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Peer-Reviewed Abstracts

Measuring residual functional capacity in chronic low back pain patients on the Dictionary of Occupational Titles.

Article Type: Research Article
Authors: Fishbain DA, Abdel-Moty E, Cutler RB, Khalil T, Sadek S, Steele-Rosomoff R, Rosomoff H.

STUDY DESIGN: This study designed and tested a functional battery based on the Dictionary of Occupational Titles (DOT). OBJECTIVES:  Such a battery can be used to measure residual functional capacity (RFC) in chronic pain patients (CCPs) and results can be matched against the demand minimal functional capacities (DMFC) of DOT jobs. BACKGROUND DATA: Physicians have difficulty translating impairment into functional limitation and thereby establishing RFC of chronic pain patients. METHODS:  The DOT, a USA government publication provides information about physical demands of every USA job according to 36 factors and sub-factors.  The authors defined and developed a functional battery based on these factors/sub-factors. This battery was tested on 67 consecutive CPP’s to determine the percentage of CPP’s able to pass specific job factors, the full battery, return to some DOT job, and evaluated the effects of pain on battery performance. The data was factor analyzed. RESULTS:  The battery deterined if CPP’s could perform DOT job factors and had the necessary RFC to be placed in a DOT job.  The vast majority of CPP’s coud not pass the full battery and the presence of pain and original job classification predicted whether a chronic pain patient could perform a job factor. Factor analysis grouped the factors into four independent categories supporting the design of the battery.  CONCLUSION:  The battery can assess whether CPP’s are able to return to work.
Journal: SPINE 1994;19:872-880.

Validity of the Dictionary of Occupational Titles-Residual Functional Capacity battery.

Article Type: Research Article
Authors: Fishbain DA, Cutler RB, Rosomoff H, Khalil T, Abdel-Moty E, Steele-Rosomoff R.

BACKGROUND DATA: The Dictionary of Occupational Titles (DOT) is a government publication that defines each job in the United states according to 20 job factors.  Fishbain et al (Spine 1994;19:872-880) developed a Dictionary of Occupational Titles – Residual Functional Capacity (DOT-RFC) battery whose predictive validity for employment/unemployment had not been tested previously. OBJECTIVES: The purpose of this study were as follows: (a) to determine whether results of a DOT-RFC battery performed at completion of pain facility treatment predicted employment status at 30 months’ follow-up, and (b) to determine whether the DOT-RFC battery predicted employment capacity as determined by the DOT employment levels of chronic pain patient’s jobs. STUDY DESIGN: This is a prospective chronic pain patient facility treatment study using employment status and the DOT occupational levels as outcome measures. METHODS:  One hundred eighty five consecutive chronic pain patients who fitted the criteria completed a DOT-RFC battery at completion of pain facility treatment and were contacted at one, three, six, twelve, eighteen, twenty-four, and thirty months for determination of their employment status and DOT employment level.  Eight DOT job factors plus pain and worker compensation status were found to be significantly different between employed and unemployed chronic pain patients, and between those employed in different DOT levels. For the ten variables, stepwise discriminant analysis was used to select final predictor variables. Sensitivity and specificity were calculated along with pain level cut-points that separated groups. RESULTS: The eight DOT job factors found to be statistically significiant between groups were the following: stooping, climbing, balancing, crouching, feeling shapes, handling left and right, lifting, carrying, and pain and worker employed and unemployed categories, with a sensitivity and specificity of approximately 75 percent.  The pain level cut-point between employed and unemployed was 5.4 on a 10 point scale. CONCLUSIONS:  We cannot yet predict DOT-RFC employment levels. However, if a chronic pain patient can pass the above eight DOT job factors and has a pain level less than 5.4 cut-point, that patient will have a 75 percent chance of being employed at 30 months after treatment.   Therefore, the DOT-RFC battery does demonstrate a predictive validity in the “real work world”.
Journal: Clinical Journal of Pain 1999;15(2):102-110.

Validity of work-related assessments

Article type: Research Article
Authors: Ev Innes, Leon Straker,

Abstract: Insufficient evidence of the validity of work-related assessments is frequently reported as a major concern in occupational rehabilitation. Despite this concern, and the continuing development of new and old assessments, no comprehensive evaluation of the evidence has been conducted. Objectives: The purpose of this study was to first determine the extent and quality of available evidence for the validity of work-related assessments, and then where sufficient evidence was available, determine the level of validity. Study Design: This study examined available literature and sources in order to review the extent to which validity has been established for 28 work-related assessments. Results: The levels of evidence and validity are presented for each assessment. Most work-related assessments have limited evidence of validity. Of those that had adequate evidence, validity ranged from poor to good. There was no instrument that demonstrated moderate to good validity in all areas. Very few work-related assessments were able to demonstrate adequate validity in more than one area, or with more than one study, even when contributory evidence was included. Conclusion: With this study clinicians will be able to examine their options with regard to the validity of the assessments they choose to use.
Journal: Work, vol. 13, no. 2, pp. 125-152, 1999.

NOTE(S): WebFCE (DOT-RFC) showed excellent Face/Content Validity (5/5) and Construct validity (5/5). Validity that has sufficient detail to enable examination of test results, and is published in a peer-reviewed journal (page 134, 135). Out of all the FCE’s on the market (28 in total), The DOT-RFC is the only assessment that has content validity established (page 141).

Reliability of work-related assessments

Article type: Research Article
Authors: Ev Innes | Leon Straker

ABSTRACT: Insufficient evidence of the reliability of work-related assessments is a major concern in this area of practice. Despite this concern there has been ongoing development of new assessments, while existing assessments have been revised, modified and updated and others are no longer used or available. Objectives: The purpose of this study was to determine the extent and quality of evidence for the reliability of work-related assessments. Study Design: This study examined available literature and sources in order to review the extent which reliability has been established for 28 work-related assessments. Results: The levels of evidence and reliability are presented for each assessment. This indicates that a number of commercially available work-related assessments have insufficient evidence of reliability. For the limited number of work-related assessments with an adequate level of evidence on which to judge their reliability, most demonstrate a moderate to good level. Few assessments, however, have demonstrated levels of reliability sufficient for clinical (and legal) purposes. Conclusion: With this study clinicians will be able to examine their options with regard to the reliability of the assessments they choose to use. Interpretation of changes in test results can be considered in the light of the evidence for the reliability of the instrument used.
Journal: Work, vol. 13, no. 2, pp. 107-124, 1999.

NOTE(S): WebFCE (DOT-RFC) demonstrated Test-Re test reliability and Intra rater reliability (Table 3).

Psychophysical modelling for combined manual materials-handling activities

Article type: Research Article
Authors: JIANG, BERNARD C |  SMITH, JAMES L. | AYOUB, M. M.

ABSTRACT: Most psychophysical studies in manual materials handling (MMH) are involved only with single MMH activities, i.e. lifting, lowering, carrying, holding, pushing or pulling. Very little research has been reported on the determination of operator capacities for combinations of MMH activities (e.g. lifting a box, then carrying the box, or carrying a box, then lowering the box). These kinds of combined activities are prevalent in industry and in our daily lives. The objective of this study was to utilize the psychophysical approach to examine the effects of combinations of lifting, carrying and lowering activities. Twelve male students served as subjects for the study. The capacities that were determined as the maximum acceptable workloads for a 1-h work period for four individual MMH activities—lifting from floor to knuckle height (LFK), lifting from knuckle to shoulder height (LKS), lowering from knuckle to floor height (LOW) and carrying for 3·4 m (C) —and three combined MMH activities—LFK + C, LFK + C + LKS and LFK + C + LOW—were determined psychophysically under three frequency conditions: one time maximum, one handling per minute and six handlings per minute. Combined MMH capacities models were developed using the following three methods: a limiting individual MMH capacity, isoinertial 1·83-m maximum strength and fuzzy-set theory. The advantages and disadvantages of different models were discussed.
Journal: Ergonomics, vol. 29, no. 10, pp. 1173-1190, 1986.

NOTE(S): Many FCE vendors do not add combined lifts into their lifting criteria even though research suggests that combining lifting, carrying, and lower activities in sequence are representative of actual industrial lifting activities. Most vendors break down the lifting into 2 or more sections and will also separate the carrying portion. Unfortunately, this does not represent a real time work environment nor does it represent accurate or actual lift/carrying strength figures. The combined lifting activities are also more stressful on the individual thus representing real occupational work activities. WebFCE incorporates this into our FCE so you can feel confident in your lift/carry test scores.