Responsiveness of the Physical Work Performance Evaluation, a Functional Capacity Evaluation, in Patients with Low Back Pain

Background and purpose The Physical Work Performance Evaluation (PWPE) is a functional capacity evaluation. This study investigated the responsiveness of the PWPE. Methods The internal and external responsiveness was tested. For the internal responsiveness, the change in the pre-/post-test PWPE scores of a group participating in a work rehabilitation program (n = 27) was compared to that of a comparison group of healthy subjects (n = 30). The external responsiveness was tested with the rehabilitation group, and the change in their PWPE scores was compared to concurrent and empirical criteria. Results The comparison of the change in pre-/post-test PWPE scores showed that the change for the rehabilitation group was significantly different from that for the comparison group, but only for one section of the PWPE. Changes in six criteria were seen after completion of the program, but there was no significant correlation between these changes and the change in the overall PWPE score. Discussion and conclusion The overall PWPE level of work score does not appear to have the ability to measure clinically significant changes achieved through a work rehabilitation program.     

Functional Self-Efficacy Beliefs Influence Functional Capacity Evaluation

Objectives: The relationship between functional self-efficacy and Functional Capacity Evaluation (FCE) lift performance was examined in workers’ compensation claimants’ with low back pain. Methods: A cross-sectional design was used. Forty-two claimants with back pain and 38 subjects without back pain were enrolled. Subjects completed a measure of functional self-efficacy related specifically to lifting. Subjects also underwent FCE floor-to-waist, waist-to-overhead and horizontal lift testing. Potential confounders were also assessed including perceived disability, pain intensity, and self-rated health. Analysis included Pearson correlation and multivariable linear regression. Results: Higher functional self-efficacy beliefs were highly associated with better FCE performance on each of the lift items tested (r = 0.50–0.73). In multivariable analysis, the measure of functional self-efficacy remained independently associated with lift performance after controlling for potential confounders. Conclusion: Functional self-efficacy beliefs appear to influence FCE lift performance. Strategies for altering functional self-efficacy beliefs and their resulting impact on patient functional performance and outcomes should be examined.     

Basis for an FCE Methodology for Patients With Work-Related Upper Limb Disorders

A reported reduction in work-related functional capacity in Work-related Upper Limb Disorders (WRULD) patients is among the most common problems in WRULD. The extent to which this reduction in functional capacity can be objectified remains unknown. A validated instrument to test functional capacity in this patient group is unavailable. The objective of this study was to design a Functional Capacity Evaluation (FCE) for WRULD patients working with Visual Display Units (VDU) and provide evidence for content validity. A review to epidemiological literature was conducted to identify physical risk factors for VDU-related WRULD. The results indicate that physical risk factors were related to repetition, duration, working in awkward and static positions and forceful movements of the upper extremity and neck. An FCE was designed based on the risk factors identified. Eight tests were selected to cover all risk factors: the overhead lift, overhead work, repetitive reaching, handgrip strength, finger strength, wrist extension strength, fingertip dexterity, and a hand and forearm dexterity test. Content validity of this FCE was established by providing the rationale, specific objectives and operational definitions of the FCE. Further research is needed to establish reliability and other aspects of validity of the WRULD FCE.     

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.     

Symptom Increase Following a Functional Capacity Evaluation in Patients with Chronic Low Back Pain: An Explorative Study of Safety

INTRODUCTION: This study was performed to study intensity and duration of symptom increase following an FCE and to explore safety of an FCE. METHODS: Included were 92 patients with chronic low back pain (CLBP), mean age 38.5 years, mean self-reported disability 12.5 (Roland Morris Disability Questionnaire). All patients underwent an FCE. Symptom increase was measured with a 2-item questionnaire. Operational definition for safety: no formal complaint filed and symptom increase to occur only temporarily. RESULTS: No formal complaints were filed (n=92). In total, 54 patients returned the questionnaire (59%; 'responders'). Of the responders, 76% reported increased symptom intensity after an FCE, ranging from 'little increase' to 'severe increase'. Symptoms of all responders returned to pre-FCE level. Duration of symptom increase of the responders ranged from 1 day to 3 weeks. Symptom increase resided to pre-FCE level within 1 week in 93% of the responders. Symptom increase was weakly related to self-reported disability (r=0.38, p<0.05). Except for gender, differences between responders and non-responders were non-significant. CONCLUSION: A temporary increase in symptom intensity following an FCE is common. Within the operational definitions of safety used in this study, assessment of functional capacity of patients with CLBP appears safe.     

Development and Validation of a Short-Form Functional Capacity Evaluation for Use in Claimants with Low Back Disorders

Objectives: Functional Capacity Evaluations (FCE) are used for making return-to-work decisions, yet FCE's modest predictive ability is currently outweighed by the administrative burden of testing. We attempted to develop a short-form FCE while maintaining comparable predictive ability. Methods: Three databases previously created for evaluating FCE predictive validity were used. Subjects were compensation claimants with low back disorders. FCE measures included items in the Isernhagen Work Systems’ FCE. Days until benefit suspension served as an indicator of return-to-work. Analysis included Cox regression. Results: Three items, floor-to-waist lift, crouching, and standing, were maintained in the short-form FCE. The short-form FCE was found to predict comparably to the entire FCE protocol in two validation cohorts (R ² difference<3%). Subjects meeting job demands on all three items consistently experienced faster benefit suspension. Conclusion: A short-form FCE for determining future work status in claimants with low back disorders was developed. A substantially abbreviated FCE may offer an efficient alternative.     

颈肩腰腿痛病人的物理康复方法研究

目的 研究颈肩腰腿痛病人的物理康复方法.方法 选取2007年2月至2010年5月在我院治疗的200例颈肩腰腿痛患者为研究对象,将其平均分为四组,每组各50例.四组分别采用中频电疗法、中医疗法、中频电疗联合中医疗法、热敷法进行治疗.观察并比较四组患者的治疗效果、C反应蛋白（CRP）、白蛋白（ALB）、钙（Ca）、磷（P）以及患者的满意度.结果 中频电疗联合中医疗法的总有效率为98％,显著高于中频电疗法的84％,差异具有统计学意义（P＜0.05）,但与中医疗法和热敷法的88％相比无显著差异（P＞0.05）.从物理康复方法后30 min内实验室指标的比较看,中频联合中医疗法的应激反应指标CRP、ALB最高,Ca、P最低,和其它组比较差异具有统计学意义（P＜0.05）.满意度方面,患者对中频联合中医疗法的满意度最高,占98％;中医疗法占92％;中频电疗占90％;热敷的满意度最差,占68％.结论 推荐使用中频联合中医疗法对颈肩腰腿痛病人 进行物理康复.     

Psychosocial Factors and Functional Capacity Evaluation Among Persons with Chronic Pain

Psychosocial factors have been found to have a significant impact on functional activity, particularly among persons with chronic pain. While various systems have been developed to assess functional limitations through functional capacity evaluation (FCE), assessment of psychosocial factors that may impact function have been largely ignored. This paper examines the existing literature on psychosocial factors and FCE performance. Given that there are few studies that have directly addressed this issue, the paper also examines psychosocial factors that have been found to influence function in persons with pain. The results of the literature review indicate that few psychosocial factors have been found to be directly associated with FCE and functional measures, although many are related to various measures of disability. The strongest evidence that psychosocial factors are related to functional performance is based on the studies examining the association between functional activity and pain-related fear, self-efficacy, and illness behavior. Psychosocial factors have also been shown to influence measures of sincerity of effort often obtained during FCE. Proposals for modifying FCE assessment are given based on the available data, as well as suggestions for future research.     

32例尘肺运动负荷试验的劳动能力初析

目的：对尘肺患者进行运动负荷试验，以探讨运动试验（ＥＴ）与常规肺功能试验（ＰＦＴ）的关系和劳动能力评价。方法：ＥＴ前做ＰＦＴ。ＰＦＴ正常或轻度损害者为受试对象。以运动时最大每分钟通气量（ＶＥｍａｘ）占最大通气量（ＭＶＶ）预计值比≥６４％为受试者最大运动量。ＥＴ最大氧耗量（ＶＯ２ｍａｘ）实测值参照ＣＴＳ标准评定呼吸功能损害程度并与ＰＦＴ比较。结果：３２例尘肺运动时（ＶＥｍａｘ／ＭＶＶ）达到６４．２１％至１０４．４９％者有１２例（ＰＦＴ正常７例，轻度异常５例），运动终止时测得ＶＯ２ｍａｘ为１９．０４±４．１１ｍｌ／ｋｇ。２１例运动时ＳａＯ２％降低者６例，（ＰＦＴ）正常２例，轻度异常４例。以ＶＯ２ｍａｘ参数评定ＰＦＴ正常的７例呼吸功能，其中６例为轻度损害，１例为中度损害。评定ＰＦＴ轻度异常的５例，３例为轻度，２例为中度损害。结论：ＥＴ能发现个别尘肺患者潜在生理学异常。ＶＯ２ｍａｘ参数评价呼吸功能损害较ＰＦＴ敏感。评定个体劳动能力较ＰＦＴ客观。     

A Method to Provide a More Efficient and Reliable Measure of Self-Report Physical Work Capacity for Patients with Spinal Pain

Self-report measures of functional ability are commonly used in occupational rehabilitation to measure the current status of an individual and his or her progress in response to intervention. Most of these measures have been developed using classical test theory that does not provide calibration of the items. Methods of test development that originated in the field of Education have been applied recently to healthcare measures, providing item calibration and allowing proportional evaluation of total scores. The purpose of this article is to demonstrate the application of these methods in the revision of an existing self-report measure. The potential value of these methods to improve established measures is demonstrated.     

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.     

The Interrater Reliability of a Functional Capacity Evaluation: The Physical Work Performance Evaluation

The purpose was to evaluate the interrater reliability of the Dynamic Strength, Position Tolerance, and Mobility tasks of the Physical Work Performance Evaluation (PWPE), a Functional Capacity Evaluation often used with workers disabled due to back pain. For each worker's evaluation, two raters were preselected among five trained raters. One of the raters administered the PWPE while the other functioned as a silent rater. A convenience sample of 40 workers disabled due to back pain and referred to an occupational rehabilitation center was used. In general, the reliability was "substantial" (0.61 < or = kappa < or = 0.80) to "almost perfect" (0.81 < or = kappa < or = 1.00) for most of the 21 tasks and three sections of the PWPE evaluated with the exception of three tasks in the Mobility section (ladder climbing (kappa = 0.47), repetitive trunk rotation--standing (kappa = 0.54), and repetitive trunk rotation--sitting (kappa = 0.37)) task and the Mobility section itself (kappa = 0.54). Several reasons could explain the lower agreement on the observation of the physical signs associated with these tasks. Since these tasks involve rotation movements or complex neuromuscular integration, it seemed difficult for the raters to define what are the normal physical signs and when physical signs of maximal functional capacity are present. The criteria for establishing the presence of the physical signs in the PWPE should be improved.     

Relationship Between Kinesiophobia and Performance in a Functional Capacity Evaluation

Fear of movement and (re)injury (kinesiophobia) has been postulated to play an important role in the performance in a Functional Capacity Evaluation (FCE). This study was performed to analyze the relationship between kinesiophobia and performance in an FCE. Kinesiophobia and FCE performance of 54 male and 10 female patients (mean age 38.0) suffering chronic low back pain (mean length of episode 9.9 months, 93% off work) were assessed. Kinesiophobia was assessed using the Dutch Version of the Tampa Scale for Kinesiophobia (scale 17–68). A lifting task and an FCE were operationalizations of avoidance. FCE results were transformed into a single measure using the classification of the Dictionary of Occupational Titles (FCE-DOT, scale 1–5). Correlations between the variables were calculated. The results are: kinesiophobia mean 41.6 (SD 7.3), lifting mean 29.5 kg (SD 11.6), FCE-DOT mean 3.6 (SD 0.6). Correlations between kinesiophobia and lifting was r = 0.01 (p = 0.93) and between kinesiophobia and FCE-DOT was = – 0.04 (p = 0.75). The results indicate that the patients were substantially kinesiophobic, yet they were able to lift a mean of 29.5 kg and were physically able to perform moderate to heavy work. The strength of the correlations was very low. The relationship between kinesiophobia and avoidance, operationalized as lifting and an FCE, could not be confirmed in this study.     

Life Satisfaction of Workers with Work-related Musculoskeletal Disorders in Brazil: Associations with Symptoms, Functional Limitation and Coping

Introduction: This study aimed at analyzing the contribution of socio-demographic, clinical, functional and psychosocial variables toward life satisfaction among workers with Work-Related Musculoskeletal Disorders (WMSD). Methods: A cross-sectional study was carried out with 155 workers suffering from WMSD in one or both upper extremities, with time since the onset of the health condition longer than six months. Most of the workers were women (85%) between 30 and 49 years of age (77%) and predominantly manual laborers with elementary education level. Main Outcome Measures: Structured form for socio-demographic and clinical identification of the participants, the Disability of the Arm, Shoulder and Hand Questionnaire, the Ways of Coping Scale and the Satisfaction With Life Scale. Results: Hierarchical multiple regression analysis was employed and the final model explained 23% of the variance regarding life satisfaction (adjusted R ² = 0.21; p = 0.0001). Single workers and those reporting higher levels of emotion-focused and lower levels of problem-focused coping reported lower life satisfaction. The strategies with which an individual copes with the disease had an influence on the level of life satisfaction regardless of the functional condition. Conclusions: In the sample studied, the strongest predictors of life satisfaction were the psychosocial variables, represented by coping strategies regarding the disease. Interventions directed at workers with WMSD that seek to promote well-being should favor coping in the most adaptive manner, going beyond the clinical realm of the disease.     

Relationships Between Functional Capacity Measures and Baseline Psychological Measures in Chronic Pain Patients

The extent to which baseline psychological measures, pain, and compensation status are related to admission and posttreatment functional capacity and employment outcome was investigated. Four pass/fail functional capacity tests based on the DOT (Dictionary of Occupational Titles) classification system and previously shown to be predictive of treatment outcome in chronic pain patients were analyzed in relation to baseline measures of depression, state and trait anxiety, and perceived stress. Statistical tests of all measures with employment level at admission to treatment, 1 month follow-up and at long-term follow-up were also performed. The results showed that pain level and/or compensation status were the primary predictors of functional capacity and employment status at follow-up. Admission functional capacity measures were also predictors of employment outcome. Depression scores at admission predicted some admission functional capacity results, however, psychological scores were not as significantly related to discharge functional capacity tests. One functional capacity test, the crouching test, was an independent predictor of short- and long-term employment outcome. Trait anxiety was the only psychological factor that was independently predictive of long-term employment outcome. In conclusion, these results suggest that psychological variables are related to measures of functional capacity measured at admission. However, psychological measures at admission are not good predictors of later functional capacity measures. Functional capacity measures are important predictors of follow-up employment outcome, but return to work cannot be predicted without taking pain into account.     

Functional Capacity Evaluations in Persons with Spinal Disorders: Predicting Poor Outcomes on the Functional Assessment Screening Test (FAST)

This study determines how performance on the simple, low exertion Functional Assessment Screening Test (FAST) relates to performance on more extensive physical and psychological testing. One hundred eighty-eight persons with chronic back disability and 17 spine healthy volunteers underwent the FAST (three 2-min static tests [kneeling, stooping, and squatting] and two 5-min tests [repetitive stooping and repetitive twisting while standing]), the Progressive Isoinertial Lifting Evaluation (PILE), trunk extension endurance, submaximal bicycle ergometry, and psychological profiles. All FAST components were completed by 88% of spine healthy subjects, but only by 19.7% (n = 37) of the back patients. Internal consistency for overall test performance was 0.82 (alpha coefficient). Back pain noncompleters had poorer performance on the PILE and trunk extension endurance despite similar cardiovascular fitness and perceived exertion during testing. They had more dysfunctional coping mechanisms, pain avoidance, depression, and self-reported disability. Since performance on nonstrenuous testing is so poor, and psychosocial variables relate strongly to test performance, extensive Functional Capacity Evaluations may not be necessary or valid in assessing the physical performance of this population of chronic back pain patients.     

Complementary value of functional capacity evaluation for physicians in assessing the physical work ability of workers with musculoskeletal disorders

Objective  To study the complementary value of information from functional capacity evaluation (FCE) for insurance physicians (IPs) who assess the physical work ability of claimants with long-term musculoskeletal disorders (MSD). Method  A post-test only design was used in the context of disability claims. Twenty-eight IPs participated in the study. Claimants with MSD formed the patient population. For each IP, the first claimant who agreed to participate was included in the study, and underwent FCE in addition to the regular disability claim assessment. Firstly, the IP performed the statutory disability claim assessment. Secondly, the FCE assessment took place. Finally, a self-formulated questionnaire was presented to the IPs after they viewed the FCE report. IPs were asked whether they perceived FCE information to be of complementary value to their judgment of the claimant’s physical work ability investigated. We considered FCE information to be of complementary value if more than 66% of the IPs indicated as such. IPs were also asked whether FCE information led them to change their initial judgment about the claimant’s physical work ability, and whether they felt this information made them more confident about their ultimate judgement. Finally, they were asked whether they planned to include FCE information in future disability claims and for what type of claimants. Differences between IPs who did or did not experience complementary value were explored. Results  Of the 28, 19 (nearly 68%) IPs considered FCE information to be of complementary value for their assessment of claimants with MSD. Half of the IPs stated that FCE information reinforced their judgment. All but four IPs changed their assessment after reading the FCE report. Sixteen IPs intended to involve FCE information in future disability claim assessments. There were no observed differences between the IPs who did or did not consider the FCE information to be of complementary value. Conclusion  FCE information was found to have complementary value at present and in the future according to most IPs in the assessment of the physical work ability of claimants with MSD. Half of the IPs felt that this information reinforces their judgment in this context.     

The Effect of Alternate Style Keyboards on Severity of Symptoms and Functional Status of Individuals with Work Related Upper Extremity Disorders

There is evidence that performing job tasks involving repetition, vibration, sustained posture or forceful movement may contribute to symptoms of work related upper extremity disorders. Typing is one such activity; symptoms that develop as a result of this activity can affect performance of work, self-care and leisure occupations. Studies investigating the impact of ergonomic keyboards on symptom reduction are limited, and little research exists regarding the reduction of key activation force as an intervention. Methods: This randomized, prospective study used a sample of 68 symptomatic workers employed by a single company. One group received a commercially available ergonomic keyboard, a second group used a modified version of the same keyboard designed to reduce activation force, vibration and key travel. We measured symptoms and clinical signs, functional status, and device satisfaction in both groups over a six-month study period. Results: Between-groups analyses indicated that the groups performed similarly on the outcomes of interest. Repeated-measure analysis identified a reduction of symptoms, an improvement in functional status, preference for and increased satisfaction with the intervention keyboards, and maintenance of typing speed and accuracy for both groups. Conclusions:     

中医护理干预对股骨颈骨折患者的效果评价

目的探讨中医护理干预在股骨颈骨折患者中的运用效果。方法选取80例股骨颈骨折患者随机分为对照组和干预组各40例,对照组使用常规护理方法,干预组在常规护理方法基础上应用中医护理措施,比较对照组与干预组的护理效果。结果对照组疼痛评分(4.73±1.55)分,干预组疼痛(3.85±1.31)分,对照组与干预组疼痛评分比较,差异有统计学意义(P<0.05);对照组不满意8例,满意率80.0%;护理不满意1例,满意率97.5%,对照组与干预组护理满意率比较,差异有统计学意义(P<0.05);对照组便秘8例、下肢静脉血栓2例,干预组便秘2例、下肢静脉血栓0例,对照组与干预组并发症总发生率比较,差异有统计学意义(P<0.05)。结论对股骨颈骨折患者实施中医护理干预,可以有效减轻患者疼痛,提高住院期间护理满意度,有效减少并发症的发生。