Journal of Back and Musculoskeletal Rehabilitation - Volume 6, issue 3
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: Researchers and practitioners, as well as vendors, have placed much emphasis on what constitutes a functional capacity testing battery. Statistical, procedural, behavioral, technological, as well as legal issues surrounding this type of human performance evaluation are also continuously being addressed in the literature. In addition, several methods, batteries, equipment, and protocols have been developed for the purpose of evaluating what an injured person can or cannot do. It is a fact that ‘testing’ of individuals is but one component of an intricate process consisting of: identification of an evaluee, researching a market, referring the evaluee to a facility, evaluating a…set of abilities, making inference about the evaluee's performance, reporting the findings, following up on the case, and possibly a legal involvement due to litigation. These components comprise the process of functional capacity testing. The purpose of this paper is to describe and analyze the various components of the process of quantitative testing of functional capacity. It is believed that each component of the FCA process is as important as the actual testing.
Keywords: Functional capacity assessment, Process assessment, Testing
Abstract: Individuals presenting with pain frequently report associated disability. Both pain and disability are complex phenomena. The bio-psycho-social complexity of pain and the different systems of disability make the evaluation of disability a very difficult process. There is a significant mismatch between complaints of pain and pathological process, as pathology can be present without symptoms of pain. Similarly, the subjective complaints of pain are disassociated with objective identification of physical impairment. Finally, the relationship between objective impairment determination and its effects on functional capacities and disability does not have a one-to-one relationship. Patients with pain, especially those with chronic low back…pain, have significant impact on healthcare costs and on societal costs due to associated disability. Patients, employers, legal professionals, and physicians alike, are involved in the disability system. Each person is interested in the determination of the functional capacities of the individual with pain, so that appropriate return to work planning can be initiated. Functional capacities assessment have gained in popularity and are frequently accepted by employers and insurance companies alike as an objective approach to assess an individual's functional abilities and potential limitations. This manuscript provides an overview of the complex nature of pain, disability, and the role of functional capacities assessment, as one of the many approaches in the medical determination of disability.
Abstract: A standardized method of evaluation of the work capacity of persons who are impaired by soft-tissue injuries is described. A demonstration project which involved testing 64 impaired subjects is described. The Cal-FCP test battery can be administered independently by a properly trained professional or by a technician under a physician's supervision and requires two hours or less to complete. This study demonstrated that the results of the test battery are unbiased in terms of both gender and age and can be applied to a standardized disability rating system.
Abstract: This paper examined the methods and issues of assessing objectively the functional capacity of workers. The primary emphasis was on aerobic capacity (VO2max ) and repetitive lifting. While the direct measurement of expired gases during exhausting exercise is the most valid method of assessing the VO2max of workers, it is rarely done outside research or medical settings. The methods more commonly used are: maximal exercise tests; submaximal exercise tests; and non-exercise tests. Maximal tests are accurate, but require medical monitoring when testing workers at medical risk. Submaximal tests are less accurate, but are safer and faster than a maximal…test. Submaximal tests use heart rate response to submaximal power output to estimate VO2max ; thus, any factor that alters heart rate response reduces the accuracy of the test. Non-exercise tests are as accurate as sub maximal tests, but require a self-report rating. The physiological criteria used to help define the recommended repetitive lift loads of the revised NIOSH equation included baseline aerobic capacity and energy expenditure values. While the goal is to reduce the risk of injury, the baseline aerobic capacity (≈ 25 ml/kg/min) and energy expenditure levels are so low (≤3.5 METs) that they may have an adverse effect on public health. Normative VO2max data on industrial cohorts suggest that 44% of male and 79% of female industrial workers are at a health risk of low aerobic fitness. Data are presented that suggests that repetitive lifting tasks are more of a function of strength and fat-free weight than aerobic capacity. While aerobic capacity, strength, and fat-free weight are objective methods to assess functional capacity, worker motivation and reaction to chronic pain can affect test results.
Abstract: The environment surrounding the functional capacity evaluation (FCA) is complex and determined by both external factors as well as those specific to the testing situation. In this paper we (1) briefly review existing models of pain, (2) highlight how current FCAs of pain patients adhere in general to behavioral conceptualizations of chronic pain, (3) review some inadequacies of current conceptualizations of FCA when it applies to chronic pain, (4) review the many internal and external environmental factors that can significantly influence FCAs, and (5) consider some psychosocial factors that play an important role in patients' performances. We conclude that not…only should evaluators more carefully consider the central influences of psychosocial factors when interpreting the results of FCAs, but that an alternate conceptual model that emphasizes both environmental and psychological factors is also needed to more adequately describe the physical performances obtained during FCAs.
Abstract: Sincerity of subject effort is critical to the functional capacity assessment process. This review examines attempts at devising ways of objectively determining whether an evaluee performed his best during functional assessment. It is concluded that good, but not conclusive, evidence of submaximal performance can be gained in some evaluees. The 5 hand position and the rapid exchange grip tests are the best validated and most practical tests devised which can provide evidence of malingering. EMG measurements, although not as practical, may be even better. Further research is needed to further validate these tests as reliable methods of determining sincerity of…subject effort
Keywords: Sincerity of effort, Validation tests, Submaximal performance