Are functional capacity evaluations affected by the patient’s pain?

Gross, Douglas P.

doi:10.1007/s11916-006-0021-3

Cited by 16 publications

(15 citation statements)

References 45 publications

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“…In evaluating a client's response to physical challenges, FCE evaluations essentially use behavioral performance as a proxy for work capability. 64 However, we must guard against the "illusion of objectivity" that functional measurements are somehow unaffected by the client's interpretations of pain and disability. Any interpretation of such behavior must be integrated with an appraisal of the person's clinical history, beliefs, and emotional responses.…”

Section: Provision Of Reports and Summariesmentioning

confidence: 99%

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Addressing Occupational Factors in the Management of Low Back Pain: Implications for Physical Therapist Practice

2011

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There is mounting evidence that occupational factors influence the extent of sickness absence following an episode of low back pain, but there have been limited efforts to integrate the identification and management of occupational factors into the routine practice of physical therapists. Systematic reviews suggest that a client's report of heavy physical demands, inability to modify job tasks, work stress, lack of organizational support, job dissatisfaction, poor expectations for resuming usual work, and fear of reinjury are indications of significant barriers to returning to work. Recommended strategies for evaluating and addressing occupational factors are explored with respect to the physical therapist's role in client assessment, development of activity and lifestyle recommendations, therapeutic exercise, communication with other providers, and summary reports. Primary recommendations include: (1) administration of self-report questionnaires to assess a client's perspective of physical job demands, (2) client-centered interviewing to highlight individual return-to-work concerns, (3) early discussions with clients about possible job modifications, and (4) incorporation of clients' workplace concerns in progress reports and summaries. These strategies may improve low back pain outcomes by encouraging effective communication with key stakeholders and by developing clients' ability to resolve obstacles to returning to work.

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Section: Provision Of Reports and Summariesmentioning

confidence: 99%

“…a Case notes adapted from nurse case manager notes in a randomized trial of return-to-work (RTW) facilitation strategies. 64 Dr Shaw and Professor Main provided concept/idea/project design. All authors provided writing.…”

Section: Level Of Concernmentioning

confidence: 99%

Addressing Occupational Factors in the Management of Low Back Pain: Implications for Physical Therapist Practice

2011

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“…A patient's performance is determined by biological, psychological and social factors [4]. Pain related fear, also referred to as fear avoidance beliefs or fear of movement and reinjury [5], and pain [6] have been identified as examples of psychological factors influencing a patient's performance during an FCE.…”

Section: Introductionmentioning

confidence: 99%

“…In a recent review pain intensity has been identified to consistently associate negatively with patient performances during FCEs [6]. The strength of the significant associations between pain intensity and FCE performances in patients with chronic pain vary from r = −0.25 to r = −0.56 [6].…”

Section: Introductionmentioning

confidence: 99%

Are Pain Intensity and Pain Related Fear Related to Functional Capacity Evaluation Performances of Patients with Chronic Low Back Pain?

et al. 2007

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Introduction: Pain related fear and pain intensity have been identified as factors negatively influencing Functional Capacity Evaluation (FCE) performances in patients with CLBP. Conflicting results have been reported in the literature. The objective of this study was to analyze the relationships between pain intensity and pain-related fear on the one hand, and performances during an FCE on the other hand in two samples of patients with chronic low back pain (CLBP). Methods: Two cross sectional observation studies were performed with two samples of patients with CLBP (study 1: n = 79; study 2: n = 58). Pain related fears were operationally defined as the score on the Tampa Scale of Kinesiophobia in study 1, and the Fear Avoidance Beliefs Questionnaire (FABQ) in study 2. Pain intensity was measured with a Numeric Rating Scale in both studies. Avoidance behavior observed during FCE was in both studies operationally defined as the unwillingness to engage in high intensity performance levels of three different functional activities: high intensity lifting, prolonged standing in a forward bend position, and fast repetitive bending at the waist. Results: A total of 25 correlations between pain and pain related fear, and performance variables were calculated, out of which 7 were significant (p < 0.05). The strength of these significant correlations ranged from r = − 0.23 to r = − 0.50. Multivariate linear regression analyses revealed non-significant relationships in most instances. Pain and pain related fear contributed little if any to these models. Conclusions: [247][248][249][250][251][252][253][254][255][256][257][258] The relation between pain and pain related fear and FCE performance is weak or non-existent in patients with CLBP.

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“…These Wndings suggest that the use of opioids for the management of occupational LBP may not always achieve its objectives. In fact, the relationship between pain intensity and functional capacity in people with LBP is poorly understood (Gross 2006) and therefore needs to be further investigated.…”

Section: Introductionmentioning

confidence: 99%

Effect of opioid administration on cardiorespiratory and muscle oxygenation during lifting in chronic back pain patients

et al. 2010

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The objectives of this study were to examine the effects of opioid administration on the acute cardiorespiratory and muscle oxygenation responses during a repetitive lifting and lowering test (RLL) to voluntary fatigue in participants with chronic low back pain (LBP). Written informed consent was obtained from 27 LBP participants (mean age 50.9 +/- 16.4 years) who completed one testing session during which they were administered a saline placebo and opioid (1 microg/kg of fentanyl intravenously) in random order. The participants performed the RLL at a rate that they felt that they could sustain for an 8-h working day. Acute opioid administration increased the total lifting time and total work done during RLL by 35 and 48%, respectively (p < 0.05). However, the increased work capacity was accompanied by a significant (p < 0.05) increase in oxygen cost of 22% per unit amount of work done and significant (p < 0.05) increases in heart rate (7%) and ventilation rate (10%). Near infrared spectroscopic analysis of erector spinae oxygenation and blood volume responses during RLL indicated no significant (p > 0.05) differences between the opioid and placebo phases. These findings suggest that the increased energy cost of lifting as a result of opioid administration was due to enhanced central oxygen transport and not peripheral muscle oxygen extraction.

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Are functional capacity evaluations affected by the patient’s pain?

Cited by 16 publications

References 45 publications

Addressing Occupational Factors in the Management of Low Back Pain: Implications for Physical Therapist Practice

Addressing Occupational Factors in the Management of Low Back Pain: Implications for Physical Therapist Practice

Are Pain Intensity and Pain Related Fear Related to Functional Capacity Evaluation Performances of Patients with Chronic Low Back Pain?

Effect of opioid administration on cardiorespiratory and muscle oxygenation during lifting in chronic back pain patients

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