Are performance-based measures predictive of work participation in patients with musculoskeletal disorders? A systematic review

Abstract

ObjectiveAssessments of whether patients with musculoskeletal disorders (MSDs) can participate in work mainly consist of case history, physical examinations, and self-reports. Performance-based measures might add value in these assessments. This study answers the question: how well do performance-based measures predict work participation in patients with MSDs?MethodsA systematic literature search was performed to obtain longitudinal studies that used reliable performance-based measures to predict work participation in patients with MSDs. The following five sources of information were used to retrieve relevant studies: PubMed, Embase, AMA Guide to the Evaluation of Functional Ability, references of the included papers, and the expertise and personal file of the authors. A quality assessment specific for prognostic studies and an evidence synthesis were performed.ResultsOf the 1,230 retrieved studies, eighteen fulfilled the inclusion criteria. The studies included 4,113 patients, and the median follow-up period was 12 months. Twelve studies took possible confounders into account. Five studies were of good quality and thirteen of moderate quality. Two good-quality and all thirteen moderate-quality studies (83%) reported that performance-based measures were predictive of work participation. Two good-quality studies (11%) reported both an association and no association between performance-based measures and work participation. One good-quality study (6%) found no effect. A performance-based lifting test was used in fourteen studies and appeared to be predictive of work participation in thirteen studies.ConclusionsStrong evidence exists that a number of performance-based measures are predictive of work participation in patients with MSDs, especially lifting tests. Overall, the explained variance was modest.

Prognostic value of self-reported work ability and performance-based lifting tests for sustainable return to work among construction workers

“…The lower lifting strength test appeared to be the most predictive of the three dynamic EK FCE lifting tests. This is in line with the review of Kuijer et al (14) who found that especially a lifting test from floor-to-waist level among patients with MSD appeared predictive for work participation. One explanation is that lifting reflects a large number of physically strenuous activities such as gripping, holding, bending, and of course lifting and lowering.…”

“…Gouttebarge et al (13) showed that dynamic lifting tests of a Functional Capacity Evaluation (FCE) [ie, the ErgoKit (EK)] were related to RTW in this population. In addition, a review on the predictive validity of performance-based tests showed that outcomes of lifting tests appeared to have prognostic value for work participation in 13 of the 14 studies among MSD patients (14). The aim of the present paper was to examo examine whether performance-based lifting tests from an FCE have additional prognostic value over self-reported work ability for sustainable RTW among Dutch construction workers on sick leave due to MSD.…”

Maximum acceptable weight of lift reflects peak lumbosacral extension moments in a functional capacity evaluation test using free style, stoop and squat lifting

“…To this end, tests of maximum acceptable weight of lift (MAWL) are commonly used (Gouttebarge et al 2009). Supporting this approach, in the study of Hamberg-van Reenen (2006) a low MAWL was found to be predictive of future LBP and Kuijer et al (2011) reported higher MAWL to be predictive of work participation in patients with LBP. The underlying assumption of using the MAWL in the context of LBP appears to be that it reflects the capacity of the low back.…”

“…Possibly maximum trunk strength measurements poorly reflect the ability to generate dynamic moments in lifting. This might also explain why Gouttebarge et al (2009) found that future risk of work disability in construction workers on sick leave due to musculoskeletal complaints was poorly associated to isometric MAWL, and moderately correlated to dynamic MAWL and why especially dynamic lifting tests are predictive of work participation in patients with low back complaints (Kuijer et al 2011). In addition, usually, tests of MAWL do not entail instructions on lifting technique.…”

Are pushing and pulling work-related risk factors for upper extremity symptoms? A systematic review of observational studies

“…To determine whether pushing or pulling at work is related to upper extremity symptoms a best evidence synthesis, presented by Kuijer et al 27 and adapted from Van Tulder et al 28 and De Croon et al, 29 was applied consisting of three levels of evidence, taking into account the risk of bias, the design of the study (prospective cohort, case–control or cross-sectional) and the outcomes of the included studies. (1) Strong evidence was defined as consistent findings in at least two prospective cohort studies with low risk of bias and effect sizes in the same direction.…”