Journal of Occupational Rehabilitation

, Volume 11, Issue 2, pp 119–132 | Cite as

Functional Capacity Evaluations in Persons with Spinal Disorders: Predicting Poor Outcomes on the Functional Assessment Screening Test (FAST)

  • Carolyn M. Ruan
  • Andrew J. Haig
  • Michael E. Geisser
  • Karen Yamakawa
  • Rodney L. Buchholz
Article

Abstract

This study determines how performance on the simple, low exertion Functional Assessment Screening Test (FAST) relates to performance on more extensive physical and psychological testing. One hundred eighty-eight persons with chronic back disability and 17 spine healthy volunteers underwent the FAST (three 2-min static tests [kneeling, stooping, and squatting] and two 5-min tests [repetitive stooping and repetitive twisting while standing]), the Progressive Isoinertial Lifting Evaluation (PILE), trunk extension endurance, submaximal bicycle ergometry, and psychological profiles. All FAST components were completed by 88% of spine healthy subjects, but only by 19.7% (n = 37) of the back patients. Internal consistency for overall test performance was 0.82 (alpha coefficient). Back pain noncompleters had poorer performance on the PILE and trunk extension endurance despite similar cardiovascular fitness and perceived exertion during testing. They had more dysfunctional coping mechanisms, pain avoidance, depression, and self-reported disability. Since performance on nonstrenuous testing is so poor, and psychosocial variables relate strongly to test performance, extensive Functional Capacity Evaluations may not be necessary or valid in assessing the physical performance of this population of chronic back pain patients.

low-back pain functional status psychological assessment Functional Capacity Evaluation 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Curtis L, Mayer TG, Gatchel RJ. Physical progress and residual impairment quantification after functional restoration. Part III: Isokinetic and isoinertial lifting capacity. Spine 1994; 19(4): 401–405.PubMedGoogle Scholar
  2. 2.
    Flores L, Gatchel RJ, Polatin PB. Objectification of functional improvement after nonoperative care. Spine 1997; 22(14): 1622–1633.Google Scholar
  3. 3.
    Gatchel RJ. Psychosocial assessment and disability management in the rehabilitation of painful spinal disorders. In: Mayer TG, ed. Contemporary conservative care for painful spinal disorders. Philadelphia: Lea & Febiger, 1991, pp. 441–454.Google Scholar
  4. 4.
    Gatchel RJ, Polatin PB, Mayer TG, Garcy PD. Psychopathology and the rehabilitation of patients with chronic low back pain disability. Arch Phys Med Rehabil 1994; 75(6): 666–670.PubMedGoogle Scholar
  5. 5.
    Gatchel RJ, Polatin PB, Mayer TG. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine 1995; 20(24): 2702–2709.PubMedGoogle Scholar
  6. 6.
    Mayer TG, Gatchel RJ, Kishino N, Keeley J, Mayer H, Capra P, Mooney V. A prospective short-term study of chronic low back pain patients utilizing novel objective functional measurement. Pain 1986; 25: 53–68.PubMedGoogle Scholar
  7. 7.
    Mayer TG, Gatchel RJ. Functional restoration for spinal disorders: The sports medicine approach. Philadelphia: Lea & Febiger, 1988.Google Scholar
  8. 8.
    Hazard RG, Fenwick JW, Kalisch SM et al. Functional restoration with behavioral support: A one-year prospective study of patients with chronic low-back pain. Spine 1989; 12(2): 157–161.Google Scholar
  9. 9.
    Hazard RG. Spine update. Functional restoration. Spine 1995; 20(21): 2345–2348.Google Scholar
  10. 10.
    Cooke C, Dusik LA, Menard MR, Fairburn SM, Beach GN. Relationship of performance on the ERGOS work simulator to illness behavior in a workers' compensation population with low back versus limb injury. J Occup Med 1994; 36(7): 757–762.PubMedGoogle Scholar
  11. 11.
    Dusik LA, Menard MR, Cooke C, Fairburn SM, Beach GN. Concurrent validity of the ERGOSwork simulator versus conventional Functional Capacity Evaluation techniques inworkers' compensation population. J Occup Med 1993; 35(8): 759–767.PubMedGoogle Scholar
  12. 12.
    Newton M, Waddell G. Trunk strength testing with Iso-machine. Part 1: Review of a decade of scientific evidence. Spine 1993; 18(7): 801–811.PubMedGoogle Scholar
  13. 13.
    Newton M, Thow M, Somerville D, Henderson I, Waddell G. Trunk strength testing with Iso-machines. Part 2: Experimental evaluation of the Cybex II back testing system in normal subjects and patients with chronic low back pain. Spine 1993; 18(7): 812–824.PubMedGoogle Scholar
  14. 14.
    Rissanen A, Alaranta H, Sainio P, Harkonen H. Isokinetic and non-dynamonmetric tests in low back pain patients related to pain and disability index. Spine 1994; 19(17): 1963–1967.PubMedGoogle Scholar
  15. 15.
    Gatchel RJ, Mayer TG, Hazard RG, Rainville J, Mooney V. Functional restoration: Pitfalls in evaluating efficacy. Spine 1992; 17: 88–95.Google Scholar
  16. 16.
    Borg G. Perceived exertion: A note on “History” and Methods. Med Sci Sports 1973; 5: 90–93.PubMedGoogle Scholar
  17. 17.
    Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG. Psychiatric illness and chronic low-back pain. The mind and the spine-which goes first? Spine 1993; 18(1): 66–71.PubMedGoogle Scholar
  18. 18.
    Holzberg AD, Robinson ME, Geisser ME, Gremillion HA. The effects of depression and chronic pain on psychosocial and physical functioning. Clin J Pain 1996; 12: 118–125.Google Scholar
  19. 19.
    Krause SJ, Wiener RL, Tait RC. Depression and pain behavior in patients with chronic pain. Clin J Pain 1994; 10: 122–127.PubMedGoogle Scholar
  20. 20.
    Merskey H. Psychological medicine, pain, and musculoskeletal disorders. Rheum Dis Clin North Am 1996; 22(3): 623–637.PubMedGoogle Scholar
  21. 21.
    Geisser ME, Roth RS, Robinson ME. Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: A comparative analysis. Clin J Pain 1997; 13: 163–170.PubMedGoogle Scholar
  22. 22.
    Radloff L. The CES-D scale: A self-report depression scale for research in the general population. J Appl Psychol Meas 1977; 1: 385–401.Google Scholar
  23. 23.
    Turk DC, Rudy TE. Toward a comprehensive assessment of chronic pain patients. Behav Res Ther 1987; 25: 237–249.PubMedGoogle Scholar
  24. 24.
    Turner JA, Romano JM. Self-report screening measures for depression in chronic pain patients. J Clin Psychol 1984; 40: 909–913.PubMedGoogle Scholar
  25. 25.
    Asmundson GJG, Norton GR, Allerdings MD. Fear and avoidance in dysfunctional chronic back pain patients. Pain 1997; 69: 231–236.CrossRefPubMedGoogle Scholar
  26. 26.
    Kori SH, Miller RP, Todd DD. Kinisiophobia: A new view of chronic pain behavior. Pain Management 1990; 3: 35–43.Google Scholar
  27. 27.
    Phillips HC. Avoidance behavior and its role in sustaining chronic pain. Behav Res Ther 1987; 25: 273–279.PubMedGoogle Scholar
  28. 28.
    Vlaeyen JWS, Kole-Snidjers AMJ, Rotteveel AM, Rvwaink R, Heuts PHTG. The role of fear of movement (re)injury in pain disability. J Occup Rehab 1995; 5: 235–252.Google Scholar
  29. 29.
    Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995; 62: 363–372.CrossRefPubMedGoogle Scholar
  30. 30.
    Kerns RD, Haythorn JA. Depression among chronic pain patients: Cognitive-behavioral analysis and effect on rehabilitation outcome. J Consult Clin Psychol 1988; 56: 870–876.PubMedGoogle Scholar
  31. 31.
    McCracken LM, Gross RT, Sorg PJ, Edmands TA. Prediction of pain in patients with chronic low back pain. Effects of inaccurate prediction and pain related anxiety. Behav Res Ther 1993; 31(7): 647–652.PubMedGoogle Scholar
  32. 32.
    Crombez G, Verfaet L, Baeyens G, Lysens R, Eelen P. Do pain expectancies cause pain in chronic low back patients? A clinical investigation. Behav Res Ther 1996; 34(11): 919–925.PubMedGoogle Scholar
  33. 33.
    Estlander A-M, Vanharanta H, Moneta GB, Kaivanto K. Anthropometric variables, self-efficacy beliefs, and pain and disability ratings on the isokinetic performance of low back pain patients. Spine 1994; 19(8): 941–947.PubMedGoogle Scholar
  34. 34.
    Deyo RA. Measuring the functional status of patients with low back pain. Arch Phys Med Rehabil 1988; 69: 1044–1053.PubMedGoogle Scholar
  35. 35.
    Gatchel RJ, Mayer TG, Capra P, Diamond P, Barnett J. Quantification of lumbar function. Part 6: The use of psychological measures in guiding physical functional restoration. Spine 1986; 11(1): 36–42.PubMedGoogle Scholar
  36. 36.
    Robinson ME, Myers CD, Sadler IJ, Riley JL, Kvaal SA, Geisser ME. Bias effects in three common self-report pain assessment measures. Clin J Pain 1997; 13: 78–81.Google Scholar
  37. 37.
    Rainville J, Ahern DK, Phalen L, Childs LA, Sutherland R. The association of pain with physical activities in chronic low back pain. Spine 1992; 17(9): 1060–1064.PubMedGoogle Scholar
  38. 38.
    Haig AJ, Theisen M, Geisser ME, Yamakawa K. The Spine Team Assessment.Physical and psychosocial performance of 429 adults with chronic low back pain disability. American Academy of Physical Medicine and Rehabilitation annual meeting, November 2–5, 2000, Philadelphia.Google Scholar
  39. 39.
    Golding LA, Myers CR, Sinning WE (ed.). The Y's way to physical fitness. Champaign, IL: Human Kinetics, 1989, pp. 88–98.Google Scholar
  40. 40.
    American College of Sports Medicine. Guidelines for exercise testing and prescription, 5th edn. Philadelphia: Williams & Wilkins, 1995, pp. 113–118.Google Scholar
  41. 41.
    Kopec JA, Esdaile JM, Abrahamowics M et al. The Quebec Back Pain Disability Scale: Conceptualization and development. J Clin Epidemiol 1996; 49(2): 151–161.PubMedGoogle Scholar
  42. 42.
    Kopec JA, Esdiale JM, Abrahamowicz M, et al. The Quebec Back Pain Disability Scale: Measurement properties. Spine 1995; 20(3): 341–352.PubMedGoogle Scholar
  43. 43.
    Bernstein IH, Jaremko E, Hinkley BS. On the utility of theWest Haven-Yale Multidimensional Pain Inventory. Spine 1995; 20(8): 956–963.PubMedGoogle Scholar
  44. 44.
    Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985; 23: 345–356.PubMedGoogle Scholar
  45. 45.
    Clark ME, Kori SH, Brockel J. Kinisiophobia and chronic pain: Psychometric characteristics and factor analysis of the Tampa Scale. Amer Pain Soc Abst 1996; 15: 71–77.Google Scholar
  46. 46.
    Turk DC, Okifuji A. Detecting depression in chronic pain patients: Adequacy of self-reports. Behav Res Ther 1994; 32: 9–16.PubMedGoogle Scholar
  47. 47.
    Mayer T, Barnes D, Kishino N et al. Progressive Isoinertial Lifting Evaluation I. A standardized protocol and normative data base. Spine 1988; 13: 993–997.PubMedGoogle Scholar
  48. 48.
    Mayer T, Barnes D, Nichols G et al. Progressive Isoinertial Lifting Evaluation II.Acomparison with isokinetic lifting in a disabled chronic low-back pain industrial population. Spine 1988; 13: 998–1002.PubMedGoogle Scholar
  49. 49.
    Kaplan GM, Wurtele SK, Gillis D. Maximal effort during Functional Capacity Evaluations: An examination of psychological factors. Arch Phys Med Rehabil 1996; 77: 161–164.PubMedGoogle Scholar
  50. 50.
    Jensen MP, Turner JA, Romano JM, Lawler BK. Relationship of pain specific beliefs to chronic pain adjustment. Pain 1994; 57: 301–309.PubMedGoogle Scholar
  51. 51.
    Hart DL. Tests and measurements in returning injured workers to work. In: Isernhagen S, ed. The comprehensive guide to work injury management. Gaithersburg: Aspen, 1994, pp. 345–367.Google Scholar
  52. 52.
    Isernhagen SJ. Contemporary issues in Functional Capacity Evaluation. In: Isernhagen S, ed. The comprehensive guide to work injury management. Gaithersburg: Aspen, 1994, pp. 410–428.Google Scholar
  53. 53.
    Tramposh AK. The Functional Capacity Evaluation: Measuring maximal work abilities. Occup Med 1992; 7(1): 113–124.PubMedGoogle Scholar
  54. 54.
    Hart DL, Isernhagen SJ, Matheson LN. Guidelines for Functional Capacity Evaluation of people with medical conditions. J Orthoped Sports Phys Ther 1993; 77(12): 682–686.Google Scholar
  55. 55.
    Blankenship K. Functional Capacity Evaluation.The procedure manual. Macon, GA: The Blankenship Corp., 1994.Google Scholar
  56. 56.
    Saunders RL, Beissner KL, Mcmanis BG. Estimates of weight that subjects can lift frequently in Functional Capacity Evaluations. Phys Ther 1997; 77(12): 1717–1728.PubMedGoogle Scholar
  57. 57.
    McCracken LM, Gross RT, Aikens J, Carnike CL. The assessment of anxiety and fear in persons with chronic pain: A comparison of instruments. Behav Res Ther 1996; 34(11/12): 927–933.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 2001

Authors and Affiliations

  • Carolyn M. Ruan
    • 1
  • Andrew J. Haig
    • 1
  • Michael E. Geisser
    • 1
  • Karen Yamakawa
    • 1
  • Rodney L. Buchholz
    • 1
    • 2
  1. 1.The Spine Program, Department of Physical Medicine & RehabilitationUniversity of Michigan Health SystemAnn Arbor
  2. 2.Theda Clark Regional Medical CenterNeenah

Personalised recommendations