Article

Physicians have difficulty predicting patients' occupational
limitations, abilities, and success from clinical evaluation (CE) of pathology
and impairments, especially in the presence of chronic pain. Additional
information from a functional capacity evaluation (FCE) may improve the accuracy
of their physical capacity assessments. It is not known whether FCE information
will change these assessments. No such study has been published using Veterans or
non-Veterans. OBJECTIVE:
To determine the influence of FCE data on the
physician's assessment of the US Department of Labor's Dictionary of Occupational
Titles (DOT) work capacity levels of Veterans with chronic moderate-intensity
pain. DESIGN: Retrospective analysis. SETTING: Tertiary care medical center.
PARTICIPANTS: Veterans aged 18-60 years with moderate chronic musculoskeletal
pain who were seeking employment. METHODS: Two kinesiotherapists performed FCEs
on all participants, namely, the lumbar protocol of the EvalTech Functional
Testing System (BTE, Inc, Hanover, MD). One physiatrist performed CEs in all
participants. Two other physiatrists assessed DOT physical capacity levels using
CE data alone and later using combined CE and FCE data. MAIN OUTCOME
MEASUREMENTS: DOT physical capacity level (sedentary = 1, light = 2, medium = 3,
heavy = 4, very heavy = 5). RESULTS: Of 55 charts reviewed, 27 met
inclusion/exclusion criteria. The mean age was 38 years, and there were 25 male
and 2 female participants. The predominant pain location was the lower back. DOT
scores for 2 physicians were averaged. The mean +/- SD DOT scores for CE only and
CE+FCE conditions were 2.04 +/- 0.33 and 2.40 +/- 0.90, respectively. In all, 65%
of DOT scores changed (17% decreased and 48% increased at least 1 level) after
FCE data were considered. A 1-sample t test revealed that the mean CE+FCE DOT
score was significantly greater than the mean CE-only score (by 20%, P = .02).
Interrater agreement (weighted kappa) for CE+FCE-based DOT scores was much higher
than for CE alone (0.715 versus 0.182). CONCLUSION: The addition of FCE data to
CE changed the majority of physician-assigned DOT levels. FCE significantly
increased the mean DOT physical work capacity level provided by the physician to
Veterans with chronic moderate-intensity pain, especially if the initial
assessment was designated as "light." FCE may facilitate a more objective and
accurate determination of Veterans' work capacity. LEVEL OF EVIDENCE: III.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS