Functional Capacity Evaluation for Injuries to the Foot and Ankle

2019 ◽  
Vol 40 (11) ◽  
pp. 1282-1287
Author(s):  
Alexander J. Idarraga ◽  
Adam Wright-Chisem ◽  
Daniel D. Bohl ◽  
Simon Lee ◽  
Johnny Lin ◽  
...  
Keyword(s):  
Functional Capacity ◽  
Functional Capacity Evaluation ◽  
Foot And Ankle ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Capacity Evaluation ◽  
The Mean ◽  
Orthopedic Injuries ◽  
Retrospective Comparative Study ◽  
Mean Time

Background: The functional capacity evaluation (FCE) is used to determine physical ability after treatment of a workplace-related injury. This evaluation is a determinant in the administration of benefits and the decision to return to work (RTW). The purpose of this study was to characterize FCE results and ability to RTW after treatment for workplace-related orthopedic injuries to the foot or ankle. Methods: A retrospective medical record review from the practices of 4 orthopedic foot and ankle surgeons was conducted. Inclusion criteria were a workplace-related injury to the foot or ankle, at least 2 years of follow-up, and an associated FCE. The FCE report and clinic notes were used to determine the patient’s preinjury job requirement, postinjury FCE-determined ability, specific FCE- or physician-imposed work restrictions, and clearance to RTW. A total of 188 patients met inclusion criteria. Results: In total, 74.4% of patients had FCE-determined work abilities at or above their preinjury job requirements, and 63.3% of patients were cleared to RTW. The mean time from injury to FCE was 1.9 ± 1.5 years, and the mean time to clearance for RTW was 2.0 ± 1.3 years. A less strenuous preinjury job requirement was positively associated with both the FCE-determined ability meeting the preinjury job requirement ( P < .001) and clearance to RTW ( P = .034). Conclusion: Two in 3 patients were cleared to RTW following workplace-related injuries to the foot or ankle culminating in an FCE. However, it took a mean of 2 years to achieve this clearance. Patients with more strenuous jobs were less likely to be able to RTW after injury. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Functional Capacity Evaluation for Work-Related Injuries to the Foot and Ankle is Associated with Low Return to Work Rate

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0022
Author(s):  
Alexander J. Idarraga ◽  
Adam Wright-Chisem ◽  
Daniel D. Bohl ◽  
Simon Lee ◽  
Johnny Lin ◽  
...  
Keyword(s):  
Return To Work ◽  
Functional Capacity ◽  
Work Ability ◽  
Functional Capacity Evaluation ◽  
Foot And Ankle ◽  
Inclusion Criteria ◽  
Work Related ◽  
Work Related Injury ◽  
Capacity Evaluation ◽  
Light Medium

Category: Hindfoot, Ankle, Midfoot/Forefoot, Injury and Rehabilitation Introduction/Purpose: The functional capacity evaluation (FCE) is used to determine a worker’s physical ability after treatment of a work-related injury. This evaluation is a critical determinant in the administration of benefits and the decision to return to work (RTW). The purpose of this study is to characterize FCE results and ability to RTW among patients treated for work- related orthopaedic injuries to the foot or ankle. Methods: A retrospective medical record review from the practices of four orthopaedic foot and ankle surgeons was conducted. Inclusion criteria were (1) treatment of a work-related injury to the foot or ankle, (2) at least 2 years of follow-up from the injury, and (3) documentation of an associated FCE. The FCE report and clinic notes were used to determine the patient’s pre-injury job requirement (Department of Labor Office category: light, medium, or heavy), post-injury FCE-determined work ability (light, medium, or heavy), specific FCE- or physician-imposed work restrictions, and clearance for RTW. Patients were considered cleared to RTW if their FCE-determined work ability met or exceeded their pre-injury job requirement and if there were no additional restrictions imposed by the FCE or physician that would prevent them from functioning in their pre-injury role. Results: A total of 188 patients met inclusion criteria. Missteps/rotational injuries (44.1%), falls from height (22.3%), and crush injuries (20.7%) were the most common mechanisms. 74.4% of patients had FCE-determined work abilities at or above their pre- injury job requirements, and 63.3% of patients were eventually cleared for RTW. The median time from injury to clearance for RTW was 2.0 ± 1.3 years. Reasons for not being cleared to RTW included failure to meet the pre-injury job requirement (67.2%), specific FCE-imposed limitations (28.3%), or specific physician-imposed limitations (4.5%). Less strenuous pre-injury job requirement was positively associated with both FCE-determined work ability meeting pre-injury job requirement and clearance for RTW (p<0.001 and p=0.034, respectively; Table 1). Conclusion: Approximately two-thirds of patients undergoing FCE after a work-related foot or ankle injury are cleared to RTW. However, it takes a median of two years to achieve this clearance. Patients with jobs that are more physically strenuous are less likely to be able to return to those jobs after injury to the foot or ankle.

Clinical Update: Functional Capacity Evaluations and Disability

1998 ◽  
Vol 3 (2) ◽  
pp. 4-5
Author(s):  
Glenn Pransky
Keyword(s):  
Direct Observation ◽  
Functional Capacity ◽  
Work Capacity ◽  
Functional Capacity Evaluation ◽  
Whole Body ◽  
Validity Of Results ◽  
Job Tasks ◽  
Capacity Evaluation ◽  
Physical Abilities ◽  
The Relationship

Abstract According to the AMA Guides to the Evaluation of Permanent Impairment, a functional capacity evaluation (FCE) measures an individual's physical abilities via a set of activities in a structured setting and provides objective data about the relationship between an impairment and maximal ability to perform work activities. A key distinction between FCEs and self-reported activities of daily living is that the former involve direct observation by professional evaluators. Numerous devices can quantify the physical function of a specific part of the musculoskeletal system but do not address the performance of whole body tasks in the workplace, and these devices have not been shown to predict accurately the ability to perform all but the simplest job tasks. Information about reliability has been proposed as a way to identify magnification and malingering, but variability due to pain and poor comprehension of instructions may cause variations in assessments. Structured work capacity evaluations involve a set of activities but likely underestimate the individual's ability to do jobs that involve complex or varying activities. Job simulations involve direct observation of an individual performing actual job tasks, require a skilled and experienced evaluator, and raise questions about expense, time, objectivity and validity of results, and interpretation of results in terms of the ability to perform specific jobs. To understand the barriers to return to work, examiners must supplement FCEs with information regarding workplace environment, accommodations, and demotivators.

Outcomes of a Cardiac Rehabilitation (CRH) Program after phase II: what about our patients almost 4 years later?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Borrego Rodriguez ◽  
C Palacios Echevarren ◽  
S Prieto Gonzalez ◽  
JC Echarte Morales ◽  
R Bergel Garcia ◽  
...  
Keyword(s):  
Phase Ii ◽  
Hospital Readmissions ◽  
Clinical Results ◽  
Level Of Evidence ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
The Mean ◽  
Acute Cardiovascular Event ◽  
Mean Time

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION CRH in patients with ischemic heart disease is recommended by the different clinical practice guidelines with an IA level of evidence, with an important role in reducing cardiovascular mortality and hospital readmissions during follow-up. OBJECTIVE The goal of this study is to show the 4-year clinical results of a population of patients who participated in an CRH program after an Acute Coronary Syndrome (ACS). METHODS Between May/2014 and September/2017, 221 patients who had recently presented an ACS completed the 12 weeks of phase II of the CRH program at our center. In May/2020 we collected epidemiological, clinical and echocardiographic information at the time of the acute cardiovascular event; and we evaluate the current vital status of the patients and the incidence of readmissions for: angina, HF, new ACS, or arrhythmic events. RESULTS Of the 221 patients, 182 were men (82%). The mean age of our population was 58.3 ± 7.8 years. 58% (129 patients) suffered from ST-elevation ACS. The mean time of hospital stay was 6.20 ± 2.9 days. An echocardiogram was performed at discharge, which showed an average LVEF of 56 ± 6%. Eight patients (4%) developed early Ventricular Fibrilation (VF) during the acute phase of ACS. Among the classic CVRF, smoking (79%) was the most prevalent, followed by dyslipidemia (53%) and hypertension (47%). The mean time from hospital discharge to the start of phase II RHC was 42 ± 16 days. The overall incidence of events was 9%: 10 patients suffered reinfarction during follow-up, and 7 were readmitted for unstable angina, all of whom underwent PCI; no patient was admitted for HF; and none of the 8 patients with early VF had a new tachyarrhythmia, registering a single admission for VT during follow-up. None of the patients had sustained ventricular tachyarrhythmias during exercise-training. At the mean 4.5-year follow-up, 218 patients were still alive (98%). CONCLUSION The incidence of CV events in the follow-up of our cohort was low, which can be explained by the fact that it is a young population, with an LVEF at low limits of normality at discharge, which is one of the most important predictors in the prognosis after an ischemic event. As an improvement, we must shorten the time until the start of phase II of the program. CRH shows once again its clinical benefit after an ACS, in consonance with the existing evidence. Abstract Figure. Outcomes of a CRH program.

Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity

2021 ◽  
pp. 107110072098290
Author(s):  
Elijah Auch ◽  
Nacime Salomao Barbachan Mansur ◽  
Thiago Alexandre Alves ◽  
Christopher Cychosz ◽  
Francois Lintz ◽  
...  
Keyword(s):  
Case Control Study ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Spearman Correlation ◽  
Foot Deformity ◽  
Weak Correlation ◽  
Level Of Evidence ◽  
Valgus Instability ◽  
Retrospective Comparative Study ◽  
Control Study

Background: Lateral overload in progressive collapsing foot deformity (PCFD) takes place as hindfoot valgus, peritalar subluxation, and valgus instability of the ankle increase. Fibular strain due to chronic lateral impingement may lead to distraction forces over the distal tibiofibular syndesmosis (DTFS). This study aimed to assess and correlate the severity of the foot and ankle offset (FAO) as a marker of progressive PCFD with the amount of DTFS widening and to compare it to controls. Methods: In this case-control study, 62 symptomatic patients with PCFD and 29 controls who underwent standing weightbearing computed tomography (WBCT) examination were included. Two fellowship-trained blinded orthopedic foot and ankle surgeons performed FAO (%) and DTFS area measurements (mm2). DTFS was assessed semiautomatically on axial-plane WBCT images, 1 cm proximal to the apex of the tibial plafond. Values were compared between patients with PCFD and controls, and Spearman correlation between FAO and DTFS area measurements was assessed. P values of less than .05 were considered significant. Results: Patients with PCFD demonstrated significantly increased FAO and DTFS measurements in comparison to controls. A mean difference of 6.9% ( P < .001) in FAO and 10.4 mm2 ( P = .026) in DTFS was observed. A significant but weak correlation was identified between the variables, with a Þ of 0.22 ( P = .03). A partition predictive model demonstrated that DTFS area measurements were highest when FAO values were between 7% and 9.3%, with mean (SD) values of 92.7 (22.4) mm2. Conclusion: To our knowledge, this was the first study to assess syndesmotic widening in patients with PCFD. We found patients with PCFD to demonstrate increased DTFS area measurements compared to controls, with a mean difference of approximately 10 mm2. A significantly weak positive correlation was found between FAO and DTFS area measurements, with the highest syndesmotic widening occurring when FAO values were between 7% and 9.3%. Our study findings suggest that chronic lateral impingement in patients with PCFD can result in a negative biomechanical impact on syndesmotic alignment, with increased DTFS stress and subsequent widening. Level of Evidence: Level III, retrospective comparative study.

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