Vincent Gouttebarge

Assessment of functional capacity of the musculoskeletal system in the context of work, daily living, and sport: A systematic review

The aim of this systematic review was to survey methods to assess the functional capacity of the musculoskeletal system within the context of work, daily activities, and sport. The following key words and synonyms were used: functional physical assessment, healthy/disabled subjects, and instruments. After applying the inclusion criteria on 697 potential studies and a methodological quality appraisal, 34 studies were included. A level of reliability > 0.80 and of > 0.60 resp 0.75 and 0.90, dependent of type of validity, was considered high. Four questionnaires (the Oswestry Disability Index, the Pain Disability Index, the Roland–Morris Disability Questionnaire, and the Upper Extremity Functional Scale) have high levels on both validity and reliability. None of the functional tests had a high level of both reliability and validity. A combination of a questionnaire and a functional test would seem to be the best instrument to assess functional capacity of the musculoskeletal system, but need further examined.

Mental and psychosocial health among current and former professional footballers.

BACKGROUNDnIn common with elite athletes from other sport disciplines, severe or recurrent injuries in professional footballers are considered to be major physical and psychosocial stressors, which may predispose to mental health problems during and after their career.nnnAIMSnTo determine the prevalence of mental health problems and psychosocial difficulties in current and former professional footballers, and to explore the association between psychosocial stressors and the health conditions studied.nnnMETHODSnBased on validated scales, a paper and electronic questionnaire was developed for current and former professional footballers and distributed by the World Footballers Union (FIFPro) and players unions in six countries. Prevalence was calculated and cross-sectional analyses were conducted.nnnRESULTSnThe response rate was 29% with 253 responses available for analysis. The prevalence of mental health complaints ranged from 5% (burnout) to 26% (anxiety/depression) in 149 current players and from 16% (burnout) to 39% (anxiety/depression) in 104 former footballers. The prevalence of psychosocial problems ranged from 3% (low self-esteem) to 26% (adverse nutrition behaviour) in current players and from 5% (low self-esteem) to 42% (adverse nutrition behaviour) in former footballers. In both current and former players, mental health problems were significantly associated with low social support (odds ratio [OR] = 1.1) and recent life events (OR = 1.4-1.6). In former players, previous surgery was significantly associated with smoking (OR = 1.9).nnnCONCLUSIONSnThe prevalence of mental health problems and/or psychosocial difficulties in current and former professional footballers was found to be high. The presence of mental health problems was associated with low social support and recent life events.

The effect of lifting during work on low back pain: a health impact assessment based on a meta-analysis

Lifting at work is considered an important risk factor for low back pain (LBP). However, contradictory findings have been reported, partly because frequency, duration and intensity (ie, the weight of the load) of lifting have not been systematically considered. This has hampered developments of threshold values for lifting. The aims of this study were: to assess the effect of lifting during work (quantified in duration, frequency or intensity) on the incidence of LBP and to quantify the impact of these relationships on the occurrence of LBP in occupational populations exposed to lifting. We searched in PubMed and EMBASE.com for longitudinal studies assessing the effect of occupational lifting on LBP incidence. For each study, the exposure–response slope of the association was estimated by loglinear regression analysis. When possible, a meta-analysis on these slopes was conducted. In a health impact assessment, the effects of the pooled exposure–response relationships on LBP incidence was assessed. Eight longitudinal studies were included. Pooled estimates resulted in ORs of 1.11 (1.05 to 1.18) per 10u2005kg lifted and 1.09 (1.03 to 1.15) per 10 lifts/day. Duration of lifting could not be pooled. Using these ORs, we estimated that lifting loads over 25u2005kg and lifting at a frequency of over 25 lifts/day will increase the annual incidence of LBP by 4.32% and 3.50%, respectively, compared to the incidence of not being exposed to lifting. Intensity and frequency of lifting significantly predict the occurrence of LBP. Exposure–response relationships show that lifting heavy loads may have a substantial impact on musculoskeletal health of the working population. This information may direct the development of occupational lifting guidelines and workplace design for LBP prevention.

Are performance-based measures predictive of work participation in patients with musculoskeletal disorders? A systematic review

ObjectiveAssessments of whether patients with musculoskeletal disorders (MSDs) can participate in work mainly consist of case history, physical examinations, and self-reports. Performance-based measures might add value in these assessments. This study answers the question: how well do performance-based measures predict work participation in patients with MSDs?MethodsA systematic literature search was performed to obtain longitudinal studies that used reliable performance-based measures to predict work participation in patients with MSDs. The following five sources of information were used to retrieve relevant studies: PubMed, Embase, AMA Guide to the Evaluation of Functional Ability, references of the included papers, and the expertise and personal file of the authors. A quality assessment specific for prognostic studies and an evidence synthesis were performed.ResultsOf the 1,230 retrieved studies, eighteen fulfilled the inclusion criteria. The studies included 4,113 patients, and the median follow-up period was 12xa0months. Twelve studies took possible confounders into account. Five studies were of good quality and thirteen of moderate quality. Two good-quality and all thirteen moderate-quality studies (83%) reported that performance-based measures were predictive of work participation. Two good-quality studies (11%) reported both an association and no association between performance-based measures and work participation. One good-quality study (6%) found no effect. A performance-based lifting test was used in fourteen studies and appeared to be predictive of work participation in thirteen studies.ConclusionsStrong evidence exists that a number of performance-based measures are predictive of work participation in patients with MSDs, especially lifting tests. Overall, the explained variance was modest.

Effect of Functional Capacity Evaluation information on the judgment of physicians about physical work ability in the context of disability claims

PurposeTo test whether Functional Capacity Evaluation (FCE) information lead insurance physicians (IPs) to change their judgment about the physical work ability of claimants with musculoskeletal disorders (MSDs).MethodsTwenty-seven IPs scored twice the physical work ability of two claimants for 12 specified activities, using a visual analogue scale. One claimant performed an FCE, the other served as a control. Outcome measure was the difference between experimental and control group in number of shifts in the physical work ability for the total of 12 specified activities.ResultsThe IPs changed their judgment about the work ability 141 times when using FCE information compared to 102 times when not using this information (P-valuexa0=xa00.001), both in the direction of more and less ability.ConclusionsThe IPs change their judgment of the physical work ability of claimants with MSDs in the context of disability claim procedures more often when FCE information is provided.

Complementary value of functional capacity evaluation for physicians in assessing the physical work ability of workers with musculoskeletal disorders

ObjectiveTo study the complementary value of information from functional capacity evaluation (FCE) for insurance physicians (IPs) who assess the physical work ability of claimants with long-term musculoskeletal disorders (MSD).MethodA post-test only design was used in the context of disability claims. Twenty-eight IPs participated in the study. Claimants with MSD formed the patient population. For each IP, the first claimant who agreed to participate was included in the study, and underwent FCE in addition to the regular disability claim assessment. Firstly, the IP performed the statutory disability claim assessment. Secondly, the FCE assessment took place. Finally, a self-formulated questionnaire was presented to the IPs after they viewed the FCE report. IPs were asked whether they perceived FCE information to be of complementary value to their judgment of the claimant’s physical work ability investigated. We considered FCE information to be of complementary value if more than 66% of the IPs indicated as such. IPs were also asked whether FCE information led them to change their initial judgment about the claimant’s physical work ability, and whether they felt this information made them more confident about their ultimate judgement. Finally, they were asked whether they planned to include FCE information in future disability claims and for what type of claimants. Differences between IPs who did or did not experience complementary value were explored.ResultsOf the 28, 19 (nearly 68%) IPs considered FCE information to be of complementary value for their assessment of claimants with MSD. Half of the IPs stated that FCE information reinforced their judgment. All but four IPs changed their assessment after reading the FCE report. Sixteen IPs intended to involve FCE information in future disability claim assessments. There were no observed differences between the IPs who did or did not consider the FCE information to be of complementary value.ConclusionFCE information was found to have complementary value at present and in the future according to most IPs in the assessment of the physical work ability of claimants with MSD. Half of the IPs felt that this information reinforces their judgment in this context.

Construct Validity of Functional Capacity Evaluation Lifting Tests in Construction Workers on Sick Leave as a Result of Musculoskeletal Disorders

OBJECTIVESnTo assess the construct (discriminative and convergent) validity of 5 Ergo-Kit (EK) functional capacity evaluation (FCE) lifting tests in construction workers on sick leave as a result of musculoskeletal disorders (MSDs).nnnDESIGNnCross sectional within-subject design.nnnSETTINGnOccupational health service for the construction industry.nnnPARTICIPANTSnMale construction workers (N=72) on 6-week sick leave as a result of MSDs.nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASUREnAfter being assessed on 5 EK FCE lifting tests, participants were asked to complete the Von Korff questionnaire on pain intensity and disability as a result of MSDs and the instrument for disability risk assessing the risk for work disability. Discriminative validity was evaluated by comparing the results of the EK FCE lifting test scores between the 2 groups of participants based on the instrument for disability risk scores (high risk for work disability compared with low risk for work disability). Convergent validity was evaluated by assessing the associations between the results of the EK FCE lifting tests and Von Korff questionnaire self-reported pain intensity and disability as a result of MSDs.nnnRESULTSnThe hypothesized differences between both instrument for disability risk groups on the 5 EK FCE lifting tests were found in the expected direction but were not statistically significant (1 test exhibited a trend). Pearson correlation coefficients showed a poor convergent validity between the scores of the Von Korff questionnaire and the EK FCE lifting tests (-.29< or =r< or =.05).nnnCONCLUSIONSnPoor construct validity of the 5 EK lifting tests was found: discriminative validity was not statistically established, and convergent validity with self-reported pain intensity and disability was poor.

Het nut van Functionele Capaciteit Evaluatie: de visie van experts

samenvattingHet doel was te onderzoeken hoe experts het nut van FCE (Functionele Capaciteit Evaluatie) waarderen als een instrument om de functionele fysieke capaciteit vast te stellen voor reïntegratie en claimbeoordeling.Eenentwintig experts op het terrein van reïntegratie en 29 claimbeoordelingexperts zijn telefoxadnisch geïnterviewd aan de hand van semi-gestructureerde vragen. De reïntegratie-experts zijn overxadwegend positief over het nut van FCE, terwijl claimbeoordelingexperts verdeeld zijn. Positieve arguxadmenten voor het nut van FCE zijn versterking van de eigen visie en de objectiviteit van meten. Als negatieve argumenten worden genoemd het gebrek aan nieuwe informatie en de mogelijke invloed van de patiënt op de uitkomst van het onderzoek. Randvoorwaarden voor het gebruik van FCE zijn aandoeningen van het bewegingsapparaat, een positieve visie van de patiënt over zijn arbeidsmogexadlijkheden en de aanwezigheid van een concrete baan.Verder onderzoek is nodig om te toetsen of de argumenten die genoemd werden op de vraag of FCE een nuttig instrument is, valide zijn.

Facilitators and Barriers in the Use of a Checklist by Insurance Physicians during Work Ability Assessments in Depressive Disorder

Objectives Depressive disorder (DD) is a complex disease, and the assessment of work ability in patients with DD is also complicated. The checklist depression (CDp) has recently been developed to support such work ability assessments and has been recommended for implementation in insurance medicine, starting with an analysis of the organisational and social contexts. The aim of this study was to identify the potential facilitators and barriers in the use of the CDp by insurance physicians (IPs) during work ability assessments of employees on sick leave due to DD. Methods A qualitative research was conducted based on semi-structured interviews. The participants were IPs with at least one year of work experience in performing work ability assessments. The interviews were audiotaped, transcribed and analysed qualitatively. Results Ten IPs (7 males, 3 females; mean 53 years) were interviewed. Important facilitators, which emerged for use of the CDp, were an oral introduction for colleagues and staff, support from management, valuing the increased transparency in work ability assessments with using the CDp, having adequate time for assessments as well as modification of the appearance (colour, plasticised form) and content (clarifying aspects of the examples) of the assessment tool. The fear of the loss of autonomy, lack of added value of the CDp, high workload, inadequate instructions and lack of time were mentioned as barriers. Conclusion Adequate introduction to the use of CDp and the fear of the loss of autonomy of IPs need special attention in planning its implementation.

Mental Health in Professional Football Players

Symptoms of common mental disorders describe a mental and emotional state of adverse thoughts and/or abnormal or maladaptive behaviour that impair activities either in daily life, work or sport. Examples of symptoms of common mental disorders are often related to distress, burnout, anxiety, depression or sleep disturbance. Among professional footballers, 4-week prevalence of symptoms of common mental disorders ranges from 9% for adverse alcohol use to 38% for anxiety/depression and 12-month incidence from 12% for distress to 37% for anxiety/depression. Symptoms of common mental disorders are generally multifactorial, occurring as a consequence of the interaction between biological, psychological, social, sport-specific and career-related stressors. Especially, severe time-loss (28 days or more) injuries during a football career can be considered as a major stressor. Professional footballers who have sustained one or more severe time-loss injuries during their career are two to four to nearly four times more likely to report symptoms of a mental disorder than professional footballers who have not suffered from similar time-loss injuries. Most of professional footballers mention that symptoms of common mental disorders influence football performance negatively, while those symptoms are likely to interfere with return to play, especially in terms of concentration, focus, emotion, reaction time, coordination, power, strength and endurance. This emphasises the importance of applying a multidisciplinary approach to the clinical care and support of professional footballers, especially when a player faces severe time-loss injuries and related return to play process.