Nancy D. Kishino

1985 volvo award in clinical sciences objective assessment of spine function following industrial injury a prospective study with comparison group and one-year follow-up

Objective functional capacity measurement techniques were used to guide a treatment program for a group of 66 chronic back pain patients. These patients were compared with a group of 38 chronic patients who were not administered the treatment program. Outcome data were collected by telephone survey at an average 1 year follow-up. In addition, functional capacity measures were collected for treatment group patients on admission and follow-up evaluations. Results demonstrated that the functional capacity measures collected for the treatment group improved in approximately 80% of the patients. These changes were also accompanied by positive changes in psychologic measures. In addition, at 1 year follow-up, the treatment group had approximately twice the rate of patients who returned to work, relative to the comparison group. Additional surgery rates were comparable for both groups (6% in the treatment and 7% in the comparison group), but the frequency of additional health-care professional visits was substantially higher in the comparison group. The findings suggest that quantitative functional capacity measures can give objective evidence of patient physical abilities and degree of effort and can significantly guide the clinician in administering an effective treatment program

Progressive isoinertial lifting evaluation: I. A standardized protocol and normative database

Dynamic tests of trunk strength and lifting capacity have become more popular in recent years, offering certain advantages over static isometric tests in measuring patient progress in functional restoration programs for spinal disorders. However, equipment for performing such tests is expensive to buy, complex to run, and requires technical expertise and clinical volume unavailable in most physician offices. In this study, a new dynamic test known as Progressive Isoinertial Lifting Evaluation (PILE) is described, which draws upon prior psychophysical and isoinertial methods. An industrial sample of 61 male and 31 female incumbent workers were tested using the PILE, and a variety of anthropometric normalizing factors were evaluated. The isolation of an “Adjusted Weight” (AW) normalizing factor is documented, after which normative data are presented for male and female workers utilizing lumbar (0–30 inches) and cervical (30–54 inches) dynamic protocols.

A prospective short-term study of chronic low back pain patients utilizing novel objective functional measurement☆☆☆

&NA; The present study utilized recently developed diagnostic tests that permit recognition of functional deficits in spine mobility, trunk strength, endurance, coordination, and dynamic lifting capacity. Changes in these tests were compared to changes in psychological functioning (e.g., self‐report of pain) as well as to outcome criteria such as return‐to‐work and resolution of litigation. The study utilized these tests repeatedly during a new treatment approach to feed back objective information of the patients functional capacity, not amenable to simple visual inspection, to both the patient and the surgeon. The program itself integrated a low back physical rehabilitation program with a multimodal pain management program and was guided by repeated functional capacity measurements. A total of 66 patients were evaluated. Results demonstrated significant improvement in physical function in these patients, which was also accompanied by changes in self‐report of pain complaints. Moreover, an 82% return‐to‐work rate was achieved in this sample which was initially 92% unemployed. These results indicate that the physician dealing with chronic low back dysfunction can employ objective measures of functional capacity as an alternative to the sole reliance on pain patient self‐report or structured tests, such as radiographie imaging, which merely document a universal, progressive degenerative process.

Progressive isoinertial lifting evaluation. II. A comparison with isokinetic lifting in a disabled chronic low-back pain industrial population

The Progressive Isoinertial Lifting Evaluation (PILE), as described in Part I of this series of articles, is a simplified test combining psychophysical and isoinertial protocols to provide an unconstrained lifting assessment. In the second part of this study, 100 chronically disabled low-back pain patients (57 men and 43 women) were studied at two points: 1) at initial evaluation, when referred for possible entry into a comprehensive Functional Restoration treatment program; and 2) at the conclusion of the treatment (an average 7 weeks later). Results of simultaneous lumbar PILE and Cybex Liftask (Lumex, Ronkonkoma, NY) tests are presented, showing that patients may frequently double or triple initial lifting capacity after undergoing the functional restoration training program, achieving lifting levels at or above normal for incumbent industrial workers. Overall, results demonstrate that the PILE test can be an effective baseline screening test for lifting capacity under certain circumstances. Although several drawbacks affecting the PILE as an isolated test are discussed, its usefulness as part of a battery of physical capacity tests making up a quantitative functional evaluation is clearly demonstrated. Finally, the potential use of PILE as a safe, inexpensive, simple, and relevant screening test for frequent lifting capacity in worker selection is discussed.

Quantification of Lumbar Function: Part 4: Isometric and Isokinetic Lifting Simulation in Normal Subjects and Low-Back Dysfunction Patients

The present study collected the first normative data on a new dynamic isokinetic lifting device and compared a normal subject sample (n = 65) with a chronic low-back pain patient sample (n = 68) on this device. In addition, a comparison was made between isometric lifting measures collected for these controls and patients, and a normative industrial sample used in an earlier isometric testing protocol. Results demonstrated significant differences between controls and patients on all measures. An unanticipated finding was the greater lifting capacity levels of the present normal sample relative to those reported in the earlier isometric testing. These findings demonstrate that dynamic lifting simulation offers an important new tool for medical and industrial assessment, and conservative medical management.

Secondary loss and pain-associated disability: theoretical overview and treatment implications.

In the area of occupational pain disability, a major barrier to effective rehabilitation of patients may be the extensive personal losses that can arise as secondary features of chronic pain disability. In this review, we discuss the concept of secondary loss and how it can have a profound impact on patients with occupational pain disability. Such secondary loss issues are extremely important to consider in any rehabilitation program in order to ensure the most comprehensive and compassionate treatment of these patients. We discuss the types of intervention that may be employed within the context of interdisciplinary rehabilitation programs.

Improvement in postoperative and nonoperative spinal patients on a self-report measure of disability: The Spinal Function Sort (SFS)

The present study was designed to evaluate the clinical utility of the Spinal Function Sort (SFS), in a group of postoperative and nonoperative low back pain patients who completed a functional restoration program. The SFS was administered to 38 spinal pain patients (16 nonoperative and 21 postoperative), before and after completing a functional restoration program. Results revealed that the SFS detected a significant improvement in Ratings of Perceived Capacity scores, and that the postoperative patients appeared to improve more than nonoperative patients. These findings demonstrate the clinical utility of the SFS as an effective assessment tool of functional capacity in both postoperative and nonoperative spinal disorder patients. It provides a time-efficient method for evaluating a patients functional status.

Fear-Avoidance Beliefs and Chronic Pain

Fear-avoidance (FA) beliefs are significantly associated with the experience of pain, especially when the pain becomes chronic in nature. The anticipated threat of intense pain will often result in the constant vigilance and monitoring of pain sensations, which, in turn, can cause even low-intensity sensations of pain to become unbearable for the person. Just the anticipation of increased pain or reinjury can further stimulate avoidance behaviors. A vicious cycle may develop, in which fears of increased pain or reinjury contribute to the avoidance of many activities, leading to inactivity and, ultimately, to greater disability. Anyone who assesses and treats pain-related disability should also be prepared to assess and treat pain-related FA.

Effects of Subacute Versus Chronic Status of Low Back Pain Patients' Response to a Functional Restoration Program

This study evaluated various functional capacity measures in two cohorts of patients participating in a functional restoration program: 1) subacute patients (defined as being admitted to the program within 1/2 year of injury), and 2) chronic patients (defined as being admitted after 1/2 year of injury). The main aim was to evaluate the differential effects of subacute versus chronic intervention functional outcomes of low back pain patients who participated in a functional restoration program. Findings clearly demonstrated that, compared to the chronic intervention group (n = 170), the subacute intervention group (n = 110) displayed greater functional performance gains in various tasks (e.g., range of motion, lifting capacity, etc.). These findings are consistent with recent suggestions in the literature that early intervention will produce greater therapeutic improvement in low back pain patients, with resultant health-care cost savings. Additional research is needed to further evaluate the utility of distinguishing among acute, subacute, and chronic patients as a means of predicting the degree of functional gains produced by intervention.

Early Intervention to Prevent the Development of Chronic Musculoskeletal Pain Disorders and Disability

As highlighted in the first chapter of this handbook, musculoskeletal disorders are the single largest category of work-related illnesses in industrialized countries today. Moreover, the recent and highly influential Institute of Medicine Report, “Relieving Pain in America,” has emphasized the urgent need for better methods of pain management because the ever-increasing costs associated with current treatment approaches are unsustainable. The report also highlighted musculoskeletal pain as the most common single type of chronic pain; within this category, chronic low back pain is the most prevalent. Supporting these high prevalence findings, chronic lower back pain (LBP), followed by temporomandibular joint and muscle disorders (TMJMD), ranks as the most frequently occurring musculoskeletal conditions that result in disability and pain (National Institute of Dental and Craniofacial Research, 2008). The critical nature of occupational musculoskeletal disorders was also earlier highlighted by the fact that, in 1998, the National Institutes of Health requested the National Academy of Sciences/National Research Council to convene a panel of experts to carefully evaluate some of the questions raised by the US Congress concerning occupational musculoskeletal disorders (National Research Council, 2001). One important issue was: “Does the research literature reveal any specific guidelines to prevent the development of chronic conditions?”