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PubMed2006

Assessment of functional capacity in patients with chronic obstructive pulmonary disease: correlation between cardiopulmonary exercise, 6 minute walk and 15 step exercise oximetry test.

BACKGROUND: Different exercise tests are used to evaluate the functional capacity in chronic obstructive pulmonary disease. The cardiopulmonary exercise test is considered the gold standard, but the 6 minute walk and the 15 step exercise oximetry test are considerably less expensive. OBJECTIVES: To determine whether reliable data could be obtained at lower cost. METHODS: The study sample consisted of 50 patients with mild to severe stable COPD. All underwent pulmonary function test and the cardiopulmonary exercise test, 6 minute walk and 15 step exercise oximetry test as part of their regular follow-up visit. Functional capacity was graded according to each test separately and the functional capacities obtained were correlated. RESULTS: The results showed that most of the patients had severe COPD according to pulmonary function tests (mean forced expiratory volume in the first second 46.3 +/- 19.9% of predicted value). There was a good correlation between the cardiopulmonary exercise test and the 6 minute walk functional capacity classes (r = 0.44, P = 0.0013). We did not find such correlation between the 15 step exercise oximetry test and the cardiopulmonary exercise test (r = 0.07, P = 0.64). CONCLUSIONS: The study shows that the 6 minute walk is a reliable and accurate test in the evaluation of functional capacity in COPD patients.

Adult↗

PubMed2006

Measurement qualities of a self-report and therapist-scored functional capacity instrument based on the Dictionary of Occupational Titles.

Studies provide convincing arguments to support the development of functional capacity instruments based on the Dictionary of Occupational Titles (DOT). The purpose of this study is to investigate the item-level measurement qualities of a newly developed DOT-based functional capacity instrument for clients undergoing rehabilitation treatment for back pain. Client and therapist ratings were collected on 124 clients from 27 rehabilitation sites using the newly developed Occupational Rehabilitation Data Base (ORDB) functional capacity instrument. Rasch analysis was used to investigate: (1) unidimensionality, (2) hierarchical item difficulty continuum, (3) rater severity, and 4) person-item match. Overall, the functional capacity scale of the ORDB showed good measurement qualities. All items, except the Handling item fit the Rasch measurement model. Because of high fit statistics and loading on factors independent from the remainder of the items, the "handling" item was removed, from further analyses. Separate client-rated and therapist-rated instruments retained good item-level psychometrics. While client and therapist items showed similar item-difficulty hierarchical structures, clients had a tendency to be more severe in their rating and the correlation between client and therapist ratings was relatively low, 0.32. These findings suggest that Handling items should not be included as a DOT measure for clients with back pain. While the above psychometric study supports using client or therapist ratings as independent instruments, the lack of concordance between these ratings requires further investigation.

Adult↗

PubMed2006

Nonlinear association of higher-level functional capacity with the incidence of falls in Japan.

OBJECTIVE: To examine the nonlinear association of higher-level functional capacity with the incidence of falls. DESIGN: We analyzed the cross-sectional data of Minamifurano-town Aging Study. Seven hundred forty-three noninstitutionalized older persons aged 65 yrs or older were mailed a self-administered questionnaire in June 2002 in which they were asked the incidence of falls in the past year and their higher-level functional capacity according to the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence. The association of higher-level functional capacity with the incidence of falls was examined using linear, polynomial, and nonparametric logistic regression models. RESULTS: Under the assumption of a nonlinear function, the quadratic function and the smoothing function provided a significant improvement of the fit compared with the linear model in women but not men. CONCLUSION: We have proposed the use of nonlinear model in estimating the incidence of falls with respect to the total score of the TMIG index of competence. The association of varying total score with the incidence of falls in women diverged from the linearity assumption. The gender-based difference in the association of higher-level functional capacity with the incidence of falls might be related to societal role or activity-related aspects.

Accidental Falls↗

PubMed2006

Activity, functional capacity and well-being in ageing Finnish workers.

BACKGROUND: The ageing of the labour force and falling employment rates have forced policy makers in industrialized countries to find means of increasing the well-being of older workers and of lengthening their work careers. AIMS: To longitudinally study the relationship between activity and functional capacity and the well-being of ageing workers. METHODS: Follow-up study to that carried out by the Finnish Institute of Occupational Health in 1981-97 (n = 3817). Activity level was measured using various free-time activities, and functional capacity was measured through daily-life activities. The measure of well-being included items with both positive and negative affects. The associations between activity, functional capacity and well-being were analysed by general linear models with repeated measures. RESULTS: Activity level and functional capacity had a strong positive effect (the effects of one unit increase were 0.32 and 0.30, respectively) on well-being. They were also interdependent. The impact of activity level in maintaining well-being became 31% greater during the follow-up, whereas the effect of functional capacity diminished by 17%. CONCLUSION: The results of the study indicate that both involvement in activities and functional capacity have an important, partly compensatory role in maintaining the well-being of ageing workers.

Aged↗

PubMed1992

The accuracy of self and informant ratings of physical functional capacity in the elderly.

To compare the accuracy of self-ratings with informant-ratings of physical functional capacity in the elderly, 150 elderly patients attending a geriatric day hospital (GDH) and their formal and informal community carers were administered a questionnaire about their ability to perform activities of daily living (ADL). Direct observation of the patients' performance by therapists at the GDH was used as a standard, after the reliability and validity of this approach had been evaluated. Self-ratings were shown to be more accurate and less biased than informant-ratings, both for individual ADL and overall functional capacity. The accuracy of all ratings tended to be greater for less complex or physically demanding ADL, and informants tended to consistently underestimate functional capacity. The concurrent validity of the adapted Barthel Index in a self-report format was also demonstrated. Wherever possible, information concerning the physical functional capacity of an elderly subject should in the first instance be sought from the subject himself, as the quality of such information may be superior to that of his carers.

Activities of Daily Living↗

PubMed1989

Exercise and functional capacity after myocardial infarction.

This paper summarizes the literature on the effects of both inpatient and outpatient exercise programs on functional capacity in patients categorized as having mild, moderate, severe and very severe left ventricular damage after myocardial infarction (MI). Current evidence suggests that inpatient activities of daily living programs do not improve functional capacity as measured by a predischarge exercise stress test. In contrast, outpatient exercise training programs can improve functional capacity through augmentation of skeletal muscle arteriovenous oxygen difference (oxygen extraction) in nearly all patients with mild left ventricular damage, in most patients with moderate damage and in a few patients with severe damage. The recently developed conceptual model of functional capacity in post-MI patients presented in this paper underscores the need for assessment of the level of structural and functional impairment of the left ventricle before the nurse prescribes any type of exercise program. It also enables the nurse to begin to explain why post-MI patients differ in their response to exercise. Further research is needed, however, before the model can be used for predicting exercise outcomes in the clinical setting.

Activities of Daily Living↗

PubMed2002

Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee.

OBJECTIVE: To compare the effects of concentric and coupled concentric-eccentric isokinetic resistance training on functional capacity and symptoms of patients with osteoarthrosis (OA) of both knees. DESIGN: Repeated measures. SETTING: A university exercise physiology laboratory. PARTICIPANTS: Twenty-three volunteers, ages 41 to 75 years. Patients were randomly assigned to 3 groups: concentric (CON, n = 9), concentric-eccentric (CON-ECC, n = 8), and nontreatment (NONTX, n = 6). INTERVENTIONS: The CON group performed 12 concentric contractions of each knee extensor and flexor muscles; the CON-ECC group performed 6 concentric and 6 eccentric contractions of each knee muscle group by using a spectrum of angular velocities ranging from 30 degrees/s to 180 degrees/s with 30 degrees/s intervals, for both sides, 3 days a week for 8 weeks. MAIN OUTCOME MEASURES: Functional capacity (rising from a chair, walking, stair climbing and descending) and pain during rest and activities, peak torque, and cross-sectional area (CSA) of knee muscle groups of subjects were tested before and after training. RESULTS: Both training groups showed marked decreases (P <.001) in pain scores and increases (P <.001) in functional capacity together with increases (P <.05--.01) in peak torque and CSA of knee muscles. However, the NONTX group did not display these marked changes after the 8-week period. The results also indicated that concentric-eccentric training has a greater influence on functional capacity, especially stair climbing and descending, than that of concentric training when compared with NONTX group; however, the improvements in pain measurements were better in the CON group compared with the CON-ECC group after the training. CONCLUSIONS: The results suggest that with the isokinetic resistance training used in this study, it is possible to improve functional capacity and decrease pain in patients with OA of the knee. The results also showed that extensive training involving a high number of repetitions and eccentric contractions was safe, effective, and well tolerated for the patients with knee OA.

Activities of Daily Living↗

PubMed2006

Impaired coronary vascular reactivity and functional capacity in women: results from the NHLBI Women's Ischemia Syndrome Evaluation (WISE) Study.

OBJECTIVES: We investigated the relationship between coronary vascular reactivity and functional capacity as assessed from the Duke Activity Status Index (DASI) in a cohort of women evaluated for suspected ischemia. BACKGROUND: Reduced functional capacity and impaired vascular reactivity are associated with poor prognosis, but an association between vascular reactivity and functional capacity is unknown. METHODS: A total of 190 women enrolled in the National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE) study had baseline clinical assessment and coronary artery flow velocity response to adenosine (CFVR(ado)). We compared these results with self-reported DASI metabolic equivalents (METs). RESULTS: Mean age was 55 +/- 11 years (range 21 to 83 years), and only 18% had coronary stenosis > or =50%. Women with a CFVR(ado) <2.5 (n = 98) had mean DASI of 15.1 +/- 13.6, compared to women (n = 92) with CFVR(ado) > or =2.5, whose mean DASI was 21.0 +/- 15.2 (p = 0.004). This relationship was maintained after adjusting for age and presence of coronary artery disease. CFVR(ado) of > or =2.5 was associated with a DASI of >20 (odds ratio 3.03, 95% confidence interval 1.56 to 5.90, p = 0.001). CONCLUSIONS: Women with reduced CFVR(ado) were significantly more likely to have reduced functional capacity. Impairment in coronary vascular function and reduced levels of activity may both play a role in the poorer prognosis observed in the WISE study women; however, the relationship between the two is still unclear.

Adenosine↗

PubMed2002

Workplace assessments and functional capacity evaluations: current practices of therapists in Australia.

UNLABELLED: The literature has focused predominantly on functional capacity evaluations and related clinic-based assessments, however, there is little that examines workplace-based assessment approaches. In Australia, rehabilitation of injured workers occurs in the workplace wherever possible, and it is expected that workplace-based services will increase elsewhere in the future. There is a lack of knowledge, however, of therapists' current practices regarding workplace- and clinic-based work-related assessments. OBJECTIVES: The purpose of this study was to understand the current practice of therapists in Australia who are directly involved in conducting work-related assessments. STUDY DESIGN: A naturalistic inquiry approach was utilised for this study. In-depth semi-structured interviews were conducted with 26 occupational therapists and physiotherapists representing a spread of geographical locations, organisations, and experience. FINDINGS: Participants described three major types of work-related assessments - workplace assessments, functional capacity evaluations (job) and functional capacity evaluations (no job). The types, purposes, and characteristics of work-related assessments were described and influences and constraints identified. Participants described using processes, data sources, methods of data collection and analysis consistent with qualitative methods, although some quantitative methods were also employed. CONCLUSION: The findings suggest that the further a work-related assessment moves away from the actual work environment and requirements of a specific job, the greater its level of standardisation and generalisability. Conversely, when work-related assessments occur in the actual work environment, qualitative processes are used, and results are specific and non-generalisable.

Accidents, Occupational↗

PubMed2005

Smoking and development of type 2 diabetes in patients with decreased functional capacity.

OBJECTIVE: Data regarding the possible contribution of cigarette smoking to development of type 2 diabetes are scarce and inconclusive. Patients with impaired functional capacity and diminished physical activity are prone to develop new diabetes. However, the role of smoking on diabetes incidence among these patients has not been specifically investigated. The present study was aimed to evaluate the association between cigarette smoking and development of type 2 diabetes in patients with coronary artery disease and decreased functional capacity over a 6.2-year follow-up period. METHODS: The study sample comprised 630 nondiabetic patients aged 45-74 years, with a fasting blood glucose of <126 mg/dl and with impaired functional capacity (New York Heart Association functional class II and III). The sample was classified into two groups: 1) non smokers (never and past smokers pooled together)--552 patients and 2) current smokers--78 patients. RESULTS: Smokers were younger but they had a relatively unfavorable lipid profile (with respect to apolipoproteins A, triglyceride and HDL-cholesterol levels). No significant differences between the groups were found for weight, body mass index, total cholesterol and blood pressure. During the follow-up, development of new diabetes was recorded in 98 patients: in 80 (14.5%) non smokers and in 18 (23.1%) smokers, p=0.05. Among the non smokers, there were no significant differences in diabetes incidence between 357 past smokers and 195 never smokers: respectively, 48 (13.4%) and 32 (16.4%), p=0.34. In addition, all-cause mortality among the smokers (23.1%) was significantly higher than in non smokers (12.7%), p=0.01. Multivariate analysis identified current smoking as an independent predictor of increased risk of new diabetes development with a hazard ratio of 1.94 (95% confidence interval 1.16-3.25). CONCLUSIONS: Current smoking was associated with an independent two-fold increased risk for development of type 2 diabetes in patients with impaired functional capacity.

Aged↗

PubMed1998

Low dose dobutamine echocardiography predicts improvement in functional capacity after exercise training in patients with ischemic cardiomyopathy: prognostic implication.

OBJECTIVES: This study sought to investigate whether the identification of hibernating myocardium by low dose dobutamine stress echocardiography (LDSE) may predict an improvement in functional capacity after moderate exercise training in patients with ischemic cardiomyopathy. Another objective was to assess whether exercise training may affect the outcome. BACKGROUND: There is evidence that exercise training improves left ventricular (LV) function as well as functional capacity in patients with a previous myocardial infarction and LV dysfunction. We hypothesized that the magnitude of these improvements might be related to the extent of hibernating myocardium. METHODS: We studied 71 consecutive patients 56+/-9 years old (mean +/- SD) with chronic heart failure secondary to ischemic cardiomyopathy (LV ejection fraction [LVEF] <40%). All patients were in sinus rhythm and were clinically stable during the previous 3 months. Patients were randomized into two matched groups. Group T (n = 36) underwent exercise training at 60% of peak oxygen uptake (Vo2) three times a week for 10 weeks. Group C (n = 35) did not exercise. At study entry and end, all patients underwent an exercise test with gas exchange analysis and LDSE (5 to 20 microg/kg body weight per min). RESULTS: At baseline, a positive contractile response (CS+) to LDSE was observed in 317 of 576 segments in group T and 291 of 560 segments in group C. After 10 weeks, peak Vo2 and peak work rate increased only in trained patients (peak Vo2: from 16.2+/-3 to 20.8+/-4 ml/kg per min; work capacity: from 108+/-20 to 131+/-25 W, p < 0.001 vs. group C for both). The presence of CS+ at baseline was associated with a sensitivity of 70% and a specificity of 77% for predicting an increase in the functional capacity after exercise training. Positive and negative predictive values of LDSE were 84% and 59%, respectively. Independent predictors of cardiac events were a pre-to-posttraining difference in LVEF at peak dobutamine infusion and the presence of a viable response at baseline (p = 0.004 and 0.008, respectively). The log-rank test demonstrated that trained patients had a significantly lower probability of cardiac events during follow-up than sedentary control patients (p < 0.001). CONCLUSIONS: The presence of hibernating myocardium as assessed by LDSE predicts the magnitude of improvement in functional capacity after moderate exercise training in patients with chronic heart failure. A significant increase in functional capacity after exercise training is associated with a lower incidence of cardiac events during follow-up.

Adult↗

PubMed2001

Functional capacity evaluation: Ecological validity of three static endurance tests.

Functional Capacity Evaluation's (FCE's) are designed to measure the functional capacity of injured workers. Static endurance tests are integrated aspects of FCE's. Little is known about the validity of the tests. In this study, three static endurance tests (overhead work, crouching and kneeling) of the Isernhagen Work Systems FCE are studied for ecological validity. By manipulating the environment in an experiment using three different conditions (normal, loud noise, high production requirement), the ecological validity of the tests was investigated. Results: the different conditions did not seem to influence the holding times, the perceived exertion and the productivity of the subjects. The results are discussed and it is concluded that the three static endurance tests meet conditions of ecological validity. In order to be able to state that the tests of the IWS FCE are ecologically valid, more research is needed to enable a generalization.

Journal Article↗

PubMed2000

[Value of the Susan Isernhangen Evaluation of Functional Capacity Scale in medical and occupational rehabilitation].

In Germany, Susan Isernhagen's Functional Capacity Evaluation (FCE) system has increasingly come into use over the last few years at the interface between medical and vocational rehabilitation. With implementation of these work-related tests of functional capacity it is possible to obtain valid statements concerning the further vocational prognosis. Along with evaluative testing by experts from different disciplines, the further steps towards integration occur on a well-founded basis. Therapies may thus be adjusted to the requirements of work, either at the former workplace or a new one, or possibly of a vocational (re-)training measure. Also, it is possible to directly deal with work-related issues in the report given at the end of rehabilitation, to initiate preliminary integrative steps in order to achieve a seamless, job retention-focussed transition back into work life. Work is simulated at different levels of loading capacity, the functional deficits of the rehabilitees are addressed in a specific, job-related manner, so as to enable an early return to work after rehabilitation.

Disability Evaluation↗

PubMed2001

Work profile and functional capacity of formwork carpenters at construction sites.

PURPOSE: This study established a work profile and functional capacity for formwork carpenters (FCs) working at construction sites. METHOD: Thirty male FCs aged 19-45 were recruited by convenient sampling from the construction training centres. All FCs participated in an interview/questionnaire and a standardized functional capacity evaluation (FCE) using the Baltimore Therapeutic Equipment Primus (BTE Primus) and Valpar Component Work Sample (VALPAR19). Thirty male adults (office workers) aged 19-45 participated in the exact FCE for comparison. RESULTS: The results of the questionnaire indicated that the job demands of formwork carpenters were frequent lifting (46.7%), carrying (50.0%) and handling (60.0%). Significantly higher lifting and carrying capacities were revealed among the FCs, but not in their isometric strengths and the endurance of the upper limbs (chi2 = 6.48, df = 2, p < 0.05). CONCLUSIONS: The dynamic and repetitive sub-maximal nature of the work of formwork carpentry induced an elevation of job-specific lifting and carrying capacities among the FCs. The job and functional capacity profiles would be useful for formulating guidelines for the rehabilitation of injured workers and the training of new workers in the trade.

Adult↗

PubMed1998

A critical review of functional capacity evaluations.

The role of functional capacity evaluations (FCEs) appears to be increasing as employers and insurers rely more heavily on them for decision making. To meet credibility requirements, and the American Physical Therapy Association's standards for measurement and documentation, all FCE suppliers need to validate and refine their systems. This article provides information that can be used to make informed decisions in the selection of an FCE and in functional assessment practices. Features of well-designed FCEs are discussed. Ten well-known FCE systems are analyzed according to these features and other common characteristics. Current issues such as the qualifications of the evaluators, reliability and validity, length of assessments, projection of endurance to 8-hour workdays, standards of practice, safety protocols, and behavioral assessment and management strategies are discussed.

Disability Evaluation↗

PubMed1999

Relationship between exertional symptoms and functional capacity in patients with heart failure.

OBJECTIVES: The present study was undertaken to investigate the relationship over time between exertional symptoms in heart failure and functional capacity. BACKGROUND: Most clinicians rely on exertional symptoms rather than on exercise testing to assess functional capacity in heart failure. However, it remains uncertain whether the subjective symptoms reported by patients provide a reliable index of functional capacity. METHODS: Fifty patients with heart failure underwent serial cardiopulmonary exercise testing and evaluation of exertional fatigue and dyspnea over a period of one to four years. Exercise testing was performed using the Naughton treadmill protocol and a MedGraphics metabolic cart. Fatigue and dyspnea were each scored from 0 to 3 (p = none, 1 = mild, 2 = moderate, 3 = severe). A composite symptom score was determined by adding together the fatigue and dyspnea scores. RESULTS: Patients underwent a total of 185 tests at an average interval of 4.3 months (average tests/patient = 3.7). Composite symptom scores noted at the time of exercise testing correlated significantly with peak exercise minute oxygen consumption (VO2) (r = 0.47, p < 0.01). In addition, the change in symptoms scores and change in peak VO2 noted between the baseline and final exercise test correlated significantly (r = 0.50, p < 0.01). However, patients reported few or no symptoms (symptom score < or =2) 45% of the time when peak VO2 was <14 ml/min/kg, consistent with a severe functional disability, and 72% of the time when peak VO2 was 14 to 18 ml/min/kg, consistent with moderate functional disability. CONCLUSIONS: Exertional symptoms reported by patients with heart failure generally correlate with maximal exercise capacity. However, exertional symptoms frequently underestimate the severity of functional disability. Cardiopulmonary exercise testing rather than symptoms should be used to assess functional capacity in heart failure.

Adult↗

PubMed1982

The use of questionnaires in the evaluation of the functional capacity in rheumatoid arthritis.

The functional capacity of 46 patients with rheumatoid arthritis was assessed by means of two systems of investigation. Three different questionnaires were used. One set of each was filled out by the patient himself; the other with the help of the occupational therapist. The results obtained were tested for their reliability. In addition they were also compared to the Ritchie-Index (method of simple measurement of disease activity) of thirty patients. The disability of each patient could be assessed with sufficient precision. A correlation to the Ritchie-Index was also registered.

Activities of Daily Living↗

PubMed2003

Relationship of sleep apnea to functional capacity and length of hospitalization following stroke.

STUDY OBJECTIVES: Recent evidence indicates that sleep apnea is common in patients with stroke. We hypothesized that the presence of sleep apnea among stroke patients would be associated with a greater degree of functional disability and longer hospitalization following stroke. DESIGN: Prospective study. SETTING AND PATIENTS: Sixty-one stroke patients admitted to a stroke rehabilitation unit. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Sleep studies were performed on all patients, and sleep apnea was defined as an apnea-hypopnea index of 10 or more per hour of sleep. Patients underwent functional assessments, including the Functional Independence Measure. Sleep apnea was found in 72% of patients; 60% had predominantly obstructive sleep apnea, while 12% had predominantly central sleep apnea. Although the severity of stroke was similar in the 2 groups, compared to patients without sleep apnea, those with sleep apnea had lower functional capacity [Functional Independence Measure score (mean +/- SEM) 80.2 +/- 3.6 versus 94.7 +/- 4.3, p < 0.05 at admission, and 101.5 +/- 2.8 versus 112.9 +/- 2.7, p < 0.05 at discharge] and spent significantly more days in rehabilitation (45.5 +/- 2.3 versus 32.1 +/- 2.7 days, p < 0.005). In addition, multiple regression analysis showed that obstructive sleep apnea was significantly and independently related to functional impairment and length of hospitalization. CONCLUSIONS: Sleep apnea is very common among stroke patients undergoing rehabilitation, and its presence is associated with worse functional impairment and a longer period of hospitalization and rehabilitation. These data suggest that sleep apnea may be contributing to functional impairment and prolonged hospitalization following stroke.

Blood Pressure↗