Search

Purpose Chronic musculoskeletal pain can have a major impact on ability to work. The work ability score is a commonly used single-item question to assess work ability but has not been fully validated yet. The aim of the present study was to evaluate test–retest reliability, agreement, construct validity, and responsiveness of the work ability score among sick-listed workers with chronic musculoskeletal pain. Methods Data of sick-listed workers with chronic musculoskeletal pain was routinely collected at seven rehabilitation centres in the Netherlands. Assessments included a set of questionnaires, administered at admission and discharge from a fifteen-week vocational rehabilitation program. Test–retest reliability was determined with the intraclass correlation coefficient. For agreement, the standard error of measurement and smallest detectable changes were calculated. Construct validity was assessed by testing hypotheses regarding Spearman rank correlation coefficient. Area under the curve obtained from the receiver operating characteristic curve and minimal clinically important change were determined for the total sample and work ability score baseline tertile groups to assess responsiveness. Results In total, 34 workers were analyzed for reliability and agreement, 1291 workers for construct validity, and 590 responded to the responsiveness questionnaire. Reliability reached an intraclass correlation coefficient of 0.89; 95% CI 0.77–0.94, a standard error of measurement of 0.69 points, and the smallest detectable change of 1.92 points. For construct validity, six of the seven predefined hypotheses were not refuted. The area under the curve was 0.76 (95% CI 0.71–0.81) allowing for discrimination between stable and improved workers, with a minimal clinically important change of 2.0 points for the total sample. Conclusion The work ability score showed good measurement properties among sick-listed workers with chronic musculoskeletal pain. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose Based on the success of the first two conferences the Third International FCE Research Conference was held in The Netherlands on September 29, 2016. The aim was to provide ongoing opportunity to share and recent FCE research and discuss its implications. Methods Invitations and call for abstracts were sent to previous attendees, researchers, practicing FCE clinicians and professionals. Fifteen abstracts were selected for presentation. The FCE research conference contained two keynote lectures. Results 54 participants from 12 countries attended the conference where 15 research projects and 2 keynote lectures were presented. The conference provided an opportunity to present and discuss recent FCE research, and provided a forum for discourse related to FCE use. Conference presentations covered aspects of practical issues in administration and interpretation; protocol reliability and validity; consideration of specific injury populations; and a focused discussion on proposed inclusion of work physiology principles in FCE testing with the Heart Rate Reserve Method. Details of this Third International FCE Research Conference are available from http://repro.rcnheliomare.nl/FCE.pdf. Conclusions Researchers, clinicians, and other professionals in the FCE area have a common desire to further improve the content and quality of FCE research and to collaborate to further develop research across systems, cultures and countries. A fourth, 2-day, International FCE research conference will be held in Valens, Switzerland in August or September 2018. A ‘FCE research Society’ will be developed. [ABSTRACT FROM AUTHOR]

Introduction: Central sensitisation (CS) can't be demonstrated and thus only be assumed to be present in humans: Human Assumed Central Sensitization (HACS)1. The Central Sensitisation Inventory (CSI)2 is a screening instrument for HACS with a cut-off score of 40 (range 0-100) 3. This study aims to re-establish the optimal cut-off value for the CSI and to study associated factors. Methods: Via ROC-analyses we compared patients with chronic pain with healthy controls. Regression analysis was performed on factors (descriptives; pain-related characteristics) possibly associated with CSI-score. Results: Based on patients (n = 1730) and controls (n = 250), CSI cut-off values for the presence of HACS were established at =30 (women: = 33; men: = 25(table)). Regression analyses showed that the CSI-score was associated with all factors (adjusted R2 = 54-58%). A low association between the CSI-score and pain severity was shown in women and men separately. Discussion: In contrast with previous studies, a lower cut-off score is established for patients with chronic pain, being higher for women than for men. Process evaluation: The question rises whether CSI should be used with a dichotomous, categorical or continuous scale. More insight is needed in the presence of HACS and, the influence of sex, other characteristics and specific sub-populations of patients. [ABSTRACT FROM AUTHOR]

Introduction: Low back pain (LBP) is the leading cause of disability in the world1. Among many first-line healthcare providers, patients seek help from a physiotherapist. Increasing numbers of physiotherapy practices have information about LBP on their website. At this moment, in the Netherlands, the quality of this information is unknown. Objective: To what extent is the information on physiotherapy websites about LBP conform LBP guidelines, and the biopsychosocial model? Methods: Cross sectional study design; the content of all existing physiotherapy websites within the Netherlands were studied. Predetermined criteria for content analysis were developed according guidelines and biopsychosocial model. A biomedical score was given with 0 psychosocial factors, limited biopsychosocial with 1-2 psychosocial factors, or fairly biopsychosocial when 3 or more psychosocial factors were mentioned. Descriptive statistics were applied. Results: 8607 entries were identified. After removal of duplicates and entries without information, 834 physiotherapy websites remained. 449 websites contained information about LBP. Most websites, 63.9% described a biomedical explanation regarding the causes of LBP, 27.7% limited biopsychosocial and 8.5% gave a fairly biopsychosocial explanation. Discussion: The minority of the physiotherapy websites within the Netherlands contained information about LBP. Of the websites with information, the majority of the information did not met current guidelines or biopsychosocial explanations. The provided information on a physiotherapy practice website is mostly not according the current state of evidence. Process evaluation: The data shown in this abstract were based on preliminary results and analysis. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction Research on Performance-Based Work Assessment, also known as Functional Capacity Evaluation (FCE), has evolved substantially over the past decades. Although this field of research has developed, the use of FCE has been an object of discussion and debate internationally. Unfortunately, there has been no platform or infrastructure available for FCE researchers to present their research, discuss, and collaborate. Methods An International FCE Research Meeting was held in Haren, The Netherlands on October 25, 2012, with 48 participants from eight countries. The meeting consisted of presentation of new research, two debates, and an open discussion that aimed at creating an overview of gaps in research as identified by the participants. Results The discussion resulted in the identification of 17 research needs, which are listed in this paper. Important categories were: further validation of FCE across settings, jurisdictions and patient groups; additional impact and cost-effectiveness evaluation of FCE compared to alternatives; and the use of ICF as guiding framework. Conclusion Researchers, clinicians, and other professionals in the FCE area are interested in improving the quality and content of FCE research by setting a common set of priorities and creating an international peer network. [ABSTRACT FROM AUTHOR]

Background: Access to pain education for healthcare professionals is an International Association for the Study of Pain's key recommendation to improve pain care. The content of preregistration and undergraduate physical therapy pain curricula, however, is highly variable., Objective: This study aimed to develop a list, by consensus, of essential pain-related topics for the undergraduate physical therapy curriculum., Methods: A modified Delphi study was conducted in four rounds, including a Delphi Panel ( N = 22) consisting of in pain experienced lecturers of preregistration undergraduate physical therapy of Universities of Applied Sciences in the Netherlands, and five Validation Panels. Round 1: topics were provided by the Delphi Panel, postgraduate pain educators, and a literature search. Rounds 2-4: the Delphi Panel rated the topics and commented. All topics were analyzed in terms of importance and degree of consensus. Validation Panels rated the outcome of Round 2., Results: The Delphi Panel rated 257, 146, and 90 topics in Rounds 2, 3, and 4, respectively. This resulted in 71 topics judged as "not important," 97 as "important," and 89 as "highly important." In total, 63 topics were rated as "highly important" by the Delphi Panel and Validation Panels., Conclusion: A list was developed and can serve as a foundation for the development of comprehensive physical therapy pain curricula.

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.

Purpose: To explore rehabilitation professionals' opinions about the influence and the pathways of injury compensation (IC) on health and disability in patients with whiplash associated disorder (WAD)., Methods: Semi-structured interviews were performed among a purposeful selected sample of Dutch expert-professionals in the field of rehabilitation of patients with WAD. Inclusion continued until saturation was reached. Inductive and deductive thematic analyses were performed., Results: Ten rehabilitation expert-professionals (five females), working as physician, psychologist or physiotherapist, were interviewed. All expert-professionals acknowledged that IC can influence rehabilitation, health and disability. The expert-professionals provided three causal pathways; a pathway through prolonged distress, a behavioral pathway, and patient characteristics that may either attenuate or worsen their response. They assess the influence of IC mainly with interview techniques. Most professionals discuss the potential influence of IC with their patients, because they want to give clear information to the patient. Some emphasize that their role is neutral in relation with the IC. Others mention that financial consequences can accompany functional improvement., Conclusions: Rehabilitation expert-professionals believe that IC may affect rehabilitation, health and disability in patients with WAD. Three pathways are mentioned by the experts-professionals., Implications for Rehabilitation: According to rehabilitation expert-professionals, an injury compensation (IC) can lead to distress, by creating a (conscious or unconscious) conflict of interests within a patient between striving for compensation on one hand, and recovery on the other hand. Patient characteristics can either attenuate or worsen IC-related distress. Reliable and valid tools need to be developed to assess the influence of IC on health, disability and rehabilitation, and to limit the negative effects. Rehabilitation professionals can discuss the possible unintended effects of IC with their patients to clarify their current situation.

Objective: To examine the work participation of Dutch people with early osteoarthritis (OA) in hips or knees and compare this with data from the American Osteoarthritis Initiative (OAI) cohort. The influence of health status and personal factors on work participation was analyzed., Methods: In the Cohort Hip and Cohort Knee (CHECK) study, 1,002 subjects were included. Baseline questionnaire data from 970 subjects were analyzed. Rate ratios were calculated to compare work participation with the general Dutch population, after correcting (by stratifying) for age, sex, and education. Health status was measured using the Short Form 36 health survey and the Western Ontario and McMaster Universities Osteoarthritis Index. Groups were compared (CHECK versus OAI, workers versus nonworkers) using t-tests., Results: The mean age of the subjects was 56 years and 79% were women. Overall participation was 51%, similar to the general Dutch population and lower than in the OAI (76%). Point prevalence of sick leave because of hip/knee symptoms was 2%, and year prevalence was 12%. Of the subjects, 14% had made work adaptations. Workers reported significantly better health status (corrected for age, sex, and education) than nonworkers., Conclusion: Work participation of Dutch people with early OA is similar to the general population and significantly lower than American subjects. Increasing age, female sex, and lower education level were related to lower participation. Societal factors appear to have had more effect on work participation than health status in this stage of OA. The better health status of workers could not be explained solely by selection bias, but may be a result of work.

Purpose: Functional Capacity Evaluations (FCEs) are batteries of tests designed to measure patients' ability to perform work-related activities. Although FCEs are used worldwide, it is unknown how patients' performances compare between countries or settings. This study was performed to explore similarities and differences in FCE performance of patients with chronic low back pain (CLBP) between three international settings that utilize the same FCE protocol., Methods: Standardized FCEs were performed on three cohorts of patients with CLBP: A sample from an outpatient rehabilitation context in The Netherlands (n = 121), a Canadian sample in a Worker's Compensation context (n = 273), and a Swiss sample in an inpatient rehabilitation context (n = 170). Patients were undergoing FCE as part of their usual clinical care. Means and standard deviations of maximum performance on the FCE material handling items were calculated and differences compared using ANOVA. Multivariable linear regression was used to determine the relationship between country of origin and FCE performance while controlling for potential confounders including, age, sex, duration of back pain problems, and self-reported pain and disability ratings., Results: Compared to the Dutch sample, the mean performance of patients in the Canadian and Swiss samples was consistently lower on all FCE items. This association remained statistically significant after controlling for potential confounders., Conclusions: Considerable differences were observed between settings in maximum weight handled on the various FCE items. Future FCE research should examine the effects of a number of potentially influential factors, including variability in evaluator judgements across settings, the evaluator-patient interaction and patients' expectations of the influence of FCE results on disability compensation.

The aim of this study was to determine test-retest reliability of a Functional Capacity Evaluation for patients with non-specific Work Related Upper Limb Disorders (WRULD FCE). The study sample included 33 healthy adults, consisting of 14 males and 19 females with a mean age of 29.2 years. The WRULD FCE consisted of 8 different tests including 26 items measuring repetitive movements, duration, working in awkward positions, forceful movements and static postures. Two FCE sessions were held with a 10-day interval. Means, 95% confidence intervals, one-way random Intraclass Correlation Coefficients (ICCs), 95% limits of agreement and repeated measures were calculated. An ICC between 0.75 and 0.90 was considered as good and an ICC above 0.90 was considered as an excellent reliability. The results showed that 14 of 26 items (54%) had excellent reliability, 9 of 26 items (35%) had good reliability and 3 of 26 items (11%) had moderate reliability based on ICC values. Significant learning effects were present in the Purdue Pegboard Task and in the Complete Minnesota Dexterity Test. It is concluded that the WRULD FCE is reliable in healthy adults.

Discrepancies exist in literature as to what extent self-reporting can replace performance-based testing. To answer this question, self-reports and performance tests should measure identical constructs. Previous studies did not measure identical constructs. The objective of our study was to investigate to what extent self-reporting can replace performance-based testing. Seventy-two healthy subjects were tested. The constructs of the self-reports and the performance tests covered the same components to enable a comparison of self-reports and performance test results. Three different self-reports and a performance test were used to measure physical performance. Additionally, rating of perceived exertion was measured after the subjects lifted a reference weight to predict maximal lifting performance. The controls were age, gender, educational level, subject's participation in fitness, availability of reference data, motivation, attitude, general self-efficacy, and mood. Results showed that all lifting tasks could be predicted, though not solely via self-reporting. A prediction of the performance test results with a margin of +/-5 kg of error could be made for at least 79% of the subjects, via gender, self-reporting, and subject's participation in fitness. Self-reporting may not replace performance testing, although performance testing can be predicted with a margin of error of +/- 5 kg for at least 79% of the healthy subjects.

The aim of this study was to investigate test-retest reliability of the Isernhagen Work System Functional Capacity Evaluation (IWS FCE) in a sample of patients (n = 30) suffering from Chronic Low Back Pain (CLBP) and selected for rehabilitation treatment. The IWS FCE consists of 28 tests that reflect work-related activities like lifting, carrying, bending, etc. In this study, a slightly modified IWS FCE was used. Patients were included in the study if they were still at work or were less than 1 year out of work because of CLBP. Participants' mean age was 40 years, the duration of low back pain ranged between 5 and 10 years. Fifteen patients (50%) were out of work for a mean of 17 weeks, and they all received financial compensation. Two FCE sessions were held with a 2-week interval in between. Means per session, 95% confidence intervals of the mean difference, one-way random Intra Class Correlations (ICC), limits of agreement, Cohen's kappa and percentage of absolute agreement were calculated where appropriate. An ICC of 0.75 or more, a kappa value of more than 0.60 and a percentage of absolute agreement of 80% were considered as an acceptable reliability. Tests of the IWC FCE were divided into tests with and tests without an acceptable test-retest reliability on the basis of the kappa values, the percentage of absolute agreement and the ICC values. Fifteen tests (79%) showed an acceptable test-retest reliability based on Kappa values and percentage of absolute agreement. Eleven tests (61%) showed an acceptable test-retest reliability based on ICC values.