Elsayed Abdel-Moty

Does Nonsurgical Pain Center Treatment of Chronic Pain Return Patients to Work?: A Review and Meta-analysis of the Literature

Evidence in the literature relating to return to work as an outcome variable for nonsurgical treatment for chronic pain was examined. Study selection criteria were as follows: a detailed definition of patient work status, delineation of work status pre-treatment and at follow-up, and documentation of the proportion of patients employed at follow-up. Of 171 studies reviewed, 37 fulfilled these selection criteria. Because the data were objective in nature, they were abstracted by the senior author only. For the coded variables of time to follow-up, proportion of patients working pre-treatment and at follow-up and number of patients, descriptive statistics and correlations were calculated. Change in employment status at follow-up was significant (P < .005) for all groups examined. In addition, comparisons for work outcome between treated patients versus patients rejected due to lack of insurance, and between treated patients versus patients who dropped out of treatment were both significant (P < .001). The mean difference in employment at follow-up for treated patients versus those not treated was approximately 50%. The proportion of patients working increased from 20% to 54% post chronic pain nonsurgical treatment. Correlation analyses did not find a significant trend in percent employed with time to follow-up. These results indicate that (1) chronic pain nonsurgical treatment does return patients to work; (2) increased rates of return to work are due to treatment, and (3) benefits of treatment are not temporary.

The prediction of return to the workplace after Multidisciplinary Pain Center treatment.

The prediction of return to the workplace after Multidisciplinary Pain Center (MPC) treatment has become a major research area. To delineate the variables that predict this outcome, the authors reviewed 164 multidisciplinary outcome studies. Of these, 79 addressed work as an outcome variable. Twenty-six studies attempted to identify patient variables predicting return to the workplace. These latter studies were critically inspected for eight methodological criteria: pain location, follow-up time interval, response percentage and follow-up method, return to work subcategorization, vocational movement, univariate vs. multivariate statistics, multicolinearity and variance, and statistical treatment of dropouts. In addition, other disability studies besides those in the chronic pain area were reviewed for return to the workplace predictor variables. Of these 26 studies, only a few appeared to satisfy the criteria examined. In addition, many studies were in conflict with one another on whether a variable was predictive. The review of the nonchronic pain/disability prediction literature yielded a large number of potential predictors that related to the work area. It is unclear which variables or set of variables predict return to the workplace after MPC treatment. Chronic pain studies may be neglecting the work area as an important source of return to the workplace predictor variables.

Measuring residual functional capacity in chronic low back pain patients based on the dictionary of occupational titles

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 (CPP) and results can be matched against the demand minimum functional capacities (DMFC) of DOT jobs. Summary of Background Data. Physicians have difficulty translating medical impairment into functional limitation and thereby establishing the RFC of CPPs. Methods. The DOT, a USA government publication, provides information about physical demands of every USA job according to 36 factors and subfactors. The authors defined and developed a fuctional battery based on these factors/subfactors. This battery was tested on 67 consecutive CPPs to determine the percentage of CPPs able to pass specific job factors and the full battery and return to some DOT job, and evaluated the effects of pain on battery performance. The data were factor analyzed. Results. The battery determined if CPPs could perform DOT job factors and had the necessary RFC to be placed in a DOT job. The vast majority of CPPs could not pass the full battery and the presence of pain and original job classification predicted whether a CPP could perform a job factor. Factor analyses grouped the factors into four independent categories supporting the design of the battery. Conclusion. The battery can assess whether CPPs are able to return to work.

Physical performance effects of low-intensity exercise among clinically defined high-risk elders

Background: Falls are among the leading causes of injuries and deaths. Results from a number of studies have suggested that a community-based exercise program may be effective in improving lower body strength, although some have shown only limited improvements. However, the impact of these programs on gait and balance are equivocal. Further, studies that have specifically targeted deconditioned elderly individuals, rather than individuals drawn from the general community, either showed limited or no improvements in gait and balance. Objective: This study examined the effectiveness of a community-based, short-term, low-intensity exercise intervention strategy on measures of mobility skills, gait and balance, and muscle strength for a clinically targeted group of elderly individuals at high risk of falls. Methods: 245 men and women aged 60 years or older were randomized into either an intervention or control group and received a baseline (T1) assessment. Subjects in the intervention group received up to 24 sessions (45 min long) of low-intensity standard exercise modalities tailored to the individual patient over an 8- to 10-week period. At the conclusion of the program, the participants in the intervention group were instructed to continue performing the exercises at home until 1 year after T1. Measures of physical function and performance were collected for all subjects at three different points of study enrollment. Results: Of the subjects assessed at baseline, 138 (56%) also had a postintervention assessment (T2), 128 (52%) had a 6-month follow-up assessment (T3), and 105 subjects had assessments at all time points. Primary analyses were based on the 105 subjects who had assessments at all time points. Intervention and control subjects did not differ in any of the physical function or performance measures at baseline. Between T1 and T2, the intervention subjects showed significantly greater improvement than the control subjects on all outcomes, with improvements plateauing for most measures between T2 and T3. Gait and balance scores continued to improve throughout the study period for both groups of subjects. Conclusions: This easily implemented, low-intensity exercise program may lead to improvements in physical functioning that are retained over the long term and effectively targets a clinically defined population of deconditioned elders at high risk of falling and sustaining serious injury.

Functional capacity and residual functional capacity and their utility in measuring work capacity.

OBJECTIVE The pain physician is often asked to establish the medical impairment of the chronic pain patient (CPP) and from that determination ascertain the work capacity of the CPP. Functional capacity (FC) testing has recently been introduced as a more objective and accurate way of facilitating the determination of work capacity. However, there are conceptual problems with the measurement of FC. These will be reviewed and the relationship of FC to residual functional capacity (RFC) will be determined. Finally, a method for measuring RFC in a job-specific manner will be suggested. DATA SOURCES The literature in reference to the measurement of medical impairment, FC, and RFC was reviewed. STUDY SELECTION Studies appropriate to the objective of this review were selected for inclusion. CONCLUSIONS The FC and RFC are poorly defined. Lack of definition has interfered with design of appropriate test batteries specific to work capacity. To circumvent this problem a job-specific RFC measurement method is suggested. This method is based on the Dictionary of Occupational Titles.

'Movement' in work status after pain facility treatment

Study Design This was a randomized prospective follow‐up study of pain facility treatment of chronic pain patients with low back pain, with return to work and work capacity as the outcome measures. Objectives To determine if after pain facility treatment chronic pain patients “move” in and out of work and in their work capacity; to determine the patterns of “movement;” and to determine the post‐pain facility treatment follow‐up sampling time points that would maximize the number of chronic pain patients correctly classified according to their final work and work capacity status. Summary of Background Data Past research and empiric observation have indicated that chronic pain patients may “move” after pain facility treatment in and out of work and in their job work capacity. Such “movement” can affect the results of outcome studies. Methods Two hundred thirty‐six consecutive chronic pain patients who fit study selection criteria were followed up at 1, 3, 6, 12, 18, 24, and 30 months after pain facility treatment for determination of work and work capacity status and separated according to the pattern of movement. Stepwise discriminant analysis was used to answer the study objectives. “Movement” in and out of work for these chronic pain patients also was compared with the US general population. Results Chronic pain patients demonstrated eight work and four work capacity movement patterns. The 24‐ and 1‐month time points predicted final work status correctly for 97.0% and 77.0% of the chronic pain patients, respectively, whereas the most significant predictor for correct work capacity status was the 24‐month point. The annual percentage change in employment status for these chronic pain patients was more than in the US general population. Conclusions Because chronic pain patients “move” in and out of employment and for work capacity status after pain facility treatment, future outcome studies using these measures will have to consider carefully the impact of “movement” on their results.

Physician limitations when assessing work capacity: A review

Literature evidence indicates that physicians have great difficulty in translating medical impairment into functional limitation and thereby establishing the work capacity or the residual functional capacity (RFC) of the injured worker. This is especially true for the chronic pain patient (CPP). Development of quantitative methods for the measurement of functional capacity (FC), have not improved the problems involved in the measurement of RFC and the translation of RFC into the demand minimum functional capacity (DMFC) of some job or jobs. The relationship between FC, RFC, work capacity and DMFC is reviewed. We have developed a method/battery for measuring RFC in CPPs utilizing the Dictionary of Occupational Titles (DOT) which is readily translatable into DMFC of some job or jobs. Suggestions are made for future directions in the measurement of work capacity.

Displays and Controls

Abstract This chapter examines the various types of displays and controls, as well as the design characteristics that make them effective or less so. Since there are many types of displays and controls already in existence, an overview is presented in this chapter to assist the practicing ergonomist in the selection of displays and controls. Important distinctions are made between quantitative and qualitative displays as well as discrete and continuous controls. Population stereotypes are also discussed as they affect the design of displays and controls.

Computerized design and analysis of sitting workplace

Abstract This paper demonstrates the use of personal micro-computers to individualize the design of the sitting workplace. Engineering static and functional anthropometry as well as ergonomic design principles are implemented. Computer outputs and a case study are presented.

The effect of back injury and load on ability to replicate a novel posture1

The purpose of this study was to investigate the effect of back injury and load on the ability to replicate a target standing posture. Subjects included 16 back-injured males and 16 age-matched controls. Subjects were asked to reproduce a target standing posture and to repeat this task while holding a weight. Trunk inclination was measured using an electrogoniometer. Analysis of variance indicated that back-injured subjects were less accurate in reproducing the target posture than were control subjects. Back-injured subjects typically overestimated how much they had moved and therefore underestimated the target position. Both groups demonstrated a small but statistically significant difference between the load and no-load condition, with greater degrees of trunk inclination under the load condition. Analysis of covariance indicated that neither self-reported pain level nor maximum voluntary range of motion contributed to significant differences between the two groups. These data indicate that, following injury to the back, individuals may develop an inaccurate perception of body position. This study has implications for training the injured worker.