~15 % higher average functional work levels recommended at time of assessment (Mann-Whitney U = 4,391.0, p < 0.001) but differences at other follow-up times were smaller (0-8 %), in favour of functional interviewing, and not statistically significant. Clinically important improvement during rehabilitation in functional work level (0.9/4, SRM = 0.94), pain intensity (2.0/10, SRM = 0.88) and self-reported disability (21.8/100, SRM = 1.45) were only observed in those undergoing the functional interview.

CONCLUSIONS

Performance-based FCE integrated into occupational rehabilitation appears to lead to higher baseline functional work levels compared to a semi-structured functional interview, but not improved RTW rates or functional work levels at follow-up. Functional interviewing has potential for efficiency gains and higher likelihood of clinically important improvement following rehabilitation, however further research is needed.

What is the rate of functional improvement during occupational rehabilitation in workers' compensation claimants?

OBJECTIVES

We examined the rate of functional change (using performance measures and a self-report questionnaire) during interdisciplinary occupational rehabilitation in workers' compensation claimants with a variety of musculoskeletal conditions. We also estimated the rate of improvement that could be considered clinically important and examined factors associated with rate of functional improvement.

METHODS

A prospective cohort design was used, with data collected before and after claimants participated in an interdisciplinary occupational rehabilitation program. A consecutive sample was formed of claimants admitted between July 2005 and June 2007. Measures included performance-based functional measures (functional capacity evaluation, FCE) and a self-report questionnaire (pain disability index, PDI).

RESULTS

The sample included 582 compensation claimants with a variety of musculoskeletal conditions. The majority of claimants experienced functional improvement during rehabilitation. Claimants with the outcome status 'Return-to-Work Pre-accident' had the highest rate of functional change (up to 5 kg/week on floor to waist lifting, ~7 points/week on the PDI).

CONCLUSION

The clinically important rate of functional change appears to be 5 kg/week on FCE floor-to-waist lifting and 7 points/week on the PDI (scored out of 100). Rate of functional change appears to be multifactorial, with a variety of physical, demographic, clinical, and environmental factors explaining rate of change.

Are performance-based measures predictive of work participation in patients with musculoskeletal disorders? A systematic review

OBJECTIVE

Assessments of whether patients with musculoskeletal disorders (MSDs) can participate in work mainly consist of case history, physical examinations, and self-reports. Performance-based measures might add value in these assessments. This study answers the question: how well do performance-based measures predict work participation in patients with MSDs?

METHODS

A systematic literature search was performed to obtain longitudinal studies that used reliable performance-based measures to predict work participation in patients with MSDs. The following five sources of information were used to retrieve relevant studies: PubMed, Embase, AMA Guide to the Evaluation of Functional Ability, references of the included papers, and the expertise and personal file of the authors. A quality assessment specific for prognostic studies and an evidence synthesis were performed.

RESULTS

Of the 1,230 retrieved studies, eighteen fulfilled the inclusion criteria. The studies included 4,113 patients, and the median follow-up period was 12 months. Twelve studies took possible confounders into account. Five studies were of good quality and thirteen of moderate quality. Two good-quality and all thirteen moderate-quality studies (83%) reported that performance-based measures were predictive of work participation. Two good-quality studies (11%) reported both an association and no association between performance-based measures and work participation. One good-quality study (6%) found no effect. A performance-based lifting test was used in fourteen studies and appeared to be predictive of work participation in thirteen studies.

CONCLUSIONS

Strong evidence exists that a number of performance-based measures are predictive of work participation in patients with MSDs, especially lifting tests. Overall, the explained variance was modest.

Are young adults with special needs ready for the physical work demands?

Youth and Adolescents with Special Needs (YASN) face many challenges during transition into employment. Although most of their physical challenges are secondary, yet they call for attention since most of them are hired for blue collar jobs. Functional Capacity Evaluation (FCE) should be adapted to prepare them addressing the physical job-demands, and maintain their jobs effectively and safely. The current pilot study aims to demonstrate the use of standard (FCE) in order to assess performance of basic generic physical activities conducted by YASN, as part of transition to work program. Specifically, it compared subtests of the Physical Work Performance Evaluation of YASN (N = 13) with matched control group (YA) (N = 13). Results revealed slower and reduced performance among YASNs than YA, in basic job demands, like dynamic strength, hand strength, and fine motor skills. Implications and recommendations for research and transition to work practice in the educational setting are discussed.

A short-form functional capacity evaluation predicts time to recovery but not sustained return-to-work

OBJECTIVES

To evaluate the ability of a short-form FCE to predict future timely and sustained return-to-work.

METHODS

A prospective cohort study was conducted using data collected during a cluster RCT. Subject performance on the items in the short-form FCE was compared to administrative recovery outcomes from a workers' compensation database. Outcomes included days to claim closure, days to time loss benefit suspension and future recurrence (defined as re-opening a closed claim, restarting benefits, or filing a new claim for injury to the same body region). Analysis included multivariable Cox and logistic regression using a risk factor modeling strategy. Potential confounders included age, sex, injury duration, and job attachment status, among others.

RESULTS

The sample included 147 compensation claimants with a variety of musculoskeletal injuries. Subjects who demonstrated job demand levels on all FCE items were more likely to have their claims closed (adjusted Hazard Ratio 5.52 (95% Confidence Interval 3.42-8.89), and benefits suspended (adjusted Hazard Ratio 5.45 (95% Confidence Interval 2.73-10.85) over the follow-up year. The proportion of variance explained by the FCE ranged from 18 to 27%. FCE performance was not significantly associated with future recurrence.

CONCLUSION

A short-form FCE appears to provide useful information for predicting time to recovery as measured through administrative outcomes, but not injury recurrence. The short-form FCE may be an efficient option for clinicians using FCE in the management of injured workers.

Functional capacity evaluations for the prevention of occupational re-injuries in injured workers

BACKGROUND

Functional capacity evaluation (FCE) has been widely used to assess workers' physical state of readiness to return to work (RTW) after an injury and to make recommendations for the time and capacity in which they might return. FCEs are also used to prevent re-injury after RTW. Despite being a commonly used tool, little is known about how effective FCE is in preventing occupational injuries.

OBJECTIVES

To assess the effectiveness of FCE-based return to work recommendations in preventing occupational re-injuries of injured workers compared with no intervention or alternative interventions.

SEARCH STRATEGY

We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 4), MEDLINE (1966 to December 2009), EMBASE (1980 to December 2009), CINAHL (1980 to December 2009), PsycINFO (1983 to December 2009) and PEDro (1929 to December 2009). The searches were not restricted by date, language or type of publication.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of FCE-based return to work recommendations for preventing occupational re-injuries in injured workers.

DATA COLLECTION AND ANALYSIS

Four authors (NM, ES, JV, ML), in pairs, independently selected studies for inclusion, extracted data and assessed risk of bias.

MAIN RESULTS

We found no studies that compared FCE to no intervention. We found one RCT with 372 participants in which a short-form of one FCE was compared to the standard long-form FCE (Isernhagen Work Systems). Outcomes were recurrence rates of re-injuries. There was no significant difference between the two forms of FCE.We rated the overall quality of the evidence as low.

AUTHORS' CONCLUSIONS

There is no evidence for or against the effectiveness of FCE compared to no intervention. A short version of FCE showed similar effectiveness to a long version in preventing re-injury. More RCTs are needed.