Libby Gibson

The reliability and validity of a measure of perceived functional capacity for work in chronic back pain

Psychosocial factors, including perceived disability and self-efficacy, are important determinants of outcome for individuals with chronic back pain. Consequently, there is a need for an evaluation and consideration of such factors in occupational rehabilitation. This study evaluated the reliability and validity of a tool, the Spinal Function Sort, as a measure of perceived capacity for work-related tasks with 42 rehabilitation clients with chronic back pain. Results provided support for the internal consistency (Cronbachs alpha of 0.97), test-rest reliability (ICC of 0.89) and construct validity of the Spinal Function Sort as a measure of perceived capacity for work-related tasks in persons with chronic back pain. Measures of similar constructs were significantly correlated with the Spinal Function Sort and were highly predictive of the Spinal Function Sort on multiple regression. Relationships between perceived work capacity and pain intensity and gender are discussed. The need for the consideration of perceived capacity in the evaluation and rehabilitation of persons with chronic back pain is highlighted.

A review of functional capacity evaluation practice.

OBJECTIVES This study evaluated the implementation of recommendations from a prior review of functional capacity evaluation practice in a regionalised rehabilitation service. The evaluation considered the acceptance of the recommendations and the current level of consistency of approach in practice. STUDY DESIGN The study was qualitative in nature, using a descriptive survey and a focus group. Participants were occupational therapists of a major rehabilitation provider in Queensland, Australia. Eighteen of 48 therapists (38%) responded to the questionnaire. Eight therapists participated in the focus group. RESULTS The results indicated some acceptance of the recommendations for functional capacity evaluation in areas such as procedure, reporting, equipment and model of evaluation. Further research into the reliability and validity of functional capacity evaluation was indicated. DISCUSSION The low response rate did not allow conclusive results. However, the findings provided some evidence of consistency in functional capacity evaluation practice. The results are discussed in relation to current issues in functional capacity evaluation practice.

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 person’s 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.

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 Evaluations 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 an 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.

Assessment of standing in Functional Capacity Evaluations: An exploration of methods used by a sample of occupational therapists

OBJECTIVE The primary aim of the study was to explore the current practice of occupational therapists when assessing standing performance during Functional Capacity Evaluations (FCEs). METHODS A semi-structured interview was conducted with occupational therapists and the participants were interviewed using both open and closed questions. PARTICIPANTS A sample of occupational therapists (n=20) from Queensland, Australia were involved in a survey. They were all experienced in conducting FCEs. RESULTS Ninety percent of the respondents used a distracting task during the assessment of standing with standardised and non-standardised nuts and bolts assembly tasks the most commonly used. Respondents reported using a mix of biophysical, physiological and psychophysical clinical observations to assess standing. The nuts and bolts assembly activities used by the respondents were rated to be of low interest in terms of engaging the client. CONCLUSIONS It was identified there are minimal guidelines in the literature which focuses on assessment of standing in FCEs. Questions were raised regarding the adequacy of the use of nuts and bolts activities as a suitably distracting task in FCEs and further research is required on assessing standing in functional capacity evaluation including the use of suitably distracting activities.

Professional supervision in the work rehabilitation arena in one Australian State

OBJECTIVE This study examined the methods and frequency of professional supervision in Queenslands work rehabilitation sector. Professional supervision is regarded as an important aspect of professional development and hence, critical to the improvement of services delivered by practitioners. However, there is little documented on the extent of supervision of practitioners in this setting and even less on the impact and effectiveness of supervision. PARTICIPANTS Eighty-two (82) work rehabilitation professionals participated in the study. METHODS The majority of participants (76) responded to a web-based survey that had been sent to them by a web-link, and 6 completed a paper based survey version of the survey, which evaluated the extent, practice methods, and barriers to the delivery and receipt of supervision. A follow-up focus group was held with key opinion holders to examine possible barriers to supervision in the industry. RESULTS 59% of the participants had not received any form of supervision in the past two years. Those who received or delivered supervision reported it to be a valuable practice. The follow-up focus group identified barriers to supervision as being pressures of commercial targets, lack of exposure to work rehabilitation in university curricula, high staff turn-over, relative inexperience of case managers and purchasers dictating product outcomes. CONCLUSIONS The development of industry standards for supervision practice is recommended to overcome the barriers to supervision.

Functional Capacity Evaluation:An Integrated Approach to Assessing Work Activity Limitations

Occupational therapists (OTs) have an established role in assessing readiness for return to work. Functional capacity evaluation (FCE) is one method frequently used for this purpose. This chapter describes the new Gibson approach to functional capacity evaluation (GAPP FCE). The assessment was developed by OTs. It provides an evidence-based and integrated framework for OTs to assess comprehensively the many aspects of performance of the physical demands of work. These aspects include key psychosocial variables known to influence physical performance and return to work. The GAPP FCE is described, including the eight-step process and a summary of evidence to date.

Simulation in Occupational Therapy Curricula: A literature review

BACKGROUND/AIM Simulated learning experiences are increasingly being used in health-care education to enhance student engagement and provide experiences that reflect clinical practice; however, simulation has not been widely investigated in occupational therapy curricula. The aim of this paper was to: (i) describe the existing research about the use and evaluation of simulation over the last three decades in occupational therapy curricula and (ii) consider how simulation has been used to develop competence in students. METHODS A literature review was undertaken with searches of MEDLINE, CINAHL and ERIC to locate articles that described or evaluated the use of simulation in occupational therapy curricula. RESULTS/FINDINGS Fifty-seven papers were identified. Occupational therapy educators have used the full scope of simulation modalities, including written case studies (22), standardised patients (13), video case studies (15), computer-based and virtual reality cases (7), role-play (8) and mannequins and part-task trainers (4). Ten studies used combinations of these modalities and two papers compared modalities. Most papers described the use of simulation for foundational courses, as for preparation for fieldwork, and to address competencies necessary for newly graduating therapists. The majority of studies were descriptive, used pre-post design, or were students perceptions of the value of simulation. CONCLUSION Simulation-based education has been used for a wide range of purposes in occupational therapy curricula and appears to be well received. Randomised controlled trials are needed to more accurately understand the effects of simulation not just for occupational therapy students but for longer term outcomes in clinical practice.

Pre-placement screenings: An exploratory study of their use in a sample of New South Wales workplaces.

OBJECTIVE To conduct an exploratory pilot study of pre-placement screening practice in Australia by examining the nature and use of pre-placement screenings in a sample of New South Wales (NSW) workplaces. PARTICIPANTS 29 of 279 employers (10.3%) invited using three sources: a public list of self-insured NSW companies, a regional chamber of commerce group and researchers contacts. The majority of respondents (31%) belonged to government administration and education. Half of the workplaces employed more than 200 people. METHODS Employers completed an online survey from a link sent by email. RESULTS Sixteen (55%) of the companies had a formal process for conducting pre-placement screenings, that were conducted by a range of professionals using a variety of methods, with costs ranging from

Perceptions of evidence-based practice: A survey of Australian occupational therapists

80 to