Introduction
Methods
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The paper is a primary study;
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The population of interest are employees with MSDs;
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The study design is a prospective or retrospective cohort study or an intervention study (in the latter case, the data of the group tested with a performance-based measure were used);
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The paper describes a reliable physical test of performance;
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The outcome measure is work participation such as in return to work, or being employed, or a surrogate like the termination of a disability claim;
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The result of a physical test of performance is statistically related to the outcome measure;
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The paper is written in English, Dutch, German, French, or Italian.
Quality description
Data extraction
Evidence synthesis
Results
Search strategy
Quality of the studies
Primary author year of publication | Study population | Follow-up | Treatment | Prognostic factors | Outcome | Analysis | Quality | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Incept | Pop | Incl | Year | %Out | Descrp | Dsgn | Stnd | Rlvnt | Valid | Pres | Rlvnt | Valid | Pres | Uni | Multi | Sum | |
Good quality
| |||||||||||||||||
Gross et al. (2004) | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 13 |
Gross and Battié (2004) | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 14 |
Gross and Battié (2005)
| 0 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 14 |
Gross and Battié (2006) | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 14 |
Streibelt et al. (2009) | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 13 |
Moderate quality
| |||||||||||||||||
Bachman et al. 2003) | 0 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 12 |
Branton et al. (2010) | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 12 |
Cheng and Cheng (2010) | 0 | 1 | 1 | 0 | 1 | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 12 |
Fishbain et al. (1999) | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 11 |
Gouttebarge et al. (2009a) | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 0 | 11 |
Gross et al. (2006) | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 9 |
Hazard et al. (1991) | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 12 |
Kool et al. (2002) | 0 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 12 |
Lechner et al. (2008) | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 0 | 9 |
Matheson et al. (2002) | 0 | 1 | 1 | 0 | 1 | 0 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 11 |
Mayer et al. (1986) | 0 | 1 | 0 | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 10 |
Strand et al. (2001) | 0 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 12 |
Vowles et al. (2004) | 0 | 0 | 1 | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 10 |
Sum score | 1 | 17 | 17 | 13 | 12 | 8 | 18 | 9 | 15 | 15 | 13 | 18 | 18 | 17 | 11 | 9 |
Characteristics of the studies
Primary author year of publication Country | Design | Population | Treatment | Performance test | Confounders | Work participation | Predictive (yes, no, unclear) |
---|---|---|---|---|---|---|---|
Good quality
| |||||||
Gross et al. (2004) Canada | Retrospective cohort 12 months |
N = 114 patients with chronic low back pain, mean age = 41 years (SD 10), 84 men and 30 women
N = 132 patients with chronic low back pain, mean age = 40 years (SD 9), 94 men and 38 women | Care provided at the major Workers’ Compensation Board-Alberta rehabilitation facility | Isernhagen Work System FCE | Age, Gender, Diagnosis, Employment status, Days from injury to FCE, Pain score on disability index, Pain Visual Analog Scale, Clinician recommendation regarding fitness or readiness to work following FCE administration, Job physical demands, Pre-injury annual salary, Number of health care visits for low back pain, Number of low back claims |
Time to total temporary disability suspension (TTD) Higher number of failed FCE tasks was related to delayed TTD (HRR = 0.91 95% CI 0.86–0.96, n = 114; HRR = 0.92 95% CI 0.87–0.97, n = 132) Higher levels on floor-to-waist lift resulted in sooner TTD (HRR = 1.48 95% CI 1.14–1.92, n = 114; HRR = 1.43 95% CI 1.09–1.89, n = 132) Pass floor-to-waist lift resulted in sooner TTD (HRR = 2.83 95% CI 1.49–5.35, n = 114; HRR = 3.74 95% CI 1.81–7.71, n = 132) | Yes |
Time to claim closure (TCC) Higher number of failed FCE tasks was related to delayed TCC (HRR = 0.92 95% CI 0.88–0.98, n = 114; HRR = 0.92 95% CI 0.870.97, n = 132) Higher levels on floor-to-waist lift resulted in sooner TCC (HRR = 1.17 95% CI 0.91–1.50, n = 114; HRR = 1.29 95% CI 1.02–1.64, n = 132) Pass floor-to-waist lift resulted in sooner TCC (HRR = 2.18 95% CI 1.26–3.77, n = 114; HRR = 4.01 95% CI 2.01–7.64, n = 114) | Yes | ||||||
Gross and Battié (2004) Canada | Retrospective cohort 12 months |
N = 226 patients with chronic low back pain, mean age = 41 years (SD 9), 160 men and 66 women | Care provided throughout the Workers’ Compensation Board-Alberta health care provider network | Isernhagen Work System FCE | Age, Gender, Diagnosis, Employment status, Days between FCE and time to total temporary disability suspension and time to claim closure, Days from injury to FCE, Pain score on disability index, Pain Visual Analog Scale, Clinician recommendation regarding fitness or readiness to work following FCE administration, Job physical demands, Pre-injury annual salary, Number of health care visits for low back pain, Number of low back claims |
Sustained return-to-work (SRTW) Number of failed FCE tasks was not related to SRTW (OR = 0.94 95% CI 0.87–1.02) Levels on floor-to-waist lift was not related SRTW (OR = 0.92 95% CI 0.62–1.38) Pass floor-to-waist lift was not related to SRTW (OR = 1.19 95% CI 0.46–3.05) | No |
Gross and Battié (2005) Canada | Prospective cohort 12 months |
N = 130 claimants with low back pain, mean age = 42 years (SD 11), 82 men and 48 women | Care provided at the Workers’ Compensation Board-Alberta rehabilitation facility | Isernhagen Work System FCE | Work-related recovery expectations, Organizational policies and practices, Injury duration at time of FCE |
Days until suspension of time-loss benefits
Fewer failed tasks (HRR = 0.91 95% CI 0.87–0.96) and higher floor-to-waist lift (HRR = 1.55 95% CI 1.28–1.89) were associated with faster suspension of benefits | Yes |
Claim closure
Fewer failed tasks (HRR = 0.93 95% CI 0.89–0.98) and higher floor-to-waist lift (HRR = 1.42 95% CI 1.12–1.80) were associated with faster claim closure | Yes | ||||||
Sustained return-to-work (SRTW) Fewer failed tasks (OR = 0.95 95% CI 0.89–1.03) and higher floor-to-waist lift (OR = 0.91 95% CI 0.63–1.33) were not significantly associated with future SRTW | No | ||||||
Gross and Battié (2006) Canada | Prospective cohort 12 months |
N = 336 claimants with upper extremity disorders, mean age = 45 years (SD 11), 239 men and 97 women | Care provided at the major Workers’ Compensation Board-Alberta outpatient rehabilitation facility | Isernhagen Work System FCE | Age, Gender, Employment status, Days between FCE and time to total temporary disability suspension and time to claim closure, Days from injury to FCE, Pain score on disability index, Pain Visual Analog Scale, Clinician recommendation regarding fitness or readiness to work following FCE administration, Job physical demands, Pre-injury annual salary, Number of health care visits for the compensable condition, Total number of previous claims, Number of previous upper extremity claims |
Days until suspension of time-loss benefits
Higher weight lifted on the waist-to-overhead lift (HRR = 1.51 95% CI 1.29–1.87) and on floor-to-waist lift (HRR = 1.21 95% CI 1.06–1.38) were associated with faster suspension of benefits | Yes |
Claim closure
Higher weight lifted on the waist-to-overhead lift (HRR = 1.81 95% CI 1.49–2.20) and on the floor-to-waist lift (HRR = 1.29 95% CI 1.13–1.49) were associated with faster claim closure | Yes | ||||||
Sustained return-to-work (SRTW) Waist-to-overhead lift OR = 0.87 95% CI 0.60–1.27) and floor-to-waist lift (OR = 1.05 95% CI 0.70–1.17) were not associated with future SRTW | No | ||||||
Streibelt et al. (2009) Germany | Prospective cohort 12 months |
N = 145, patients with imminent or prevailing occupational disability due to musculoskeletal disorders, mean age = 48 years (SD 9), 114 men and 31 women | Multidisciplinary rehabilitation program | Isernhagen Work System FCE | Patient’s expected disability in the job, Employment status at admission, Number of weeks on sick leave prior to admission |
Non-Return-to-work (RTW) All FCE information showed significant relations to non-RTW (r = 0.28–0.43, p < 0.05) Higher maximum functional capacity (OR = 0.22 95% CI 0.07–0.67) More failed test (OR = 1.10 95% CI 1.01–1.19) Recommended work ability > 6 h a day based on actual FCE performance compared to the last job performed (OR = 0.24 95% CI 0.07–0.85) Using the prediction rule of more than 5 failed tests defined non RTW in the best manner: 76.9% of the patients could be predicted correctly regarding RTW in the 1-year follow-up (sensitivity: 69.7%, specificity: 80.0%). | Yes |
Moderate quality
| |||||||
Bachman et al. (2003) Switzerland | Prospective cohort 12 months |
N = 115 patients with more than 3 months musculoskeletal pain, mean age = 42 years (SD 9), 92 men and 23 women | Structured therapy program with daily walking and strength training, and sports therapy | 3-min step-test on a 30 cm high platform with a frequency of 24 steps per minute Laying on one’s back and lifting a weight of 3 kg in each hand for 2 min | Nationality, Having no job at entry, Lifting more than 25 kg at work, Sick leave > 6 months |
Unemployed (vs. Employed) Failing both performance tests (or one of these test in combination with a high pain score (9 or 10 on a scale from 0 to 10) or having more than 3 Waddell signs) resulted in a sensitivity 22% and a specificity 78% for unemployment | Yes |
Branton et al. (2010) Canada | Prospective cohort 12 months |
N = 147 claimants in a workers’ compensation rehabilitation facility with one MSD and no occupational disease, mean age = 44 years (SD 11), 101 men and 46 women | Care provided at the Workers’ Compensation Board of Alberta’s rehabilitation facility | Short-form FCE (Isernhagen Workwell System)
Trunk
15-min stand, Floor-to-waist lift, 1-min crouch, 2-min kneel. 5-min rotation
Lower extremity
15-min stand, Floor-to-waist lift, 1-min crouch, 2-min kneel, Stepladder/stairs
Upper extremity
15-min stand, Waist-to-overhead lift, Elevated work, Crawling, Handgrip, Hand coordination | Age, Gender, Injury duration, Having a job and an employer to which to return, Occupation classification, Salary, Number of prior disability claims, Number of health care visits, Pain score on disability index, Pain Visual Analog Scale |
Days to benefit suspension
Pass all FCE test resulted in hazard ratio = 5.4 (95% CI 2.7–10.9) | Yes |
Claim closure
Pass all FCE test resulted in hazard ratio = 5.8 (95% CI 3.5–9.6) for claim closure | Yes | ||||||
Cheng and Cheng (2010) China | Retrospective cohort 3 months |
N = 645 patients with non-specific low back pain, mean age = 42 years (SD 10), 390 men and 255 women | Care provided at designated work rehabilitation centers in Hong Kong | BTE work simulator, including torso lifting, arm lifting, high-near lifting, bi- and unilateral horizontal pushing and pulling, bilateral carrying, stooping and bending | Age, Gender, Days from injury to work, Being a breadwinner, Educational level, Compensability, Occupational categories, Physical work demand level |
Employed (vs. Unemployed) Pass all FCE tasks resulted in positive prediction of 80% Fail all FCE tasks resulted in negative prediction of 62% | Yes |
Fishbain et al. (1999) United States of America | Prospective cohort 30 months |
N = 185 patients with chronic low back pain, mean age = ? years (SD ?), ? men and ? women | Chronic pain patient treatment facility | Dictionary of Occupational Titles-Residual FCE | Pain level |
Employed (vs. Unemployed) Pass 8 DOT job measures (stooping, climbing, balancing, crouching, feeling shapes, handling left and right, lifting, carrying), and a pain level of less than 5.4, then patient had a 75% chance of being employed at 30 months (sensitivity: 75%, specificity 76%) | Yes |
Gouttebarge et al. (2009a) Netherlands | Prospective cohort 12 months |
N = 60 construction workers 6 weeks on sick leave due to MSDs, mean age = 42 years (SD 9), 60 men | Care provided at the largest occupational health and safety service in the Dutch construction industry | ErgoKit FCE lifting tests | No |
Time to sustainable return-to-work
Carrying and Lower lifting strength test were significant (p ≤ 0.03) although weak (HR = 1.03; HR = 1.05) predictors of the number of days on sick leave until sustainable return-to-work | Yes |
Gross et al. (2006) Canada | Prospective cohort 12 months | Three cohorts (n = 183, n = 138, n = 228) of claimants with low back disorders, mean age = ? years (SD ?), ? men and ? women | Care provided at the major Workers’ Compensation Board-Alberta rehabilitation facility | Isernhagen Work System FCE—short form consisting of passing or failing three tests: floor-to-waist lift, crouching and standing | ? |
Days until suspension of time-loss benefits
Pass three FCE tests was associated with faster suspension of benefits in all three cohorts (HRR = 4.70 95% CI 2.70–8.21; HRR = 2.86 95% CI 1.60–5.11; HRR = 1.89 95% CI 1.07–3.32) | Yes |
Hazard et al. (1991) United States of America | Prospective cohort 12 months |
N = 258 patients with chronic low back pain, mean age = 37 years (SD 9), 173 men and 85 women | Functional restoration program | Floor-to-waist lift | ? |
Employed (vs. Unemployed) Employed lifted higher weight at discharge than unemployed at 12 months (30 kg versus 27 kg, p = 0.024) | Yes |
Kool et al. (2002) Switzerland | Prospective cohort 12 months |
N = 99 patients with chronic low back pain mean age = 42 years (SD 9), 84 men and 15 women | Interdisciplinary rehabilitation including strength and endurance training, exercise therapy, back school, relaxation, and passive treatment and, depending on personal needs, psychological interventions | 3 min step-test on a 30 cm high platform with a frequency of 24 steps per minute Laying on one’s back and lifting a weight of 3 kg in each hand for 2 min | Physical work load, Time of work, Unemployment, Nationality |
Non-Return-to-work
Failing both performance tests (or one of these tests in combination with a high pain score (9 or 10 on a scale from 0 to 10) or having more than 3 Waddell signs) resulted in a sensitivity 0.45, positive predictive value 0.97 and a specificity 0.95 for unemployment | Yes |
Lechner et al. (2008) United States of America | Prospective cohort 6 months |
N = 30 patients with injuries of the lower extremities, upper extremities or spine, mean age = 41 years (SD 11), 26 men and 4 women | Industrial rehabilitation program | Physical Work Performance Evaluation | ? |
Return-to-work according to recommendation
(Percentage (%)) Full (86%) Modified (64%) Not (100%) Kappa = 0.7 | Yes |
Matheson et al. (2002) United States of America | Retrospective cohort 7 months |
N = 650 clients of clinics affiliated with Isernhagen Work System FCE, mean age = 42 years (SD 10), ? men and ? women | Care provided by 25 Clinics in 16 States in the United States of America and one province in Canada affiliated with the Isernhagen Work System | Isernhagen Work System FCE, Floor-to-waist lift, Waist-to-overhead lift, Horizontal lift, Grip force | Age, Gender, Time of work |
Return-to-work (RTW) Higher weight lifted on the floor-to-waist lift was associated with an improved likelihood of RTW (χ2 = 4.81, p = 0.028) | Yes |
Mayer et al. (1986) United States of America | Prospective cohort 5 months |
N = 66 chronic low back pain patients, mean age = 36 years (SD ?), 42 men and 24 women | Comprehensive treatment program based on functional capacity measures | Isometric and multispeed isokinetic dynamic trunk strength utilizing cybex trunk strength tester | ? |
Return-to-work (RTW) Positive change on trunk strength was associated with an improved likelihood of RTW compared to those who showed no or negative change (p < 0.001) | Yes |
Strand et al. (2001) Norway | Prospective intervention study (RCT) 12 months |
N = 81 patients with low back pain, mean age = 45 years (SD 10), 33 men and 48 women | Multidisciplinary rehabilitation program for 4 weeks | Five tests of physical performance: Pick-up test, Sock test, Roll-up test, Fingertip-to-floor test, lift test | ? |
Non-Return-to-work(RTW) A lower score for the pick-up test (score 0: OR = 1, score 1; OR = 4.7 95% CI 1.7–13.0, score 2,3: OR = 22.5 95% CI 2.6–196.1) and the lift test (>15 lifts: OR = 1, 1–15 lifts; OR = 5.3 95% CI 1.6–16.8, 0 lift: OR = 13.3 95% CI 3.5–50.8) was consistently related to non-RTW | Yes |
Vowles et al. (2004) United States of America | Prospective cohort 6 months |
N = 138, patients with chronic musculoskeletal complaints, mean age = 41 years (SD 8), 81 men and 57 women | Interdisciplinary treatment program based on a sports medicine approach to rehabilitation | Isernhagen Work System FCE, Floor-to-waist lift and Waist-to-shoulder lift | Age, Gender, Education, Pain duration, Pain anxiety symptoms, Depression, Pain intensity, Pain-related disability |
Non-Return-to-work
Lower amounts of floor-to-waist lift was correlated with less likely to return to work (r = −0.21, p < 0.05) | Yes |