Assessing work speed using MODAPTS: A tool for occupational therapists

BACKGROUND

The importance to be able to work is recognised as one of the United Nation's Sustainable Development Goals. Occupational therapists working in vocational rehabilitation require cost effective, valid, and reliable tests that offer flexibility during the work evaluation process. The use of self-developed work samples standardized using Modular Arrangement of Predetermined Time Standards (MODAPTS) as an objective measure of work speed could meet this need.

OBJECTIVE

Evaluate the face, content, and criterion validity of MODAPTS work samples to assess work speed.

METHODS

We conducted a quantitative cross-sectional, descriptive study. Occupational therapists completed electronic surveys to evaluate face and content validity. We evaluated criterion validity during a multiphase process that involved a realist synthesis, online survey, and comparing MODAPTS to Methods Time Management (MTM) time standards using three work samples that measured work speed.

RESULTS

MODAPTS had good face validity for measuring work speed. We also confirmed the content and criterion validity of codes used to analyse basic movement and handling of smaller and larger articles as well as other body actions.

CONCLUSION

MODAPTS demonstrated adequate face, content and criterion validity of tasks involving basic movements, handling of articles and other body actions.

Workplace-based rehabilitation with garment workers: A multiple case study

BACKGROUND: Garment workers are at risk of developing work-related upper limb disorders (WRULD) due to the highly repetitive nature of their work. Workplace-based rehabilitation (WBR) facilitates improvement in work performance by providing intervention at the worker’s place of work. OBJECTIVE: This study aims to determine the documented outcomes of workplace-based occupational therapy rehabilitation of garment workers with upper limb conditions. METHODS: A multiple case study design was used through a retrospective record review. All garment workers with upper limb conditions who were treated at a student occupational therapy practice in Cape Town, South Africa, with pre- and post-intervention outcome assessment, were included in the study (n = 7). Data were extracted from occupational therapy and medical files. RESULTS: 70% of the cases (n = 5) improved after WBR while 30% of cases showed no improvement or deterioration. Participants received 3– 5 individual WBR sessions of approximately 30 minutes each, over a period of 4 to 6 weeks. Interventions included workstation adaptations, job rotation, psychoeducation, work task modification, assistive technology and exercise programmes. Outcome measures most commonly used were the RULA, DASH, Boston Carpal Tunnel Questionnaire and pain intensity using the VAS. CONCLUSION: Workplace-based occupational therapy can be effective at improving upper limb function, pain and ergonomic risk amongst garment workers with upper limb conditions.

Overactivity assessment in chronic pain: The development and psychometric evaluation of a multifaceted self-report assessment

Background

Overactivity in the context of chronic pain (i.e. activity engagement that significantly exacerbates pain) is an important clinical issue that has gained empirical attention in the last decade. Current assessment concepts of overactivity tend to focus on frequency to quantify the severity of the pain behaviour. This study aimed to develop and validate a more comprehensive self‐assessment, the Overactivity in Persistent Pain Assessment (OPPA).

Methods

A sample of 333 individuals with chronic pain completed the OPPA. A subset of 202 individuals also completed a set of existing measures of pain‐related outcomes and activity patterns. The remaining 131 participants were provided with a second copy of the OPPA to fill in one week following their initial assessment.

Results

A principal component analysis confirmed that the OPPA items were best represented by a single construct. The OPPA was found to correlate with pain‐related measures in an expected way that is supported by both theory and qualitative data. When compared to existing overactivity measures, the OPPA was the only measure to contribute significantly to the regression models predicting higher levels of pain severity, more pain interference and lower levels of activity participation after controlling for age, gender and activity avoidance. In addition, the OPPA scale exhibited acceptable internal consistency and good test–retest reliability.

Conclusion

The results of this study reinforce the potentially important role of overactivity in the maintenance of pain‐related suffering and supports a corresponding assessment tool with preliminary psychometric evidence for clinical and research applications.

Significance

This study deconstructs the overactivity concept and develop a corresponding assessment based on five quantifiable severity features: severity of pain exacerbation, maladaptive coping strategies used, impact on occupational performance, recovery time and frequency. Results of the psychometric evaluation indicate that this comprehensive assessment of overactivity severity features may be necessary to understand the impact of overactivity on pain severity and physical functioning from both a clinical and research perspective.

Do wearable fitness devices correlate with performance-based tests of work-related functional capacity?

BACKGROUND

The use of wearable accelerometers in conjunction with Functional Capacity Evaluation (FCE) may provide additional useful information about maximum performance in workers and enhance the validity of functional testing. However, little research has been conducted to compare accelerometer output with performance during FCE.

OBJECTIVE

The objectives of this study were to: (1) Determine the magnitude and direction of correlation between participant performance on five FCE tasks and scores from Actigraph activity monitors; and (2) Compare the results of two different placements of Actigraph devices.

METHOD

We used a cross-sectional design and convenience sampling to collect data from 46 healthy participants. Each participant completed 5 functional tasks selected from the WorkWell FCE protocol while wearing 2 Actigraph devices, 1 on the dominant side waist and 1 on the non-dominant wrist. The FCE tasks included 5-repetition maximum lifting (floor-to-waist, waist to crown and front carry), a sustained overhead work endurance task, and the 6-minute walk test. Analysis included calculating Pearson regression coefficients between maximum FCE item performance and Actigraph vector magnitudes (VM) along with Intraclass Correlation Coefficients (ICC) to compare VM activity counts derived from the Actigraphs on the waist and wrist.

RESULTS

Thirty-Nine (84.8%) participants had complete data and were included in analysis. Findings indicate Actigraph VM data from the device worn on the waist correlated positively with maximum lift performance (r = 0.39-0.64, p < 0.001 to 0.08) and 6-minute walk distance (r = 0.66, p < 0.001). Actigraph data from wrist placement were not significantly correlated with FCE performance on any of the functional tasks, except when comparing average VM data and waist to crown lift (r = 0.44, p < 0.001). There was no significant correlation in either Actigraph placement for VM and overhead work time. ICCs between the two Actigraph placements ranged from poor to acceptable agreement (ICC = 0.24-0.70, p < 0.001 to 0.19).

CONCLUSIONS

Actigraph device output correlated moderately with maximum performance on FCE lift and ambulation tests. Waist placement appears more suitable than wrist during performance-based tests.

Outcomes of an interdisciplinary work rehabilitation program

BACKGROUND:

Work rehabilitation programs were developed to help workers with an injury return to work (RTW). While studies have examined intervention characteristics, prognostic factors, and disability level, there is little or no research examining interdisciplinary interventions, lifting capacity/strength and the level of a patient’s RTW status (e.g., not working, new job, or ongoing restrictions) at the time of discharge.

OBJECTIVE:

To evaluate outcomes (RTW status and lifting capacity/strength changes) of an interdisciplinary work rehabilitation program and examine whether time off work prior to the program and type of injury were related to RTW status and strength changes.

METHODS:

A retrospective database analysis was conducted with a sample of 495 participants (M_age = 44.44 years, SD = 10.13) of which 375 (76%) were male. Participants were workers with injuries who participated in an interdisciplinary work rehabilitation program from 2006 to 2010.

RESULTS:

A significantly higher number of participants were working at the end of the program than at the beginning (83.9% vs. 31.6%, p < 0.0001). Mean strength was higher at the time of discharge compared to at admission (p < 0.0001). The participants that did not RTW had had significantly more days off work prior to the program (U = 11757, z = –3.152, p = 0.002). The type of injury was not related to strength at the time of discharge.

CONCLUSIONS:

Findings suggest the interdisciplinary program is associated with positive outcomes and early intervention may be an important factor when treating patients with work-related injuries.

The Importance of Job Analysis in Occupational Therapy

Occupational therapists can play a major role in the work rehabilitation process through the assessment and rehabilitation of clients for a return to work (Gibson and Strong 2003). The challenge facing the occupational therapist is identifying if the client's current functional abilities are a suitable match for the demands of the job. Ideally, the occupational therapist should assess the demands of the job that the client is required to perform as well as completing an assessment of the client's work abilities. The purpose of this opinion piece is to highlight to occupational therapists the importance of job analysis in all specialties within vocational rehabilitation and to illustrate the process used by the occupational therapists in the Occupational Health and Safety Advisory Service.

A Survey of Occupational Therapists in Canada about Their Knowledge and Use of the ICF

Background. The current impact of the International Classification of Functioning, Disability and Health (ICF) on the field of occupational therapy within Canada is unknown. Purpose. To survey occupational therapists in Canada about their knowledge, use of, and suggestions for education about the ICF. Method. Mixed methods design included (i) an online survey, with data analyzed using quantitative methods; and (ii) semi-structured interviews with a purposeful sample of 10 therapists, using content analysis. Results. The online survey was completed by 587 occupational therapists (17.6% return). Four hundred and ten respondents (70.0%) indicated some ICF knowledge, and 121 of those individuals (29.5%) reported using it in practice. Interview participants suggested resources, perceived meaning and investment factors impact ICF knowledge. Suggested uses include frameworks and interprofessional collaboration, while ideas for education involve meaningful and accessible formats. Practice Implications. The ICF may be useful to occupational therapists in different settings if it fulfills a meaningful purpose and fits with practice models.

Interest of the Ergo-Kit(®) for the clinical practice of the occupational physician. A study of 149 patients recruited in a rehabilitation program

OBJECTIVE

Functional capacity evaluation is commonly used to assess the abilities of patients to perform some tasks. Ergo-Kit(®) is a validated tool assessing both functional capacities of patients and workplace demands. The objective of this study was to evaluate the relevance of the Ergo-Kit(®) data for occupational physicians during the return-to-work process.

METHODS

A retrospective and monocenter study was conducted on all patients included in a rehabilitation program and assessed with the Ergo-Kit(®) tool between 2005 and 2014. Workplace demands and patients' functional capacities were evaluated and confronted. Self-beliefs and perceived disability were also assessed and compared to the functional capacity evaluation.

RESULTS

One hundred and forty-nine working-age patients (85 men, 64 women; 39±12 years) suffering from musculoskeletal disorders or other diseases were included. Main causes of mismatch between workplace demands and functional capacities were manual handling of loads, postures with arms away from the body and repetitive motions at work; sitting posture was correlated with a lesser physical workload; and Oswestry score was correlated with functional capacities evaluated by the Ergo-Kit(®).

CONCLUSION

Ergo-Kit(®) is a relevant tool to assess the multidimensional aspects of workplace demands and functional capacities. It could be very helpful for occupational physicians to manage return-to-work.

Occupational therapy and return to work: a systematic literature review

Background

The primary aim of this review study was to gather evidence on the effectiveness in terms of return to work (RTW) of occupational therapy interventions (OTIs) in rehabilitation patients with non-congenital disorders. A secondary aim was to be able to select the most efficient OTI.

Methods

A systematic literature review of peer-reviewed papers was conducted using electronic databases (Cinahl, Cochrane Library, Ebsco, Medline (Pubmed), and PsycInfo). The search focussed on randomised controlled trials and cohort studies published in English from 1980 until September 2010. Scientific validity of the studies was assessed.

Results

Starting from 1532 papers with pertinent titles, six studies met the quality criteria. Results show systematic reviewing of OTIs on RTW was challenging due to varying populations, different outcome measures, and poor descriptions of methodology. There is evidence that OTIs as part of rehabilitation programs, increase RTW rates, although the methodological evidence of most studies is weak.

Conclusions

Analysis of the selected papers indicated that OTIs positively influence RTW; two studies described precisely what the content of their OTI was. In order to identify the added value of OTIs on RTW, studies with well-defined OT intervention protocols are necessary.

Use of Job-Specific Functional Capacity Evaluation to Predict the Return to Work of Patients With a Distal Radius Fracture

OBJECTIVE. We examined the predictive validity of a job-specific functional capacity evaluation (FCE) in relation to the return to work of patients with a distal radius fracture.

METHOD. Return-to-work recommendations for 194 participants with a distal radius fracture were based on FCE performance. Three months after the evaluation, participants were contacted to ascertain their employment status to examine the predictive validity of each FCE-based rating.

RESULTS. The recommendation return to previous job (94.83%) was correct more often than the recommendations do not work at the moment (60.47%), change job (52.63%), and return to previous job with modifications (9.38%). A longer period from injury to FCE and compensable injury reduces the predictive ability of job-specific FCE.

CONCLUSION. Job-specific FCE shows a better predictive validity in relation to the return to work of patients with a specific injury, such as a distal radius fracture, than of patients with a nonspecific injury.

Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation

PURPOSE

To present a systematic literature review on the state of the art of the utilisation of the International Classification of Functioning, Disability and Health (ICF) since its release in 2001.

METHOD

The search was conducted through EMBASE, MEDLINE and PsychInfo covering the period between 2001 and December 2009. Papers were included if ICF was mentioned in title or abstract. Papers focussing on the ICF-CY and clinical research on children and youth only were excluded. Papers were assigned to six different groups covering the wide scenario of ICF application.

RESULTS

A total of 672 papers, coming from 34 countries and 211 different journals, were included in the analysis. The majority of publications (30.8%) were conceptual papers or papers reporting clinical and rehabilitation studies (25.9%). One-third of the papers were published in 2008 and 2009.

CONCLUSIONS

The ICF contributed to the development of research on functioning and on disability in clinical, rehabilitation as well as in several other contexts, such as disability eligibility and employment. Diffusion of ICF research and use in a great variety of fields and scientific journals is a proof that a cultural change and a new conceptualisation of functioning and disability is happening.

Test-Retest Reliability of the GAPP Functional Capacity Evaluation in Healthy Adults

Background. Functional capacity evaluations are commonly used in work rehabilitation practice to assess a person's capacity to perform work-related activities. Purpose. This study examined the test-retest reliability of participants' performance and administrator ratings using the Gibson Approach to Functional Capacity Evaluation (GAPP FCE). Methods. Forty-eight healthy adults were evaluated twice on 12 recommended core items of the GAPP FCE and rated for overall performance. Findings. The ICCs and 95% CIs for the Physical Level of Work and Alternative Physical Level of Work Ratings were 0.93 (0.87-0.96) and 0.86 (0.72-0.93) respectively. The ICCs for the core item-level ratings ranged from 0.15 to 0.94, and the ICCs for the actual loads handled in the manual handling items ranged from 0.88 to 0.95. Implications. The stability of an overall physical level of work rating shows potential for use in functional capacity evaluation practice and research. Further research is needed to investigate other measurement properties of the GAPP FCE using populations with injury or disability.

Towards consensus in operational definitions in functional capacity evaluation: a Delphi Survey

INTRODUCTION

The problem of inconsistent terminology in functional capacity evaluation (FCE) has been widely addressed in the international literature. Many different terms seem to be used interchangeably while other terms appear to be interpreted differently. This may seriously hinder FCE research and clinical use. To gain consensus in operational definitions in FCE and conceptual framework to classify terminology used in FCE.

METHODS

A Delphi Survey with FCE experts was conducted which consisted of three rounds of questioning, using semi and full structured questions. The expert group was formed from international experts in FCE. Experts were selected if they met any of the following criteria: at least one international publication as first author and one as co-author in the field of FCE; or an individual who had developed an FCE that was subject of investigation in at least one publication in international literature. Consensus of definitions was considered when 75% or more of all experts agreed with a definition.

RESULTS

In total, 22 international experts from 6 different countries in Australia, Europe and North America, working in different health related sectors, participated in this study.

CONCLUSION

Consensus concerning conceptual framework of FCE was met in 9 out of 20 statements. Consensus on definitions was met in 10 out of 19 definitions. Experts agreed to use the ICF as a conceptual framework in which terminology of FCE should be classified and agreed to use pre-defined terms of the ICF. No consensus was reached about the definition of FCE, for which two potential eligible definitions remained. Consensus was reached in many terms used in FCE. For future research, it was recommended that researchers use these terms, use the ICF as a conceptual framework and clearly state which definition for FCE is used because no definition of FCE was consented.

Occupational Therapy in Occupational Health: Factors Influencing Referral

The early management of ill or injured workers, including occupational therapy, could help to reduce the costs and minimise the negative consequences of sickness absence. In an occupational health service that employed an occupational therapist, 37% (92) of the workers referred to occupational therapy over a 3-year period had been absent for more than 6 months. The occupational therapist was keen to examine the reasons that employees were not referred earlier and a questionnaire was sent to the human resource advisers who contracted with this service. The results of this small-scale survey suggest that referrals are delayed by several factors, including poor awareness of the skills of occupational therapists, poor awareness of the effectiveness and cost-effectiveness of therapy and confusion over the different skills that occupational health professionals have.

Functional capacity evaluation as a performance measure: evidence for a new approach for clients with chronic back pain

OBJECTIVES

To report the research and development of a new approach to Functional Capacity Evaluation, the Gibson Approach to Functional Capacity Evaluation (GAPP FCE) for chronic back pain clients.

METHODS

Four studies, including pilot and feasibility testing, expert review, and preliminary interrater reliability examination, are described here. Participants included 7 healthy young adults and 19 rehabilitation clients with back pain who underwent assessment using the GAPP FCE. Thirteen therapists were trained in the approach and were silently observed administering the Functional Capacity Evaluations by at least 1 other trained therapists or the first investigator or both. An expert review using 5 expert occupational therapists was also conducted.

RESULTS

Study 1, the pilot with healthy individuals, indicated that the GAPP FCE was a feasible approach with good utility. Study 2, a pilot using 2 trained therapists assessing 5 back pain clients, supported the clinical feasibility of the approach. The expert review in Study 3 found support for GAPP FCE. Study 4, a trial of the approach with 14 rehabilitation clients, found support for the interrater reliability of recommendations for return to work based on performance in the GAPP FCE.

DISCUSSION

The evidence thus far available supports the GAPP FCE as an approach that provides a sound method for evaluating the performance of the physical demands of work with clients with chronic back pain. The tool has been shown to have good face and content validity, to meet acceptable test standards, and to have reasonable interrater reliability. Further research is occurring to look at a larger interrater reliability study, to further examine content validity, and to examine predictive validity.