Basis for a Functional Capacity Evaluation Methodology for Patients with Work-related Neck Disorders

Background Neck pain is a common musculoskeletal complaint and a relationship with reduced work-related functional capacity is assumed. A validated instrument to test functional capacity of patients with neck pain is unavailable. The objective of this study was to develop a Functional Capacity Evaluation (FCE), which is content valid for determining functional capacity in patients with work related neck disorders (WRND). Methods A review of epidemiological review literature was conducted to identify physical risk factors for WRND. Results Evidence was found that physical risk factors contribute in development of WRND. Physical risk factors were related to repetitive movements, forceful movements, awkward positions and static contractions of the neck or the neck/shoulder region. An FCE was designed based on the risk factors identified. Eight tests were selected to cover all risk factors: repetitive side reaching, repetitive reaching overhead, static overhead work, front carry, forward static bend neck, overhead lift and the neck strength test. Content validity of this FCE was established by providing the rationale, specific objectives and operational definitions of the FCE. Conclusions Further research is needed to establish reliability and other aspects of validity of the neck-FCE.     

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.     

Mapping capacity in the health sector: a conceptual framework

Capacity improvement has become central to strategies used to develop health systems in low-income countries. Experience suggests that achieving better health outcomes requires both increased investment (i.e. financial resources) and adequate local capacity to use resources effectively. International donors and non-governmental agencies, as well as ministries of health, are therefore increasingly relying on capacity building to enhance overall performance in the health sector. Despite the growing interest in capacity improvement, there has been little consensus among practitioners and academics on definitions of 'capacity building' and how to evaluate it. This paper aims to review current knowledge and experiences from ongoing efforts to monitor and evaluate capacity building interventions in the health sector in developing countries. It draws on a wide range of sources to develop (1) a definition of capacity building and (2) a conceptual framework for mapping capacity and measuring the effects of capacity building interventions. Mapping is the initial step in the design of capacity building interventions and provides a framework for monitoring and evaluating their effectiveness. Capacity mapping is useful to planners because it makes explicit the assumptions underlying the relationship between capacity and health system performance and provides a framework for testing those assumptions.     

Post-offer, pre-placement testing in industry

BACKGROUND: Pre-placement testing was implemented during World War II. Its current use has been reshaped by economic factors, litigation, legislation, and advances in medicine. In response to a request from a local industry intent upon lowering their work-related injuries, a post-offer screening program was developed and implemented. The aim of this study was to develop a testing protocol for determining physical capacity that could be adapted for a post-offer, pre-placement program. METHODS: Functional capacity evaluation (FCE) testing was used to determine the physical capacity of 2,482 uninjured, healthy prospective new employees of a large food production plant. A comprehensive medical history and 20 different anthropometric, fitness, strength, and lifting tests were administered to all new hires in the first phase of this study to determine if injury incidence could be estimated through functional screening testing. The second study was designed to determine the effectiveness of the application of a post-offer, pre-placement program in an electrical equipment manufacturing facility. RESULTS: Strength testing alone was of no predictive value for work injury incidence. There was a strong correlation of physical capacity to physical job requirements. If an employee had the physical capability to perform the essential functions of the job, there was a lower injury rate as compared to the employee not demonstrating the physical strength or ability to perform the essential functions of the job. The incidence of low back injuries in those workers with the physical capabilities to perform the required functions of their job was 3%. However, among those workers who did not demonstrate the strength or physical abilities to perform their job, there was a 33% incidence of low back injuries. CONCLUSIONS: This study indicates that physical capacity testing that compares lifting ability to job lifting requirements correlates to work injury incidence. The application of appropriate post-offer, pre-placement testing is shown to be a cost-effective method to lower the incidence of work-related injuries.     

Functional capacity evaluation: Rationale,procedure, utility of the kinesiophysical approach

The return to work process of an injured worker is dependent upon matching the physical abilities of the worker with physical demands of work tasks. Functional work movements and tasks are complex. Machines, equipment and isolated musculoskeletal testing have not produced data that is broad enough to project multi-faceted work ability. Functional capacity evaluations, which are sets of dynamic work tests, have seen a growing acceptance because of their whole-worker approach. The basic items of functional evaluations (lifting, carrying, bending, reaching, climbing) are compiled into a comprehensive test which results in information about the whole of work and overall ability of the worker. Projections into an eight-hour day and comparison to physical demands of the job are included in outcome of a functional capacity evaluation. The Kinesiophysical design approach also produces information on safety, compliance, movement characteristics and physical reasons behind work limitations. Utility of functional evaluation is exemplified when employers, and physicians use it as a basis for safe work return of the employee.     

The Concurrent Validity of the ERGOS™ Work Simulator and the Ergo-Kit® with Respect to Maximum Lifting Capacity

The aim of this study was to investigate the concurrent validity—as regarding maximum lifting capacity—between the Functional Capacity Evaluation (FCE) methods, ERGOS Work Simulator and Ergo-Kit^®. Twenty-five healthy, male fire fighters participated. Dynamic lower and upper lifting capacities were determined using both FCE methods. Paired t tests showed the mean maximum lifting capacities to be significantly higher statistically when determined by the Ergo-Kit^® for lower, as well as, upper lifting. Spearman rank correlation coefficients varied between 0.49 and 0.66. It was concluded that the concurrent validity for lifting between both FCE methods was poor.     

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.     

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.     

Efficacy of Vitamin D Supplementation in Addition to Aerobic Exercise Training in Obese Women with Perceived Myalgia: A Single-Blinded Randomized Controlled Clinical Trial

Obese women were more susceptible to myalgia because of their significantly lower vitamin D concentrations; the present study investigated the efficacy of vitamin D in addition to an aerobic interval training in the management of obese women with myalgia. Forty-five obese women with vitamin D deficiency and myalgia (30 to 40 years old) were assigned randomly into three equal groups. Group A received an aerobic interval training with vitamin D supplementation, Group B received vitamin D supplementation only, and Group C received aerobic interval training only; participants in all groups were on calorie deficient diets. The study outcomes were the Visual Analog Scale (VAS) for Pain Evaluation, serum vitamin D level, and Cooper 12-Minute Walk Test for Functional Capacity Evaluation, while the Short-Form Health Survey (SF) was used for assessment of quality of life. We detected a significant improvement in pain intensity level, serum vitamin D level, and quality of life in all groups with significant difference between Group A and groups B and C. We also detected a significant improvement in functional capacity in groups A and C, with no significant change in Group B. Aerobic interval training with vitamin D supplementation was more effective for the management of obese women with perceived myalgia.     

The reliability and validity of two new tests of maximum lifting capacity

This study investigated the test-retest reliability and validity of the isokinetic and gravity/inertia modes of the Lido Lift ^TM and the Progressive Lifting Capacity II test (PLC II). Maximum lifting capacity tests were performed in the isokinetic and gravity/inertia modes on the Lido Lift and with the PLC II with 29 healthy male subjects. Pearson product-moment correlations were calculated to determine the test-retest reliabilities and to compare PLC II test values with isokinetic and gravity/inertia test values. The correlations for the isokinetic, gravity inertia, and the PLC II werer=.90, .82, and .91, respectively. The correlations between the isokinetic and gravity/inertia tests and the PLC II werer=.64 and .74 during the test andr=.72 and .81 during the retest. The results of this study support the reliability of both Lido Lift ^TM tests and of the PLC II, and the validity of the isokinetic and gravity/inertia tests when compared to the PLC II.     

Objectively measuring physical ability in elderly persons: the Physical Capacity Evaluation.

The Physical Capacity Evaluation, a performance measure of functional capabilities comprised of 13 tasks simulating those used in activities of daily living, was tested on 289 community-dwelling elderly people and compared against a widely used self-report measure of function, the Health Assessment Questionnaire. Factor analysis identified one dominant component in each instrument. Internal consistency reliability (Cronbach's alpha) was .90 for both instruments. Global disability (Health Assessment Questionnaire) and function (Physical Capacity Evaluation) scores were correlated -.74. One-week retest reliabilities on 58 subjects were .94 for the Physical Capacity Evaluation and .95 for the Health Assessment Questionnaire. The Physical Capacity Evaluation is a valid and reliable measure of physical performance for use with elderly people.     

Functional Capacity Evaluation in Subjects with Early Osteoarthritis of Hip and/or Knee; is Two-Day Testing Needed?

Introduction The Work Well Functional Capacity Evaluation (WW FCE) is a two-day performance based test consisting of several work-related activities. Three lifting and carrying test items may be performed on both days. The objective of this study was to assess the need for repeated testing of these items in subjects with early osteoarthritis of the hip and/or the knee and to analyze sources of variation between the 2 days of measurement. Methods A standardized WW FCE protocol was applied, including repeated testing of lifting low, lifting overhead and carrying. Differences and associations between the 2 days were calculated using paired samples t-tests, intraclass correlation coefficients (ICC) and limits of agreement (LoA). Possible sources of individual variation between the 2 days were identified by Wilcoxon signed ranks tests. Pearson correlation coefficients were calculated for differences in performances between days and differences in possible sources of variation between days. Results Seventy-nine subjects participated in this study, their mean (SD) age was 56.6 (4.8) years, median (min–max) WOMAC (Western Ontario and McMaster Universities) index scores for pain, stiffness and physical function were 5 (0–17), 3 (0–7) and 14 (0–49), respectively. Median (min–max) SF36 physical function was 75 (5–95), and SF36 pain score was 67 (12–76). Mean performance differences ranged from −0.2 to −0.8 kg (P > 0.05). ICC’s ranged from 0.75 (lifting overhead) to 0.88 (lifting low). LoA were: lifting low 8.0 kg; lifting overhead 6.5 kg; carrying 9.0 kg. Pearson’s correlations were low and non-significant. Conclusions All three tests show acceptable two-day consistency. WW FCE testing on two consecutive days is not necessary for groups of subjects with early osteoarthritis. Individual sources of variation could not be identified.     

Predictive Value of the Fear-Avoidance Model on Functional Capacity Evaluation

Purpose Measuring the predictive value of the Fear-Avoidance Model (FAM) on lifting tasks in Functional Capacity Evaluation (FCE), and on reasons for stopping the evaluation (safe maximal effort, versus self-limited). Methods A monocentric prospective study was conducted on 298 consecutive inpatients. Components of the FAM were analyzed using the Cumulative Psychosocial Factor Index (CPFI: kinesiophobia, catastrophizing, depressive mood) and perceived disability (Hand/Spinal Function Sort: HFS/SFS). Floor-to-waist, waist-to-overhead and dominant-hand lifting tests were measured according to the FCE guidelines. Maximal safe performance was judged by certified FCE assessors. Analyses were conducted with linear multiple regression models. Results The CPFI was significantly associated with the 3 FCE lifting tests: floor-to-waist (ß?=???1.12; p?=?0.039), waist-to-overhead (ß?=???0.88; p?=?0.011), and dominant-handed lifting (ß?=???1.21; p?=?0.027). Higher perceived disability was also related to lower performances: floor-to-waist (ß?=?0.09; p?<?0.001), waist-to-overhead (ß?=?0.04; p?<?0.001), and dominant-handed lifting (ß?=?0.06; p?<?0.001). The CPFI was not related to performances of patients with self-limited effort despite higher psychological scores, while a relationship was found for patients who achieved a safe maximal performance. Higher perceived disability was related to performances in both situations. Conclusions FAM components should be taken into account when interpreting maximal physical performance in FCE. This study also suggests that factors other than pain-related fears may influence patients with self-limited effort.     

A comparison of two lifting assessment approaches in patients with chronic low back pain

The Progressive Isoinertial Lifting Evaluation (PILE) and the lifting test of the WorkWell Systems Functional Capacity Evaluation (WWS) are well known as lifting performance tests. The objective of this study was to study whether the PILE and the WWS can be used interchangeably in patients with Chronic Low Back Pain (CLBP) and to explore whether psychosocial variables can explain possible differences. Methods: 53 Patients (32 men and 21 women) with CLBP were tested twice in a counter balanced design. Pearson Correlation Coefficient of r > 0.75 and non-significant differences on two-tailed t tests were considered as good comparability. Results: Pearson Correlation Coefficient was 0.75 (p < 0.01). Lifting performance on the WWS was a mean of 6.0 kg higher compared to the PILE (p < 0.01). The difference between the PILE and the WWS was unrelated to psychological variables. Conclusion: It can be concluded that the PILE and the WWS cannot be used interchangeably. Psychosocial variables cannot explain the differences between both tests.     

Functional capacity evaluation reports for clients with personal injury claims: A content analysis

Functional capacity evaluations (FCEs) for personal injury claimants are rigorously scrutinized by the stakeholders because of their financial implications. This study examined 51 medico-legal FCE reports for clients all of whom suffered with spinal pain attributed to a motor vehicle accident. The FCEs were completed by 14 occupational therapists. Content analysis of the FCE reports identified categories and sub-categories of objective and subjective information on which occupational therapists reported. They included employment, activities of daily living, pain, functional physical capacities and job demands. Recommendations included the suitability of current and future jobs. However, the reasoning behind occupational therapists' recommendations in the FCE reports was frequently not stated. This content analysis demonstrated that these detailed FCE reports had a consistent focus on work capacity; further, the researchers suggest refinements to FCE reporting practices so that findings, recommendations and predictions about work outcomes for clients are interpreted clearly and realistically.     

非政府组织艾滋病预防能力测评工具的适用性研究

目的 探索非政府组织艾滋病预防能力测评的工具在中国的适用性,为评价中国非政府组织艾滋病预防能力提供参考和技术支持.方法 翻译、修正国际艾滋病联盟（International HIV/AIDS Alliance）开发的非政府组织艾滋病预防能力测评工具,对国内22家非政府组织进行测量,根据测量结果进行信度、效度分析.结果 能力测评工具的Cronbach＇s α系数为0.924,各条目对应的最大因子负荷的分类结果与工具的设计基本符合.结论 翻译修正后的测评工具具有良好的信度和效度,适用于中国非政府组织艾滋病预防能力测评.     

Repetition in Clinical Job Strength Rating Calculations: Facilitating Safe Dynamic Rehabilitation in a Lumbar Cumulative Trauma Injury

A work-related repetitive trauma disorder to the lumbar spine was treated effectively with initial appropriate Physical Therapy Modalities followed by a Dynamic Active approach. Return-to-work orders, duties restriction, and improvement were substantiated with regular Functional Capacity Evaluations, following NIOSH guidelines intermediate level of the lifting task evaluation. Job Strength Rating (JSR) calculations were made concerning ability to return to work by calculating repetitions into the equation. Upon obtaining acceptable JSR readings, the patient was allowed to return to work on a graduated scale and a mild exacerbation was experienced. Due to this incident, functional exercises were developed to help achieve higher repetition movements, thus satisfying his high repetitious job duty specifications. By reviewing the findings, we were able to categorize this patient as a Qualified Injured Worker enabling him vocational rehabilitation. The most effective component to his release was the development of functional dynamic lifting task exercises, and calculation of his Job Strength Rating, remembering the importance of repetitions, and its effect on true Functional Capacity.     

Effects of psychophysical lifting training on maximal repetitive lifting capacity

The purpose of this investigation was to determine the effectiveness of psychophysical lifting training on maximal repetitive lifting capacity. Maximal repetitive lifting capacity was defined as the maximum box mass that could be lifted for 1 hr to a height of 132 cm at a rate of 6 lifts/min. Eight male subjects participated in five psychophysical lifting training sessions each week for 4 weeks. During each session subjects were presented with one empty and one heavily loaded box and asked to adjust the box mass to the maximum load they felt capable of lifting for 1 hr. This load was lifted at a rate of 6 lifts/min to a height of 132 cm for two 15-min periods each session. Heart rate was recorded, and subjects were asked to provide a rating of their perceived exertion. At the end of 4 weeks of training, subjects did not select a heavier training load, exhibit a decreased training heart rate, or report a decreased rating of perceived exertion. The training program did produce a significant increase in 1-hr maximal repetitive lifting capacity, as indicated by a greater box mass selected, but there was no concomitant change in VO2, heart rate, or rating of perceived exertion. It can be concluded that 4 weeks of psychophysical training of inexperienced lifters can produce a substantial increase in work output for a given energy expenditure. These increases are attributed to neural factors (skill, neuromuscular coordination) and to possible increases in the muscular endurance of specific muscle groups occurring with practice.