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PubMed2006

Test-retest reliability of a WRULD functional capacity evaluation in healthy adults.

The aim of this study was to determine test-retest reliability of a Functional Capacity Evaluation for patients with non-specific Work Related Upper Limb Disorders (WRULD FCE). The study sample included 33 healthy adults, consisting of 14 males and 19 females with a mean age of 29.2 years. The WRULD FCE consisted of 8 different tests including 26 items measuring repetitive movements, duration, working in awkward positions, forceful movements and static postures. Two FCE sessions were held with a 10-day interval. Means, 95% confidence intervals, one-way random Intraclass Correlation Coefficients (ICCs), 95% limits of agreement and repeated measures were calculated. An ICC between 0.75 and 0.90 was considered as good and an ICC above 0.90 was considered as an excellent reliability. The results showed that 14 of 26 items (54%) had excellent reliability, 9 of 26 items (35%) had good reliability and 3 of 26 items (11%) had moderate reliability based on ICC values. Significant learning effects were present in the Purdue Pegboard Task and in the Complete Minnesota Dexterity Test. It is concluded that the WRULD FCE is reliable in healthy adults.

Adult↗

PubMed2001

Functional capacity late after partial left ventriculectomy: relation to ventricular geometry and performance.

OBJECTIVES: While partial left ventriculectomy (PLV) may improve functional status, the duration and determinants of this improvement are poorly known. This study sought to assess the relationship between left ventricular (LV) shape and function and functional status in late survivors after PLV for non-ischemic dilated cardiomyopathy (DCM). METHODS: We assessed the relations between LV shape and function and functional status in 17 consecutive patients who survived >12 months after PLV for non-ischemic DCM. Invasive diagnostic studies were performed before, early after, at mid-term after, and late after PLV. According to their functional status after >12 months of follow-up, patients were divided into responders (n=10) or non-responders (n=7). RESULTS: After PLV, the LV systolic major-to-minor axis ratio was higher in responders at early, mid-, and late follow-up (P=0.003, P=0.008 and P=0.04, respectively). LV circumferential end-diastolic stress decreased early after PLV, but increased afterwards in non-responders only (P=0.049). LV ejection fraction was similar in the two groups at baseline, and at early and mid-follow-up, but was lower in non-responders at late follow-up (P=0.006). However, LV end-diastolic and end-systolic volumes, and LV end-systolic circumferential stress showed no difference between the two groups. CONCLUSIONS: It appears that poor functional capacity in late post-PLV survivors is related to postoperative LV geometry.

Adult↗

PubMed1999

[Functional capacity (dyspnea) and quality of life in patients with chronic obstructive lung disease (COPD): instruments of assessment and methodological aspects].

Functional capacity (dyspnea) and quality of life are important criteria for the assessment of disease impact and treatment outcome in patients with chronic obstructive pulmonary disease (COPD). We will review measures for dyspnea and quality of life with particular emphasis on their methodological properties. Because asthma and COPD exhibit important differences and are therefore not comparable, we discuss only those measures which have been verified methodologically in patients with COPD. A critical review of current measures for dyspnea reveals at best an only fair association between perceived dyspnea and physiological lung function, sharing not more than 30% of common variance. Moreover, the affective state of the patients, their individual adaptation level and further psychological variables serve as mediators between lung function and perceived dyspnea. However, several valid and reliable measures for dyspnea are available for research and clinical practice. While the term "quality of life" is rather broad and unspecified, many researches in the field prefer the more restrictive term "health-related quality of life (HRQOL), that is the quality of life as affected by health status. The concept of HRQOL encompasses the impact of the individual's health on his or her ability to perform activities of daily living such as social role functioning, home management, social and family relationships, self-care, mobility, recreation and hobbies. In the past 15 years there has been an increasing body of literature on the measurement of HRQOL in patients with COPD. Several disease-specific and generic instruments for the use in COPD patients have been published. There is a growing consensus about the methodological criteria a given instrument has to fulfill. These are validity, sensitivity (for change) and reliability. They have to be tested in patients suffering from the illness for which the HRQOL instrument is planned to be applied in clinical studies or routine. The disease-specific instruments are supposed to be more sensitive to small therapeutically induced changes. However, the empirical results in patients with COPD are mixed and do not clearly favour disease-specific instruments. Lung function, dyspnea measures and exercise tolerance as well do not correlate strongly with HRQOL. Most associations cover only between 10% and 16% of shared variance. Exercise tolerance is not well associated with lung function but correlates better with HRQOL. Nowadays we can rely on several measures for dyspnea and HRQOL which have been thoroughly verified methodologically in COPD patients. However, some disease-specific and generic instruments exhibit substantial flaws, so that they need to be revised and it seems better not to use them at present. Many methodological and conceptual questions remain unanswered in the field indicating a strong need for more research.

Dyspnea↗

PubMed1984

Errors in predicting functional capacity for postmyocardial infarction patients using a modified Bruce protocol.

Clinically, the modified Bruce protocol is widely used to predict functional capacity in postmyocardial infarction (post-MI) patients. However, it has been suggested that post-MI patients have lower oxygen uptakes for standard workloads. In order to study this, we measured oxygen uptake (VO2) and venous blood lactic acid concentration in 12 post-MI patients and 12 normal male subjects during a modified Bruce treadmill protocol. During the first four stages of the protocol, mean oxygen uptake was significantly lower (1.0 to 6.2 cc X kg-1 X min-1; p less than 0.001) for the post-MI patients than for the normal male subjects. Venous blood lactic acid concentrations were different only at stage 4. However, a higher respiratory exchange ratio was observed for post-MI patients (p less than 0.001 at stage 3), suggesting an increased anaerobic metabolism and adequate buffering of lactic acid. The post-MI patient's measured VO2 for three stages of the protocol ranged from 1.8 to 7.3 cc X kg-1 X min-1 lower than the Bruce prediction for cardiac patients. In addition, maximal measured VO2 for the post-MI patients ranged from 3.7 to 11.2 cc X kg-1 X min-1 lower than predicted VO2 derived from the normal subjects. These data suggest myocardial damage may slow oxygen uptake kinetics, thus increasing the oxygen deficit at standard workloads during progressive exercise. An increased respiratory exchange ratio secondary to the buffering of lactic acid suggests that anaerobic metabolism may compensate for this oxygen deficit.

Coronary Disease↗

PubMed2002

Test-retest reliability of lifting and carrying in a 2-day functional capacity evaluation.

The objectives of this study were to establish test-retest reliability of lifting and carrying of a functional capacity evaluation (FCE) on two consecutive days and to verify the need for a 2-day protocol. A cohort of 50 patients (39 men, 11 women) with nonspecific low back pain were evaluated using a 2-day FCE protocol. Intraclass correlation coefficients (ICC) were calculated for weight lifted and carried. Predictive relationships between test and retest were explored by means of a regression analysis. The results of ICC were lifting low 0.87, lifting overhead 0.87, and carrying 0.77. Performances on day 2 were on an average 6-9% higher. Other than the amount of weight handled on day 1, no variable was found to predict performance on day 2. It was concluded that test-retest reliability of lifting and carrying was good, and the need for a 2-day protocol could not be confirmed.

Adult↗

PubMed2000

Influence of cardiac functional capacity on gender differences in maximal oxygen uptake in children.

OBJECTIVE: To examine the role of gender differences in cardiac functional capacity in explaining higher mean values for maximal oxygen uptake (VO(2)max) in boys than in girls. DESIGN: Comparative group exercise testing. SETTING: Pediatric exercise testing laboratory. SUBJECTS: Twenty-five prepubertal boys (mean [+/- SD] age, 12 +/- 0.4 years) and 24 premenarcheal girls (mean age, 11.7 +/- 0.5 years). INTERVENTIONS: Maximal incremental upright cycle exercise. MEASUREMENTS AND RESULTS: Mean values for VO(2)max were the following: boys, 47.2 +/- 6.1 mL/kg/min; and girls, 40.4 +/- 5.8 mL/kg/min (16.8% difference; p < 0.05). The average maximal stroke index with Doppler echocardiography was 62 +/- 9 mL/m(2) for boys and 55 +/- 9 mL/m(2) for girls (12.7% difference; p < 0.05). No significant gender differences were seen in maximal heart rate or arterial venous oxygen difference. When VO(2)max and maximal stroke volume (SV) were expressed relative to lean body mass, gender differences declined but persisted, falling to 6.2% and 5.2%, respectively. CONCLUSIONS: These findings indicate that differences in SV as well as in body composition contribute to gender-related variations in VO(2)max during childhood. Whether this reflects small gender differences in relative heart size or dynamic factors influencing ventricular preload and contractility during exercise is unknown.

Body Composition↗

PubMed1999

[The validity and reliability of a questionnaire for assessing the functional capacity of older persons].

OBJECTIVES: Our aim was to evaluate the validity and reliability of a questionnaire to measure the functional capacity in older people. DESIGN: Observational cross-sectional study. SETTING: Community level. Three basic health areas. PARTICIPANTS: 519 individuals over 64 selected by systematic random sampling taking as sampling units a list of household living at least an individual over 64 years. MEASUREMENTS AND MAIN RESULTS: A new questionnaire was developed starting from the OARS-MFAQ, the CVA. This new questionnaire is shorter but it maintains the same structure. Ten interviews were recorded in a videotape and subsequently analyzed and marked by four different observers to evaluate the inter-observer agreement. To assess the criterion validity the rates of 40 individuals in the CVA were compared with the rates assigned to the same individuals by experts in each area of the questionnaire (physical health, mental health, daily activities, economic resources, and social support). The criterion validity of the version to proxies of CVA (CVA-I) was studied comparing the answers in the CVA of 31 individuals and the answers given in the CVA-I by proxies of the same 31 individuals. The internal consistency in both versions of the questionnaire was studied in 519 individuals, agreement showed values of kappa coefficient between 0.43 and 0.69. Correlation coefficients Interobserver between expert's rates showed values between 0.54 and 0.74. Correlation coefficients between CVA and CVA-I showed values between 0.60 and 0.74 except in the social support dimension (0.16). The Cronbach alpha coefficient were 0.73 for CVA and 0.62 for CVA-I. CONCLUSIONS: The CVA questionnaire showed an acceptable validity and reliability except in the social support dimension of the CVA-I.

Activities of Daily Living↗

PubMed2002

Functional capacity evaluation following flexor tendon injury.

This article describes the indications for and the purpose and performance of the upper limb functional capacity evaluation (FCE) for persons who have sustained flexor tendon injury. It begins with the essential foundation concepts such as the U.S. Department of Labor Physical Demand Characteristics of Labor that clinicians use worldwide. The article explains how the clinician forms the plan for each FCE and the essential components that each FCE includes. While variation in the impact of upper limb injury makes a set format for performing the upper limb FCE impossible, even with a specific diagnosis, a general FCE outline with multiple options is presented. A discussion about relevant modifications to maximise function follows the identification of the critical factors to evaluate with flexor tendon injury. Importantly, the article provides insight into controversial issues such as assessment of endurance and inconsistent or sub-maximum effort. It addresses the challenge of documentation and report writing, and concludes with the issue of FCE validity.

Biomechanical Phenomena↗

PubMed1997

Assessment of the functional capacity for intracellular death and phagocytosis of polymorphonuclear cells in healthy neonates.

The objective of this study was to assess the functional capacity for intracellular death (ID) and/or phagocytic index (PI) of polymorphonuclear cells of 24-h-old healthy newborns with respect to the PMN cells of adults using the same standard exogenous source of opsonins. The ID and PI techniques were standardized and 2-3 ml of blood were used. No differences were found in the percentages of ID, P, PI among the PMNs of the newborns and those of the adults: 43.95 +/- 15.70 vs. 44.56 +/- 8.43 for ID; 38.96 +/- 14.34 vs. 39.00 +/- 14.54 for P; 1.71 +/- 0.54 vs. 1.73 0.45 for PI, respectively. It was concluded that the PMNs of 24-h newborns have an ID, P, PI functionality comparable to adult PMNs; differences observed in PMN function in newborns may be due to humoral deficiencies (opsonins).

Adult↗

PubMed2005

Functional capacity and cardiovascular assessment: submaximal exercise testing and hidden candidates for pharmacologic stress.

Submaximal exercise testing is often used to estimate functional capacity in non-athletes, to assess cardiovascular disease in elderly or frail patients, to demonstrate exercise equipment, or to risk-stratify patients after myocardial infarction. However, submaximal exercise testing is not sufficiently sensitive, specific, or predictive to have widespread clinical utility, except in post-myocardial infarction protocols. Many patients for whom submaximal exercise testing is not useful are unable to exercise sufficiently for maximal testing and are referred for imaging with pharmacologic stress. Although some patients who are unable to exercise adequately are easily recognized, many are not. The identification of such patients before they fail a maximal exercise test attempt is beneficial to both the patient and the imaging laboratory.

Aged↗

PubMed2004

Test-retest reliability of the Isernhagen Work Systems Functional Capacity Evaluation in healthy adults.

Aim of this study was to investigate test-retest reliability of the Isernhagen Work System Functional Capacity Evaluation (IWS FCE) in healthy subjects. The IWS FCE consists of 28 tests that reflect work-related activities such as lifting, carrying, bending, etc. A convenience sample of 26 healthy subjects participated in the study. The subjects' mean age was 34.9 years. Two FCE sessions were held within a 2-3 week interval. Descriptives per session, Intra Class Correlations (ICC), limits of agreement, Cohen's Kappa, and percentage of agreement were calculated where appropriate. An ICC of > or =0.75, a Kappa value > or =0.60, and a percentage of absolute agreement of > or =80% were considered acceptable reliability. Acceptable reliability was demonstrated for seven out of nine tests (78%) of the material handling group and the shuttle walk test based on ICC analyses only. Sixteen out of 17 criterion and ceiling tests (94%) showed acceptable reliability based on Kappa values and percentage of agreement. Of these 17 tests, 8 were eligible for further analysis, and of those 8 tests the reliability of one test was acceptable based on ICC analyses (13%). In conclusion, the test-retest reliability of the material-handling group is acceptable. Crude analyses of the ceiling and criterion tests reveal acceptable test-retest reliability of most, but not all, tests.

Adult↗

PubMed1976

[The value of the diastolic pulmonary arterial pressure for the estimation of the cardiac functional capacity in patients with myocardial infarct].

From 4 weeks to several months after infarction the patients revealed an altogether clearly decreased total physical functional capacity compared with healthy persons. Behaviour of pulse and blood pressure as well as ventilatory indices in comparable Watt-degrees did not reveal any significant differences compared with persons with a healthy heart. The stroke volume pro surface and the heart-time-volume did also not reveal any determinable deviation concerning the mean values compared with normal persons. In patients with compensated infarction the pulmonary arterial pressure in rest was, as a rule, within the normal. However, under load it increased more than in healthy persons. Patients with decompensated infarction revealed a PAEDP in rest between 20 and more than 30 Torr. The question about a critical PAEDP under load should further be pursued. The ECG gives reliable limiting findings in functional examinations.

Adult↗

PubMed2004

Aerobic and functional capacity in a group of healthy women: reference values and repeatability.

Twenty-five randomly selected, low or moderately fit and healthy women (22-44 years) rated their perceived physical capacity and performed an incremental cycle exercise test with respiratory gas analysis. The aerobic and functional capacity did not decrease with age. However, tauVo(2) increased with age. The mean value of the perceived physical capacity was 10 metabolic equivalents and that of Vo(2max) 2075 ml min(-1). The increasing anaerobic metabolism was determined at three points DX (where the rate of Vco(2) increase just exceeds the rate of Vo(2) increase), PX (where Vco(2)/Vo(2) = 1.0) and PQ (where ventilation increase disproportionately in relation to Vco(2)). The mean Vo(2) (% of Vo(2max)) at DX, PX and PQ were 1263 (63%), 1528 (73%) and 1620 (78%) ml min(-1), respectively. The mean value of deltaVo(2)/deltaW was 10.2 ml min(-1) W(-1) while that of tauVo(2) was 0.578 (age) + 15.6. Ten women performed a test and re-test on two consecutive days, and eight of these performed another re-test 4 weeks later. The repeatability was analysed and the variations were expressed as 2 SD of the differences between the tests. The variation was greater for the 4-week re-test than the day-to-day re-test regarding Vo(2max), o(2) at DX, PX and PQ, deltaVo(2)/deltaW and HR. The variation in Vo(2max), PX and deltaVo(2)/deltaW for the 4-week re-test was more than twice that of the previously reported 4-week variation for men. The considerable variation, especially for 4-week re-testing for women should be considered when evaluating the effects of exercise and rehabilitation.

Adult↗

PubMed2006

Cardiopulmonary exercise testing determination of functional capacity in mitral regurgitation: physiologic and outcome implications.

OBJECTIVES: This study was designed to evaluate prevalence, determinants, and clinical outcome implications of reduced functional capacity (FC) in patients with organic mitral regurgitation (MR). BACKGROUND: Evaluation of FC by exercise testing is rarely performed in MR because little is known about the clinical determinants and outcome implications of FC. METHODS: Cardiopulmonary exercise testing (CPET) was prospectively performed in 134 asymptomatic patients with organic MR to assess FC (peak oxygen consumption [VO2]) simultaneously to Doppler-echocardiographic quantitation of MR (effective regurgitant orifice [ERO]) and left ventricular (LV) systolic and diastolic function. RESULTS: Peak VO2 was 26 +/- 6 ml/kg/min (96 +/- 16% of age-predicted), but varied widely (57% to 145% of predicted) and was markedly reduced (< or =84% of predicted) in 19% of patients. Although ERO of MR was univariately associated with reduced FC (26 vs. 9% with ERO > or =40 vs. <40 mm2), independent determinants of reduced FC were LV diastolic function (higher E/E' ratio, p = 0.006), atrial fibrillation (p = 0.01), and lower forward stroke volume (p = 0.03). Clinical events (death, heart failure, new atrial fibrillation) and clinical events or surgery were more frequent with than without reduced FC (3 years, 36 +/- 14% vs. 13 +/- 4%, p = 0.02; and 66 +/- 11% vs. 29 +/- 5%, p = 0.001, respectively), even adjusting (risk ratios 1.80 and 1.54 respectively, both p < or = 0.03) for age and ERO. CONCLUSIONS: In asymptomatic organic MR, FC quantitatively assessed by CPET is unexpectedly markedly reduced in one out of every four to five patients. Reduced FC is independently determined by consequences rather than severity of MR and predicts increased subsequent clinical events. Therefore, CPET frequently reveals functional limitations not detected clinically and is an important tool in managing patients with organic MR.

Exercise Test↗

PubMed2006

Does creatine supplementation improve functional capacity in elderly women?

The purpose of this study was to determine the effects of short-term (7 days) oral creatine supplementation (0.3 g.kg(-1)) in elderly women during exercise tests that reflect functional capacity during daily living tasks. We assessed several indices of endurance capacity (1-mile walk test, gross mechanical efficiency, ventilatory threshold, and peak oxygen intake determined during cycle-ergometry) and lower-extremity functional performance (time to complete sit-stand test). Subjects were assigned to a creatine (n = 10; age 67 +/- 6 years) or placebo (n = 6; age 68 +/- 4 years) group. We found a significant improvement only after creatine loading in the sit-stand test (placebo: 9.7 +/- 0.9 seconds for pretest and 9.3 +/- 0.7 seconds for posttest, p > 0.05; creatine: 10.0 +/- 0.7 seconds for pretest and 8.8 +/- 1.1 seconds for posttest). Significance was recorded at p < 0.05 for the interaction effect (group [creatine, placebo] x time [pretest, posttest]). In elderly women, short-term oral creatine supplementation does not improve endurance capacity but increases the ability to perform lower-body functional living tasks involving rapid movements.

Activities of Daily Living↗

PubMed2003

Relationship between kinesiophobia and performance in a functional capacity evaluation.

Fear of movement and (re)injury (kinesiophobia) has been postulated to play an important role in the performance in a Functional Capacity Evaluation (FCE). This study was performed to analyze the relationship between kinesiophobia and performance in an FCE. Kinesiophobia and FCE performance of 54 male and 10 female patients (mean age 38.0) suffering chronic low back pain (mean length of episode 9.9 months, 93% off work) were assessed. Kinesiophobia was assessed using the Dutch Version of the Tampa Scale for Kinesiophobia (scale 17-68). A lifting task and an FCE were operationalizations of avoidance. FCE results were transformed into a single measure using the classification of the Dictionary of Occupational Titles (FCE-DOT, scale 1-5). Correlations between the variables were calculated. The results are: kinesiophobia mean 41.6 (SD 7.3), lifting mean 29.5 kg (SD 11.6), FCE-DOT mean 3.6 (SD 0.6). Correlations between kinesiophobia and lifting was r = 0.01 (p = 0.93) and between kinesiophobia and FCE-DOT was rho = -0.04 (p = 0.75). The results indicate that the patients were substantially kinesiophobic, yet they were able to lift a mean of 29.5 kg and were physically able to perform moderate to heavy work. The strength of the correlations was very low. The relationship between kinesiophobia and avoidance, operationalized as lifting and an FCE, could not be confirmed in this study.

Adult↗

PubMed2006

A lower-limb functional capacity test for enlistment into Swedish Armed Forces ranger units.

The present work validated minimal performance standards for a lower-limb functional capacity test used at enrollment to predict the risk of discharge from strenuous military ranger training in the Swedish Armed Forces. To set a relevant level of performance, trained conscripts in a ranger unit (n = 38) performed a maximal physical fitness test, including the newly developed ranger test, during the last week of their 1-year basic training. The following year, basic training started with an initial strength test performed by all conscripts (n = 285). They performed the ranger test as a submaximal one. The relative risk was high (risk ratio, 48.5) for discharge attributable to knee problems for conscripts who failed the submaximal ranger test during the initial strength test. The area under the receiver operating characteristic curve was 0.91 (SE, 0.09) for failing the test. The submaximal ranger test had a high discriminating ability and predictive value for discharge caused by knee problems.

Adult↗

PubMed2005

Discrimination of functional capacity for oral hygiene in elderly Spanish people by the Barthel General Index.

OBJECTIVES: To explore, among the institutionalized elderly in Spain, the association between functional dependence in manipulating aids used in oral self-care (oral hygiene dependence) and general functional capacities, as measured by the Index of Activities of Daily Oral Hygiene (ADOH) and the Barthel Index (BI), respectively. METHODS: A cross-sectional study was performed in 2002 on 390 Spanish residents of a residential home for the elderly aged, 65-101 years. All study subjects underwent a oral examination and their ADOH and BI scores assessed. The association between the index scores was studied and the discriminant capacity of BI for oral hygiene dependence was calculated. RESULTS: The mean number of decayed, missing, or filled permanent teeth (+/-SD) was 26.6 +/- 7.3. The mean BI score was 68.31 (95% CI 64.35-72.27), and 172 individuals (44.1%; 95% CI 39.2-49.0%) were independent in all BI-measured functions. The mean ADOH score was 2.43 (95% CI 2.11-2.75), and 238 individuals (61.0%; 95% CI 56.2-65.9%) were independent for oral hygiene, 39 (10.0%; 95% CI 7.2-13.4%) required assistance (assistive devices), and 113 (29.0%; 95% CI 24.5-33.5%) were completely dependent. The BI scores were significantly correlated with the ADOH scores (r = -0.80, P < 0.001). The BI showed a high discriminant capacity to identify the individuals who were dependent for oral hygiene in this population (area under the ROC curve +/- SE = 0.929 +/- 0.013). Using the optimal cut-off point according to the Youden Index (<61), the sensitivity was 0.87 +/- 0.03 and specificity 0.87 +/- 0.02. CONCLUSION: There is a close association between BI and ADOH in this population, which could be useful to identify elderly individuals who are dependent for oral hygiene.

Activities of Daily Living↗