Selbsteinschätzung der funktionellen Leistungsfähigkeit (SELF): Messeigenschaften in der beruflich orientierten medizinischen Rehabilitation

Zusammenfassung Ziel Ermittlung der konkurrenten, diskriminanten und prognostischen Validität der Selbsteinschätzung der funktionellen Leistungsfähigkeit (SELF) bei orthopädischen Patienten der beruflich orientierten medizinischen Rehabilitation. Material und Methoden In einer prospektiven Kohortenstudie wurden Patienten aus vier Einrichtungen mit beruflich orientierter medizinischer Rehabilitation rekrutiert. Als Außenkriterien für die Überprüfung der konkurrenten Validität dienten der Work Ability Score (WAS) und die Functional Capacity Evaluation (FCE)-basierte Einschätzung der zulässigen Arbeitsschwere nach REFA. Für die diskriminante Validität wurde das Ultra-Kurz-Screening (UKS) verwendet. Die a priori definierten Hypothesen wurden anhand von bivariaten und partiellen Korrelationsmaßen überprüft. Die prognostische Validität wurde mittels logistischer Regressionsmodelle berechnet. Zielgröße war die Rückkehr in Arbeit (RTW) drei Monate nach Reha-Ende. Ergebnisse Die Daten von 227 rekrutierten Probanden wurden analysiert. Hinsichtlich der konkurrenten Validität bestätigten sich die a priori definierten Hypothesen (0,4≤r≤0,6) zum WAS (r=0,41) und der zulässigen Arbeitsschwere (r=0,50). Der Zusammenhang mit dem UKS lag erst nach Kontrolle der derzeitigen Schmerzen (r=−0,24) im erwarteten Bereich (−0,1≤r≤−0,3). Zur Überprüfung der prognostischen Validität wurden die von 127 Probanden verfügbaren Nachbefragungsdaten ausgewertet. Ein Anstieg des SELF um einen Punkt war nach Kontrolle der Arbeitsschwere der Tätigkeit mit einer 1,07-fach (p<0,001) höheren RTW-Chance assoziiert. Schlussfolgerung Die konkurrente und diskriminante Validität des SELF wurde bei orthopädischen Patienten der beruflich orientierten medizinischen Rehabilitation bestätigt. Das Instrument erwies sich darüber hinaus als prognostisch valide. Die Anpassungsgüte des ausschließlich auf dem SELF basierenden Modells war jedoch gering.

Effects of Injury Pattern and Treatment on Case Length and Disposition for Hand Injuries Treated Under a Workers’ Compensation Claim

Background: In treating occupational hand injuries under workers’ compensation, the 2 most important goals are to maximize patient function, ideally to preinjury levels, and permit a timely return to work (RTW). The purpose of this study was to determine factors affecting total case length, that is, the total time from injury until primary closure of a patient’s claim, and disposition among patients with hand injuries treated under workers’ compensation. Methods: All cases treated under workers’ compensation by a single fellowship-trained hand surgeon within a single year were retrospectively reviewed. A case is defined as the entire management and treatment of a single patient related to a single occupational injury incident. Independent variables included age, sex, body mass index, comorbidity, occupation, injury pattern, and treatment modality. Dependent variables included treatment duration from injury to case closure and final case disposition (RTW, functional capacity evaluation [FCE], or loss to follow-up [LTFU]). Comparison between groups was accomplished with analysis of variance. Multivariate linear and logistic regression analysis was performed to predict case length and disposition. Results: In all, 447 cases involving a workers’ compensation claim were reviewed. Among these, 75 (16.8%) were LTFU, 24 (5.4%) required an FCE, and 346 (77.4%) an RTW. The RTW cases averaged 138.5 days, whereas those requiring FCE averaged 331.5 days. Compared with average case length, crush injuries (76.8 days. P < .001) and fractures (111.8 days, P = .0224) had significantly shorter time to closure. In a multivariate linear model, cases of soft tissue and nerve injury were associated with longer case lengths, remaining open for an additional 56.8 and 347.1 days, respectively ( P < .001). Each treatment modality studied, therapy, injections, and surgery, was associated with an increase in case length. Conclusions: Cases requiring FCE were open significantly longer than those resulting in RTW. In addition, injury pattern and treatment modality were associated with significant variations in total case length. These results imply that a specific subset of patients, namely those with soft tissue and nerve injuries, may experience delayed resolution among patients treated under a workers’ compensation claim.

Task-Contingent Persistence is Related to Better Performance-Based Measures in Patients with Chronic Musculoskeletal Pain

Purpose. Pacing, avoidance, and overdoing are considered the three main behavioral strategies, also labeled activity patterns. Their relationship with functioning of patients with chronic pain is debated. The purpose of this study was to measure the influence of activity patterns on lifting tasks commonly used in daily life. Method. We performed a monocentric observational study and included patients performing Functional Capacity Evaluation (FCE). Avoidance, pacing, and persistence were assessed with using the Patterns of Activity Measures–Pain (POAM-P). Maximal safe performance was measured for floor-to-waist, waist-to-overhead, horizontal lift, and carrying with dominant-hand tests according to the FCE guidelines. Descriptive statistics, associations of POAM-P subscales with various sociodemographic variables, and correlations are presented. Standard multiple linear regression models were applied to measure the associations between FCE tests and POAM-P subscales, adjusting for the following potential confounders: age, gender, body mass index (BMI), pain severity, trauma severity, localization of injury, and education. Results. Persistence was significantly positively associated with performance on the 4 FCE tests: floor-to-waist (coefficient = 0.20; p=0.001), waist-to-overhead (coefficient = 0.13; p=0.004), horizontal lift (coefficient = 0.31; p≤0.001), and dominant-handed lifting (coefficient = 0.19; p=0.001). Pacing was found to have a negative influence on the carrying dominant-hand test (coefficient = –0.14; p=0.034), and avoidance was not found to have an influence on the 4 FCE tests. Conclusion. This study shows that task-persistence pattern is positively associated with physical performance in FCE, whereas pacing can have a negative influence on some tests.

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

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.