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Objective: To determine whether functional capacity evaluation (FCE) tests predict future work capacity (WC) of patients with whiplash-associated disorders (WADs) grades I and II who did not regain full WC 6 to 12 weeks after injury.Design: Prospective cohort study.Setting: Rehabilitation center.Participants: Workers (N=267) listed on workers' compensation with grade I or El WADs 6 to 12 weeks after injury.Interventions: Patients performed 8 work-related FCE tests.Main Outcome Measures: WC (0-100%) measured at baseline and 1, 3, 6, and 12 months after testing. Correlation coefficients between FCE tests and WC were calculated. A linear mixed-model analysis was used to assess the association between FCE and future WC.Results: Mean +/- SD WC increased over time from 20.8%+/- 27.6% at baseline to 32.3%+/- 38.4%, 51.3%+/- 42.8%, 65.6%+/- 42.2%, and 83.2%+/- 35.0% at the 1-, 3-, 6-, and 12-month follow-ups, respectively. Correlation coefficients between FCE tests and WC ranged from r=.06 (lifting low at 12-mo follow-up) to r=.39 (walking speed at 3mo). Strength of the correlations decreased over time. FCE tests did not predict WC at follow-up. The predictors of WC were ln (time) (beta=23.74), mother language (beta=5.49), WC at baseline (beta=1.01), and self-reported disability (beta=-.20). Two interaction terms, ln (time) x WC (beta=-.19) and ln (time) x self-reported disability (beta=-.21), were significant predictors of WC.Conclusions: FCE tests performed within 6 to 12 weeks after WADs injury grades I and II are associated with WC at baseline but do not predict future WC, whereas time course, mother language, WC at baseline, and self-reported disability do predict future WC. Additionally, the interaction between time course WC at baseline and self-reported disability predicted future WC. (C) 2014 by the American Congress of Rehabilitation Medicine

Objectives: To analyze test-retest reliability and agreement, and to explore the safety of neck functional capacity evaluation (Neck-FCE) tests in patients with chronic multifactorial neck pain.Design: Test-retest; 2 FCE sessions were held with a 2-week interval.Setting: University-based outpatient rehabilitation center.Participants: Individuals (N=18; 14 women) with a mean age of 34 years. Interventions: Not applicable.Main Outcome Measures: The Neck-FCE protocol consists of 6 tests: lifting waist to overhead (kg), 2-handed carrying (kg), overhead working (s), bending and overhead reaching (s), and repetitive side reaching (left and right) (s). Intraclass correlation coefficients (ICCs) and limits of agreement (LoA) were calculated. ICC point estimates between.75 and.90 were considered as good, and >.90 were considered as excellent reliability.Results: ICC point estimates ranged between.39 and.96. Ratios of the LoA ranged between 32.0% and 56.5%. Mean +/- SD numeric rating scale pain scores in the neck and shoulder 24 hours after the test were 6.7 +/- 2.6 and 6.3 +/- 3.0, respectively. Conclusions: Based on ICC point estimates and 95% confidence intervals, 3 tests had excellent reliability and 3 had poor reliability. LoA were substantial in all 6 tests. Safety was confirmed.

Soer R, de Vries HJ, Brouwer S, Groothoff JW, Geertzen JH, Reneman MF. Do workers with chronic nonspecific musculoskeletal pain, with and without sick leave, have lower functional capacity compared with healthy workers? Arch Phys Med Rehabil 2012;93:2216-22.Objectives: (1) To analyze whether functional capacity (FC) of sick listed workers with chronic nonspecific musculoskeletal pain (CMP) referred for rehabilitation (SL-Rehab group) and workers with CMP who stay at work (SAW group) differ from the FC of healthy workers (HW group). (2) To analyze if FC of workers with CMP is insufficient to meet work demands, and to assess factors associated with insufficient FC.Design: A 3-group cross-sectional comparison.Setting: Rehabilitation center.Participants: Workers (N=942) were included (SL-Rehab group: n=122, SAW group: n=119, and HW group: n=701).Interventions: All subjects performed a short Functional Capacity Evaluation (FCE) and completed questionnaires assessing demographics, personal, and work characteristics.Main Outcome Measure: FCE performances. Participants' FC was insufficient to meet their work demands when their FC was lower than the 5th percentile of the HW group's FC.Results: Both the SL-Rehab and SAW groups had significantly lower FC compared with the HW group; 15% to 71% demonstrated insufficient FC. Insufficient FC was associated with group status (SL Rehab group: odds ratio [OR]=6.5; SAW group: OR=7.2), having physically high demanding work (OR=35.1), being a woman (OR=35.7), higher age (OR=1.2), and lower effort level during FCE (OR=1.9). Among subjects with CMP, kinesiophobia, physical health, and perceived disability were associated with having an insufficient FC for work.Conclusions: Workers in the SL-Rehab group have lower FC than their working counterparts. Many workers in both groups with CMP demonstrated insufficient FC. Not the pain itself, but personal and work-related factors are related to insufficient FC.

Soer R, Brouwer S, Geertzen JH, van der Schans CP, Groothoff JW, Reneman MF. Decline of functional capacity in healthy aging workers. Arch Phys Med Rehabil 2012;93:2326-32.Objectives: (1) To study the natural decline in functional capacity (FC) of healthy aging workers; (2) to compare FC to categories of workload; and (3) to study the differences in decline between men and women.Design: Cross-sectional design.Setting: A rehabilitation center at a university medical center.Participants: Volunteer sample of healthy workers (N=701) between 20 and 60 years of age, working at least 20 hours per week in the year prior to the study. Subjects were recruited via local press and personal networks.Interventions: FC was measured with a 14-item Functional Capacity Evaluation. Demographics and health status were measured with a general demographic questionnaire and the RAND-36 questionnaire.Main Outcome Measures: Workload was expressed by the workload categories, as described by the Dictionary of Occupational Titles. Descriptive statistics were used to present FC of workers. Change in FC by age was tested with segmented regression analyses with a cutoff point at 45 years of age.Results: Significant but small declines of FC under age 45 years were present in repetitive reaching, hand dexterity, and energetic capacity. Up to 45 years of age, hand and finger strength increased on average. Over 45 years of age, lifting, carrying, hand and finger strength, and coordinative tests declined more compared with the group aged less than 45 years. Work capacity of men and women working in sedentary and light work was sufficient in all age categories. There are no differences in decline between men and women.Conclusions: FC of healthy workers declines with age. This study demonstrates substantial variation in the type of FC decline among healthy workers between 20 and 60 years of age. Material handling, hand and finger strength, and hand coordination appear to decline the most in workers over age 45 years. The objective of rehabilitation is to maximize an individual's FC, particularly with respect to environmental demand. Thus, return to work programs must appreciate both FC and workplace demands in an effort to restore/enhance equilibrium between the 2.

Reneman MF, de Vries RI, van den Hengel EJ, Brouwer S. van der Woude LH. Different level, but a similar day pattern of physical activity in workers and sick-listed people with chronic nonspecific musculoskeletal pain. Arch Phys Med Rehabil 2012;93:1864-7.Objective: To investigate whether physical activity (PA) levels and day patterns of sick-listed workers with chronic nonspecific musculoskeletal pain (CMP) admitted for multidisciplinary rehabilitation are different from those of workers with CMP.Design: Cross-sectional.Setting: Outpatient rehabilitation center and general community.Participants: A convenience sample of sick-listed patients with CMP (n = 27) referred for multidisciplinary pain rehabilitation, and a volunteer sample of workers with CMP (n = 107;Intervention: Participants wore an accelerometer for 5 to 7 consecutive days.Main Outcome Measure: PA, expressed as activity counts. All analyses were corrected for confounders.Results: PA levels of workers with CMP were higher than those of sick-listed patients (P = .01). After correction for confounders, work status explained 3.5% of the variance observed in activity counts (F-change = 5.27, P=.024). In the mornings, group status significantly contributed to the variance in mean activity counts (F-change = 5.32, P = .02). In afternoons (F-change =3.29, P = .07) and evenings (F-change = 2.41, P = .12), the effect of group status on PA level was nonsignificant. No Significant interaction was observed between time and group status (Wilks' lambda = .92, F-14,F-104 = .66, P = .80).Conclusions: Workers with CMP have a higher PA level compared with sick-listed patients. The PA day pattern did not differ significantly between the 2 groups.

Objective: (1) To determine the prevalence of musculoskeletal complaints (MSCs) in individuals with upper limb absence in The Netherlands, (2) to assess the health status of individuals with upper limb absence in general and in relation to the presence of MSCs, and (3) to explore the predictors of development of MSCs and MSC-related disability in this population.Design: Cross-sectional study: national survey.Setting: Twelve rehabilitation centers and orthopedic workshops.Participants: Individuals (n=263; mean age, 50.7 +/- 16.7y; 60% men) >= 18 years old, with transverse upper limb reduction deficiency (42%) or amputation (58%) at or proximal to the carpal level (response, 45%) and 108 individuals without upper limb reduction deficiency or amputation (n=108; mean age, 50.6 +/- 15.7y; 65% men) (N=371).Interventions: Not applicable.Main Outcome Measures: Point and year prevalence of MSCs, MSC-related disability (Pain Disability Index), and general health perception and mental health (RAND-36 subscales).Results: Point and year prevalence of MSCs were almost twice as high in individuals with upper limb absence (57% and 65%, respectively) compared with individuals without upper limb absence (27% and 34%, respectively) and were most often located in the nonaffected limb and upper back/neck. MSCs were associated with decreased general health perception and mental health and higher perceived upper extremity work demands. Prosthesis use was not related to presence of MSCs. Clinically relevant predictors of MSCs were middle age, being divorced/widowed, and lower mental health. Individuals with upper limb absence experienced more MSC-related disability than individuals without upper limb absence. Higher age, more pain, lower general and mental health, and not using a prosthesis were related to higher disability.Conclusions: Presence of MSCs is a frequent problem in individuals with upper limb absence and is associated with decreased general and mental health. Mental health and physical work demands should be taken into account when assessing such a patient. Clinicians should note that MSC-related disability increases with age. (C) 2016 by the American Congress of Rehabilitation Medicine

Soer R, van der Schans CP, Geertzen JH, Groothoff JW, Brouwer S, Dijkstra PU, Reneman MF. Normative values for a functional capacity evaluation. Objective To establish normative values for a functional capacity evaluation (FCE) of healthy working subjects. Design Descriptive. Setting Rehabilitation center. Participants Healthy working subjects (N=701; 448 men, 253 women) between 20 and 60 years of age, working in more than 180 occupations. Interventions Subjects performed a 2-hour FCE consisting of 12 work-related tests. Subjects were classified into categories based on physical demands according to the Dictionary of Occupational Titles . Main Outcome Measures Means, ranges, SDs, and percentiles were provided for normative values of FCE, and a regression analysis for outcome of the 12 tests was performed. Results Normative FCE values were established for 4 physical demand categories. Conclusions The normative values enable comparison of patients' performances to these values. If a patient's performance exceeds the lowest scores in his/her corresponding demand category, then the patient's capacity is very likely to be sufficient to meet the workload. Further, clinicians can make more precise return-to-work recommendations and set goals for rehabilitation programs. A comparison of the normative values can be useful to the fields of rehabilitation, occupational, and insurance medicine. Further research is needed to test the validity of the normative values with respect to workplace assessments and return-to-work recommendations.

To evaluate the quality of Functional Capacity Evaluation (FCE) information in predicting return to work (RTW).Prospective cohort study.Inpatient rehabilitation clinic.Patients (N=220) with chronic musculoskeletal disorders (MSD) conducting a medical rehabilitation.Not applicable.Patients filled in questionnaires at admission and 1-year follow-up. An FCE was performed on admission. RTW was defined as a combination of employment at 1-year follow-up with a maximum of 6 weeks sick leave because of MSD in the postrehabilitation year. As predictive FCE information, the physical capacity (Dictionary of Occupational Titles categories 1-5), the number of test results not meeting work demands (0-25), and the tester's recommendation of work ability in the actual job (or =6h/d) were analyzed. Logistic regression models (crude and adjusted for the concurrent predictors employment, preadmission sick leave, and patient's prognosis of RTW) were created to predict RTW.Complete data were obtained for 145 patients. The sample showed a non-RTW at 1-year follow-up for 37.9%. All FCE information showed significant relations to RTW (r=.28-.43; P.05). In the crude as well as in the adjusted regression models, all FCE information predicted RTW, but the models' quality was low. The integration of FCE information led to an increase of 5%. The predictive efficiency was poor. The adjusted model for failed tests showed a substantial improvement compared with the reference model (concurrent predictors only).There was a significant relation between FCE information and RTW with and without concurrent predictors, but the predictive efficiency is poor. Primarily, the number of failed tests seemed to be of significance for patients with ambiguous RTW prognosis. A first proposal for a prediction rule was discussed.