Dynamic low back functional motion capacity evaluation

Most current functional capacity evaluations focus on range of motion and strength as measures of Wellness. The goal of this study was to evaluate the dynamic functional motion capacity of controls (those without low back pain) and low back pain patients in the three cardinal planes of the body. The hypothesis was that injury would not only affect sagittal motion but also lateral and twisting motion that would load the spine in a different manner. Twenty-six age and gender matched controls and low back pain patients were tested. Trunk motion parameters of range of motion (ROM), velocity, and acceleration were measured in all three planes of the body as subjects performed three separate tasks eliciting motion in each of the three cardinal planes of the body. Controls exhibited significantly higher performance than low back pain patients in all three planes of the body for velocity and acceleration but not ROM. Single parameter discriminant function models indicated that the velocity and acceleration motion parameters distinguished between LBP patients and the control group more effectively than ROM in the cardinal planes. Multiple parameter discriminant function demonstrated that coupled motion models further increased the ability to distinguish between the control and patient groups. These results provide insight into new methods of evaluating functional capacity using velocity, acceleration, and coupling which may provide valuable information in determining the recovery of a patient.     

The reliability and validity of a measure of perceived functional capacity for work in chronic back pain

Psychosocial factors, including perceived disability and self-efficacy, are important determinants of outcome for individuals with chronic back pain. Consequently, there is a need for an evaluation and consideration of such factors in occupational rehabilitation. This study evaluated the reliability and validity of a tool, the Spinal Function Sort, as a measure of perceived capacity for work-related tasks with 42 rehabilitation clients with chronic back pain. Results provided support for the internal consistency (Cronbach's alpha of 0.97), test-rest reliability (ICC of 0.89) and construct validity of the Spinal Function Sort as a measure of perceived capacity for work-related tasks in persons with chronic back pain. Measures of similar constructs were significantly correlated with the Spinal Function Sort and were highly predictive of the Spinal Function Sort on multiple regression. Relationships between perceived work capacity and pain intensity and gender are discussed. The need for the consideration of perceived capacity in the evaluation and rehabilitation of persons with chronic back pain is highlighted.     

Safety Issues in Functional Capacity Evaluation: Findings From a Trial of a New Approach for Evaluating Clients With Chronic Back Pain

Although safety is recognized as a critical issue in functional capacity evaluations (FCEs), it has rarely been investigated. This paper reports on the findings of a study which examined safety aspects of a new approach to FCE. Fourteen rehabilitation clients with chronic back pain participated in the study. Aspects examined included the pre-FCE screening procedures, the monitoring of performance and safety during the FCE, and the end of FCE measures and follow-up procedures. Support was found for the screening procedures of the approach, particularly blood pressure measurement, and for the combined approach to monitoring of the persons performance from biomechanical, physiological and psychophysical perspectives. Issues for FCE safety in general are identified and discussed, including the importance of screening procedures to determine readiness for FCEs and the issue of load handling in FCEs, especially in relation to clients with chronic back pain.     

A conceptual framework of functional capacity evaluation for occupational therapy in work rehabilitation

Functional capacity evaluation (FCE) is commonly used in work rehabilitation to assess the capacity of the injured worker for return to work. Occupational therapists are major providers of FCE, especially in Australia. Despite a history of involvement in the functional assessment of clients for work, occupational therapy has few theoretical models for work assessment in general, and for FCE in particular. This may account for some of the confusion that exists about the conceptual basis of FCE in occupational therapy practice. This paper presents a framework for FCE that parallels occupational therapy's occupational performance model and the World Health Organisation's International Classification of Functioning, Disability and Health. The framework is used to clarify some of the confusions that exist in FCE research and practice, particularly the issue of measuring a client's function versus impairment. A redefinition of FCE for occupational therapy practice in the work assessment continuum is presented that supports occupational therapy practice and research in the area.     

Measuring Maximum Holding Times and Perception of Static Elevated Work and Forward Bending in Healthy Young Adults

The objectives of this study were to investigate the maximum holding times (MHT) of two highly stressful postures: standing in a forward bend position and performing elevated work in a standing position. The relationship between perceived exertion and MHT was also studied. Subjects were 44 young adults, age 20–29 years (25 female, 19 male). A test-retest design was used to establish reliability. Mean maximum holding times for forward bending and elevated work were respectively 14.51 and 16.18 min with large interindividual variations. A logarithmic rather than a linear relation between perceived exertion and performance is found. It is not possible to reliably predict MHTs from subjective data. Test-retest correlation is high (n = 19, r = 0.716 and 0.813, p < 0.001), and the scores did not differ significantly (p < 0.005), indicating a reliable procedure. The average holding times of the population studied are higher than expected from literature. Neither generic formulas, curve estimations, or predictions can reliably predict an individual's MHT. An individual's MHTs are best tested through performance based testing.     

Reliability of occupational therapists in determining safe, maximal lifting capacity

Determination of an individual's lifting capacity is an important component in Functional Capacity Evaluation, which is widely used to delineate potential for work. Despite a recent surge in the number and types of Functional Capacity Evaluations, and therefore in approaches to determining lifting capacity, there has been limited research to support the reliability and validity of their use. This study evaluated the inter-rater reliability of five occupational therapists in determining safe maximal lifting capacity using a biomechanical approach. In addition, the use of an operational definition of a safe lift was examined to determine its effect on therapists' decision-making process and therefore the reliability of their ratings. The use of an operational definition was found to significantly affect therapists' decision-making process in differentiating safe from unsafe lifts, with all raters showing highly significant improvements in their ability to determine the safety of lifts from pre- to postdefinition ratings, according to McNemar's χ ² statistic. The provision of a definition also enhanced therapists' reliability of ratings, with kappa values that ranged from 0.47 to 0.74 predefinition changing to 0.56–0.82 postdefinition. Possible explanations for the change in decision-making are discussed and the need for ongoing evaluation of procedures used in Functional Capacity Evaluation, particularly with regard to the determination of lifting capacity, are highlighted.     

Test–Retest Reliability of the Isernhagen Work Systems Functional Capacity Evaluation in Patients with Chronic Low Back Pain

The aim of this study was to investigate test–retest reliability of the Isernhagen Work System Functional Capacity Evaluation (IWS FCE) in a sample of patients (n = 30) suffering from Chronic Low Back Pain (CLBP) and selected for rehabilitation treatment. The IWS FCE consists of 28 tests that reflect work-related activities like lifting, carrying, bending, etc. In this study, a slightly modified IWS FCE was used. Patients were included in the study if they were still at work or were less than 1 year out of work because of CLBP. Participants' mean age was 40 years, the duration of low back pain ranged between 5 and 10 years. Fifteen patients (50%) were out of work for a mean of 17 weeks, and they all received financial compensation. Two FCE sessions were held with a 2-week interval in between. Means per session, 95% confidence intervals of the mean difference, one-way random Intra Class Correlations (ICC), limits of agreement, Cohen's kappa and percentage of absolute agreement were calculated where appropriate. An ICC of 0.75 or more, a kappa value of more than 0.60 and a percentage of absolute agreement of 80% were considered as an acceptable reliability. Tests of the IWC FCE were divided into tests with and tests without an acceptable test–retest reliability on the basis of the kappa values, the percentage of absolute agreement and the ICC values. Fifteen tests (79%) showed an acceptable test–retest reliability based on Kappa values and percentage of absolute agreement. Eleven tests (61%) showed an acceptable test–retest reliability based on ICC values.     

Changes in psychopathology following functional restoration of chronic low back pain patients: A prospective study

Past research has consistently demonstrated high rates of psychopathology in patients disabled with chronic low back pain. The purpose of the present study was to evaluate whether functional restoration treatment of these patients would lead to significant changes in psychopathology. Fifty-six patients were evaluated for current psychiatric disorders, using a structured clinical interview for DSM-III-R disorders, upon admission to a comprehensive 3 week functional restoration program, and again at 6 months following their rehabilitation. Results clearly documented significant decreases in prevalence rates of psychiatric disorders, particularly somatoform pain disorder and major depression. Such findings demonstrate that effective rehabilitation can significantly decrease the high rates of psychopathology commonly found in chronic low back pain patients.     

Development of a measure of perceived functional ability

The intra-test and test-retest reliability of the Spinal Function Sort was assessed in a multisite study involving 180 disabled subjects. The results of this study demonstrate the reliability of the instrument across a variety of sites. In addition, this study demonstrated both differences in absolute scores and a pattern of reactivity to the instrument that suggests that perceived functional ability may be affected by the subject's degree of chronicity measured in terms of the time that elapsed between date of injury and datae of testing.     

Construct Validity of a Kinesiophysical Functional Capacity Evaluation Administered Within a Worker's Compensation Environment

The construct validity of a kinesiophysical Functional Capacity Evaluation (FCE) administered within a worker's compensation context was examined. A cross-sectional study design was employed. Clinical and demographic information on workers' compensation claimants was extracted from a rehabilitation facility's database. Measures of interest were the Isernhagen Work Systems' (Duluth, MN) FCE, the Pain Disability Index (PDI), and a pain visual analogue scale (VAS). A multitrait Pearson correlation matrix was created to observe the pattern of relationships between variables. The sample consisted of 321 subjects with work-related, medically stable low back pain of median duration of 307 days. FCE performance was moderately correlated with the PDI (r = –0.44–0.52) and with the pain VAS (r = 0.34–0.45). Pain intensity was correlated highly with the PDI (r = 0.79). The moderate relationship between FCE and the PDI supports the construct validity of FCE as a functional measure. However, kinesiophysical FCE performance was not unrelated to pain severity ratings as purported.     

A comparison of isometric strength and dynamic lifting capacity in men with work-related low back injuries

Job classification, return to work status, and job placement are determined by the results of lifting capacity tests. Lifting capacity is often assessed by maximum static or dynamic physical exertions. The purpose of this study was to compare maximum isometric lifting strength with maximum dynamic lifting capacity in subjects with work-related low back injury. Twenty-seven men performed five dynamic lifting tasks and two isometric strength tests. The mean Pearson product-moment correlation between maximum isometric lifting strength measurements and maximum dynamic lifting capacity measurements was .51 with a range of .30–.73. The results indicate low to moderate associations between isometric strength measurements and lifting capacity suggesting that estimates of functional lifting capacity should not be based on static measurements alone. Dynamic lift tests are often a better simulation of the task being assessed and may be more appropriate for a back-injured population.     

The Effect of Order of Testing in Functional Performance in Persons with and Without Chronic Back Pain

Batteries of individually standardized physical and functional tests are commonly used to assess persons with chronic back pain disability. The order of testing may affect performance on later tests. One hundred and fifty patients with>3 months of back pain disability underwent a multidisciplinary Spine Team Assessment involving Physical Therapy, Occupational Therapy, Pain Psychology, and Vocational Rehabilitation Counselor assessments at a university spine clinic. Seventeen back healthy volunteers performed the physical component of the assessment. For the volunteers the order of testing was randomized to OT tests first or PT test first, with 0.5 h rest between the tests. For patients the order of testing was arbitrarily set by an alternating schedule, with 1 h psychological testing between the two components. For both the patients and volunteers, among the 14 test components, there was no significant difference (p > 0.05) in performance with order of testing. This held true for the subgroup of patients who put out good cardiac effort. Volunteers performed better than patients on all individual tests (p < 0.001). Results suggest that the order of physical testing during a Spine Team Assessment does not affect test performance either in chronic low back disabled patients or in volunteers.     

Isokinetic strength testing in monitoring progress in a multidisciplinary work reentry program: A case study

The purpose of this paper is to present a case study of a patient with a history of low back pain and the use of isokinetic testing in tracking that patient through a work-reentry program. A 44-year-old male with a diagnosis of low back pain underwent a functional capacity evaluation and began a work-reentry program. Initial isokinetic testing revealed low torque outputs in both the trunk and knee flexion and extension tests as well as limited active range of motion. Coefficient of variation appeared to be relatively high and the patient seemed guarded in his movements during the testing. Psychological testing revealed a high fear of reinjury which may have influenced the initial test. Subsequent isokinetic testing performed on the tenth and twenty-fourth days of program and at 1 month post-program exhibited greater than expected increases in torque output. This could be due in part to a reduction in the fear of reinjury, a learning effect with repeated exposure to testing, and the patient's increased confidence in the use of unguarded movements. His trunk range of motion remained essentially the same throughout the serial testing. Pain in the back and left leg was slightly diminished despite an increase in strength and function.     

Safe Lifting in Patients with Chronic Low Back Pain: Comparing FCE Lifting Task and Niosh Lifting Guideline

Introduction: Both the floor-to-waist lifting task of the Isernhagen Work Systems Functional Capacity Evaluation (IWS FCE) and recommended weight limit (RWL) of the NIOSH produce safe lifting weights and are used world-wide nowadays. It is unknown whether they produce similar safe lifting weights. Aim of this study was to compare FCE performance on the floor-to-waist lifting task and RWL of the NIOSH lifting guideline for this task, in patients with chronic low back pain (CLBP). Methods: Ninety-two patients performed the FCE lifting task. RWL was calculated for this task. Performance was compared with RWL. A lifting index was calculated by dividing performance by RWL. Differences between groups with a lifting index ≤1, 1–3, and >3 were calculated for pain intensity, scores on the Roland Morris Disability Questionnaire (RMDQ) and work status. Results: Men lifted on average 32.5 kg (SD 15.4) and women 18.8 kg (SD 7.8). RWL for this task was 12.8 kg. Mean difference between performance and RWL was 15.0 kg (SD 14.7; range −8.8 to 59.2). The Roland Morris Disability score of patients with a lifting index ≤1 was significantly lower than patients with a lifting index 1–3 and >3. No difference in pain intensity and work status was found between groups. Conclusion: It was concluded that performance on the FCE floor-to-waist lifting task and RWL of the NIOSH for this task produce different safe lifting weights in individual patients with CLBP, which may result in contradictory recommendations about need for rehabilitation and return to work.     

Test-retest reliability of the Upper Extremity Questionnaire among keyboard operators.

BACKGROUND: Questionnaires are often used in research among workers although few have been tested in the working population. The Upper Extremity Questionnaire is a self-administered questionnaire designed for epidemiological studies and tested among workers. This study assessed reliability of the instrument. METHODS: A two-part assessment was conducted among 138 keyboard operators as part of a large medical survey. Test-retest reliability was analyzed using the kappa statistic, paired t-test, and intraclass correlation coefficient (ICC). Logistic regression models were used to test the effect of demographic and work-related factors on reliability. RESULTS: The average respondent was a white woman, age 35 years, with some college education, in permanent employment with tenure of 1.4 years. Overall, reports of symptoms were stable from Round 1 to 2. Most kappa values for symptom reports were between 0.60 and 0.89. Kappa values for right and left hand diagrams were 0.57 and 0.28, respectively. Among psychosocial items, Perceived Stress and Job Dissatisfaction Scales were most reliable (ICC = 0.88); co-worker support was least reliable (ICC = 0.44). CONCLUSION: Reliability of items on the Upper Extremity Questionnaire were generally good to excellent. Reports of symptom severity and interference with work were less stable. Demographic and work-related factors were not statistically significant in modeling the variation in reliability. Repeated use of the questionnaire with similar results suggests findings are applicable to a larger working population.     

Evaluation of a postgraduate educational programme for occupational physicians on work rehabilitation guidelines for patients with low back pain

OBJECTIVES—The postgraduate educational programme for occupational physicians on guidelines for work rehabilitation of patients with low back pain was evaluated as to what extent did knowledge of the guidelines increase, and did the workers improve their performance at work.
METHODS—An experimental group (n=25) attended an educational programme and a reference group did so (n=20) 6 months later. Knowledge and performance were assessed for both groups, before and after education of the experimental group. Knowledge was assessed for the reference group after education.
RESULTS—Knowledge increased significantly more in the experimental group. The reference group's score increased further after education. The experimental group's adjusted gain score for performance indicators was significantly positive. Analysis of covariance also showed a significant effect for the experimental group for increased performance score.
CONCLUSIONS—The educational programme improved the quality of care because knowledge and performance of occupational physicians improved and complied better with practice guidelines.


Keywords: evaluation; postgraduate education; occupational physicians; low back pain; guidelines     

Effects of Subacute Versus Chronic Status of Low Back Pain Patients' Response to a Functional Restoration Program

This study evaluated various functional capacity measures in two cohorts of patients participating in a functional restoration program: 1) subacute patients (defined as being admitted to the program within 1/2 year of injury), and 2) chronic patients (defined as being admitted after 1/2 year of injury). The main aim was to evaluate the differential effects of subacute versus chronic intervention functional outcomes of low back pain patients who participated in a functional restoration program. Findings clearly demonstrated that, compared to the chronic intervention group (n = 170), the subacute intervention group (n = 110) displayed greater functional performance gains in various tasks (e.g., range of motion, lifting capacity, etc.). These findings are consistent with recent suggestions in the literature that early intervention will produce greater therapeutic improvement in low back pain patients, with resultant health-care cost savings. Additional research is needed to further evaluate the utility of distinguishing among acute, subacute, and chronic patients as a means of predicting the degree of functional gains produced by intervention.     

Specified diagnosis in 532 cases of back pain

In the city of Malmö, Sweden, a project was started to improve the rehabilitation of patients with back pain. Among 532 patients with back pain who were on sick leave for an average of 98 days the year preceding the consultation, very few specific diagnoses were made in spite of a thorough clinical and radiological examination. Only five of the patients were cured by surgery. During the same period 103 patients were operated on for disc herniation or nerve root stenosis at the Orthopaedic Department at Malmö General Hospital. Thus the routines for somatic diagnosis of the medical service in Malmö are adequate and an improvement would have very little effect on the expenditures for sick leave and early retirement. As suggested in this paper social and psychological factors are of greater importance in the rehabilitation and we should focus less on the physical problems of the patient.