Journal of occupational rehabilitation
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Although safety is recognized as a critical issue in functional capacity evaluations (FCEs), it has rarely been investigated. This paper reports on the findings of a study which examined safety aspects of a new approach to FCE. ⋯ Support was found for the screening procedures of the approach, particularly blood pressure measurement, and for the combined approach to monitoring of the person's performance from biomechanical, physiological and psychophysical perspectives. Issues for FCE safety in general are identified and discussed, including the importance of screening procedures to determine readiness for FCEs and the issue of load handling in FCEs, especially in relation to clients with chronic back pain.
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Comparative Study
Test-retest reliability of the Isernhagen Work Systems Functional Capacity Evaluation in patients with chronic low back pain.
The aim of this study was to investigate test-retest reliability of the Isernhagen Work System Functional Capacity Evaluation (IWS FCE) in a sample of patients (n = 30) suffering from Chronic Low Back Pain (CLBP) and selected for rehabilitation treatment. The IWS FCE consists of 28 tests that reflect work-related activities like lifting, carrying, bending, etc. In this study, a slightly modified IWS FCE was used. ⋯ Tests of the IWC FCE were divided into tests with and tests without an acceptable test-retest reliability on the basis of the kappa values, the percentage of absolute agreement and the ICC values. Fifteen tests (79%) showed an acceptable test-retest reliability based on Kappa values and percentage of absolute agreement. Eleven tests (61%) showed an acceptable test-retest reliability based on ICC values.
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The extent to which baseline psychological measures, pain, and compensation status are related to admission and posttreatment functional capacity and employment outcome was investigated. Four pass/fail functional capacity tests based on the DOT (Dictionary of Occupational Titles) classification system and previously shown to be predictive of treatment outcome in chronic pain patients were analyzed in relation to baseline measures of depression, state and trait anxiety, and perceived stress. Statistical tests of all measures with employment level at admission to treatment, 1 month follow-up and at long-term follow-up were also performed. ⋯ In conclusion, these results suggest that psychological variables are related to measures of functional capacity measured at admission. However, psychological measures at admission are not good predictors of later functional capacity measures. Functional capacity measures are important predictors of follow-up employment outcome, but return to work cannot be predicted without taking pain into account.
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Randomized Controlled Trial Clinical Trial
Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study.
In an attempt to prevent acute low-back pain from becoming a chronic disability problem, an earlier study developed a statistical algorithm which accurately identified those acute low-back pain patients who were at high risk for developing such chronicity. The major goal of the present study was to evaluate the clinical effectiveness of employing an early intervention program with these high-risk patients in order to prevent the development of chronic disability at a 1-year follow-up. Approximately 700 acute low-back pain patients were screened for their high-risk versus low-risk status. ⋯ Cost-comparison savings data were also evaluated. These data revealed that there were greater cost savings associated with the early intervention group versus the no early intervention group. The overall results of this study clearly demonstrate the treatment- and cost-effectiveness of an early intervention program for acute low-back pain patients.
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Comparative Study
The back pain beliefs of health care providers: are we fear-avoidant?
The purpose of this study was to survey the level of fear-avoidance beliefs for practicing general practitioners and physical therapists and to relate this to self-reported practice behaviors for patients with back pain. To this end, 60 general practitioners and 71 physical therapists were recruited. These participants completed a questionnaire including 11 items slightly revised from instruments designed to assess fear-avoidance beliefs in patients, and four items about treatment practices. ⋯ Those with high levels of fear-avoidance beliefs were compared to those with low levels. Those with high levels of fear-avoidance belief had an increased risk for believing sick leave to be a good treatment (RR = 2.0; 90%CI = 1.02-3.92), not providing good information about activities (RR = 1.7; 90%CI = 1.19-2.45), and being uncertain about identifying patients at risk for developing persistent pain problems (RR = 1.5; 90%CI = 1.00-2.27). It is concluded that some practitioners hold beliefs reflecting fear-avoidance and that these beliefs may influence treatment practice.