A framework for systematically improving occupational therapy expert opinions on work capacity

Aim: To present an evidence-based framework to improve the quality of occupational therapy expert opinions on work capacity for litigation, compensation and insurance purposes. Methods: Grounded theory methodology was used to collect and analyse data from a sample of 31 participants, comprising 19 occupational therapists, 6 medical specialists and 6 lawyers. A focused semistructured interview was completed with each participant. In addition, 20 participants verified the key findings. Results: The framework is contextualised within a medicolegal system requiring increasing expertise. The framework consists of (i) broad professional development strategies and principles, and (ii) specific strategies and principles for improving opinions through reporting and assessment practices. Conclusions: The synthesis of the participants' recommendations provides systematic guidelines for improving occupational therapy expert opinion on work capacity.

Functional capacity evaluation as a performance measure - Evidence for a new approach for clients with chronic back pain

Objectives: To report the research and development of a new approach to Functional Capacity Evaluation, the Gibson Approach to Functional Capacity Evaluation (GAPP FCE) for chronic back pain clients. Methods: Four Studies, including pilot and feasibility testing, expert review, and preliminary interrater reliability examination, are described here. Participants included 7 healthy young adults and 19 rehabilitation clients with back pain who underwent assessment using the GAPP FCE. Thirteen therapists were trained in the approach and were silently observed administering the Functional Capacity Evalutions by at least 1 other trained therapists or the first investigator Or both. An expert review using 5 expert occupational therapists was also conducted. Results: Study 1, the pilot with healthy individuals, indicated that the GAPP FCE was a feasible approach with good utility. Study 2, a pilot using 2 trained therapists assessing 5 back pain clients, supported the clinical feasibility of the approach. The expert review in Study 3 found support for GAPP FCE. Study 4, a trial of the approach with 14 rehabilitation clients, found support for the interrater reliability of recommendations for return to work based on performance in the GAPP FCE. Discussion: The evidence thus far available supports the GAPP FCE as ail approach that provides a Sound method for evaluating the performance of the physical demands of work with clients with chronic back pain. The tool has been shown to have good face and content validity, to meet acceptable test standards, and to have reasonable interrater reliability. Further research is occurring to look at a larger interrater reliability study, to further examine content validity, and to examine predictive validity.

Safety issues in functional capacity evaluation: Findings from a trial of a new approach for evaluating clients with chronic back pain

Although safety is recognized as a critical issue in functional capacity evaluations (FCEs), it has rarely been investigated. This paper reports on the findings of a study which examined safety aspects of a new approach to FCE. Fourteen rehabilitation clients with chronic back pain participated in the study. Aspects examined included the pre-FCE screening procedures, the monitoring of performance and safety during the FCE, and the end of FCE measures and follow-up procedures. Support was found for the screening procedures of the approach, particularly blood pressure measurement, and for the combined approach to monitoring of the persons performance from biomechanical, physiological and psychophysical perspectives. Issues for FCE safety in general are identified and discussed, including the importance of screening procedures to determine readiness for FCEs and the issue of load handling in FCEs, especially in relation to clients with chronic back pain.

Item validity of the physical demands from the Dictionary of Occupational Titles for the functional capacity evaluation of clients with chronic back pain

This study assessed the item validity of 15 of the physical demands from the Dictionary of Occupational Titles (DOT), as evaluated in a new approach to functional capacity evaluation (FCE) for clients with chronic back pain, the Gibson Approach to FCE (GAPP FCE). Fifty-two occupational therapists were sent the specifications of the items in the GAPP FCE procedures and were asked to rate the items in terms of item-objective congruence, relevance and difficulty. A response rate of 59.2% was obtained. The majority of the therapists agreed that most of the items were congruent with the objectives based on the definition of the physical demands from the DOT. The items evaluating Balancing and Pushing and Pulling had the lowest item-objective congruence. The evaluation of Balancing and the Lifting, Carrying and Pushing and Pulling of loads greater than light-medium weight (10–16 kg) were not considered significantly relevant. Concerns were raised about the difficulty and safety of the evaluation of Lifting, Carrying and Pushing and Pulling with clients with chronic back pain, particularly if the therapist evaluates the manual handling of medium to heavy loads. These results may have implications for other FCEs, particularly those which are based on the DOT, or when assessing clients with chronic back pain.

An analytical model for capacity evaluation of VoIP on HCCA and TCP file transfers over EDCA in an IEEE 802.11e WLAN

In the context of the IEEE 802.11e standard for WLANs, we provide an analytical model for obtaining the maximum number of VoIP calls that can be supported on HCCA, such that the delay QoS constraint of the accepted calls is met, when TCP downloads are coexistent on EDCA. In this scenario, we derive the TCP download throughput by using an analytical model for the case where only TCP sessions are present in the WLAN. We show that the analytical model for combined voice and TCP transfers provides accurate results in comparison with simulations (using ns-2).

Validity and relevance of the pack hike wildland firefighter work capacity test: a review

Fighting wildland fire is a physically demanding occupation. Wildland firefighters need to be physically fit to work safely and productively. To determine whether personnel are fit for duty, many firefighting agencies employ physical competency tests, such as the pack hike test (PHT). The PHT involves a 4.83-km hike over level terrain carrying a 20.4-kg pack within a 45-min period. The PHT was devised to test the job readiness of US wildland firefighters but is also currently used by some fire agencies in Australia and Canada. This review discusses the history and development of the PHT with emphasis on the process of test validation. Research-based training advice for the PHT is given, as well as discussion of the risks associated with completing the PHT. Different versions and modifications to the PHT have emerged in recent years and these are discussed with regard to their validity. Finally, this review addresses the relevance and validity of the PHT for Australian and Canadian wildland firefighters.

There is no anaerobic work capacity replenishment at critical power intensity: An indirect evidence

Aim. - This study aimed to test if investigate whether the anaerobic work capacity is replenished while exercising at critical power intensity. Then, a known exercise duration, which demands high anaerobic energy contribution, was compared to intermittent exercise duration with passive and active (cycling at critical power intensity) rest periods.Methods. - Nine participants performed five sessions of testing. From the 1st to the 3rd sessions, individuals cycled continuously at different workloads (P-high, P-intermediate and P-low) in order to estimate the critical power and the anaerobic work capacity. The 4th and 5th sessions were performed in order to determine the influence of anaerobic work capacity replenishment oil exercise duration. They consisted of manipulating the resting type (passive or active) between two cycling efforts. The total exercise duration was determined by the sum of the two cycling efforts duration.Results. - The exercise duration under passive resting condition (408.0 +/- 42.0 s) was longer (p<0.05) than known exercise duration at P-intermediate (T-intermediate = 305.8 +/- 30.5 s) and than exercise duration performed under active resting conditions (T-active = 304.4 +/- 30.7s). However, there was no significant difference between T-intermediate and T-active.Conclusion. - These results demonstrated indirect evidence that the anaerobic work capacity is not replenished while exercising at critical power intensity. (C) 2008 Elsevier Masson SAS. All rights reserved.

Cross-cultural adaptation of the Work Disability Diagnosis Interview (WoDDI) for the Brazilian context

The Work Disability Diagnosis Interview (WoDDI) is a structured interview guide developed by the University of Sherbrooke, Canada to help clinicians detect the most important work-related disability predictors and to identify one or more causes of prolonged absenteeism. This methodological study aims for the cross-cultural adaptation of the WoDDI for the Brazilian context. The method followed international guidelines for studies of this kind, including the following steps: initial translation, synthesis of translations, back translation, evaluation by an expert committee and testing of the penultimate version. These steps allowed obtaining conceptual, semantic, idiomatic, experiential and operational equivalences, in addition to content validity. The results showed that the translated WoDDI is adapted to the Brazilian context and can be used after training.