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van der Laan TMJ, Postema SG, Alkozai SA, van der Sluis CK, Reneman MF. Musculoskeletal complaints, physical work demands, and functional capacity in individuals with a brachial plexus injury: An exploratory study. Work 2024; 77:811-825. [PMID: 37781839 DOI: 10.3233/wor-220680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Musculoskeletal complaints (MSCs) may be more common in individuals with brachial plexus injury (BPI), whose physical work demands exceed their functional capacity (FC). OBJECTIVES (a) To assess the concurrent validity of five methods for measuring upper extremity work demands and the Dictionary of Occupational Titles (DOT). (b) To explore the relations between MSCs, physical work demands, and FC in individuals with BPI. METHODS This study had a descriptive correlational design. Physical work demands of 16 individuals with BPI (12 males, 6 one-handed workers) were assessed during work using five assessment methods and the DOT. Spearman correlation coefficients between work demand methods were determined. FC was assessed using the functional capacity evaluation one-handed (FCE-OH). A questionnaire was used to examine MSCs. The relationship between MSCs, physical work demands and FC was analyzed visually, using Spearman correlation coefficients, and by comparing FCE-OH results to FCE reference values. RESULTS Spearman correlation coefficients for the DOT and four out of five assessment methods for determining work demands on upper extremities were significant and moderate (four combinations: r = 0.65-0.79) to strong (five combinations: r = 0.81-0.94). Correlations of the fifth method with the other methods were weak to fair. No significant relationships were found between MSCs, physical work demands and FCE-OH results. CONCLUSION The relationships between MSCs, physical work demands, and FC are evidently complex and require further investigation. In this small sample the concurrent validity of the DOT and four methods for determining work demands on upper extremities was moderate to good.
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Affiliation(s)
- Tallie M J van der Laan
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sietke G Postema
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Siawash A Alkozai
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Moens M, Goudman L, Van de Velde D, Godderis L, Putman K, Callens J, Lavreysen O, Ceulemans D, Leysen L, De Smedt A. Personalised rehabilitation to improve return to work in patients with persistent spinal pain syndrome type II after spinal cord stimulation implantation: a study protocol for a 12-month randomised controlled trial-the OPERA study. Trials 2022; 23:974. [PMID: 36471349 PMCID: PMC9721015 DOI: 10.1186/s13063-022-06895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/07/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND For patients with therapy-refractory persistent spinal pain syndrome type II (PSPS-T2), spinal cord stimulation (SCS) may serve as an effective minimally invasive treatment. Despite the evidence that SCS can improve return to work (RTW), only 9.5 to 14% of patients implanted with SCS are effectively capable of returning to work. Thus, it seems that current post-operative interventions are not effective for achieving RTW after SCS implantation in clinical practice. The current objective is to examine whether a personalised biopsychosocial rehabilitation programme specifically targeting RTW alters the work ability in PSPS-T2 patients after SCS implantation compared to usual care. METHODS A two-arm, parallel-group multicentre randomised controlled trial will be conducted including 112 patients who will be randomised (1:1) to either (a) a personalised biopsychosocial RTW rehabilitation programme of 14 weeks or (b) a usual care arm, both with a follow-up period until 12 months after the intervention. The primary outcome is work ability. The secondary outcomes are work status and participation, pain intensity, health-related quality of life, physical activity and functional disability, functional capacities, sleep quality, kinesiophobia, self-management, anxiety, depression and healthcare expenditure. DISCUSSION Within the OPERA project, we propose a multidisciplinary personalised biopsychosocial rehabilitation programme specifically targeting RTW for patients implanted with SCS, to tackle the high socio-economic burden of patients that are not re-entering the labour market. The awareness is growing that the burden of PSPS-T2 on our society is expected to increase over time due to the annual increase of spinal surgeries. However, innovative and methodologically rigorous trials exploring the potential to decrease the socio-economic burden when patients initiate a trajectory with SCS are essentially lacking. TRIAL REGISTRATION ClinicalTrials.gov NCT05269212. Registered on 7 March 2022.
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Affiliation(s)
- Maarten Moens
- grid.8767.e0000 0001 2290 8069STIMULUS research group, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.411326.30000 0004 0626 3362Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette, 1090 Belgium ,grid.411326.30000 0004 0626 3362Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium
| | - Lisa Goudman
- grid.8767.e0000 0001 2290 8069STIMULUS research group, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.411326.30000 0004 0626 3362Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.434261.60000 0000 8597 7208Research Foundation Flanders (FWO), Egmontstraat 5, Brussels, 1000 Belgium
| | - Dominique Van de Velde
- grid.5342.00000 0001 2069 7798Faculty of Medicine and Healthcare Sciences, Department of Rehabilitation Sciences, Occupational Therapy Program, Ghent University, Ghent, 9000 Belgium
| | - Lode Godderis
- grid.5596.f0000 0001 0668 7884Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Leuven, 3000 Belgium ,IDEWE, External Service for Prevention and Protection at Work, Heverlee, 3001 Belgium
| | - Koen Putman
- grid.8767.e0000 0001 2290 8069Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium
| | - Jonas Callens
- grid.8767.e0000 0001 2290 8069STIMULUS research group, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium
| | - Olivia Lavreysen
- grid.5596.f0000 0001 0668 7884Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Leuven, 3000 Belgium
| | - Dries Ceulemans
- grid.5342.00000 0001 2069 7798Faculty of Medicine and Healthcare Sciences, Department of Rehabilitation Sciences, Occupational Therapy Program, Ghent University, Ghent, 9000 Belgium
| | - Laurence Leysen
- grid.8767.e0000 0001 2290 8069STIMULUS research group, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium
| | | | - Ann De Smedt
- grid.8767.e0000 0001 2290 8069STIMULUS research group, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.8767.e0000 0001 2290 8069Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090 Belgium ,grid.411326.30000 0004 0626 3362Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette, 1090 Belgium
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Yang CL, Yin YR, Chu CM, Tang PL. Does category of strength predict return-to-work after occupational injury? BMC Public Health 2022; 22:1472. [PMID: 35918669 PMCID: PMC9344704 DOI: 10.1186/s12889-022-13817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Occupational accidents may lead laborers to lose their working capacities, affecting their physical and mental health. Occupational rehabilitation helps improve the ability of patients with occupational accidents and suggests appropriate jobs to avoid second injuries. This study aimed to identify whether any of the functional capacity evaluation (FCE) strength subtests predicted successful return to work. Methods Data were collected of 84 patients receiving government-subsidized occupational rehabilitation between September 2016 and December 2018. A structured questionnaire was employed for pre- and post-training assessment, including basic information, information of the occupational accident, status of the laborer at the opening of the injury case, physical requirement for the job, and physical capacity. Eight subtests of strength were included in the physical capacity evaluation, i.e., carrying, lifting to several levels, power grip, and lateral pinch, to explore the association between the strength tests and return to work. Results The unadjusted model showed that for every additional kilogram in bilateral carrying strength before work hardening training, the odds of successful return to work increased (crude odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.01–1.24, p = 0.027). After adjustment for basic demographic information and pre-accident physical functional elements of work, the odds of successful return to work increased (adjusted OR = 1.27, 95% CI = 1.04–1.54, p = 0.02) for every additional kilogram in the pre-training bilateral carrying strength. There were no statistically significant differences observed in the other seven subtests. Conclusion Through thorough evaluation and work hardening training provided in the occupational rehabilitation, patients’ physical capacity can be understood and improved. However, a full evaluation of functional capacities is prolonged and time-consuming. This study provides evidence that pre-work-hardening bilateral carrying strength may be a promising predictor of return to work and we recommend to consider it as a prioritized test to assist in determining appropriate advice regarding return to work. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13817-2.
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Affiliation(s)
- Chia-Lin Yang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC)
| | - Yan-Ru Yin
- Department of Occupational Medicine, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC)
| | - Chuan-Man Chu
- Department of Occupational Medicine, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC)
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC). .,Department of Health-Business Administration, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City, 83102, Taiwan (ROC). .,College of Nursing, Kaohsiung Medical University, 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (ROC).
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Hohmann E, Tetsworth K, Pieterse R. The Test-Retest Reliability of the Pieterse Protocol Return to Flight Assessment for Cabin Crew. Aerosp Med Hum Perform 2022; 93:551-556. [DOI: 10.3357/amhp.6007.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION: The purpose of this study was to assess test-retest reliability of the Pieterse return to flight duty protocol for cabin crew to return to flight duties.METHOD: Flight attendants between 20–50 yr old were included if they underwent rehabilitation
at the musculoskeletal rehabilitation unit for a musculoskeletal injury, surgical treatment for orthopedic trauma or industrial injuries, and were assessed by the treating physical therapist and aviation medical examiner to be ready for return to work. Test-retest reliability was calculated
with the Fleiss kappa coefficient.RESULTS: Included were 18 flight attendants (10 men, 34.9 ± 6.3 yr; 8 women, 34.2 ± 3.4 yr). Eight participants were rehabilitated following upper extremity injury, eight following lower extremity, and two following both upper and
lower extremity injury. Perfect test-retest reliability was observed for nine items; kappa values above 0.9 were observed for three items; one item had a kappa value above 0.8 and two items had a kappa value of 0.78. The results for all 15 items were highly significant, demonstrating that
the Fleiss kappa coefficients were significantly different from zero. The kappa coefficient strength of agreement was almost perfect for 13 and substantial for the remaining 3 items. Overall test-retest reliability was 0.95.DISCUSSION: This study demonstrated almost perfect test-retest
reliability for 13 items and substantial reliability for two items, with an overall test-retest reliability of 0.95 for a return to flight assessment for flight attendants. The Pieterse protocol is a reliable tool to establish return to work for cabin crew.Hohmann E, Tetsworth K, Pieterse
R. The test-retest reliability of the Pieterse protocol return to flight assessment for cabin crew. Aerosp Med Hum Perform. 2022; 93(7):551–556.
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Do patient characteristics affect the predictive validity of Functional Capacity Evaluations? Int Arch Occup Environ Health 2021; 95:877-885. [PMID: 34709439 PMCID: PMC8551349 DOI: 10.1007/s00420-021-01807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/30/2021] [Indexed: 12/02/2022]
Abstract
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.
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Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG102. [PMID: 34338006 DOI: 10.2519/jospt.2021.0303] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Work rehabilitation refers to the process of assisting workers to remain at work or return to work (RTW) in a safe and productive manner, while limiting the negative impact of restricted work, unemployment, and work disability. The primary purpose of this clinical practice guideline (CPG) is to systematically review available scientific evidence and provide a set of evidence-based recommendations for effective physical therapy evaluation, treatment, and management of individuals experiencing limitations in the ability to participate in work following injury or illness. J Orthop Sports Phys Ther 2021;51(8):CPG1-CPG102. doi:10.2519/jospt.2021.0303.
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Remedios SM, Armstrong DP, Graham RB, Fischer SL. Exploring the Application of Pattern Recognition and Machine Learning for Identifying Movement Phenotypes During Deep Squat and Hurdle Step Movements. Front Bioeng Biotechnol 2020; 8:364. [PMID: 32426346 PMCID: PMC7212384 DOI: 10.3389/fbioe.2020.00364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/31/2020] [Indexed: 12/29/2022] Open
Abstract
Background Movement screens are increasingly used in sport and rehabilitation to evaluate movement competency. However, common screens are often evaluated using subjective visual detection of a priori prescribed discrete movement features (e.g., spine angle at maximum squat depth) and may not account for whole-body movement coordination, or associations between different discrete features. Objective To apply pattern recognition and machine learning techniques to identify whole-body movement pattern phenotypes during the performance of exemplar functional movement screening tasks; the deep squat and hurdle step. Additionally, we also aimed to compare how discrete kinematic measures, commonly used to score movement competency, differed between emergent groups identified via pattern recognition and machine learning. Methods Principal component analysis (PCA) was applied to 3-dimensional (3D) trajectory data from participant's deep squat (DS) and hurdle step performance, identifying emerging features that describe orthogonal modes of inter-trial variance in the data. A gaussian mixture model (GMM) was fit and used to cluster the principal component scores as an unsupervised machine learning approach to identify emergent movement phenotypes. Between group features were analyzed using a one-way ANOVA to determine if the objective classifications were significantly different from one another. Results Three clusters (i.e., phenotypes) emerged for the DS and right hurdle step (RHS) and 4 phenotypes emerged for the left hurdle step (LHS). Selected discrete points commonly used to score DS and hurdle step movements were different between emergent groups. In regard to the select discrete kinematic measures, 4 out of 5, 7 out of 7 and 4 out of 7, demonstrated a main effect (p < 0.05) between phenotypes for the DS, RHS, and LHS respectively. Conclusion Findings support that whole-body movement analysis, pattern recognition and machine learning techniques can objectively identify movement behavior phenotypes without the need to a priori prescribe movement features. However, we also highlight important considerations that can influence outcomes when using machine learning for this purpose.
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Affiliation(s)
- Sarah M Remedios
- Occupational Biomechanics and Ergonomics Laboratory, Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Daniel P Armstrong
- Occupational Biomechanics and Ergonomics Laboratory, Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Ryan B Graham
- Spine Biomechanics Laboratory, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Steven L Fischer
- Occupational Biomechanics and Ergonomics Laboratory, Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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Predictive validity of a customized functional capacity evaluation in patients with musculoskeletal disorders. Int Arch Occup Environ Health 2020; 93:635-643. [DOI: 10.1007/s00420-020-01518-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
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Determining the minimal clinically important difference of the hand function sort questionnaire in vocational rehabilitation. Ann Phys Rehabil Med 2019; 62:155-160. [DOI: 10.1016/j.rehab.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022]
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De Baets S, Calders P, Schalley N, Vermeulen K, Vertriest S, Van Peteghem L, Coussens M, Malfait F, Vanderstraeten G, Van Hove G, Van de Velde D. Updating the Evidence on Functional Capacity Evaluation Methods: A Systematic Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:418-428. [PMID: 28988355 DOI: 10.1007/s10926-017-9734-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objectives To synthesize the evidence on the psychometrics functional capacity evaluation (FCE) methods. Methods A systematic literature search in nine databases. The resulting articles were screened based on predefined in- and exclusion criteria. Two reviewers independently performed this screening. Included studies were appraised based on their methodological quality. Results The search resulted in 20 eligible studies about nine different FCE methods. The Baltimore Therapeutic Equipment work simulator showed a moderate predictive validity. The Ergo-Kit (EK) showed moderate variability and high inter- and intra-rater reliability. Low discriminative abilities and high convergent validity were found for the EK. Concurrent validity of the EK and the ERGOS Work Simulator was low to moderate. Moderate to high test-retest, inter- and intra-reliability was found in the Isernhagen Work-Systems (IWS) FCE. The predictive validity of the IWS was low. The physical work performance evaluation (PWPE) showed moderate test-retest reliability and moderate to high inter-rater reliability. Low internal and external responsiveness were found for the PWPE, predictive validity was high. The predictive validity of the short-form FCE was also high but need to be further examined on several psychometric properties. Low discriminative and convergent validity were found for the work disability functional assessment battery. The WorkHab showed moderate to high test-retest, inter- and intra-rater reliability. Conclusion Well-known FCE methods have been rigorously studied, but some of the research indicates weaknesses in their reliability and validity. Future research should address how these weaknesses can be overcome.
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Affiliation(s)
- Stijn De Baets
- Occupational Therapy Program, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Noortje Schalley
- Occupational Therapy Program, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Katrien Vermeulen
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sofie Vertriest
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Lien Van Peteghem
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Marieke Coussens
- Occupational Therapy Program, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Fransiska Malfait
- Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Guy Vanderstraeten
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Geert Van Hove
- Department of Special Needs Education, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Dominique Van de Velde
- Occupational Therapy Program, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
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Abstract
Purpose: The purpose of this study was to explore the difference in maximal lifting capability between 2 modes of lifting (traditional crate and XRTS Lever Arm) over multiple days. The differences in absolute strength values were compared with existing criteria for sincere effort during distraction-based lifting. In addition, rate of perceived exertion (RPE) is presented for the 2 modes of lifting on each day. Primary Practice Setting: Workers' compensation. Methodology and Sample: Forty-four subjects between the ages of 20 and 44 years participated in this study. Investigators established 1 repetition maximum (RM) for each subject performing the crate lift. Subjects were randomly assigned 5 weights ranging from 10% to 100% of their determined 1RM and asked to give their rating of perceived exertion after each lift. The same procedure was repeated 2–5 days later using the XRTS Lever Arm. Paired t tests and Spearman's correlation coefficient were used for data analysis. Alpha was set at less than .05. Results: There was a statistically significant difference (p < .04) between maximal lift values for the 2 lifting modes. The percent difference between the modes of lifting was 10.5% ± 6.4%. In addition, there was a positive correlation between the RPE on the 2 modes of lifting (p = .87). Implications for Case Management Practice: A functional capacity evaluation (FCE) is typically ordered after the completion of physical rehabilitation and before releasing a patient to full or modified duty. In addition to assessing the ability to function within normal job demands, an assessment of effort by the participant typically takes place during an FCE. Case managers and physicians are presented with information, allowing them to make comparisons between functional lifting abilities displayed during treatment sessions and the FCE. These comparisons may often take place with the subpoena of medical records and may be discussed during the deposition or trial process. If an FCE takes place at a different facility than the physical therapy or work conditioning treatment, 2 different modes of lifting may take place based on the equipment within each facility. The results of this study indicate that the 2 modes of lifting on separate days meet established criteria for lift comparison testing during FCEs.
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Lang AE, Dickerson CR. Normative kinematics of reaching and dexterity tasks: moving towards a quantitative baseline for Functional Capacity Evaluations (FCEs). Int Biomech 2017. [PMCID: PMC7857447 DOI: 10.1080/23335432.2017.1326843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: This work generates a comprehensive description of upper extremity and torso kinematics of a healthy population during reaching and dexterity Functional Capacity Evaluation (FCE) tasks. Methods: Upper limb and torso kinematic data were collected from 30 young, healthy participants as they performed three common FCE tasks: repetitive reaching, fingertip dexterity, and hand and forearm dexterity. Kinematic profiles were created for all clinically relevant angles of the torso, shoulder, elbow, and wrist. Results: These provocative tasks require large ranges of motion and create high demand postures for the upper limb, specifically at the shoulder. Arm elevation was up to 90°, while humeral internal rotation of 25° was observed. Torso angles were typically below 30° from neutral and elbow flexion remained within 90°–120° for nearly all tasks. Wrist ulnar deviation ranged from 0° to 26° for both wrists. Conclusion: The normative data created in this investigation provide a description of healthy motion during reaching and dexterity tasks. These normative curves are the initial step towards understanding movement that would contraindicate return to work during an FCE. This work supports a future clinical goal of being able to identify persons at risk of further injury or disability if returned to work too early.
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Affiliation(s)
- Angelica E. Lang
- Department of Health Science, University of Saskatchewan, Saskatoon, Canada
| | - Clark R. Dickerson
- Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Waterloo, Canada
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Lang AE, Dickerson CR. Task intensity influences upper limb and torso kinematics during two common overhead Functional Capacity Evaluation tasks. Work 2017; 58:121-134. [DOI: 10.3233/wor-172614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Angelica E. Lang
- Department of Health Sciences, University of Saskatchewan, Saskatoon, SK, Canada
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Reneman M, Roelofs M, Schiphorst Preuper H. Reliability and Agreement of Neck Functional Capacity Evaluation Tests in Patients With Chronic Multifactorial Neck Pain. Arch Phys Med Rehabil 2017; 98:1476-1479. [DOI: 10.1016/j.apmr.2016.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/06/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
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Sinden KE, McGillivary TL, Chapman E, Fischer SL. Survey of kinesiologists' functional capacity evaluation practice in Canada. Work 2017; 56:571-580. [PMID: 28339418 DOI: 10.3233/wor-172519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In Canada, functional capacity evaluations (FCEs) are commonly administered by several health care professions including kinesiologists. Kinesiologists have been recently regulated as health care professionals in Ontario and we know little about their demographics, the frequency of FCE administration, or the types of FCEs used by this group. OBJECTIVE The purposes of this study were to identify: 1) the demographic characteristics and FCE education of kinesiology FCE practitioners; 2) the FCE systems most used by these practitioners and 3) the constructs from assessments used to determine functional capacity. METHODS A survey was distributed to members of the Canadian Kinesiology Alliance. Descriptive statistics and frequency distributions were calculated from the survey responses (n = 77). RESULTS FCE practitioners were represented by kinesiologists (79%) practicing more than 15 years and 1-5 years, who received FCE training from a certification course. ARCON (23%) was the most common FCE system used. Low-level lifting (43%), mid-lift (38%), pulling (38%) and walking (38%) are the most common FCE task components used to assess functional capacity. Although kinesiologists consider multiple factors when making decisions about task component endpoints, biomechanical observations/body mechanics are the primary methods used. CONCLUSIONS Kinesiologists are conducting FCEs for the primary purpose of preparing return-to-work or workplace accommodation recommendations. Although functional capacity is determined using multiple factors, there is an emphasis on biomechanics and body mechanics. Focusing FCE training and research on these constructs may provide opportunities to further strengthen the reliability and validity of FCE outcomes.
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Affiliation(s)
- Kathryn E Sinden
- School of Kinesiology, Lakehead University, Thunder Bay, ON, Canada
| | | | | | - Steven L Fischer
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.,School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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Peters SE, Johnston V. Methods and tools used by healthcare professionals to identify barriers to return-to-work for workers with upper extremity conditions in Australia. HAND THERAPY 2016. [DOI: 10.1177/1758998316665058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Healthcare professionals, including hand therapists, are frequently called upon to identify barriers to return-to-work for workers with upper extremity injuries. However, the methods and tools used to assess barriers to return-to-work remain unknown. Results from these assessments can be used to direct appropriate interventions for those who may be at risk of a prolonged work absence. Methods The purpose of this study was to identify the tools and methods used by healthcare professionals to assess barriers to return-to-work for workers with upper extremity conditions. A total of 596 Australian healthcare professionals responded to an open-ended question regarding the tools/methods they use to identify barriers to return-to-work. All responses were coded and analysed descriptively. Differences between professional disciplines were recorded. Results Healthcare professionals nominated 59 types of tools and methods that they use to identify barriers to return-to-work for workers with upper extremity conditions in their clinical practice. The most favoured method was clinical interviewing. Other commonly used tools were clinical measures, e.g., strength, and a return-to-work risk-factor screening tool validated on musculoskeletal diagnoses, the Orebro Musculoskeletal Screening Questionnaire. Discussion Healthcare professionals use a variety of methods and tools to identify barriers to return-to-work for workers with upper extremity conditions. Generally, they favoured subjective methods. Future research is needed to develop or validate assessment tools designed to identify barriers to return-to-work for workers with upper extremity conditions. In the absence of upper extremity specific screening tools, hand therapists should consider the biopsychosocial framework when evaluating barriers to return-to-work.
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Affiliation(s)
- Susan E Peters
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Queensland, Australia
| | - Venerina Johnston
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
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Mahmud N, Schaafsma FG, Fassier J, Verbeek JH, Reneman MF. WITHDRAWN: Functional capacity evaluations for the prevention of occupational re-injuries in injured workers. Cochrane Database Syst Rev 2016; 2:CD007290. [PMID: 26905766 PMCID: PMC10644048 DOI: 10.1002/14651858.cd007290.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Norashikin Mahmud
- Universiti Teknologi MalaysiaProgram of Industrial and Organizational Psychology, Faculty of ManagementJohor Bahru CampusSkudaiJohorMalaysia81310
| | - Frederieke G Schaafsma
- VU University Medical Center, EMGO+ InstituteDepartment of Public and Occupational HealthVan der Boechorststraat 7 ‐ room A524Postbus 7057AmsterdamNetherlands1007 MB
| | - Jean‐Baptiste Fassier
- Université Claude Bernard ‐ Lyon 1UMRESTTE ‐ UMR 9405Domaine RockefellerCedex 08LyonFrance69373
| | - Jos H Verbeek
- Finnish Institute of Occupational HealthCochrane Work Review GroupPO Box 310KuopioFinland70101
| | - Michiel F Reneman
- University Medical Center GroningenCenter of RehabilitationGroningenNetherlands
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18
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Birman MV, Solomon GS, Vender MI. Functional Capacity Evaluation in Hand Surgery. J Hand Surg Am 2016; 41:133-4. [PMID: 26710745 DOI: 10.1016/j.jhsa.2015.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/06/2015] [Accepted: 11/12/2015] [Indexed: 02/02/2023]
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Caron J, Ronzi Y, Bodin J, Richard I, Bontoux L, Roquelaure Y, Petit A. Interest of the Ergo-Kit(®) for the clinical practice of the occupational physician. A study of 149 patients recruited in a rehabilitation program. Ann Phys Rehabil Med 2015; 58:289-97. [PMID: 26381198 DOI: 10.1016/j.rehab.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Functional capacity evaluation is commonly used to assess the abilities of patients to perform some tasks. Ergo-Kit(®) is a validated tool assessing both functional capacities of patients and workplace demands. The objective of this study was to evaluate the relevance of the Ergo-Kit(®) data for occupational physicians during the return-to-work process. METHODS A retrospective and monocenter study was conducted on all patients included in a rehabilitation program and assessed with the Ergo-Kit(®) tool between 2005 and 2014. Workplace demands and patients' functional capacities were evaluated and confronted. Self-beliefs and perceived disability were also assessed and compared to the functional capacity evaluation. RESULTS One hundred and forty-nine working-age patients (85 men, 64 women; 39±12 years) suffering from musculoskeletal disorders or other diseases were included. Main causes of mismatch between workplace demands and functional capacities were manual handling of loads, postures with arms away from the body and repetitive motions at work; sitting posture was correlated with a lesser physical workload; and Oswestry score was correlated with functional capacities evaluated by the Ergo-Kit(®). CONCLUSION Ergo-Kit(®) is a relevant tool to assess the multidimensional aspects of workplace demands and functional capacities. It could be very helpful for occupational physicians to manage return-to-work.
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Affiliation(s)
- J Caron
- LUNAM université, université d'Angers, laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), faculté de médecine d'Angers, rue Haute-de-Reculée, 49045 Angers cedex 01, France; Centre de consultations de pathologie professionnelle, CHU d'Angers, médecine E, 4, rue Larrey, 49933 Angers cedex 9, France.
| | - Y Ronzi
- LUNAM université, université d'Angers, laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), faculté de médecine d'Angers, rue Haute-de-Reculée, 49045 Angers cedex 01, France; Département de médecine physique et de réadaptation, CHU d'Angers, 28, rue des Capucins, 49103 Angers cedex 02, France
| | - J Bodin
- LUNAM université, université d'Angers, laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), faculté de médecine d'Angers, rue Haute-de-Reculée, 49045 Angers cedex 01, France
| | - I Richard
- LUNAM université, université d'Angers, laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), faculté de médecine d'Angers, rue Haute-de-Reculée, 49045 Angers cedex 01, France; Département de médecine physique et de réadaptation, CHU d'Angers, 28, rue des Capucins, 49103 Angers cedex 02, France
| | - L Bontoux
- LUNAM université, université d'Angers, laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), faculté de médecine d'Angers, rue Haute-de-Reculée, 49045 Angers cedex 01, France; Département de médecine physique et de réadaptation, CHU d'Angers, 28, rue des Capucins, 49103 Angers cedex 02, France
| | - Y Roquelaure
- LUNAM université, université d'Angers, laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), faculté de médecine d'Angers, rue Haute-de-Reculée, 49045 Angers cedex 01, France; Centre de consultations de pathologie professionnelle, CHU d'Angers, médecine E, 4, rue Larrey, 49933 Angers cedex 9, France
| | - A Petit
- LUNAM université, université d'Angers, laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), faculté de médecine d'Angers, rue Haute-de-Reculée, 49045 Angers cedex 01, France; Centre de consultations de pathologie professionnelle, CHU d'Angers, médecine E, 4, rue Larrey, 49933 Angers cedex 9, France
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Konzelmann M, Burrus C, Hilfiker R, Rivier G, Deriaz O, Luthi F. Cross-cultural adaptation, reliability, internal consistency and validation of the Hand Function Sort (HFS©) for French speaking patients with upper limb complaints. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:18-24. [PMID: 24839002 DOI: 10.1007/s10926-014-9514-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Functional evaluation of upper limb is not only based on clinical findings but requires self-administered questionnaires to address patients' perspective. The Hand Function Sort (HFS©) was only validated in English. The aim of this study was the French cross cultural adaptation and validation of the HFS© (HFS-F). METHODS 150 patients with various upper limbs impairments were recruited in a rehabilitation center. Translation and cross-cultural adaptation were made according to international guidelines. Construct validity was estimated through correlations with Disabilities Arm Shoulder and Hand (DASH) questionnaire, SF-36 mental component summary (MCS),SF-36 physical component summary (PCS) and pain intensity. Internal consistency was assessed by Cronbach's α and test-retest reliability by intraclass correlation. RESULTS Cronbach's α was 0.98, test-retest reliability was excellent at 0.921 (95 % CI 0.871-0.971) same as original HFS©. Correlations with DASH were-0.779 (95 % CI -0.847 to -0.685); with SF 36 PCS 0.452 (95 % CI 0.276-0.599); with pain -0.247 (95 % CI -0.429 to -0.041); with SF 36 MCS 0.242 (95 % CI 0.042-0.422). There were no floor or ceiling effects. CONCLUSIONS The HFS-F has the same good psychometric properties as the original HFS© (internal consistency, test retest reliability, convergent validity with DASH, divergent validity with SF-36 MCS, and no floor or ceiling effects). The convergent validity with SF-36 PCS was poor; we found no correlation with pain. The HFS-F could be used with confidence in a population of working patients. Other studies are necessary to study its psychometric properties in other populations.
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Affiliation(s)
- M Konzelmann
- Service de réadaptation de l'appareil locomoteur, Clinique romande de réadaptation suvacare, Avenue du grand champsec, 90, 1950, Sion, Switzerland,
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Soer R, Reneman MF, Frings-Dresen MHW, Kuijer PP. Experts opinion on the use of normative data for functional capacity evaluation in occupational and rehabilitation medicine and disability claims. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:806-811. [PMID: 24659470 DOI: 10.1007/s10926-014-9507-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
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.
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Affiliation(s)
- Remko Soer
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, 30.002, 9750 RA, Haren, The Netherlands,
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Fore L, Perez Y, Neblett R, Asih S, Mayer TG, Gatchel RJ. Improved Functional Capacity Evaluation Performance Predicts Successful Return to Work One Year After Completing a Functional Restoration Rehabilitation Program. PM R 2014; 7:365-75. [DOI: 10.1016/j.pmrj.2014.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 09/24/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Lisa Fore
- PRIDE Research Foundation, Dallas, TX
| | | | | | - Sali Asih
- PRIDE Research Foundation, Dallas, TX
| | - Tom G. Mayer
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center at Dallas, 5701 Maple Ave. #100, Dallas, TX 75235
| | - Robert J. Gatchel
- Department of Psychology, University of Texas at Arlington, Arlington, TX
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Bailey RR, Lang CE. Upper-limb activity in adults: referent values using accelerometry. ACTA ACUST UNITED AC 2014; 50:1213-22. [PMID: 24458962 DOI: 10.1682/jrrd.2012.12.0222] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/08/2013] [Indexed: 11/05/2022]
Abstract
The goal of physical rehabilitation following upper-limb (UL) impairment is functional restoration of the UL for use in daily activities. Because capacity for UL function may not translate into real-world activity, it is important that assessment of real-world UL activity be used in conjunction with clinical measures of capacity. Accelerometry can be used to quantify duration of UL activity outside of the clinic. The purpose of this study was to characterize hours of UL activity and potential modifying factors of UL activity (sedentary activity, cognitive impairment, depressive symptomatology, additive effects of comorbidities, cohabitation status, and age). Seventy-four community-dwelling adults wore accelerometers on bilateral wrists for 25 h and provided information on modifying factors. Mean time of dominant UL activity was 9.1 +/- 1.9 h, and the ratio of activity between the nondominant and dominant ULs was 0.95 +/- 0.06 h. Decreased hours of dominant UL activity was associated with increased time spent in sedentary activity. No other factors were associated with hours of dominant UL activity. These data can be used to help clinicians establish outcome goals for patients given preimpairment level of sedentary activity and to track progress during rehabilitation of the ULs.
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Affiliation(s)
- Ryan R Bailey
- Programs in Physical Therapy and Occupational Therapy, Department of Neurology, Washington University School of Medicine, St. Louis, MO
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24
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Pfingsten M, Lueder S, Luedtke K, Petzke F, Hildebrandt J. Significance of Physical Performance Tests for Patients with Low Back Pain. PAIN MEDICINE 2014; 15:1211-21. [DOI: 10.1111/pme.12482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Pfingsten
- Pain Clinic; Deparment of Anesthesiology; University Clinic; Georg-August University Goettingen; Goettingen Germany
| | - Susanne Lueder
- Pain Clinic; Deparment of Anesthesiology; University Clinic; Georg-August University Goettingen; Goettingen Germany
| | | | - Frank Petzke
- Pain Clinic; Deparment of Anesthesiology; University Clinic; Georg-August University Goettingen; Goettingen Germany
| | - Jan Hildebrandt
- Pain Clinic; Deparment of Anesthesiology; University Clinic; Georg-August University Goettingen; Goettingen Germany
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Nastasia I, Coutu MF, Tcaciuc R. Topics and trends in research on non-clinical interventions aimed at preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs): a systematic, comprehensive literature review. Disabil Rehabil 2014; 36:1841-56. [PMID: 24472007 DOI: 10.3109/09638288.2014.882418] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study sought to provide an overview of the main topics and trends in contemporary research on successful non-clinical interventions for preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs). METHODS A systematic electronic search (English and French) was performed in ten scientific databases using keywords and descriptors. After screening the identified titles and abstracts using specific sets of criteria, categorical and thematic analyses were performed on the retained articles. RESULTS Five main topics appear to dominate the research: (1) risk factors and determinants; (2) effectiveness of interventions (programmes, specific components, strategies and policies); (3) viewpoints, experiences and perceptions of specific actors involved in the intervention process; (4) compensation issues; and (5) measurement issues. A currently widespread trend is early screening to identify risks factors for appropriate intervention and multidisciplinary, multimodal approaches. Morover, workplace-related psychosocial and ergonomic factors are considered vital to the success and sustainability of return-to-work (RTW) interventions. Finally, involving workplace actors, and more specifically, affected workers, in the RTW process appears to be a powerful force in improving the chances of moving workers away from disabled status. CONCLUSIONS The findings of this literature review provide with information about the main topics and trends in research on rehabilitation interventions, revealing some successful modalities of intervention aimed at preventing prolonged work disability. IMPLICATIONS FOR REHABILITATION Successful intervention for preventing prolonged work disability in workers compensated for WRMSDs address workplace issues: physical and psychosocial demands at work, ability of the workers to fill these demands, work organization and support of the worker, and worker' beliefs and attitudes related to work. Successful intervention promotes collaboration, coordination between all actors and stakeholders involved in the process of rehabilitation. Strategies able to mobilize the employees, employers, insurers and health care providers are still needed to be implemented.
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Affiliation(s)
- Iuliana Nastasia
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) , Montreal, Quebec , Canada and
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Gross DP, Zhang J, Steenstra I, Barnsley S, Haws C, Amell T, McIntosh G, Cooper J, Zaiane O. Development of a computer-based clinical decision support tool for selecting appropriate rehabilitation interventions for injured workers. JOURNAL OF OCCUPATIONAL REHABILITATION 2013; 23:597-609. [PMID: 23468410 DOI: 10.1007/s10926-013-9430-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To develop a classification algorithm and accompanying computer-based clinical decision support tool to help categorize injured workers toward optimal rehabilitation interventions based on unique worker characteristics. METHODS Population-based historical cohort design. Data were extracted from a Canadian provincial workers' compensation database on all claimants undergoing work assessment between December 2009 and January 2011. Data were available on: (1) numerous personal, clinical, occupational, and social variables; (2) type of rehabilitation undertaken; and (3) outcomes following rehabilitation (receiving time loss benefits or undergoing repeat programs). Machine learning, concerned with the design of algorithms to discriminate between classes based on empirical data, was the foundation of our approach to build a classification system with multiple independent and dependent variables. RESULTS The population included 8,611 unique claimants. Subjects were predominantly employed (85 %) males (64 %) with diagnoses of sprain/strain (44 %). Baseline clinician classification accuracy was high (ROC = 0.86) for selecting programs that lead to successful return-to-work. Classification performance for machine learning techniques outperformed the clinician baseline classification (ROC = 0.94). The final classifiers were multifactorial and included the variables: injury duration, occupation, job attachment status, work status, modified work availability, pain intensity rating, self-rated occupational disability, and 9 items from the SF-36 Health Survey. CONCLUSIONS The use of machine learning classification techniques appears to have resulted in classification performance better than clinician decision-making. The final algorithm has been integrated into a computer-based clinical decision support tool that requires additional validation in a clinical sample.
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Affiliation(s)
- Douglas P Gross
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada,
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van Holland BJ, de Boer MR, Brouwer S, Soer R, Reneman MF. Sustained employability of workers in a production environment: design of a stepped wedge trial to evaluate effectiveness and cost-benefit of the POSE program. BMC Public Health 2012; 12:1003. [PMID: 23164366 PMCID: PMC3533991 DOI: 10.1186/1471-2458-12-1003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 11/14/2012] [Indexed: 11/28/2022] Open
Abstract
Background Sustained employability and health are generating awareness of employers in an aging and more complex work force. To meet these needs, employers may offer their employees health surveillance programs, to increase opportunities to work on health and sustained employability. However, evidence for these health surveillance programs is lacking. The FLESH study (Functional Labour Evaluation for Sustained Health and employment) was developed to evaluate a comprehensive workers’ health promotion program on its effectiveness, cost-benefit, and process of the intervention. Methods The study is designed as a cluster randomised stepped wedge trial with randomisation at company plant level and is carried out in a large meat processing company. Every contracted employee is offered the opportunity to participate in the POSE program (Promotion Of Sustained Employability). The main goals of the POSE program are 1) providing employee’s insight into their current employability and health status, 2) offering opportunities to improve employability and decrease health risks and 3) improving employability and health sustainably in order to keep them healthy at work. The program consists of a broad assessment followed by a counselling session and, if needed, a tailored intervention. Measurements will be performed at baseline and will be followed up at 20, 40, 60, 80, 106 and 132 weeks. The primary outcome measures are work ability, productivity and absenteeism. Secondary outcomes include health status, vitality, and psychosocial workload. A cost-benefit study will be conducted from the employers’ perspective. A process evaluation will be conducted and the satisfaction of employer and employees with the program will be assessed. Discussion This study provides information on the effectiveness of the POSE program on sustained employment. When the program proves to be effective, employees benefit by improved work ability, and health. Employers benefit from healthier employees, reduced sick leave (costs) and higher productivity. The study can expose key elements for a successful implementation and execution of the POSE program and may serve as an example to other companies inside and outside the industry. Trial registration The trial is registered at the Dutch Trial Register (http://www.trialregister.nl): NTR3445
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Affiliation(s)
- Berry J van Holland
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Laisné F, Lecomte C, Corbière M. Biopsychosocial predictors of prognosis in musculoskeletal disorders: a systematic review of the literature (corrected and republished). Disabil Rehabil 2012; 34:1912-41. [DOI: 10.3109/09638288.2012.729362] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Souza NSS, Santana VS. Fatores associados à duração dos benefícios por incapacidade: um estudo de coorte. Rev Saude Publica 2012; 46:425-34. [DOI: 10.1590/s0034-89102012005000025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 12/01/2011] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar fatores associados à duração dos benefícios por incapacidade por doenças musculoesqueléticas na região cervical e/ou em membros superiores relacionadas ao trabalho. MÉTODOS: Estudo de coorte ambispectivo com 563 trabalhadores segurados do Regime Geral da Previdência Social que receberam benefício por incapacidade temporária por doenças musculoesqueléticas da região cervical e membros superiores relacionadas ao trabalho em Salvador, BA, em 2008. Os dados provieram de um inquérito conduzido pela Auditoria Regional do Instituto Nacional do Seguro Social e de registros administrativos. Foram analisadas variáveis sociodemográficas, relacionadas ao trabalho, características do agravo e aspectos relacionados ao seguro social. Os fatores associados ao tempo até a cessação do benefício foram identificados com técnicas de análise de sobrevida. RESULTADOS: Posição socioeconômica baixa (RR = 1,29; IC95% 1,02;1,64), idade abaixo de 39 anos (RR = 1,23; IC95% 1,03;1,47), reposição de renda pelo Instituto Nacional do Seguro Social < 100% (RR = 1,24; IC95% 1,04;1,47) e expectativa alta de retorno ao trabalho (RR = 1,20; IC95% 1,00;1,44) são as categorias relacionadas com maior taxa de cessação do benefício e sua menor duração. CONCLUSÕES: Fatores não estritamente médicos, como posição socioeconômica, idade, expectativa relativa ao retorno ao trabalho e nível de reposição de renda pelo Instituto Nacional do Seguro Social parecem influenciar a duração do benefício. Essas hipóteses deverão ser testadas posteriormente com estudos confirmatórios para aprimorar o entendimento do processo de determinação da incapacidade para o trabalho.
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Phillips LA, Carroll LJ, Voaklander DC, Gross DP, Beach JR. Pain coping in injured workers with chronic pain: what’s unique about workers? Disabil Rehabil 2012; 34:1774-82. [DOI: 10.3109/09638288.2012.662261] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Laisné F, Lecomte C, Corbière M. Biopsychosocial predictors of prognosis in musculoskeletal disorders: a systematic review of the literature. Disabil Rehabil 2011; 34:355-82. [DOI: 10.3109/09638288.2011.591889] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cheng ASK, Cheng SWC. Use of Job-Specific Functional Capacity Evaluation to Predict the Return to Work of Patients With a Distal Radius Fracture. Am J Occup Ther 2011; 65:445-52. [DOI: 10.5014/ajot.2011.001057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
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 employment 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.
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Affiliation(s)
- Andy S. K. Cheng
- 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;
| | - Stella W. C. Cheng
- Stella W. C. Cheng, MPH, HKROT, is Department Manager, Department of Occupational Therapy, Princess Margaret Hospital, New Territories, Hong Kong
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Kuijer PPFM, Gouttebarge V, Brouwer S, Reneman MF, Frings-Dresen MHW. Are performance-based measures predictive of work participation in patients with musculoskeletal disorders? A systematic review. Int Arch Occup Environ Health 2011; 85:109-23. [PMID: 21660469 PMCID: PMC3266502 DOI: 10.1007/s00420-011-0659-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/24/2011] [Indexed: 12/05/2022]
Abstract
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.
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Affiliation(s)
- P P F M Kuijer
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
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Spanjer J, Groothoff JW, Brouwer S. Instruments used to assess functional limitations in workers applying for disability benefit: a systematic review. Disabil Rehabil 2011; 33:2143-50. [DOI: 10.3109/09638288.2011.570413] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Feuerstein M, Todd BL, Moskowitz MC, Bruns GL, Stoler MR, Nassif T, Yu X. Work in cancer survivors: a model for practice and research. J Cancer Surviv 2010; 4:415-37. [DOI: 10.1007/s11764-010-0154-6] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 09/30/2010] [Indexed: 11/12/2022]
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Mahmud N, Schonstein E, Schaafsma F, Lehtola MM, Fassier JB, Verbeek JH, Reneman MF. Functional capacity evaluations for the prevention of occupational re-injuries in injured workers. Cochrane Database Syst Rev 2010:CD007290. [PMID: 20614456 DOI: 10.1002/14651858.cd007290.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Norashikin Mahmud
- Faculty of Health Sciences, University of Sydney, Cumberland Campus C42, 75 East St (PO Box 170), Lidcombe, NSW, Australia, 2141
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McFadden S, MacDonald A, Fogarty A, Le S, Merritt BK. Vocational assessment: a review of the literature from an occupation-based perspective. Scand J Occup Ther 2010. [DOI: 10.3109/11038120903096633] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Soer R, van der Schans CP, Geertzen JH, Groothoff JW, Brouwer S, Dijkstra PU, Reneman MF. Normative Values for a Functional Capacity Evaluation. Arch Phys Med Rehabil 2009; 90:1785-94. [DOI: 10.1016/j.apmr.2009.05.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 04/20/2009] [Accepted: 05/04/2009] [Indexed: 11/26/2022]
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Streibelt M, Blume C, Thren K, Reneman MF, Mueller-Fahrnow W. Value of functional capacity evaluation information in a clinical setting for predicting return to work. Arch Phys Med Rehabil 2009; 90:429-34. [PMID: 19254607 DOI: 10.1016/j.apmr.2008.08.218] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 08/26/2008] [Accepted: 08/26/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the quality of Functional Capacity Evaluation (FCE) information in predicting return to work (RTW). DESIGN Prospective cohort study. SETTING Inpatient rehabilitation clinic. PARTICIPANTS Patients (N=220) with chronic musculoskeletal disorders (MSD) conducting a medical rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patients filled in questionnaires at admission and 1-year follow-up. An FCE was performed on admission. RTW was defined as a combination of employment at 1-year follow-up with a maximum of 6 weeks sick leave because of MSD in the postrehabilitation year. As predictive FCE information, the physical capacity (Dictionary of Occupational Titles categories 1-5), the number of test results not meeting work demands (0-25), and the tester's recommendation of work ability in the actual job (> or =6h/d) were analyzed. Logistic regression models (crude and adjusted for the concurrent predictors employment, preadmission sick leave, and patient's prognosis of RTW) were created to predict RTW. RESULTS Complete data were obtained for 145 patients. The sample showed a non-RTW at 1-year follow-up for 37.9%. All FCE information showed significant relations to RTW (r=.28-.43; P<.05). In the crude as well as in the adjusted regression models, all FCE information predicted RTW, but the models' quality was low. The integration of FCE information led to an increase of 5%. The predictive efficiency was poor. The adjusted model for failed tests showed a substantial improvement compared with the reference model (concurrent predictors only). CONCLUSIONS There was a significant relation between FCE information and RTW with and without concurrent predictors, but the predictive efficiency is poor. Primarily, the number of failed tests seemed to be of significance for patients with ambiguous RTW prognosis. A first proposal for a prediction rule was discussed.
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Affiliation(s)
- Marco Streibelt
- Department of Health Care Research and Quality Management in Rehabilitation, Charité University Berlin, Germany.
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Wind H, Gouttebarge V, Kuijer PPFM, Sluiter JK, Frings-Dresen MHW. Complementary value of functional capacity evaluation for physicians in assessing the physical work ability of workers with musculoskeletal disorders. Int Arch Occup Environ Health 2008; 82:435-43. [DOI: 10.1007/s00420-008-0361-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 09/22/2008] [Indexed: 10/21/2022]
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The influence of a continuum of care model on the rehabilitation of compensation claimants with soft tissue disorders. Spine (Phila Pa 1976) 2007; 32:2898-904. [PMID: 18246015 DOI: 10.1097/brs.0b013e31815b64b6] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Population-based before-and-after design with concurrent control group. OBJECTIVE As continuums of care have been little studied, we evaluated the impact of the Workers' Compensation Board of Alberta (WCB-Alberta) model on sustained return to work, satisfaction with care, and cost. SUMMARY OF BACKGROUND DATA Musculoskeletal conditions, such as back pain, continue to be leading causes of disability and work loss. From 1996 through 1997, the WCB-Alberta implemented a continuum of care model to guide rehabilitation service delivery for claimants with soft tissue injury. The model was designed as a decision-making tool to promote a consistent, evidence-based approach to care within the jurisdiction. METHODS The model was implemented province-wide so the entire population of workers insured by the WCB-Alberta was studied. Data were extracted from the WCB-Alberta administrative database from 2 years before implementation (1994-1995) to 5 years after (1996-2000). An intervention group was created from patients filing soft tissue injury claims for the low back, ankle, knee, elbow, and shoulder. The comparison group was formed of workers experiencing fractures or other traumatic non-soft tissue injuries. Satisfaction was measured through surveys. Primary outcome was cumulative days receiving wage replacement benefits. Multivariable Cox regression was used to determine the model's effect. RESULTS Over the entire study period, 70,116 claimants filed soft tissue injury claims while 101,620 claimants experienced non-soft tissue injuries. Significant improvement was observed in intervention group return-to-work outcomes after model implementation (hazard ratio = 1.54). Median duration of benefits decreased from 13 to 8 days. Little change was seen in the control group's disability duration (median duration, consistently 10 days). The majority of claimants were satisfied with care received. Cost savings over a 2-year full implementation period was $21.5 million (Canadian). CONCLUSION Implementation of a soft tissue injury continuum of care involving staged application of various types of rehabilitation services appears to have resulted in more rapid and sustained recovery.
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Gross DP, Battié MC, Asante AK. Evaluation of a short-form functional capacity evaluation: less may be best. JOURNAL OF OCCUPATIONAL REHABILITATION 2007; 17:422-35. [PMID: 17534702 DOI: 10.1007/s10926-007-9087-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 04/30/2007] [Indexed: 05/02/2023]
Abstract
PURPOSE Functional Capacity Evaluation (FCE) contributes to clinical decisions regarding fitness-for-work and may improve return-to-work outcomes. However, FCE is a burdensome clinical tool in terms of time and cost. We evaluated the effectiveness of a short-form FCE protocol. METHODS A cluster randomized controlled trial was conducted. Data were collected on all claimants undergoing FCE at Alberta's workers' compensation rehabilitation facility. Twenty-three clinicians who were trained and experienced with FCE were randomized to either an intervention or control group. The intervention group was trained to conduct short-form FCE and used this protocol through the trial's duration, while the control group continued standard FCE procedures. Data on subject characteristics, administrative outcomes (days to suspension of time loss benefits, days to claim closure, and future recurrence) and claimant satisfaction were extracted from the WCB-Alberta computer databases. Clinicians logged time taken to complete assessments. Analysis included examining differences between groups using independent samples t tests, Cox and logistic regression. RESULTS Subjects included 372 claimants of whom 173 were tested with short-form FCE. Subjects were predominantly employed (64%) males (69%) with chronic musculoskeletal conditions (median duration 252 days). Administrative recovery outcomes were similar between groups as were claimant satisfaction ratings. No statistically significant or clinically relevant differences were observed on these outcomes between groups. A 43% reduction in functional assessment time was seen. CONCLUSION A short-form FCE appears to reduce time of assessment while not affecting recovery outcomes when compared to standard FCE administration. Such a protocol may be an efficient option for therapists performing fitness-for-work assessments.
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Affiliation(s)
- Douglas P Gross
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, Canada, T6G 2G4.
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Tschernetzki-Neilson PJ, Brintnell ES, Haws C, Graham K. Changing to an outcome-focused program improves return to work outcomes. JOURNAL OF OCCUPATIONAL REHABILITATION 2007; 17:473-86. [PMID: 17619124 DOI: 10.1007/s10926-007-9094-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 06/18/2007] [Indexed: 05/16/2023]
Abstract
OBJECTIVES The purposes of this study were to: (1) evaluate the effectiveness of changing a Return to Work (RTW) program's focus to one that was "outcome-focused", and (2) to determine which factors collected in the facility's database were most predictive of RTW. METHODS A total of 13,428 client files were extracted from Millard Health's database which included data on two cohorts of subjects: those in the program before and after the change in focus had been made. This was to determine whether significant improvements in outcomes were achieved. Variables that were hypothesized to be predictive of RTW were selected based on previous published literature. Analyses included ANOVA's, logistic regression analysis and Pearson correlation. RESULTS Statistically significant improvements in RTW, total temporary disability claims, client satisfaction, efficiency of services and scores on the Perceived Disability Index (PDI), Short Form-36 (SF-36) and Visual Analogue Scale (VAS) for perceived pain were found. Variables that were predictive of RTW included: more efficient services, completion of a worksite visit, having the worker participate in the visit, availability of modified duties from the employer, fewer absences from the program and better scores on the PDI, SF-36 and VAS. The most predictive variable of RTW was sores on the PDI indicating lower levels of perceived disability. CONCLUSIONS Changing to an outcome-focused program improved various outcomes in this RTW program. Several factors predict the outcome of RTW and these should be considered in treatment planning.
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