Normative Values for a Functional Capacity Evaluation

Comparison of Surgical Outcomes for Arthrodesis and Arthroplasty for Thumb Carpometacarpal Osteoarthritis in Female Workers

Background

Both arthrodesis and trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI) arthroplasty are reliable surgical procedures for thumb carpometacarpal (CMC) osteoarthritis. Here, we compared surgical outcomes between arthrodesis and T + LRTI for female workers aged over 40 years with thumb CMC osteoarthritis to determine an optimal procedure.

Patients and Methods

Fourteen thumbs of 13 patients who underwent arthrodesis with locking plates and 11 thumbs of 10 patients who underwent T + LRTI and were followed up for at least 12 months were retrospectively analyzed. For the two groups, we investigated the range of motion (ROM) of the thumb, grip strength, pinch strength, disabilities of the arm, shoulder, and hand (DASH) score, Hand20 score, and visual analog scale (VAS) scores for pain at 1-year follow-up and compared them between the two groups. In addition, we investigated surgical complications and resumption of work.

Results

Both procedures provided similar subjective outcomes in terms of Hand20 and VAS scores; however, arthrodesis provided significantly larger ROM of the metacarpophalangeal and interphalangeal joints of the thumb, grip and pinch strength, and DASH score, whereas T + LRTI provided a significantly better palmar abduction at 1-year follow-up. There were three and four postoperative complications in the arthrodesis and T + LRTI groups, respectively. One patient in the arthrodesis group had resigned, whereas two patients in T + LRTI had changed their jobs to less physically demanding ones postoperatively.

Conclusion

Both procedures satisfy female workers aged over 40 years with thumb CMC osteoarthritis. Nevertheless, arthrodesis can provide favorable outcomes that are equal to or better than T + LRTI.

Normative Data Estimation in Neuropsychological Tests: A Systematic Review

OBJECTIVE

To quantify the evolution, impact, and importance of normative data (ND) calculation by identifying trends in the research literature and what approaches need improvement.

METHODS

A PRISMA-guideline systematic review was performed on literature from 2000 to 2022 in PubMed, Pub-Psych, and Web of Science. Inclusion criteria included scientific articles about ND in neuropsychological tests with clear data analysis, published in any country, and written in English or Spanish. Cross-sectional and longitudinal studies were included. Bibliometric analysis was used to examine the growth, productivity, journal dispersion, and impact of the topic. VOSViewer compared keyword co-occurrence networks between 1952-1999 and 2000-2022.

RESULTS

Four hundred twelve articles met inclusion and exclusion criteria. The most studied predictors were age, education, and sex. There were a greater number of studies/projects focusing on adults than children. The Verbal Fluency Test (12.7%) was the most studied test, and the most frequently used variable selection strategy was linear regression (49.5%). Regression-based approaches were widely used, whereas the traditional approach was still used. ND were presented mostly in percentiles (44.2%). Bibliometrics showed exponential growth in publications. Three journals (2.41%) were in the Core Zone. VOSViewer results showed small nodes, long distances, and four ND-related topics from 1952 to 1999, and there were larger nodes with short connections from 2000 to 2022, indicating topic spread.

CONCLUSIONS

Future studies should be conducted on children's ND, and alternative statistical methods should be used over the widely used regression approaches to address limitations and support growth of the field.

Musculoskeletal complaints, physical work demands, and functional capacity in individuals with a brachial plexus injury: An exploratory study

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.

Effect of a Multicomponent Intervention with Tele-Rehabilitation and the Vivifrail© Exercise Programme on Functional Capacity after Hip Fracture: Study Protocol for the ActiveFLS Randomized Controlled Trial

INTRODUCTION

Hip fractures are the most common fracture leading to hospitalization and are associated with high costs, mortality rates and functional decline. Although several guidelines exist for preventing new fractures and promoting functional recovery, they tend to focus on osteoporosis treatment and do not take into account the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. Moreover, most health systems are fragmented and are incapable of providing appropriate management for frail and vulnerable individuals who are at risk of experiencing fragility fractures. Multicomponent interventions and physical exercise using tele-rehabilitation could play a role in the management of hip fracture recovery. However, the effectiveness of exercise prescription and its combination with a comprehensive geriatric assessment (CGA) is still unclear.

METHODS

This randomized clinical trial will be conducted at the Hospital Universitario de Navarra (Pamplona, Spain). A total of 174 older adults who have suffered a hip fracture and fulfil the criteria for inclusion will be randomly allocated to either the intervention group or the control group. The intervention group will receive a multicomponent intervention consisting of individualized home-based exercise using the @ctive hip app for three months, followed by nine months of exercise using Vivifrail. Additionally, the intervention group will receive nutrition intervention, osteoporosis treatment, polypharmacy adjustment and evaluation of patient mood, cognitive impairment and fear of falling. The control group will receive standard outpatient care according to local guidelines. This research aims to evaluate the impact of the intervention on primary outcome measures, which include changes in functional status during the study period based on the Short Physical Performance Battery.

DISCUSSION

The findings of this study will offer valuable insights into the efficacy of a comprehensive approach that considers the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. This study's findings will contribute to the creation of more effective strategies tailored to the requirements of these at-risk groups.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Tele-Assessment of Functional Capacity: Validity, Intra- and Inter-rater Reliability

BACKGROUND

Functional capacity evaluation is a standardized tool that assesses work-related skills. Although there are different test batteries, the most frequently used one is Work Well Systems. This study aims to determine the validity and inter- and intra-rater reliability of remote implementation of functional capacity tests (repetitive reaching, lifting object overhead, and working overhead) in asymptomatic individuals.

METHODS

A total of 51 asymptomatic individuals were included in the study. Participants completed all tests both face-to-face and remotely. Remote assessment videos were rewatched by the same researcher and different researchers for intra- and inter-rater reliability. All processes were scored by two independent researchers.

RESULTS

Remotely performing repetitive reaching (intraclass correlation coefficient [ICC]: 0.85-0.92, p < .001), lifting object overhead (ICC: 0.98, p < .001), and working overhead (ICC: 0.88 p < .001) tests are valid and reliable.

DISCUSSION

Repetitive reaching, lifting an object overhead, and sustained overhead work tests in the Work Well Systems-Functional Capacity Evaluation test battery can be performed remotely through videoconferencing. Remotely evaluating these tests, which are especially important in work-related situations, may be important in pandemic conditions and hybrid working conitions.

A novel physical functioning test to complement subjective questionnaires in chronic low back pain assessments

BACKGROUND CONTEXT

Lifting disability commonly affects patients with chronic low back pain (CLBP) and may not correlate with the existing lifting-related physical assessment tests, such as the loaded forward reach (LFR) test.

PURPOSE

The Lift and Place (LAP) test was developed to assess lifting disability in CLBP based on known risk factors. The LAP test was compared with established physical assessment test, including the LFR test and self-reported disability questionnaires.

STUDY DESIGN/SETTING

This cross-sectional study measured self-reported disability questionnaires along with LAP and other physical assessment test results PATIENT SAMPLE: Eighty three CLBP and 82 asymptomatic participants aged 18 to 55 with normal BMI according to WHO classification.

OUTCOME MEASURES

Oswestry disability index (ODI), Roland-Morris disability questionnaire (RMDQ), Numerical Pain Rating Scale, Trunk Extensor Endurance test, 5 Repetition Sit-To-Stand test, LAP and LFR test.

METHODS

Physical assessment test scores were compared between the two groups. The correlation of assessment test scores with ODI and RMDQ in patients with CLBP was calculated. Receiver operating characteristic (ROC) curve analysis was performed to calculate the area under the curve (AUC) of each assessment tests. Assessment tests, ODI, and RMDQ were measured twice for CLBP patients on separate days to calculate the test-retest intraclass correlation (ICC) reliability. Two researchers scored the assessment tests independently to calculate the inter-rater ICC.

RESULTS

Patients with CLBP were slower in the LAP test (CLBP vs asymptomatic: 21.6±4.9 s vs 18.6±3.6 s) and had shorter reach in the LFR test (CLBP vs asymptomatic: 33.6±6.0 cm vs 36.3±6.6 cm). The LAP was correlated with both ODI (r=0.418) and RMDQ (r=0.390), while the LFR was not. In the ROC analysis, the LAP and LFR bore AUCs of 0.685 and 0.379, respectively. Their test-retest ICCs were 0.913 and 0.858, and their inter-rater ICCs were 0.997 and 0.969, respectively.

CONCLUSIONS

The LAP test demonstrated higher reliability and significant correlation with the ODI and RMDQ, indicating its potential as performance assessment for lifting disability in CLBP. Further studies should investigate the use of LAP and other physical assessments for rapid CLBP screening.

Protocol for a multicenter study on effectiveness and economics of the Back At work After Surgery (BAAS): a clinical pathway for knee arthroplasty

BACKGROUND

Optimizing return to work (RTW) after knee arthroplasty (KA) is becoming increasingly important due to a growing incidence of KA and poor RTW outcomes after KA. We developed the Back At work After Surgery (BAAS) clinical pathway for optimized RTW after KA. Since the effectiveness and cost analysis of the BAAS clinical pathway are still unknown, analysis on effectiveness and costs of BAAS is imperative.

METHOD

This protocol paper has been written in line with the standards of Standard Protocol Items: Recommendations for Interventional Trails. To assess the effectiveness and cost-effectiveness for RTW, we will perform a multicenter prospective cohort study with patients who decided to receive a total KA (TKA) or an unicompartmental KA (UKA). To evaluate the effectiveness of BAAS regarding RTW, a comparison to usual care will be made using individual patient data on RTW from prospectively performed cohort studies in the Netherlands.

DISCUSSION

One of the strengths of this study is that the feasibility for the BAAS clinical pathway was tested at first hand. Also, we will use validated questionnaires and functional tests to assess the patient's recovery using robust outcomes. Moreover, the intervention was performed in two hospitals serving the targeted patient group and to reduce selection bias and improve generalizability. The limitations of this study protocol are that the lead author has an active role as a medical case manager (MCM) in one of the hospitals. Additionally, we will use the data from other prospective Dutch cohort studies to compare our findings regarding RTW to usual care. Since we will not perform an RCT, we will use propensity analysis to reduce the bias due to possible differences between these cohorts.

TRAIL REGISTRATION

This study was retrospectively registered at clinicaltrails.gov ( https://clinicaltrials.gov/ct2/show/NCT05690347 , date of first registration: 19-01-2023).

Functional capacity of individuals with brachial plexus injury

BACKGROUND

To enable (pain free) functioning, individuals with brachial plexus injury (BPI) may require a higher functional capacity compared to two-handed individuals, because the load on unaffected structures is greater.

OBJECTIVE

This study compared the functional capacity of individuals with BPI and healthy controls and explored differences in the functional capacity of BPI-affected individuals with respect to: those with and without hand function; affected and unaffected sides; with and without musculoskeletal complaints (MSCs).

METHODS

Six functional capacity tests adjusted for one-handed function were performed by 23 BPI-affected individuals and 20 healthy controls. Hand function was assessed through physical examination and the Dutch Musculoskeletal Questionnaire was used to assess MSCs.

RESULTS

Individuals with BPI scored lower for the two-handed tests, compared with the controls (p≤0.01, effect size (r) ≤-0.41 for both tests). However, both groups performed similar in the one-handed tests. On average individuals with BPI met the physical demands to perform sedentary to light physical work. Among BPI-affected individuals, two-handed overhead lifting capacity was higher in those with hand function than in those without hand function (p = 0.02; r = 0.33). Functional capacity tended to be lower for the unaffected side than for the affected side (4 tests; p≤0.05, r≤-0.36). Test results of BPI-affected Individuals with and without MSCs were similar.

CONCLUSION

Individuals with BPI demonstrated lower two-handed functional capacity than healthy controls. Effect sizes were medium. Capacity of their unaffected side was similar to the dominant side of controls. No association was found between MSCs and functional capacity.

Maximal aerobic capacity is associated with lifting capacity, but not with self-reported functioning measures in patients with primary chronic low back pain: a cross-sectional study

Objective

Maximal exercise testing is considered the gold standard to assess V̇O₂max. However, maximal exercise testing was previously deemed unfeasible and unsafe in chronic low back pain (CLBP) patients. Consequently, most previous studies on aerobic capacity and functioning in patients with CLBP were performed with submaximal testing protocols. A recent study demonstrated the safety, feasibility and tolerance of maximal exercise testing in patients with CLBP. Therefore, the relation between aerobic capacity and functioning should be reevaluated. This cross-sectional study aims to determine the relationship between maximal aerobic capacity and four measures of functioning: lifting capacity, work ability, pain-related disability and physical functioning in patients with CLBP.

Methods

The maximal aerobic capacity of patients with CLBP was assessed with a maximal cardiopulmonary exercise test. Functioning was measured with a floor-to-waist lifting capacity test and three questionnaires: Work Ability Score, Pain Disability Index and Physical Functioning subscale of RAND-36. The associations between maximal aerobic capacity and each of the functioning measures were analysed with multiple linear regression analyses while controlling for potential confounders.

Results

Data of n=74 patients with CLBP were analysed. After controlling for potential confounders, maximal aerobic capacity was moderately associated with lifting capacity (β=0.32, p=0.006), but not with any of the other functioning measures (β=−0.08 to 0.12, p>0.288).

Conclusion

A higher level of maximal aerobic capacity is moderately associated with a higher lifting capacity, but not with self-reported work ability, pain-related disability and physical functioning.

Association of imbalance between job workload and functional ability with return to work in ARDS survivors

BACKGROUND

Inability to return to work (RTW) is common after acute respiratory distress syndrome (ARDS). Mismatch in an individual's job workload and his or her functional ability, termed work ability imbalance, is negatively associated with RTW, but has not been evaluated in ARDS survivors.

OBJECT

We examine associations between work ability imbalance at 6 months and RTW at 6 months and 12 months, as well as the ability to sustain employment in ARDS survivors.

METHODS

Previously employed participants from the ARDS Network Long-Term Outcomes Study (N=341) were evaluated. Pre-ARDS workload was determined based on the US Occupational Information Network classification. Post-ARDS functional ability was assessed using self-reported 36-Item Short Form Health Survey (SF-36) physical functioning, social functioning and mental health subscales, and Mini-Mental State Examination. ARDS survivors were categorised into four work ability imbalance categories: none, psychosocial, physical, and both psychosocial and physical.

RESULTS

Almost 90% of ARDS survivors had a physical and/or psychosocial work ability imbalance at both 6-month and 12-month follow-up. Compared with survivors with no imbalance at 6 months, those with both physical and psychosocial imbalance had lower odds of RTW (6 months: OR=0.33, 95% CI=0.13 to 0.82; 12 months: OR=0.22, 95% CI=0.07 to 0.65). Thirty-eight (19%) of those who ever RTW were subsequently jobless at 12 months.

CONCLUSION

Interventions aimed at rebalancing ARDS survivors' work ability by addressing physical and psychosocial aspects of their functional ability and workload should be explored as part of efforts to improve RTW, maintain employment and reduce the financial impact of joblessness.

Exploring a 1-Minute Paced Deep-Breathing Measurement of Heart Rate Variability as Part of a Workers' Health Assessment

Low heart rate variability (HRV) is related to health problems that are known reasons for sick-leave or early retirement. A 1-minute-protocol could allow large scale HRV measurement for screening of health problems and, potentially, sustained employability. Our objectives were to explore the association of HRV with measures of health. Cross-sectional design with 877 Dutch employees assessed during a Workers' Health Assessment. Personal and job characteristics, workability, psychological and mental problems, and lifestyle were measured with questionnaires. Biometry was measured (BMI, waist circumference, blood pressure, glucose, cholesterol). HRV was assessed with a 1-minute paced deep-breathing protocol and expressed as mean heart rate range (MHRR). A low MHRR indicates a higher health risk. Groups were classified age adjusted for HRV and compared. Spearman correlations between raw MHRR and the other measures were calculated. Significant univariable correlations (p < 0.05) were entered in a linear regression model to explore the multivariable association with MHRR. Age, years of employment, BMI and waist circumference differed significantly between HRV groups. Significant correlations were found between MHRR and age, workability, BMI, waist circumference, cholesterol, systolic and diastolic blood-pressure and reported physical activity and alcohol consumption. In the multivariable analyses 21.1% of variance was explained: a low HRV correlates with aging, higher BMI and higher levels of reported physically activity. HRV was significantly associated with age, measures of obesity (BMI, waist circumference), and with reported physical activity, which provides a first glance of the utility of a 1-minute paced deep-breathing HRV protocol as part of a comprehensive preventive Workers' Health Assessment.

Central Sensitisation and functioning in patients with chronic low back pain: protocol for a cross-sectional and cohort study

INTRODUCTION

A relevant subsample of patients with chronic low back pain (CLBP) have manifested augmented central pain processing, central sensitisation (CS). Patients with CLBP have limited functioning and participation. Theoretically, physical functioning in patients with CLBP can plausibly be linked to CS; however, evidence to explain such association is scarce. Moreover, there is no gold standard for CS diagnosis. The objectives of the study are: (1) to analyse the association between instruments assessing reference symptoms and signs attributed to CS; (2) to analyse whether reference symptoms and signs attributed to CS are associated with functioning measurement outcomes; and (3) to analyse whether changes (between baseline and discharge) in reference symptoms and signs attributed to CS are related to changes in each of the functioning measurement outcomes.

METHODS AND ANALYSIS

A cross-sectional and longitudinal observational study is performed with measurements taken at baseline and discharge of an interdisciplinary rehabilitation programme. A sample size of 110 adult patients with CLBP has been calculated for the study. CS measurements are: Central Sensitisation Inventory, quantitative sensory testing and heart rate variability. Functioning measurements are: lifting capacity, maximal aerobic capacity, accelerometry and reported functioning. Statistical analyses to be performed are: (1) correlation between CS measurements, (2) multiple regression between functioning (dependent variable) and CS measurements (independent variable), and (3) multiple regression between changes in scores of functioning (dependent variable) and CS measurements (independent variable), and corrected for sex and age.

ETHICS AND DISSEMINATION

The study obtained the clearance to its implementation from the Medical Research Ethics Committee of the University Medical Center Groningen in July 2017. The results will be disseminated through scientific publications in peer-reviewed journals, presentations at relevant conferences, and reports to stakeholders.

TRIAL REGISTRATION NUMBER

NTR7167/NL6980.

Impingement pain affects kinematics of breast cancer survivors in work-related functional tasks

BACKGROUND

Breast cancer survivors may encounter upper limb morbidities post-surgery. It is currently unclear how these impairments affect arm kinematics, particularly during functional task performance. This investigation examined upper body kinematics during functional tasks for breast cancer survivors and an age-matched control group.

METHODS

Fifty women (aged 35-65) participated: 25 breast cancer survivors who had undergone mastectomy and 25 age-range matched controls. Following basic clinical evaluation, including shoulder impingement tests, motion of the torso and upper limbs were tracked during six upper limb-focused functional tasks from which torso, scapular, and thoracohumeral angles were calculated. Between-group differences were evaluated with independent t-tests (p < .05). The breast cancer group was then divided based upon impingement tests and differences between the three new groups were tested with one-way ANOVAs (p < .05).

FINDINGS

Breast cancer survivors had higher disability scores, lower range of motion, and lower performance scores. The largest kinematic differences existed between the breast cancer survivors with impingement pain and the two non-pain groups. During overhead tasks, right peak scapular upward rotation was significantly reduced (d = 0.80-1.11) in the breast cancer survivors with impingement pain. This group also demonstrated trends of decreased peak humeral abduction and internal rotation at extreme postures (d = 0.54-0.78). These alterations are consistent with kinematics considered high risk for rotator cuff injury development.

INTERPRETATION

Impingement pain in breast cancer survivors influences functional task performance and may be more important to consider than self-reported disability when evaluating pain and potential injury development.

Trajectories of Physical Work Capacity in Early Symptomatic Osteoarthritis of Hip and Knee: Results from the Cohort Hip and Cohort Knee (CHECK) Study

Purpose To evaluate the 5-year course of physical work capacity of participants with early symptomatic osteoarthritis (OA) of the hip and/or the knee; to identify trajectories and explore the relationship between trajectories and covariates. Methods In a prospective cohort study, physical work capacity was measured at baseline, using a test protocol (functional capacity evaluation) consisting of work-related physical activities. Participants were invited to participate in 1, 2 and 5 year follow-up measurements. Multilevel analysis and latent classes analysis were performed, in models with test performances as dependent variables and age, sex, work status, self-reported function (Western Ontario McMasters Arthritis Scale-WOMAC), body mass index (BMI) and time as independent variables. Multiple imputation was used to control for the influence of missing data. Results At baseline and after 1, 2 and 5 years there were 96, 64, 61 and 35 participants. Mean (SD) age at baseline was 56 (4.9) years, 84% were females. There was no statistically significant change in test performances (lifting low and high, carrying, static overhead work, repetitive bending, repetitive rotations) between the 4 measurements. Male sex, younger age and better self-reported function were statistically significant (p < 0.05) determinants of higher performance on most of the tests; having a paid job, BMI and progression of time were not. Three trajectories were identified: 'weak giving way', 'stable and able', and 'strong with decline'. Discussion In subgroups of participants with early symptomatic OA, determined by age, sex and self-reported function, physical work capacity seems to be a stable characteristic over 5 years.

Cognitive functioning as a predictor of employment status in relapsing-remitting multiple sclerosis: a 2-year longitudinal study

Background

Cognitive functioning has been linked to employment outcomes in multiple sclerosis (MS) in cross-sectional studies. Longitudinal studies are however lacking and previous studies did not extensively examine executive functioning.

Objectives

We examined whether baseline cognitive functioning predicts a change in employment status after 2 years, while taking into account mood, fatigue and disability level.

Methods

A total of 124 patients with relapsing-remitting MS (pwMS) and 60 healthy controls were included. They underwent neurological and neuropsychological examinations and completed online questionnaires. PwMS were divided into a stable and deteriorated employment status group (SES and DES), based on employment status 2 years after baseline. We first examined baseline differences between the SES and DES groups in cognitive functioning, mood, fatigue and disability level. A logistic regression analysis was performed, with change in employment status (SES/DES) as dependent variable.

Results

The DES group included 22% pwMS. Group differences were found in complex attention, executive functioning, self-reported cognitive functioning, fatigue and physical disability. More physical disability (OR = 1.90, p = 0.01) and lower executive functioning (OR = 0.30, p = 0.03) were retained as independent predictors of DES (R² = 0.22, p ≤ 0.001).

Conclusions

Baseline physical disability and executive functioning, but none of the other variables, moderately predicted a deterioration in employment status 2 years later.

Trial registration

This observational study is registered under NL43098.008.12: ‘Voorspellers van arbeidsparticipatie bij mensen met relapsing-remitting Multiple Sclerose’. This study is registered at the Dutch CCMO register (https://www.toetsingonline.nl).

Electronic supplementary material

The online version of this article (10.1007/s10072-019-03999-w) contains supplementary material, which is available to authorized users.

Functional Capacity Evaluation in Different Societal Contexts: Results of a Multicountry Study

Purpose To examine factors associated with Functional Capacity Evaluation (FCE) results in patients with painful musculoskeletal conditions, with focus on social factors across multiple countries. Methods International cross-sectional study was performed within care as usual. Simple and multiple multilevel linear regression analyses which considered measurement's dependency within clinicians and country were conducted: FCE characteristics and biopsychosocial variables from patients and clinicians as independent variables; and FCE results (floor-to-waist lift, six-minute walk, and handgrip strength) as dependent variables. Results Data were collected for 372 patients, 54 clinicians, 18 facilities and 8 countries. Patients' height and reported pain intensity were consistently associated with every FCE result. Patients' sex, height, reported pain intensity, effort during FCE, social isolation, and disability, clinician's observed physical effort, and whether FCE test was prematurely ended were associated with lift. Patient's height, Body Mass Index, post-test heart-rate, reported pain intensity and effort during FCE, days off work, and whether FCE test was prematurely ended were associated with walk. Patient's age, sex, height, affected body area, reported pain intensity and catastrophizing, and physical work demands were associated with handgrip. Final regression models explained 38‒65% of total variance. Clinician and country random effects composed 1-39% of total residual variance in these models. Conclusion Biopsychosocial factors were associated with every FCE result across multiple countries; specifically, patients' height, reported pain intensity, clinician, and measurement country. Social factors, which had been under-researched, were consistently associated with FCE performances. Patients' FCE results should be considered from a biopsychosocial perspective, including different social contexts.

Repeatability and Safety of the Functional Capacity Evaluation-One-Handed for Individuals with Upper Limb Reduction Deficiency and Amputation

Purpose To assess repeatability and safety of the functional capacity evaluation-one-handed (FCE-OH), a FCE-OH individuals, consisting of eight items. Method The FCE-OH protocol was administered twice to 23 individuals with upper limb absence (87% male; median age 46 years; median 2 days between sessions). To examine repeatability, test-retest reliability and agreement were assessed with the intraclass correlations coefficient (ICC) and limits of agreement (LoA), respectively. Reliability was considered acceptable when ICC-values were ≥0.75. Widths of LoA of four tests were compared with those of healthy adults. Safety and pain response were assessed with a questionnaire. Results After controlling for stability of construct, ICC-values ranged between 0.23 and 0.96, and widths of LoA ranged between 16 and 79%. Intertrial (learning) effects were present in three test items. No serious adverse reactions were reported. A pain response was reported by 30% of the participants. Conclusion Good or excellent reliability was observed in five tests, while three items showed poor or moderate test-retest reliability. Interpretation of agreement was possible for four tests, of which three showed widths of LoA similar to those reported in healthy adults. Learning effects were present; therefore, interpretation at the individual level should be performed with care. As the CI of several items were wide, confirmation of results in a larger sample is warranted. Safety was confirmed.

Upper limb functional capacity of working patients with osteoarthritis of the hands: A cross-sectional study

STUDY DESIGN

A cross-sectional design was used.

INTRODUCTION

Little is known about the effects of osteoarthritis of the hands (OAH) on work ability in working patients with OAH.

PURPOSE OF THE STUDY

The study aimed to analyze the differences in upper limb functional capacity (ULFC) between working patients with OAH and healthy workers and to evaluate variables associated with ULFC and with self-reported disability (SRD) in working patients with OAH.

METHODS

Forty-one patients performed the ULFC Evaluation (ULFCE) and also completed 2 SRD measures. The patients' results were compared with the ULFCE results of 82 matched healthy workers from a reference database. Three sets of multivariate regression analyses were used to reveal the predictors of ULFC and SRD.

RESULTS

Patients scored 12%-45% lower on all ULFCE tests (P values ranging from P P Discussion Working patients with OAH had a considerably lower ULFC compared with healthy workers. Female gender and the presence of OAH predicted lower ULFC. Pain and lower finger strength predicted worse scores on SRD.

CONCLUSION(S)

In the case of professionals advising working patients with OAH, our results suggest that a careful evaluation of the ULFC and SRD is warranted. Subsequently, advice regarding exercises or adjustments at work can be given.

LEVEL OF EVIDENCE

3b.

Measurement Properties of the Modified Spinal Function Sort (M-SFS): Is It Reliable and Valid in Workers with Chronic Musculoskeletal Pain?

Purpose To analyze the reliability and validity of a picture-based questionnaire, the Modified Spinal Function Sort (M-SFS). Methods Sixty-two injured workers with chronic musculoskeletal disorders (MSD) were recruited from two work rehabilitation centers. Internal consistency was assessed by Cronbach's alpha. Construct validity was tested based on four a priori hypotheses. Structural validity was measured with principal component analysis (PCA). Test-retest reliability and agreement was evaluated using intraclass correlation coefficient (ICC) and measurement error with the limits of agreement (LoA). Results Total score of the M-SFS was 54.4 (SD 16.4) and 56.1 (16.4) for test and retest, respectively. Item distribution showed no ceiling effects. Cronbach's alpha was 0.94 and 0.95 for test and retest, respectively. PCA showed the presence of four components explaining a total of 74% of the variance. Item communalities were >0.6 in 17 out of 20 items. ICC was 0.90, LoA was ±12.6/16.2 points. The correlations between the M-SFS were 0.89 with the original SFS, 0.49 with the Pain Disability Index, -0.37 and -0.33 with the Numeric Rating Scale for actual pain, -0.52 for selfreported disability due to chronic low back pain, and 0.50, 0.56-0.59 with three distinct lifting tests. No a priori defined hypothesis for construct validity was rejected. Conclusions The M-SFS allows reliable and valid assessment of perceived self-efficacy for work-related tasks and can be recommended for use in patients with chronic MSD. Further research should investigate the proposed M-SFS score of <56 for its predictive validity for non-return to work.

Functional Capacity Evaluation in Upper Limb Reduction Deficiency and Amputation: Development and Pilot Testing

Purpose To develop and pilot test a functional capacity evaluation (FCE) for individuals with upper limb absence (ULA) due to reduction deficiency or amputation, and to examine the relationship between FCE results and presence of musculoskeletal complaints (MSC). Method Five tests (overhead lifting, overhead working, repetitive reaching, fingertip dexterity, and handgrip strength) were selected and adapted if necessary. The newly developed FCE, called FCE-One-Handed (FCE-OH), was pilot tested in 20 adults individuals with ULA, and 20 matched controls. MSC were assessed via a questionnaire. Results Adaptations were considered necessary for all tests, except the handgrip strength test. The repetitive overhead lifting test of the non-affected limb was added. On the overhead lifting test, individuals with above-elbow ULA (ten males), performed similar to controls using one hand. When lifting bimanually using the prosthesis, a trend for lower lifting capacity of individuals with below-elbow ULA (seven males, three females) was observed compared to controls. On the overhead working test, individuals with above-elbow ULA performed worse compared to controls. Other tests showed no significant differences between groups. Relationships between FCE results and presence of MSC were non-significant. Conclusion The FCE-OH can be used to test functional capacity of one-handed individuals. Individuals with ULA generally showed similar functional capacity as two-handed individuals. FCE results were not related to MSC. It was discussed that a higher physical load on the non-affected limb might reflect a relative deficit of functional capacity.

Effectiveness and Cost-benefit Evaluation of a Comprehensive Workers' Health Surveillance Program for Sustainable Employability of Meat Processing Workers

Objective To evaluate the effectiveness of a comprehensive workers' health surveillance (WHS) program on aspects of sustainable employability and cost-benefit. Methods A cluster randomized stepped wedge trial was performed in a Dutch meat processing company from february 2012 until march 2015. In total 305 workers participated in the trial. Outcomes were retrieved during a WHS program, by multiple questionnaires, and from company registries. Primary outcomes were sickness absence, work ability, and productivity. Secondary outcomes were health, vitality, and psychosocial workload. Data were analyzed with linear and logistic multilevel models. Cost-benefit analyses from the employer's perspective were performed as well. Results Primary outcomes sickness absence (OR = 1.40), work ability (B = -0.63) and productivity (OR = 0.71) were better in the control condition. Secondary outcomes did not or minimally differ between conditions. Of the 12 secondary outcomes, the only outcome that scored better in the experimental condition was meaning of work (B = 0.18). Controlling for confounders did not or minimally change the results. However, our stepped wedge design did not enable adjustment for confounding in the last two periods of the trial. The WHS program resulted in higher costs for the employer on the short and middle term. Conclusions Primary outcomes did not improve after program implementation and secondary outcomes remained equal after implementation. The program was not cost-beneficial after 1-3 year follow-up. Main limitation that may have contributed to absence of positive effects may be program failure, because interventions were not deployed as intended.

Normative kinematics of reaching and dexterity tasks: moving towards a quantitative baseline for Functional Capacity Evaluations (FCEs)

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.

Process Evaluation of a Workers' Health Surveillance Program for Meat Processing Workers

Objective To evaluate the implementation process of a workers' health surveillance (WHS) program in a Dutch meat processing company. Methods Workers from five plants were eligible to participate in the WHS program. The program consisted of four evaluative components and an intervention component. Qualitative and quantitative methods were used to evaluate seven process aspects. Data were gathered by interviews with stakeholders, participant questionnaires, and from registries of the company and occupational health service. Results Two recruitment strategies were used: open invitation or automatic participation. Of the 986 eligible workers, 305 participated in the program. Average reach was 53 %. Two out of five program components could not be assessed on dose delivered, dose received and fidelity. If components were assessable, 85-100 % of the components was delivered, 66-100 % of the components was received by participants, and fidelity was 100 %. Participants were satisfied with the WHS program (mean score 7.6). Contextual factors that facilitated implementation were among others societal developments and management support. Factors that formed barriers were program novelty and delayed follow-up. Conclusion The WHS program was well received by participants. Not all participants were offered the same number of program components, and not all components were performed according to protocol. Deviation from protocol is an indication of program failure and may affect program effectiveness.

Physical Workload and Work Capacity across Occupational Groups

This study aimed to determine physical performance criteria of different occupational groups by investigating physical activity and energy expenditure in healthy Swiss employees in real-life workplaces on workdays and non-working days in relation to their aerobic capacity (VO_2max). In this cross-sectional study, 337 healthy and full-time employed adults were recruited. Participants were classified (nine categories) according to the International Standard Classification of Occupations 1988 and merged into three groups with low-, moderate- and high-intensity occupational activity. Daily steps, energy expenditure, metabolic equivalents and activity at different intensities were measured using the SenseWear Mini armband on seven consecutive days (23 hours/day). VO_2max was determined by the 20-meter shuttle run test. Data of 303 subjects were considered for analysis (63% male, mean age: 33 yrs, SD 12), 101 from the low-, 102 from the moderate- and 100 from the high-intensity group. At work, the high-intensity group showed higher energy expenditure, metabolic equivalents, steps and activity at all intensities than the other groups (p<0.001). There were no significant differences in physical activity between the occupational groups on non-working days. VO_2max did not differ across groups when stratified for gender. The upper workload limit was 21%, 29% and 44% of VO_2max in the low-, moderate- and high-intensity group, respectively. Men had a lower limit than women due to their higher VO_2max (26% vs. 37%), when all groups were combined. While this study did confirm that the average workload limit is one third of VO_2max, it showed that the average is misrepresenting the actual physical work demands of specific occupational groups, and that it does not account for gender-related differences in relative workload. Therefore, clinical practice needs to consider these differences with regard to a safe return to work, particularly for the high-intensity group.

Influence of Physical Therapists' Kinesiophobic Beliefs on Lifting Capacity in Healthy Adults

BACKGROUND

Physical therapists' recommendations to patients to avoid daily physical activity can be influenced by the therapists' kinesiophobic beliefs. Little is known about the amount of influence of a physical therapist's kinesiophobic beliefs on a patient's actual lifting capacity during a lifting test.

OBJECTIVE

The objective of this study was to determine the influence of physical therapists' kinesiophobic beliefs on lifting capacity in healthy people.

DESIGN

A blinded, cluster-randomized cross-sectional study was performed.

METHODS

The participants (n=256; 105 male, 151 female) were physical therapist students who performed a lifting capacity test. Examiners (n=24) were selected from second-year physical therapist students. Participants in group A (n=124) were tested in the presence of an examiner with high scores on the Tampa Scale of Kinesiophobia for health care providers (TSK-HC), and those in group B (n=132) were tested in the presence of an examiner with low scores on the TSK-HC. Mixed-model analyses were performed on lifting capacity to test for possible (interacting) effects.

RESULTS

Mean lifting capacity was 32.1 kg (SD=13.6) in group A and 39.6 kg (SD=16.4) in group B. Mixed-model analyses revealed that after controlling for sex, body weight, self-efficacy, and the interaction between the examiners' and participants' kinesiophobic beliefs, the influence of examiners' kinesiophobic beliefs significantly reduced lifting capacity by 14.4 kg in participants with kinesiophobic beliefs and 8.0 kg in those without kinesiophobic beliefs.

LIMITATIONS

Generalizability to physical therapists and patients with pain should be studied.

CONCLUSIONS

Physical therapists' kinesiophobic beliefs negatively influence lifting capacity of healthy adults. During everyday clinical practice, physical therapists should be aware of the influence of their kinesiophobic beliefs on patients' functional ability.

Construct Validity of Functional Capacity Evaluation in Patients with Whiplash-Associated Disorders

PURPOSE

The construct validity of functional capacity evaluations (FCE) in whiplash-associated disorders (WAD) is unknown. The aim of this study was to analyse the validity of FCE in patients with WAD with cultural differences within a workers' compensation setting.

METHODS

314 participants (42% females, mean age 36.7 years) with WAD (grade I and II) were referred for an interdisciplinary assessment that included FCE tests. Four FCE tests (hand grip strength, lifting waist to overhead, overhead working, and repetitive reaching) and a number of concurrent variables such as self-reported pain, capacity, disability, and psychological distress were measured. To test construct validity, 29 a priori formulated hypotheses were tested, 4 related to gender differences, 20 related associations with other constructs, 5 related to cultural differences.

RESULTS

Men had significantly more hand grip strength (+17.5 kg) and lifted more weight (+3.7 kg): two out of four gender-related hypotheses were confirmed. Correlation between FCE and pain ranged from -0.39 to 0.31; FCE and self-reported capacity from -0.42 to 0.61; FCE and disability from -0.45 to 0.34; FCE and anxiety from -0.36 to 0.27; and FCE and depression from -0.41 to 0.34: 16 of 20 hypotheses regarding FCE and other constructs were confirmed. FCE test results between the cultural groups differed significantly (4 hypotheses confirmed) and effect size (ES) between correlations were small (1 hypothesis confirmed). In total 23 out of 29 hypotheses were confirmed (79%).

CONCLUSIONS

The construct validity for testing functional capacity was confirmed for the majority of FCE tests in patients with WAD with cultural differences and in a workers' compensation setting. Additional validation studies in other settings are needed for verification.

Workers' Health Surveillance in the Meat Processing Industry: Work and Health Indicators Associated with Work Ability

BACKGROUND

Workers' health surveillance (WHS) programs commonly measure a large number of indicators addressing health habits and health risks. Recently, work ability and functional capacity have been included as important risk measures in WHS. In order to address work ability appropriately, knowledge of associations with work and health measures is necessary. The objective of this study was to evaluate which of the factors measured in a WHS are independently associated with work ability in a group of meat processing workers.

METHODS

A cross-sectional study was performed in a large meat processing company in The Netherlands. Data were collected during a WHS between February 2012 and March 2014. Personal characteristics, health habits and health-risk indicators, functional capacity, and work-related factors were measured. Work ability was measured with the Work Ability Index and was used as dependent variable. Univariable and multivariable logistic regression analyses were conducted, a receiver operating characteristic curve was constructed and the area under the curve (AUC) was calculated.

RESULTS

Data sets from 230 employees were used for analyses. The average age was 53 years and the average work ability index score was 39.3. In the final multivariable model age (OR 0.94), systolic blood pressure (OR 1.03), need for recovery (OR 0.56), and overhead work capacity (OR 3.95) contributed significantly. The AUC for this model was 0.81 (95% CI 0.75-0.86).

CONCLUSION

Findings from the current study indicate that multifactorial outcomes (age, systolic blood pressure, need for recovery, and overhead work capacity) from a WHS were independently associated with work ability. These factors can be used to assess employees at risk for low work ability and might provide directions for interventions.

Cost-effectiveness of 40-hour versus 100-hour vocational rehabilitation on work participation for workers on sick leave due to subacute or chronic musculoskeletal pain: study protocol for a randomized controlled trial

BACKGROUND

Although vocational rehabilitation is a widely advocated intervention for workers on sick leave due to subacute or chronic nonspecific musculoskeletal pain, the optimal dosage of effective and cost-effective vocational rehabilitation remains unknown. The objective of this paper is to describe the design of a non-inferiority trial evaluating the effectiveness and cost-effectiveness of 40-h multidisciplinary vocational rehabilitation compared with 100-h multidisciplinary vocational rehabilitation on work participation for workers on sick leave due to subacute or chronic musculoskeletal pain.

METHODS/DESIGN

A non-inferiority study design will be applied. The study population consists of workers who are on part-time or full-time sick leave due to subacute or chronic nonspecific musculoskeletal pain. Two multidisciplinary vocational rehabilitation programs following the bio-psychosocial approach will be evaluated in this study: 40-h vocational rehabilitation and 100-h vocational rehabilitation, both delivered over a maximum of 15 weeks. The 100-h vocational rehabilitation comprises five modules: work participation coordination, graded activity, cognitive behavioral therapy, group education, and relaxation. The 40-h vocational rehabilitation comprises work participation coordination and a well-reasoned choice from the other four modules. Four rehabilitation centers will participate in this study, each delivering both interventions. Patients will be randomized into one of the interventions, stratified for the duration of sick leave (<6 weeks or ≥ 6 weeks) and type of sick leave (part-time or full-time). The primary outcome is work participation, measured by self-reported sick leave days, and will be assessed at baseline, mid-term, discharge, and at 2, 4, 6, 8, 10, and 12 months follow-up. Secondary outcomes are work ability, disability, quality of life, and physical functioning and will be assessed at baseline, discharge, and at 6 and 12 months follow-up. Cost outcomes are absenteeism, presenteeism, healthcare usage, and travelling costs. Cost-effectiveness will be evaluated from the societal and employer perspectives.

DISCUSSION

The results obtained from this study will be useful for vocational rehabilitation practice and will provide stakeholders with relevant insights into two versions of vocational rehabilitation.

TRIAL REGISTRATION

Dutch Trial Register identifier: NTR4362 (registered 17 March 2014).

Functional Capacity Evaluation: Performance of Patients with Chronic Non-specific Low Back Pain Without Waddell Signs

PURPOSE

The primary objective of this study is to evaluate the effect of Waddell signs (WS) on Functional Capacity Evaluation (FCE) in patients with chronic non-specific low back pain (CNSLBP) undergoing fitness for work evaluation. If an effect is observed, the secondary objective is to report performance of patients without WS in a standardized 1 day FCE protocol.

METHODS

Survey of patients with CNSLBP as their primary complaint, referred for fitness for work evaluation, age between 20 and 60 years. Main outcome measures were WS and performance during manual handling assessed with lifting from floor to waist, waist to crown, horizontal and one handed carry; grip strength with Jamar hand held Dynamometer; ambulation with stair climbing and six minute walking test; work postures with elevated work, forward bend standing, kneeling, and sitting.

RESULTS

145 male with a mean age of 44.5 years (±10.1), and 53 females with a mean age of 43.6 years (±11.0) were included. Mean days off work were in male 658 (±1,056) and in female 642 (±886). 33% of all patients presented positive WS. FCE performance in male and female patients with positive and negative WS differed significantly in all comparisons except grip strength of the dominant hand and sitting in female. Performance of patients with negative WS indicated a mean physical capacity corresponding to lightmedium work in females and medium work in males for both age groups.

CONCLUSIONS

WS should be assessed for interpretation of FCE results. Despite long work absence, patients with CNSLBP with negative WS demonstrated a physical capacity corresponding to substantial physical work demands.

Comprehensive nutritional status in sarco-osteoporotic older fallers

OBJECTIVES

In older persons, the combination of osteoporosis and sarcopenia has been proposed as a subset of frailer individuals at higher risk of falls and fractures. However, the particular nutritional status of the sarco-osteoporotic (SOP) patients remains unknown. The goal of this study was to obtain a comprehensive picture of nutritional status in SOP patients.

DESIGN

Cross-sectional study.

SETTING

Falls and Fractures Clinic, Nepean Hospital (Penrith, Australia).

PARTICIPANTS

680 subjects (mean age=79, 65% female) assessed between 2008-2013.

MEASUREMENTS

Assessment included medical history, mini-nutritional assessment, physical examination, bone densitometry and body composition by DXA, and blood tests for nutritional status (albumin, creatinine, hemoglobin, vitamin D, vitamin B-12, calcium, phosphate and folate). Patients were divided in 4 groups: 1) osteopenia/osteoporosis (BMD<-1.0 SD); 2) sarcopenia; 3) SOP; and 4) normal (no sarcopenia/no osteoporosis). Difference between groups was assessed with one-way ANOVA and chi square analysis. Multivariable linear regression evaluated the association between the groups and measures of nutritional parameters.

RESULTS

Sarcopenia was present in 47.4% of those with osteopenia (167/352) and 62.7% in those with osteoporosis (91/145). Mean age of the SOP was 80.4±7 years. SOP patients showed significantly higher prevalence of falls and fractures. Univariate analyses showed that SOP were more likely than normal to have a BMI< 25 (OR 2.42 95%CI 1.45-4.041, p<0.001), a MNA score <12 (OR 2.0, 95%CI 1.15-3.49, p<0.05), serum folate <20 nmol/L (OR 4.0 95%CI 1.35-11.87, p<0.01) and hemoglobin <120g/L (OR 2.0 95%CI 1.28-3.30, p<0.01). Multivariate analysis showed that a MNA score <12 was independently associated with SOP compared to normal when adjusted for age and gender. Hemoglobin <120g/L, BMI <25, and GDS >6 remained independently associated with SOP after adjustment for all variables including inflammatory conditions. Hypoalbuminemia (<35 g/L) was associated with just osteopenia/osteoporosis (OR: 2.03, 95%CI 1.08-3.81, p<0.01) and just sarcopenia (OR: 1.77, 95%CI 1.0-3.0, p<0.01) compared to normal. No differences in vitamin D, glomerular filtration rate, albumin, corrected calcium, phosphate, red blood cells folate or vitamin B12 levels were found between the subgroups.

CONCLUSIONS

In approaching SOP patients, early prevention protocols directed to optimize their nutritional status would be a key strategy to prevent poor outcomes such as falls and fractures in this high risk population. Therefore, nutritional assessment and early nutritional supplementation should be essential domains in this strategy.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Relationship between self-reported disability and functional capacity in patients with whiplash associated disorder

PURPOSE

Patients with chronic Whiplash Associated Disorders (WAD) report symptoms and disability. Neither the relationship between self-reported disability and functional capacity, nor its predictors have been investigated in patients with WAD. This was the purpose of this study.

METHOD

This was a cross-sectional study. Participants were patients with WAD on sick leave. Self-reported disability was assessed with the Neck Disability Index (NDI). Functional capacity was assessed with a six-item neck functional capacity evaluation (FCE). Correlation coefficients were used to express the relationship between NDI (total and items) and FCE. Multivariate linear regression analyses were performed to identify independent predictors of NDI and FCE.

RESULTS

Forty patients were measured, of whom 18 (45 %) were male. Mean age was 33 years, median duration of complaints was 12 months, and 75 % had a pending insurance claim. Correlations between NDI and FCE tests varied from -0.39 to -0.70. Independent predictors of NDI were pain intensity and a pending claim, explaining 43 % of the variance. independent predictors of fce were ndi, gender, and pain intensity, explaining 20-55 % of the variance.

CONCLUSIONS

Self-reported disability and functional capacity are related but different. Both can part be predicted by pain intensity. A pending claim can predict higher self-reported disability. Both constructs are complementary and are recommended to determine disability in patients with WAD comprehensively.

Work Rehabilitation Questionnaire (WORQ): development and preliminary psychometric evidence of an ICF-based questionnaire for vocational rehabilitation

PURPOSE

The International Classification of Functioning, Disability and Health (ICF) has proven to be a valuable framework for vocational rehabilitation (VR). No reliable and valid ICF-based instruments to capture work functioning is known, hence, the aims of this study were: (1) to outline the process for developing an ICF-based questionnaire, the Work Rehabilitation Questionnaire (WORQ) to assess functioning in VR and (2) to report preliminary psychometric evidence.

METHODS

ICF categories were selected from the ICF Core Sets for VR using explorative Rasch-analysis and VR literature review. Questions were worded to assess identified ICF categories. WORQ was translated from English to German. Psychometrics for the German version of WORQ was examined in one VR centre in Switzerland.

RESULTS

44 ICF categories were selected which resulted in 36 questions related to functioning. The psychometric evaluation of WORQ showed high test-retest reliability (Spearman correlation 0.79) (n = 53) and good internal consistency (Cronbachs Alpha 0.88) (n = 74) WORQ showed moderate correlation with Beck Depression Inventory II (Spearman correlation 0.511) and low correlation (Spearman correlation -0.353) with SF-36.

CONCLUSIONS

WORQ appears to be a reliable, ICF-based questionnaire to evaluate functioning in VR, easy to administer by health or vocational professionals. The additional information gained when using WORQ would contribute to improving interdisciplinary understanding of the patient's situation and therefore support the integrative planning of the return-to-work process or engagement in gainful employment. However, further studies are needed to further examine its use in clinical practice and research, when validated in other patient populations and settings.

Towards comprehensive and transparent reporting: context-specific additions to the ICF taxonomy for medical evaluations of work capacity involving claimants with chronic widespread pain and low back pain

Background

Medical evaluations of work capacity provide key information for decisions on a claimant’s eligibility for disability benefits. In recent years, the evaluations have been increasingly criticized for low transparency and poor standardization. The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive spectrum of categories for reporting functioning and its determinants in terms of impairments and contextual factors and could facilitate transparent and standardized documentation of medical evaluations of work capacity. However, the comprehensiveness of the ICF taxonomy in this particular context has not been empirically examined. In this study, we wanted to identify potential context-specific additions to the ICF for its application in medical evaluations of work capacity involving chronic widespread pain (CWP) and low back pain (LBP).

Methods

A retrospective content analysis of Swiss medical reports was conducted by using the ICF for data coding. Concepts not appropriately classifiable with ICF categories were labeled as specification categories (i.e. context-specific additions) and were assigned to predefined specification areas (i.e. precision, coverage, personal factors, and broad concepts). Relevant specification categories for medical evaluations of work capacity involving CWP and LBP were determined by calculating their relative frequency across reports and setting a relevance threshold.

Results

Forty-three specification categories for CWP and fifty-two for LBP reports passed the threshold. In both groups of reports, precision was the most frequent specification area, followed by personal factors.

Conclusions

The ICF taxonomy represents a universally applicable standard for reporting health and functioning information. However, when applying the ICF for comprehensive and transparent reporting in medical evaluations of work capacity involving CWP and LBP context-specific additions are needed. This is particularly true for the documentation of specific pain-related issues, work activities and personal factors. To ensure the practicability of the multidisciplinary evaluation process, the large number of ICF categories and context-specific additions necessary for comprehensive documentation could be specifically allocated to the disciplines in charge of their assessment.

Matching physical work demands with functional capacity in healthy workers: can it be more efficient?

OBJECTIVES

To determine if functional capacity (FC) and physical work demands can be matched and to determine the validity of normative values for FC related to physical work demands as a screening instrument for work ability.

METHODS

Forty healthy working subjects were included in this study. Subjects were categorized into four physical work demand categories (sedentary, light, moderate and heavy). FC was tested with a standardized Functional Capacity Evaluation (FCE) following the WorkWell Protocol and physical work demands were determined with an onsite Work Load Assessment (WLA) according to the Task Recording and Analyses on Computer (TRAC) method. Physical work demands were compared to FC and normative values derived from previous research.

RESULTS

88% of the subjects scored higher on FCE than observed during WLA. The tenth percentile of normative values appeared valid in 98% for sedentary/light work for the subjects tested in this study. For moderate or heavy work, the thirtieth percentile of normative values appeared valid in 78% of all cases.

CONCLUSION

Functional capacity and physical work demands can be matched in most instances, but exceptions should be kept in mind with regards to professions classified as moderate or heavy physical work, especially concerning lifting high. Normative values may be considered as an additional screening tool for balancing workload and capacity. It is recommended to further validate normative values in a broader and more extensive working population.

Towards a comprehensive Functional Capacity Evaluation for hand function

The aim of this study was to develop a more efficient (i.e. shortened) protocol for hand function capacity evaluation and to test the agreement of the protocol compared to the original protocol. 643 Healthy subjects performed tests for hand function. Agreement between two shortened protocols was compared with an existing protocol. The original protocol was performed once and the proposed shortened protocol differed in the number of trials which were reduced by statistical elimination. Agreement was determined with Intraclass Correlation Coefficients (ICC) and Limits of Agreement (LoA). Excellent ICCs (≥0.91) were observed in all proposed protocols except for the one trial purdue pegboard test protocol. For all tests of hand function, shorter protocols are valid to determine hand function. For Tip Pinch Strength testing, Palmar Pinch Strength testing and the Purdue Pegboard test, a two-trial protocol is recommended, because the LoA were considerable, which could affect decision-making with regards to hand capacity. For the Hand Grip strength test, the Key Pinch Strength test and the Complete Minnesota Dexterity Test, a one-trial protocol is recommended, because the LoA were acceptable. It was concluded that for healthy subjects, this shorter protocol is a reliable measure. Further testing of the short form hand FCE protocols should be completed on patients with disabling conditions prior to widespread use of these protocols among clinical samples.

Disability evaluation, social security, and the international classification of functioning, disability and health: the time is now

OBJECTIVE

To present the International Classification of Functioning, Disability and Health (ICF) as a standard in disability evaluation and to discuss the usefulness and challenges of the ICF when applied in disability evaluation.

CONCLUSIONS

Disability evaluation can be described and measured using the ICF and ICF-related tools such as the Generic Set, ICF Core Sets specific to health conditions or settings, and measurement instruments that have been linked to the ICF. Wide implementation of the ICF in disability evaluation, specifically in work disability and social security, is needed along with education on the ICF of those in occupational medicine, work rehabilitation, disability adjudication, policy and legislation, and government agencies. The ICF can be used to provide disability criteria in determining functional and work capacity and as a reference framework and a language of disability to help facilitate a common ground of understanding.

Towards an ICF- and IMMPACT-based pain vocational rehabilitation core set in the Netherlands

BACKGROUND

For clinical use and research of pain within the context of vocational rehabilitation, a specific core set of measurements is needed. The recommendations of the International Classification of Functioning, Disability and Health (ICF) brief Core Set for Vocational Rehabilitation (VR) and those of Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) cover two broad areas. These two sources can be integrated when made applicable to vocational rehabilitation and pain. Objective To develop a core set of diagnostic and evaluative measures specifically for vocational rehabilitation of patients with subacute and chronic musculoskeletal pain, while using the brief ICF core set for VR as the reference framework in VR, and the IMMPACT recommendations in the outcome measurements around pain.

METHODS

Three main steps were taken. The first step was to remove irrelevant and duplicate domains of the brief ICF Core Set for Vocational Rehabilitation and the IMMPACT recommendations around pain. The second step was to match the remaining domains with existing instruments or measures. Instruments were proposed based on availability and its proven use in Dutch practice and based on proof of sufficient clinimetric properties. In step 3, the preliminary VR-Pain core set was presented to 3 expert panels: proposed users, Dutch pain rehabilitation experts, and international VR experts.

RESULTS

Experts agreed with the majority of the proposed domains and instruments. The final VR-Pain Core Set consists of 18 domains measured with 12 instruments. All instruments possessed basic clinimetric properties.

CONCLUSION

An agreed-upon VR-Pain Core Set with content that covers relevant domains for pain and VR and validated instruments measuring these domains has been developed. The VR-Pain Core Set may be used for regular clinical purposes and research in the field of vocational rehabilitation and pain, but adaptations should be considered for use outside the Netherlands.

Construct validity of functional capacity tests in healthy workers

BACKGROUND

Functional Capacity (FC) is a multidimensional construct within the activity domain of the International Classification of Functioning, Disability and Health framework (ICF). Functional capacity evaluations (FCEs) are assessments of work-related FC. The extent to which these work-related FC tests are associated to bio-, psycho-, or social factors is unknown. The aims of this study were to test relationships between FC tests and other ICF factors in a sample of healthy workers, and to determine the amount of statistical variance in FC tests that can be explained by these factors.

METHODS

A cross sectional study. The sample was comprised of 403 healthy workers who completed material handling FC tests (lifting low, overhead lifting, and carrying) and static work FC tests (overhead working and standing forward bend). The explainable variables were; six muscle strength tests; aerobic capacity test; and questionnaires regarding personal factors (age, gender, body height, body weight, and education), psychological factors (mental health, vitality, and general health perceptions), and social factors (perception of work, physical workloads, sport-, leisure time-, and work-index). A priori construct validity hypotheses were formulated and analyzed by means of correlation coefficients and regression analyses.

RESULTS

Moderate correlations were detected between material handling FC tests and muscle strength, gender, body weight, and body height. As for static work FC tests; overhead working correlated fair with aerobic capacity and handgrip strength, and low with the sport-index and perception of work. For standing forward bend FC test, all hypotheses were rejected. The regression model revealed that 61% to 62% of material handling FC tests were explained by physical factors. Five to 15% of static work FC tests were explained by physical and social factors.

CONCLUSIONS

The current study revealed that, in a sample of healthy workers, material handling FC tests were related to physical factors but not to the psychosocial factors measured in this study. The construct of static work FC tests remained largely unexplained.

Self-reported work ability and work performance in workers with chronic nonspecific musculoskeletal pain

PURPOSE

To assess self-reported work ability and work performance of workers who stay at work despite chronic nonspecific musculoskeletal pain (CMP), and to explore which variables were associated with these outcomes.

METHODS

In a cross-sectional study we assessed work ability (Work Ability Index, single item scale 0-10) and work performance (Health and Work Performance Questionnaire, scale 0-10) among 119 workers who continued work while having CMP. Scores of work ability and work performance were categorized into excellent (10), good (9), moderate (8) and poor (0-7). Hierarchical multiple regression and logistic regression analysis was used to analyze the relation of socio-demographic, pain-related, personal- and work-related variables with work ability and work performance.

RESULTS

Mean work ability and work performance were 7.1 and 7.7 (poor to moderate). Hierarchical multiple regression analysis revealed that higher work ability scores were associated with lower age, better general health perception, and higher pain self-efficacy beliefs (R(2) = 42 %). Higher work performance was associated with lower age, higher pain self-efficacy beliefs, lower physical work demand category and part-time work (R(2) = 37 %). Logistic regression analysis revealed that work ability ≥8 was significantly explained by age (OR = 0.90), general health perception (OR = 1.04) and pain self-efficacy (OR = 1.15). Work performance ≥8 was explained by pain self-efficacy (OR = 1.11).

CONCLUSIONS

Many workers with CMP who stay at work report poor to moderate work ability and work performance. Our findings suggest that a subgroup of workers with CMP can stay at work with high work ability and performance, especially when they have high beliefs of pain self-efficacy. Our results further show that not the pain itself, but personal and work-related factors relate to work ability and work performance.

Effects of balance training using a virtual-reality system in older fallers

Poor balance is considered a challenging risk factor for falls in older adults. Therefore, innovative interventions for balance improvement in this population are greatly needed. The aim of this study was to evaluate the effect of a new virtual-reality system (the Balance Rehabilitation Unit [BRU]) on balance, falls, and fear of falling in a population of community-dwelling older subjects with a known history of falls. In this study, 60 community-dwelling older subjects were recruited after being diagnosed with poor balance at the Falls and Fractures Clinic, Nepean Hospital (Penrith, NSW, Australia). Subjects were randomly assigned to either the BRU-training or control groups. Both groups received the usual falls prevention care. The BRU-training group attended balance training (two sessions/week for 6 weeks) using an established protocol. Change in balance parameters was assessed in the BRU-training group at the end of their 6-week training program. Both groups were assessed 9 months after their initial assessment (month 0). Adherence to the BRU-training program was 97%. Balance parameters were significantly improved in the BRU-training group (P < 0.01). This effect was also associated with a significant reduction in falls and lower levels of fear of falling (P < 0.01). Some components of balance that were improved by BRU training showed a decline after 9 months post-training. In conclusion, BRU training is an effective and well-accepted intervention to improve balance, increase confidence, and prevent falls in the elderly.