Background and Purpose. The relationship between functional capacity evaluation (FCE) data and work disability has not been studied. The validity of FCE testing results in terms of subsequent return to work (RTW) was the focus of this exploratory study. Subjects and Methods. Six hundred fifty adults of working age were evaluated as part of a standardized FCE. Clients were contacted by telephone 6 months after the FCE to determine their work status. Predictor variables were gender, age, time off work, maximum safe loads during 3 dynamic lifts, and isometric grip force. Other variables measured were whether or not the client returned to work (RTW-Y/N) and level of return to work (RTW level). Results. A multivariate logistic regression analysis demonstrated that the more time a worker was away from work, the less likely was RTW. Male subjects were less likely to return to work than female subjects. The more weight lifted from floor to waist, the more likely was RTW. The logistic regression equation correctly classified 80.3% of the subjects who returned to work and 56.6% of the subjects who did not return to work. Each of the 3 lift tests was related to RTW level, whereas the grip force tests were not related to either RTW-Y/N or RTW level. Discussion and Conclusion. Time off work and gender were the strongest predictors of RTW, but certain FCE subtests of lifting were related to RTW and RTW level for people with work-related chronic symptoms. Grip force was not related to RTW.

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Relationships among lifting ability, grip force, and return to work.

Increasing Days at Work Using Function-Centered Rehabilitation in Nonacute Nonspecific Low Back Pain: A Randomized Controlled Trial

OBJECTIVES: A review of outcome research conducted between 1982 and 1992 revealed return-to-work rates for industrial rehabilitation programs that ranged from 50% to 88%. Variations in outcome statistics appeared to reflect discrepancies in factors such as type of research design, initial characteristics of the client sample, and clients excluded from the study group. METHOD: A work-hardening outcome study involving 36 programs was conducted by the Work Programs Special Interest Section to address questions left unanswered by existing studies regarding (a) rates of program nonacceptance or noncompletion, (b) basic client characteristics and outcome, (c) length of disability and outcome, (d) breakdown of client disposition after program completion, and (e) program characteristics and return to work. RESULTS: Findings included the following: (a) 11.5% of clients were not accepted into work hardening and 24.6% did not complete the program; (b) outcome was not related to client age, gender, area of injury, or physical demand level of job before injury; (c) as duration of disability increased, return to work decreased significantly; (d) at discharge, 48.2% of clients returned to the usual and customary job and 30.5% to alternate or modified work, whereas 13.6% were referred to a vocational counselor; and (e) there was no relationship between number of visits or number of professionals seen and return to work. CONCLUSION: The authors suggest a need for uniform standards in collection of outcome data to establish a basis for comparison of efficacy among programs. Recommendations include tracking comparison or control groups, grouping clients in terms of length of disability, computing success rate on the basis of number of clients who completed their program, using relevant subcategories when reporting return to work, and consistency of the postdischarge interval for follow-up. Language: en

Work Hardening: Past, Present, and Future — The Work Programs Special Interest Section National Work-Hardening Outcome Study

Jerk as an indicator of physical exertion and fatigue

The purpose of this article is to review the research on the effectiveness of work hardening and work conditioning programs. Twelve studies of work hardening and work conditioning programs in the United States and abroad were reviewed. One study produced convincing evidence in a randomized study that a work conditioning program was useful in producing a higher percentage of return to work and an earlier return to work in a group of patients off work for at least 2 months. Another study demonstrated that a work hardening program increased the rate of return to work by 52% in patients off work for greater than 4 months. Most of the other studies reviewed suggested positive results, but more carefully documented, randomized, and controlled studies are needed to support the efficacy of these programs and to determine the optimum and most cost-effective work hardening and work conditioning interventions.

Work Hardening and Work Conditioning Interventions: Do They Affect Disability?

Work hardening, presented in this paper as a "new" service for the industrially injured, is actually well grounded in the traditional models and practices of occupational therapy. From the profession's early roots in industrial therapy to the development of a variety of programs for the industrially injured through the 1950s and 1960s, the historical and philosophical bases of occupational therapy support the use of work as an evaluative and therapeutic medium. What is actually new is the adoption of terminology, technology, and a program format that fits in with the needs of consumers in the 1980s. Recent developments that created the need for the specialized services that occupational therapists are uniquely qualified to provide include growth of private sector vocational rehabilitation, changes in workers' compensation laws, and increasing costs of vocational rehabilitation. This paper describes work hardening in its present form. A case example is given that demonstrates how work hardening can be a cost-effective and time-saving bridge which spans the gap between curative medicine and the return to work.

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Linda Dempster Ogden

Papers

Work hardening: occupational therapy in industrial rehabilitation.