Effectiveness of vocational rehabilitation on work participation in adults with musculoskeletal disorders: an umbrella review protocol.

Review question/objective: : The objective of this umbrella review is to determine the effectiveness of vocational rehabilitation on work participation in working age adults with musculoskeletal disorders (MSDs). More specifically the review will address the following questions:

An investigation of the inter-rater reliability of the Valpar Joule functional capacity evaluation in healthy adults.

BACKGROUND: A functional capacity evaluation (FCE) can provide a comprehensive, objective measure of a worker's ability to meet work demands to support return to work decision making. Research evidence of a FCE's reliability and validity, involving more than one study, and covering all test components with a diverse range of populations, is essential to ensure confidence in any FCE system. OBJECTIVE: This study aimed to establish the inter-rater reliability of the Valpar Joule FCE functional capacity evaluation (FCE) for which there is currently limited published literature regarding its reliability. METHODS: Twelve healthy subjects were digitally recorded completing the initial protocol of the Valpar Joule. Assessments were rated separately by 3 raters and the results then compared. RESULTS: Using Intraclass Correlation Coefficients (ICC), with percentages of agreement and t-tests to determine bias, inter-rater reliability was high for determining last safe weight lifted for forceful tasks with ICC>0.90. Agreement ranged from 97.2% -100% for determining reasons for terminating tests; 97.2% -98.6% for identifying maximum safe capacity, but was only between 8.3% -50% for full agreement for identification of last weight safely lifted in forceful tasks. Differences were identified between raters with different training and experience for identifying poor body mechanics in lifting. CONCLUSION: Results demonstrated high inter-rater reliability for the Valpar Joule functional capacity evaluation in healthy adults. Further development of criteria identifying poor body mechanics and training in its use is recommended to increase evaluator objectivity.

Coronary artery bypass grafting with a minimized cardiopulmonary bypass circuit: a prospective, randomized trial.

OBJECTIVE: The study was designed to determine differences in blood loss and transfusion associated with a minimized cardiopulmonary bypass circuit versus a standard bypass circuit. METHODS: From February 2005 through April 2006, 199 patients were randomized to undergo coronary artery bypass grafting with a standard cardiopulmonary bypass circuit (Medtronic, Inc., Minneapolis, Minn) or a minimized bypass circuit, the Medtronic Resting Heart Circuit. Laboratory perimeters (hemoglobin and platelet count), were measured at baseline, after initiation of cardiopulmonary bypass, and on intensive care unit admission. Lowest values recorded were noted. Blood administration was controlled by study-specific protocol orders, (transfusion for hemoglobin <8mg%). Patient demographic data were retrieved from the Society of Thoracic Surgeons database. Blood product administration was recorded during hospital admission, and chest tube drainage as total output collected from operating room to discontinuation. Continuous variables were tested with a Wilcoxin rank test, and categoric variables with X(2) and Fisher's exact tests. RESULTS: Hematocrit, equivalent at baseline, was higher in minimized circuit cohort at lowest point during cariopulmonary bypass (31.5% +/- 3.9% vs. 25.5% +/- 3.7%), after protamine (31.6% +/- 3.9% vs 29.2% +/- 3.7%), and on intensive care unit arrival (35.2% +/- 4.1% vs 31.8% +/- 3.5%, P < .001). Similarly, platelet count was higher in minimized circuit group on intensive care unit arrival, as was lowest platelet count recorded (170 x 10(3) +/- 48 cells/mm(3) vs 107 x 10(3) +/- 28 cells/mm(3), P < .0001). Time to extubation was shorter in minimized circuit group (848 +/- 737 minutes vs. 526 +/- 282 minutes, (P < .01), and total chest tube drainage was lower (1124 +/- 647 mL vs. 506 +/- 214 mL, P < .01). Fewer red blood cells (148 vs 19 units) were given in minimized circuit group (P < .0001). CONCLUSIONS: A minimized cardiopulmonary bypass circuit provides less hemodilution, platelet consumption, chest tube output and lower post-operative blood loss than standard cardiopulmonary bypass. Red blood cell usage was also less. All differences are advantageous.

Using computer aided case based reasoning to support clinical reasoning in community occupational therapy.

Community occupational therapists have long been involved in the provision of environmental control systems. Diverse electronic technologies with the potential to improve the health and quality of life of selected clients have developed rapidly in recent years. Occupational therapists employ clinical reasoning in order to determine the most appropriate technology to meet the needs of individual clients. This paper describes a number of the drivers that may increase the adoption of information and communication technologies in the occupational therapy profession. It outlines case based reasoning as understood in the domains of expert systems and knowledge management and presents the preliminary results of an ongoing investigation into the potential of a prototype computer aided case based reasoning tool to support the clinical reasoning of community occupational therapists in the process of assisting clients to choose home electronic assistive or smart house technology.