Week 2 Reading Flashcards
How are disability assessment tools classified? Which classification is most useful?
By tool format
example: Patient questionnaires, semi-structured clinical interviews, worksite meeting and inspection, clinician impression, objective measures, administrative data
By tool utilities: screening to predict person’s risk for long term disability, assessing work ability, assessing obstacles to return to work
How can we choose appropriate disability management tools? What criteria should we follow
Consider the following
- measurement issues (appropriateness of tool, reliability, validity, responsiveness, precision, interpretability)
- practical issues: acceptability and feasibility
What are the 3 main approaches to FCEs? Which approach have we discussed in class?
the kinesiophysical/biomechanical approach
Psychophysical approach: maximum functional capacity is determined by patient. Patient selects appropriate weights on different tests based on his or her perception of pain, effort, anxiety, and physiological stress. Subjective maximum performance depends not only on physical but psychosocial factors
Kinesiophysical/biomechanical approach: maximum functional capacity is determined by observation of physical efforts. Evaluator assesses several signs such as body mechanics, movement patterns, facial expression, change in movement velocity to assist in determining appropriate weight for each activity
Physiological approach: maximum functional capacity is based on physiological signs such as heart rate
How can the validity of an FCE be improved?
Validity: whether a tool measures what it intends to measure
Perform in an environment that simulates work (non-clinical)
Consult employer on work requirements
Modify FCE items based on job requirements
Improve instrumentation used in FCE
Grip measurement tools - are they similar to the girth of the equipment the worker normally holds?
Done over several days (a bad day and good day for someone)
Can see the variation in capacity due to injury so you can assign appropriate work on bad or good days
Which RTW predictors does an FCE not measure well?
Psychosocial factors Cognitive factors
Environmental factors
What is an assessment of work performance?
What are the strengths of an AWP (assessment of work performance) over and above an FCE?
Observational tool - 14 items on a four-point ordinal scale from deficient performance to competent performance. domains: motor skills, process skills, communication skills
Strengths: generic nature - applicable to multiple jobs; available in many languages
Can be used in a work setting but mostly ended up using it in a clinical setting
Can’t use it when the task is too simple or limited
Takes into account cognitive skills as well as physical
What is a return to work self-efficacy questionnaire?
What are the strengths of an RWSEQ over and above an FCE?
Purpose: assess worker’s beliefs about current ability to RTW following pain onset. Assesses individual’s concern with RTW and self-perceived problem solving abilities. Important to understand obstacles that may affect success in RTW plan
Description: self-administered 28-item questionnaire 11 point scale (0-10)
3 domains: 1. Managing pain; 2. Obtaining help; 3. Meeting job demands
Strengths: generic - can be used across a wide range of jobs, focuses on self-efficacy and work-related constructs
Focuses on psychosocial factors that can impede RTW
Self administered questionnaire is an opportunity for person to reflect on their attitude in returning to work and their concerns - if administered at 2 time points, 1st time point can allow person to self-identify gaps in their ability to RTW; 2nd time filling it out can allow person to see their healing progress and perhaps give them confidence in their ability to RTW
What is a WoDDI used for? How well accepted is it?
WoDDI: Work Disability Diagnostic Interview
Purpose: interview guide to help clinicians detect most important work disabiltiy factors in subacute and chronic patients with work related MSKD
well accepted, pretested by trained clinicians, adjusted based on their feedback
Made a model that predicts work status using 9 factors from factors identified using the work disability diagnostic interview
Predicts work status with 77% accuracy
Study found screening for predictive factors and obstacles at time of admission to a work rehabilitation program allows for more specifically tailored and effective intervention
Early detection of factors influencing long-term absence and return to work makes it possible not only to target the complex cases but also to identify the intervention targets, and lastly, to minimize the impact of the long-term absence risk factors
Define: appropriateness
Whether the content of the tool matches the intended purpose of the assessment
Define: reliability
Whether measurement on different occasions, by different observers and using similar or parallel tests, produces the same results
Define: validity
whether a tool measures what it intends to measure
Define: responsiveness to change
Whether a tool has the ability to measure clinically important changes over time, when change is present
Define: precision
Whether the tool reflects the true changes or differences
Define: interpretability
Whether the tool provides meaningful scores
Define: acceptability
Whether patients have the willingness or ability to complete a tool
Define: feasibility
Whether the tool requires time and resources to administer, to score, and to interpret
