Work-Readiness self report lift capacity test short form.

BACKGROUND: The Multidimensional Task Ability Profile (MTAP) is a measure of self reported physical work capacity developed for injured workers with musculoskeletal disorders (MSDs) to determine readiness to return to work. OBJECTIVE: This study compared the concurrent validity of a new short form MTAP (MTAP-SF) comprised of 16 lifting and/or carrying items with the MTAP 55-item version. The hypothesis addressed is whether the validity of a version that imposes less respondent burden (MTAP-SF) would be comparable to the more burdensome instrument (MTAP-55). METHODS: MTAP scores were compared with demonstrated lift capacity in 1,252 healthy adults. Parallel regression analyses were conducted to examine the explanatory power of both MTAP versions. RESULTS: Age, gender, body mass and MTAP-SF explained 55% of the variance (p < 0.001) in demonstrated lift capacity, equivalent to MTAP-55. CONCLUSIONS: Self reported performance in physical work capacity tasks accounts for significant variance in lifting performance. MTAP-SF diminishes respondent burden while maintaining validity and may be useful for managing MSDs by enhancing understanding of the evaluee's psychophysical component in return-to-work rehabilitation planning.

Bridging the gap: Hospital to workplace.

BACKGROUND: Work-oriented neurorehabilitation to return to competitive employment after a serious neurologic illness or injury is an interdisciplinary process that begins as soon as pathology has stabilized. OBJECTIVE: This bimonthly column provides narratives of anonymized clients in situations that challenge their return-to-work. Each case study is designed for postgraduate education about tools and methods that are appropriate to consider in similar situations. METHODS: Through case studies of adults attempting to return to safe and dependable competitive employment, real-world issues are explored that occur at the interface between the client and their employer. RESULTS: The current case describes Structured Task Self Appraisal (STSA), a forensic rehabilitation method to collect self-report baseline information concerning the client's job-relevant functional limitations. STSA guides return-to-work rehabilitation services. CONCLUSION: Information concerning the core tasks and important abilities of the client's target occupation that are immediately available in O*NET can be analyzed in a structured manner to provide the workplace context for rehabilitation.

Use of item response theory to develop a return to work measure for acquired brain injury: The employment feasibility checklist.

BACKGROUND: The 2001 Feasibility Evaluation Checklist (FEC) is an assessment of work readiness for individuals with acquired brain injury (ABI). It establishes the integrity of basic safety, productivity, and interpersonal factors in neurorehabilitation and vocational settings. This study represents an effort to further develop the FEC to increase its clinical utility. OBJECTIVE: To redesign the FEC by conducting Item Response Theory (IRT) analyses on the study's results and combining those mathematical calibrations with clinical expert judgement. The result will be a new measure for use in clinical ABI neurorehabilitation and vocational settings: the Employment Feasibility Checklist (EFC). METHODS: Seven participants with ABI were administered a situational assessment on multiple occasions by occupational therapists in a community rehabilitation clinic. The FEC was used to assess the participant's performance across three areas of basic employment feasibility: safety, productivity, and interpersonal factors. Results were analyzed with IRT-Rasch analysis and then subjected to clinical expert judgment, resulting in adjustment recommendations for the FEC. RESULTS: In this scale development study, IRT analysis of results from 89 observation trials was combined with expert clinical judgment resulting in a redesigned tool with increased clinical utility for persons with ABI. The EFC is a 12-item observational rating scale for employment feasibility constructs of Productivity and Interpersonal Relations, with an additional six-item Workplace Safety subsection. CONCLUSION: The EFC is a mathematically calibrated tool designed to gauge feasibility for competitive employment in clients with ABI. The tool may be useful in clinical neurorehabilitation settings and vocational rehabilitation settings.

Development and validation of a method to screen for co-morbid depression by non-behavioral health practitioners treating musculoskeletal pain.

BACKGROUND: Although diagnosis and treatment of depressive illness is outside the scope of practice for non-behavioral health practitioners such as occupational therapists, physical therapists, kinesiotherapists, and chiropractors, it frequently is comorbid with painful musculoskeletal disorders such as low back pain and it negatively affects outcomes, including return to work. As psychologically-informed practice becomes more widely implemented without the immediate availability of behavioral health practitioners, safe and effective methods to screen for and appropriately triage depressive illness by nonbehavioral health practitioners are necessary. OBJECTIVES: To demonstrate the efficacy and validity of a method employed by non-behavioral health practitioners to screen for and appropriately triage musculoskeletal pain patients who also are experiencing depressive illness. METHODS: As part of a previously-published psychometric research study conducted in a community-based musculoskeletal pain rehabilitation program, a method was developed for nonbehavioral health practitioners to screen for and appropriately triage patients for co-morbid depressive illness, thus providing the current opportunity to examine the effects of depressive illness on work outcomes. The first step in the two-step process involves a 22-item questionnaire, providing scores used in the second step to triage for outside consultation with behavioral health practitioners. This paper describes the screening method and its application in an observational study of the impact of depressive illness on work outcomes. RESULTS: Among 156 consecutive patients who were presenting with musculoskeletal pain disorders to an outpatient rehabilitation program, 22.3% also were identified to have co-morbid clinical depression. The screening process allowed all patients to continue in the rehabilitation program. Those who were already receiving behavioral health care were encouraged to inform care providers of their participation in the program. Those who were not receiving behavioral health care were successfully triaged to care outside of the clinic. Depressive illness was found to affect success in the program, confirming the validity of the screening process for outpatient rehabilitation program participants experiencing chronic pain. CONCLUSIONS: A simple and effective depression screening process that triages patients without interruption of musculoskeletal treatment can be employed by nonbehavioral health practitioners. Because return to work outcomes were found to be negatively affected by depressive illness, this approach has the potential to improve overall program efficacy.

Validity of the Multidimensional Task Ability Profile.

Background The Multidimensional Task Ability Profile (MTAP) is a patient-reported outcome (PRO) measure that provides a global score linked to the physical demand characteristics of work, but needs to be validated against established measures. Purpose To assess the concurrent validity of the MTAP compared with the Oswestry Disability Index (ODI), Neck Disability Index (NDI), Disabilities of the Arm, Shoulder, and Hand (DASH), Lower Extremity Functional Scale (LEFS), and Short Form 12 Health-Related Quality of Life (SF-12) questionnaires. Methods An observational study was conducted in 157 patients undergoing musculoskeletal rehabilitation. At baseline and after 30 days of treatment, patients completed the MTAP, ODI, NDI, DASH, LEFS, and SF-12 and provided self-reported work status. Results At baseline and after 30 days, convergent validity between the MTAP and DASH, LEFS, NDI, and ODI was good to excellent. Concurrent validity between the MTAP and SF-12 physical component score (PCS) and mental component score (MCS) was moderate or fair, respectively. Sensitivity to change over the 30-day treatment interval was established for the MTAP, SF-12 PCS, SF-12 MCS, and LEFS. Fair to moderate predictive validity for work status was found for the MTAP, ODI, NDI, DASH, and SF-12 PCS. Conclusions The MTAP demonstrated adequate concurrent validity, predictive validity, and sensitivity to change compared to other PROs. For patients with various impairment types, the MTAP may be a useful omnibus measure to supplement specialty instruments such as the DASH, NDI, ODI, or LEFS.

Age and gender normative data for lift capacity.

BACKGROUND: Functional Capacity Evaluations (FCEs) are routinely used in physical medicine to ascertain an individual's work ability; with lift capacity being an important aspect of many evaluations. Despite the widespread use of lift capacity tests, there are few studies that provide age and gender normative data. OBJECTIVE: To evaluate the safety, reliability, and validity of the EPIC Lift Capacity test, and to examine the effects of age and gender on lift capacity. METHODS: This study used a test-retest design with 4,443 adult participants in good general health. Test-retest of participants' lift capacity was undertaken to examine safety and reliability. Age and gender and the self-reported physical demands of each employed participant's usual and customary job were collected to examine validity. RESULTS: Safety and reliability were demonstrated for both measures of lift capacity for each of the six sub-tests in the EPIC Lift Capacity test battery. Inter-subtest differences and expected age and gender differences were found across all subtests. CONCLUSIONS: The EPIC Lift Capacity test is a safe and reliable test of lift capacity.Normative data are presented that allow comparison within age and gender categories.

Development and reliability testing of Spanish language and english language versions of the multidimensional task ability profile.

PURPOSE: The purpose of this study was to assess the: (1) test-retest reliability of the English and Spanish language versions of the Multidimensional Task Ability Profile (MTAP), (2) cross-cultural adaptation of the Spanish language version of the MTAP, and (3) practicality of both versions in terms of time required for administration. The MTAP is a patient-reported outcome measure of physical function that uses a combination of text and pictorial illustrations. METHODS: An observational study was conducted with a convenience sample of patients with musculoskeletal disorders from three outpatient physical rehabilitation centers. Participants (n = 110) completed the MTAP two times, whereby the second test was completed 24-72 h after the first test. Focus groups were conducted at the end of the study. Correlation analyses were used to assess test-retest reliability and qualitative analyses were used to assess cultural adaptation of the MTAP. RESULTS: The English and Spanish versions of the MTAP displayed good test-retest reliability (ICC 2,1 = 0.87-0.97, p < 0.05). Qualitative analyses demonstrated adequate cross-cultural adaptation of the Spanish language version of the instrument. CONCLUSIONS: The findings of this study indicate that the MTAP has been adequately adapted from its original English version for use with Spanish-speaking individuals. The MTAP in its current form of 50 items is reliable when administered to individuals with musculoskeletal disorders in either English or Spanish.

Preparing difficult clients to return to work.

OBJECTIVE: Investigate the effect of the symptom magnification syndrome (SMS) behavior pattern on industrial rehabilitation on return to work and maintenance at work. PARTICIPANTS: A sample of 99 clients with active workers' compensation claims was studied; 25 identified as having SMS. METHODS: A protocol-driven functional capacity evaluation (FCE) was administered and the presence of SMS was determined from a standard protocol that considered 13 factors. RESULTS: Upon conclusion of intervention, 80 of the 99 clients were classified as ready to return to full-time usual and customary employment. The readiness for full-time return to work among those who did not have SMS (84%) was not statistically different from those with the syndrome (72%). Six months after discharge, follow-up work status data were obtained for 63 clients. Among those that did not display SMS, 76% continued to work full time, while 39% of those initially identified as SMS were working, a statistically significant difference. CONCLUSIONS: SMS had no significant bearing on work readiness, but appears to impact maintenance of employment. The value of return to work on a modified basis may need to be reconsidered, because none of the clients who had been discharged ready for modified work were employed at the six-month follow-up.

Executive dysfunction, severity of traumatic brain injury, and IQ in workers with disabilities.

OBJECTIVE: To study whether severity of traumatic brain injury and the intelligence quotient are related to executive dysfunction. PARTICIPANTS: Sixty-two adults with brain injury who were referred for a work capacity evaluation. METHODS: Retrospective review of severity of traumatic brain injury, intelligence quotient from a previously-conducted neuropsychological evaluation, determination of executive function status from the neuropsychological evaluation, and both self-report and informant-report executive dysfunction scores from the Behavior Rating Inventory of Executive Function. RESULTS: Executive dysfunction and the intelligence quotient are related to severity of traumatic brain injury, but executive dysfunction and the intelligence quotient are not related to each other. Executive dysfunction as determined by a neuropsychological evaluation was not consistent with clients' self-reports but was consistent with informant-reported executive dysfunction. Five types of executive dysfunction were reported by knowledgeable informants, with significant elevations on the Shift, Plan/Organize, Task Monitor, Organization of Materials, and Working Memory BRIEF clinical scales. CONCLUSIONS: The intelligence quotient is not a useful indicator of executive dysfunction. Informant-report executive dysfunction is a reliable and potentially useful adjunct to a neuropsychological evaluation. Working memory is the most severe type of executive dysfunction and may not be adequately measured by current neuropsychological evaluation methods.

Performance-integrated self-report measurement of physical ability.

BACKGROUND CONTEXT: The technology of self-report measures has advanced rapidly over the past few years. Recently, this technology was used to develop a performance-integrated self-report measure for use with patients with musculoskeletal impairments that may lead to work disability. Psychometric studies of the new measure in patient populations have been successful. A validation study of the measure with adults in good general health is necessary. PURPOSE: The purpose of this study was to assess the concurrent validity of a new performance-integrated self-report measure, the multidimensional task ability profile (MTAP). STUDY DESIGN/SETTING: A prospective validation study was conducted in which a self-report measure was administered online, and a physical performance test was administered at various clinics in North America. PATIENT SAMPLE: One hundred ninety-six (34% male) adult volunteers in good general health participated in this study. OUTCOME MEASURES: Self-report measure-MTAP. Physiologic measure-EPIC Lift Capacity test. METHODS: The MTAP was administered online within 1 week of formal testing of lift capacity using a standardized lift capacity test, the EPIC Lift Capacity test. MTAP scores were compared with performance on the EPIC Lift Capacity test. Stepwise regression analysis was used to identify the strength of the relationship between the two measures and the relative explanation of lift capacity variance by the MTAP score, along with gender and age. RESULTS: The combination of MTAP score, gender, and age demonstrated a regression coefficient of R=0.82, which accounts for 67.3% of the variance in lift capacity. CONCLUSIONS: The MTAP displayed good concurrent validity compared with actual physical performance as assessed by the EPIC Lift Capacity test. Modern performance-integrated self-report measures, such as the MTAP, have the potential to provide information about functional capacity that is sufficiently useful to confirm status and help guide treatment algorithms.

Initial development of a work-related assessment of dysexecutive syndrome: the Complex Task Performance Assessment.

UNLABELLED: This article describes the initial development of the Complex Task Performance Assessment (CTPA) as a work-related assessment of dysexecutive syndrome. METHODS: A cross-sectional case-control pilot study using the Complex Task Performance Assessment (CTPA) and a neuropsychological battery consisting of subtests from the Delis Kaplan Executive Function System (DKEFS) were used with a population of adults with mild stroke and a control group of healthy community participants (n = 9). RESULTS: A correlation matrix between the DKEFS and the CTPA found no significant relationships between overall performance efficiency on the CTPA compared to the DKEFS scaled scores. In contrast, four of the six variables tested on the CTPA were found to have significant differences between the mild stroke group and the controls (p < 0.05). CONCLUSION: The sensitivity of the CTPA in this pilot sample justifies future study to provide a link between traditional neuropsychological assessment and rehabilitation professionals' observation of performance related to return to work. Neuroperformance assessment such as the CTPA will provide clinicians with a way to identify dysexecutive syndrome and higher-level cognitive processing deficits in the context of care.

A method to provide a more efficient and reliable measure of self-report physical work capacity for patients with spinal pain.

Self-report measures of functional ability are commonly used in occupational rehabilitation to measure the current status of an individual and his or her progress in response to intervention. Most of these measures have been developed using classical test theory that does not provide calibration of the items. Methods of test development that originated in the field of Education have been applied recently to healthcare measures, providing item calibration and allowing proportional evaluation of total scores. The purpose of this article is to demonstrate the application of these methods in the revision of an existing self-report measure. The potential value of these methods to improve established measures is demonstrated.

Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of continuous low-level heat wrap therapy for the prevention and early phase treatment (ie, 0-48 h postexercise) of delayed-onset muscle soreness (DOMS) of the low back. DESIGN: Two prospective randomized controlled trials. SETTING: Outpatient medical facility. PARTICIPANTS: Sixty-seven subjects asymptomatic of back pain and in good general health (mean age, 23.5+/-6.6 y). INTERVENTIONS: Participants performed vigorous eccentric exercise to experimentally induce low back DOMS. Participants were assigned to 1 of 2 substudies (prevention and treatment) and randomized to 1 of 2 treatment groups within each substudy: prevention study (heat wrap, n=17; control [nontarget muscle stretch], n=18) and treatment study (heat wrap, n=16; cold pack, n=16). Interventions were administered 4 hours before and 4 hours after exercise in the prevention study and between hours 18 to 42 postexercise in the treatment study. MAIN OUTCOME MEASURES: To coincide with the expected occurrence of peak symptoms related to exercise-induced low back DOMS, hour 24 postexercise was considered primary. Pain intensity (prevention) and pain relief (treatment) were primary measures, and self-reported physical function and disability were secondary measures. RESULTS: In the prevention study, at hour 24 postexercise, pain intensity, disability, and deficits in self-reported physical function in subjects with the heat wrap were reduced by 47% (P<.001), 52.3% (P=.029), and 45% (P=.013), respectively, compared with the control group. At hour 24 in the treatment study, postexercise, pain relief with the heat wrap was 138% greater (P=.026) than with the cold pack; there were no differences between the groups in changes in self-reported physical function and disability. CONCLUSIONS: In this small study, continuous low-level heat wrap therapy was of significant benefit in the prevention and early phase treatment of low back DOMS.

Reliability of a visual analog version of the QuickDASH.

BACKGROUND: The QuickDASH, an abbreviated form of the Disabilities of the Arm, Shoulder and Hand Questionnaire, uses a graded-adjectives ordinal measurement response scale. In order to improve the sensitivity of the measure and to make it compatible with widely used measures of pain and disability, a visual analog scale version was developed. The present study investigated the reliability of the new version over time when used for the evaluation of patients undergoing treatment. METHODS: A test-retest model with a two-day interval was used to evaluate a sample of thirty-eight consecutive patients in an interdisciplinary tertiary rehabilitation setting who were identified as having an upper extremity disorder. RESULTS: The intraclass correlation coefficient indicating test-retest reliability was 0.90 for the eleven-item QuickDASH visual analog scale questionnaire (without the work component) and 0.94 for the fifteen-item questionnaire (with the work component), neither of which was significantly different from the results reported for the original questionnaire. CONCLUSIONS: The QuickDASH visual analog scale questionnaire has acceptable reliability over time, and it can be used as an alternative to the original QuickDASH.

Reliability and validity of the Milliken Activities of Daily Living Scale.

Development of a self-report measure of activity limitation that combines measures of ability with necessity is described. The history of the Milliken Activities of Daily Living Scale (MAS) is traced, and the current measure is described. The test-retest reliability and concurrent validity of the MAS is studied. The MAS is found to have excellent reliability and good validity. The utility of the instrument to guide clinical practice is described, with a discussion of the importance of client-centered self-report measures of activity limitation.

Treating acute low back pain with continuous low-level heat wrap therapy and/or exercise: a randomized controlled trial.

BACKGROUND CONTEXT: Restorative exercise and palliative modalities are frequently used together for the treatment of acute low back pain. However, little is known about the effects of combining these treatments. PURPOSE: To evaluate the efficacy of combining continuous low-level heat wrap therapy with directional preference-based exercise on the functional ability of patients with acute low back pain. STUDY DESIGN/SETTING: A randomized controlled trial was conducted at three outpatient medical facilities. PATIENT SAMPLE: One hundred individuals (age 31.2+/-10.6 years) with low back pain of less than 3 months duration. OUTCOME MEASURES: The primary outcome measure was functional ability assessed by the Multidimensional Task Ability Profile questionnaire. Secondary outcomes were disability assessed by the Roland-Morris Disability Questionnaire and pain relief assessed by a 6-point verbal rating scale. METHODS: Participants were randomized to one of four groups: Heat wrap therapy alone (heat wrap, n=25); directional preference-based exercise alone (exercise, n=25); combination of heat wrap therapy and exercise (heat+exercise, n=24); or control (booklet, n=26). Treatment was administered for five consecutive days and included four visits to the study center over 1 week. RESULTS: At 2 days after the conclusion of treatment (Day 7), functional improvement for heat+exercise was 84%, 95%, and 175% greater than heat wrap, exercise, and booklet, respectively (p<.05). Seventy-two percent of the subjects in the heat+exercise group demonstrated a return to pre-injury function compared with 20%, 20%, and 19% for heat wrap, exercise, and booklet, respectively (p<.05). Disability reduction for heat+exercise was 93%, 139%, and 400% greater than heat wrap, exercise, and booklet, respectively (p<.05). Pain relief for heat+exercise was 70% and 143% greater than exercise and booklet, respectively (p<.05). CONCLUSIONS: Combining continuous low-level heat wrap therapy with directional preference-based exercise during the treatment of acute low back pain significantly improves functional outcomes compared with either intervention alone or control. Either intervention alone tends to be more effective than control.

Reliability and validity of a new computer-administered pictorial activity and task sort.

Development of a new pictorial activity and task sort and examination of its reliability and validity is described. The Multidimensional Task Ability Profile (MTAP) is the latest in a series of measures that use a combination of drawings and task descriptions in a self-report format to assess functional capacity. The MTAP is found to be reliable on a test-retest and split-half basis. The concurrent validity of the MTAP was examined in performance testing of lift capacity. Results demonstrate that the MTAP has good concurrent validity.

History, design characteristics, and uses of the pictorial activity and task sorts.

Development of the Pictorial Activity and Task Sort (PATS) technology in the field of Occupational Rehabilitation is described. The history of several PATS measures is traced, and each measure is briefly described. The use of these measures to efficiently collect data in functional capacity evaluation and to provide guidance in occupational rehabilitation is briefly described. Key design characteristics are presented and several recommendations are provided for future development of PATS.

Improvement in postoperative and nonoperative spinal patients on a self-report measure of disability: the Spinal Function Sort (SFS).

The present study was designed to evaluate the clinical utility of the Spinal Function Sort (SFS), in a group of postoperative and nonoperative low back pain patients who completed a functional restoration program. The SFS was administered to 38 spinal pain patients (16 nonoperative and 21 postoperative), before and after completing a functional restoration program. Results revealed that the SFS detected a significant improvement in Ratings of Perceived Capacity scores, and that the postoperative patients appeared to improve more than nonoperative patients. These findings demonstrate the clinical utility of the SFS as an effective assessment tool of functional capacity in both postoperative and nonoperative spinal disorder patients. It provides a time-efficient method for evaluating a patient's functional status.