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PubMed1990

Measurement and prediction of functional capacity in Alzheimer's disease.

Functional loss in Alzheimer's disease is difficult to measure or predict. The Blessed Dementia Rating Scale (Part 1) correlates well with postmortem changes but is not an effective antemortem index of functional change since disparate behavioral domains are assessed. We performed a factor analysis of the Blessed items in 187 patients with clinically diagnosed Alzheimer's disease and identified 4 independent factors: (I) cognitive, (II) personality, (III) apathy, and (IV) basic self-care. An endpoint, consisting of a score indicative of moderate disability, was determined for each factor. We then used life table analyses to compare the probability of reaching these endpoints over time in longitudinally followed patients. Patients with extrapyramidal signs at their initial visit reached the factor IV endpoint sooner, and those with psychosis or no family history of dementia also reached the factor I endpoint faster. These data illustrate the utility of a multifactorial approach to the assessment of functional capacity in Alzheimer's disease, and also indicate that extrapyramidal symptoms and psychosis are powerful predictors of the rate of decline in basic self-care activities and cognition.

Aged↗

PubMed2002

Reliability of safe maximum lifting determinations of a functional capacity evaluation.

BACKGROUND AND PURPOSE: Functional capacity evaluations (FCEs) are measurement tools used in predicting readiness to return to work following injury. The interrater and test-retest reliability of determinations of maximal safe lifting during kinesiophysical FCEs were examined in a sample of people who were off work and receiving workers' compensation. SUBJECTS: Twenty-eight subjects with low back pain who had plateaued with treatment were enrolled. Five occupational therapists, trained and experienced in kinesiophysical methods, conducted testing. METHODS: A repeated-measures design was used, with raters testing subjects simultaneously, yet independently. Subjects were rated on 2 occasions, separated by 2 to 4 days. Analyses included intraclass correlation coefficients (ICCs) and 95% confidence intervals. RESULTS: The ICC values for interrater reliability ranged from.95 to.98. Test-retest values ranged from.78 to.94. DISCUSSION AND CONCLUSION: Inconsistencies in subjects' performance across sessions were the greatest source of FCE measurement variability. Overall, however, test-retest reliability was good and interrater reliability was excellent.

Adult↗

PubMed1999

Administration and application of the Worker Role Interview: looking beyond functional capacity.

Assessing factors beyond the functional capacity of the injured worker is challenging, yet essential for deriving a more complete understanding of the worker. Insight into a worker's perceptions of abilities and limitations, commitment to the worker role, perception of the impact of the injury on non-work roles, ability to adjust habits and routines, and perception of the work environment allows the therapist to identify and address barriers to return-to-work. The Worker Role Interview (WRI), based on the Model of Human Occupation, is designed to assist the therapist in obtaining this information. The therapist's ratings on a four-point scale provide a picture of the factors which support and interfere with successful return-to-work. This paper describes the WRI and discusses its clinical application. A case example illustrates how the information gained from the WRI can be used for treatment planning.

Journal Article↗

PubMed2001

Disability management and functional capacity evaluations: A dynamic resource.

Functional capacity evaluation (FCE), as an objective resource for disability managers, is an invaluable tool in the return to work process. Effective communication of expectations between the employee, employer, medical providers, disability management team, and the FCE provider contributes to enhancing the benefits of the FCE to all participants. Careful review of the results of the FCE as compared to the employee's other pertinent medical/functional information provides clarity for that person's rehabilitation goals and RTW potential. Finally, future opportunities and proactive uses for the FCE are shared.

Journal Article↗

PubMed1996

The development of the Functional Capacity Index.

OBJECTIVE: This paper describes the development of the Functional Capacity Index (FCI) and compares it to the Abbreviated Injury Scale (AIS) and the Injury Impairment Scale (IIS). METHODS: The FCI maps 1990 AIS injury descriptions into scores that reflect expected levels of reduced functional capacity at 1 year after injury. Its development involved three steps. First, an expert clinical panel identified 10 relevant dimensions of function and defined levels of capacity within each dimension. A group of 114 individuals then rated the relative severity of different levels of function in terms of their impact on daily living. The third step involved clinical experts assigning FCI scores to AIS '90 injury descriptions based on their knowledge of the likely 1-year consequences associated with each injury. As a first step in validating the FCI, 1 year postinjury levels of impairment (based on range of motion and strength) were correlated with FCI, IIS, and AIS scores derived for 301 patients with severe lower extremity fractures. RESULTS: Consistency of FCI scores derived within and across dimensions of function argue for the conceptual integrity of the index. Non-zero FCI scores were assigned to only 26% of the 1,272 AIS injury descriptions, indicating that, for most of the injuries in the AIS dictionary, very little or no residual impairment is expected for the average person at 1 year. FCI scores derived for 301 patients with lower extremity fractures ranged from 0 to 63 (out of a possible 100 points). A modest correlation was found between FCI scores and actual levels of impairment observed at 1 year. Compared with the AIS and the IIS, the FCI appeared to discriminate somewhat better among different levels of function. CONCLUSIONS: Although further empirical validation of the FCI is essential before it can be broadly applied, its development represents an important first step in the generation of an AIS-based measure of expected functional outcome. Its validation is encouraged across a variety of settings and injury types.

Abbreviated Injury Scale↗

PubMed1987

Questionnaire, walking time and button test measures of functional capacity as predictive markers for mortality in rheumatoid arthritis.

Mortality over 9 years in rheumatoid arthritis was studied according to baseline demographic, disease, therapy and comorbidity variables, and measures of functional capacity variables. Significant differences between patients who survived and died over the next 9 years were seen for 8 variables: age, joint count, oral corticosteroid use, presence of concurrent heart disease, formal educational level, and 3 quantitative measures of functional capacity, questionnaire responses regarding activities of daily living, modified walking time and the button test. Five-year survivals of 50% or less were seen in patients with severely dysfunctional values for the 3 quantitative measures of functional capacity. Increased relative risk of mortality according to functional capacity measures was not explained by age, sex, duration of disease, smoking history, joint count, hand radiograph score, grip strength, morning stiffness, formal educational level, oral corticosteroid or parenteral gold use, or various comorbidities, and was not expected by a majority of physicians.

Actuarial Analysis↗

PubMedDate not supplied

Effects of aerobic interval training on cancer patients' functional capacity.

The effect of a 10-week aerobic interval-training cycle ergometer protocol on the functional capacity (VO2Lmax) of 45 women receiving chemotherapy for treatment of Stage II breast cancer was studied. Subjects were stratified by baseline functional capacity (+/- 1 MET) and randomized to experimental (EX), placebo (PL), and control (CO) groups. EX subjects completed a 10-week, 3 times/week exercise training program; PL subjects participated in 10 weeks of nonaerobic stretching and flexibility exercises; the CO group maintained normal activities. The EX group showed significant, p less than .05, improvement on pre- to posttest VO2Lmax as well as workload and test time compared to the PL and CO groups. The interval-training exercise intervention was effective in improving the functional capacity of Stage II breast cancer patients on adjuvant chemotherapy.

Antineoplastic Agents↗

PubMed1993

NORA--Nordic research on ageing. Functional capacity of 75-year-old men and women in three Nordic localities.

The aim of this cross-national study was to describe and compare differences in functional capacity of 75-year old people in three Nordic urban localities. As the life-expectancy at the age of 75 differs between the Nordic countries, there is reason to look for similar differences in functional capacity, taking differences in socio-demography, lifestyle, living conditions and health into consideration. In 1989-1991, 400 75-year-old men and women were selected to represent 75-year-olds in a Danish, Finnish and Swedish city. They participated in examinations which focused on functional capacity and health, where identical questionnaires, tests, and equipment were employed. The methods employed were developed from the experience gathered during previous studies of epidemiology of ageing in Glostrup, Gothenburg, and Jyväskylä. Functional capacity is the dependent variable multifactorially related to age, health, living conditions, and life style. The data collection was performed with participation rates in the interviews of 85% in Glostrup, 83% in Gothenburg, and 92% in Jyväskylä. The participation rates in the laboratory examinations were 76%, 67% and 77%, respectively. Examples of differences in socio-demographic background, lifestyle and measures of health and performance in the three localities are given. The Nordic study on physical, psychological and social capacity of 75-year-olds was performed with sufficiently standardised methods to allow a comparison of the results. Similar comprehensive cross-sectional comparative studies of the elderly people have not been performed earlier. Local and cross-national results will be published in each field separately and in combination.

Aged↗

PubMed2005

Trunk muscle composition as a predictor of reduced functional capacity in the health, aging and body composition study: the moderating role of back pain.

BACKGROUND: Cross-sectionally, lower trunk muscle attenuation (higher fat infiltration) has been associated with poorer physical function in older adults. We hypothesize that lower trunk muscle attenuation will be associated with lower functional capacity 3 years later and that back pain status will moderate this relationship. METHODS: The study sample consisted of a biracial cohort of well functioning men (739) and women (788) aged 70-79 years from the Pittsburgh site of the Health, Aging and Body Composition (Health ABC) study. Computed tomography was used to measure trunk muscle area and attenuation of the lumbar paraspinal, lateral abdominal, and rectus abdominus muscles at baseline. The Health ABC Physical Performance Battery (usual and narrow walk, chair stands, and standing balance) was used to measure functional capacity at the first and fourth annual clinic visits. RESULTS: Regardless of back pain status, average trunk muscle attenuation (but not muscle area) was positively associated with overall physical performance, particularly balance (p <.01), in a fully adjusted model. The association between trunk attenuation and functional capacity was significantly stronger in participants with at least moderate back pain in the year prior to baseline (p <.05 for interaction; attenuation x back pain). Participants with moderate to extreme back pain had a greater decline in function over time (p <.05). CONCLUSIONS: Older adults with poorer trunk muscle composition (higher fat infiltration) exhibit reduced functional capacity, especially balance, 3 years later. Improving trunk muscle composition may be an important yet overlooked approach to maintain function and potentially reduce balance impairments, particularly in persons with a history of back pain.

Aged↗

PubMed2006

Gender differences in health-related quality of life among the elderly: the role of objective functional capacity and chronic conditions.

Although worse Health-Related Quality of Life (HRQL) among women has been widely described, it remains unclear whether this is due to differential reporting patterns, or whether there is a real difference in health status. The objective of this study was to evaluate to what extent gender differences in HRQL among the elderly might be explained by differences in performance-based functional capacity and chronic conditions, using the conceptual model of health outcomes as proposed by Wilson and Cleary. Data are from a cross-sectional home survey of 872 surviving individuals from an elderly cohort representative of Barcelona's general population. Complete valid data for these analyses were obtained from 62% of the subjects (n = 544). The evaluation included the Nottingham Health Profile (NHP), a generic measure of HRQL; three performance-based functional capacity tests (balance, chair-stand, and walking tests); and a standardized list of self-reported chronic conditions. A series of multiple linear regression models were built with the total NHP score as the dependent variable, with gender, socio-demographic information, performance-based functional capacity and chronic conditions included sequentially, as independent variables. Women (65.4%) showed worse results than men on HRQL (mean of NHP total score 28.3 vs 16.7, p < 0.001) and functional capacity (mean of summary score 7.1 vs 8.3, p < 0.001). Functional capacity, arthritis, back pain, diabetes, and depression were significantly associated to the NHP total score in the final regression model, which explained 42% of the variance. Raw differences by gender in the total NHP score were 11.5 points (p < 0.001), but decreased to a non-significant 3.2 points (p = 0.18) after adjusting for all the other variables. In conclusion, our data suggest that worse reported HRQL in elderly women is mainly due to a higher prevalence of disability and chronic conditions.

Activities of Daily Living↗

PubMed2005

Validating the functional capacity index: a comparison of predicted versus observed total body scores.

BACKGROUND: The Functional Capacity Index (FCI) was designed to predict physical function 12 months after injury. We report a validation study of the FCI. METHODS: This was a consecutive case series registered in the Queensland Trauma Registry who consented to the prospective 12-month telephone-administered follow-up study. FCI scores measured at 12 months were compared with those originally predicted. RESULTS: Complete Abbreviated Injury Scale score information was available for 617 individuals, of whom 587 (95%) could be assigned at least one FCI score (range, 1-17). Agreement between the largest predicted FCI and observed FCI score was poor (kappa = 0.05; 95% confidence interval, 0.00-0.10) and explained only 1% of the variability in observed FCI. Using an encompassing model that included all FCI assignments, agreement remained poor (kappa = 0.05; 95% confidence interval, -0.02-0.12), and the model explained only 9% of the variability in observed FCI. CONCLUSION: The predicted functional capacity poorly agrees with actual functional outcomes. Further research should consider including other (noninjury) explanatory factors in predicting FCI at 12 months.

Abbreviated Injury Scale↗

PubMed2003

Maturity-associated variation in the growth and functional capacities of youth football (soccer) players 13-15 years.

The objective was to estimate the contribution of experience, body size and maturity status to variation in the functional capacities of adolescent football (soccer) players. The sample included 69 players 13.2-15.1 years of age from three clubs which competed in the highest division for their age group in the first Portuguese national division. Height and weight were measured and stage of pubic hair development was assessed at clinical examination. The number of years of experience in football was obtained at interview. Three tests of functional capacity were administered: 30-m dash (running speed), vertical jump (explosive power) and a yo-yo intermittent endurance test (aerobic resistance). Multiple linear regression analysis was used to estimate the relative contributions of age, stage of sexual maturity, height, weight and years of formal training in football to the three indicators of functional capacity. Stage of puberty, body size and years of training accounted for 21% to 50% of the variance in the three tasks. Sexual maturity status was the primary contributor to the variance in the intermittent shuttle run, whereas weight and height were the primary contributors to the explained variance in the 30-m dash and vertical jump, respectively. In conclusion, biological maturity status significantly influences the functional capacity of adolescent football players 13-15 years of age. Training is a significant contributor to aerobic resistance, whereas weight and height are significant contributors to the sprint and vertical jump, respectively.

Adaptation, Physiological↗

PubMed1995

[Relationship of physical condition and functional capacity to depressive status in person aged 75 years].

The purpose of the present study is to examine cross-sectionally and longitudinally the relationship of physical conditions and functional capacity to depressive status in the elderly. Subjects comprised 308 men and women aged 75 years and over living at home in a rural community. Geriatric Depression Scale (GDS) was employed to assess depressive status, and physical conditions and functional capacity were simultaneously investigated. The results obtained were as follows; 1. There was no significant difference in GDS score by age or sex. 2. Cross-sectionally, the depressive status was significantly associated with weakened grip strength and poor locomotion in men, and it was associated with experience of falls, poor chewing ability, and low levels in high functional capacity as measured by the TMIG Index of Competence. 3. Longitudinally over a 2 year period, bereavement, decline of locomotion, and persistent anxiety about physical conditions significantly influenced aggravation of the depressive status in men. In women, high systolic blood pressure and visual and/or hearing impairment influenced the aggravation. Decline in functional capacity as measured by the TMIG Index of Competence appeared to influence the aggravation in both men and women.

Aged↗

PubMed1984

Functional capacity of men born in 1906-10, 1926-30 and 1946-50. A basic report.

This interdisciplinary study aims at describing the functional capacity of men belonging to different generation cohorts. The development of methods for the assessment of functional capacity is also the purpose of the study. Functional capacity is defined as a hierarchy comprising physical, mental and social areas into which individuals can be placed depending on the levels of the assessed functions. The study also aims at analyzing environmental and individual factors which are assumed to cause variation in the levels of functions. The purpose of this first report is to describe the framework of the study, the methods and main results concerning differences between cohorts and occupational groups. The sampling frame consisted of the population register of Jyväskylä town in January 1981. The basic populations were men in three age groups, born in 1946-50, 1926-30 and 1906-10. From each age group a systematic random sample of 250 men was made. Persons who had moved or died by the end of August 1981 or were living in institutions (6 men) were removed from the samples. The sample sizes were further randomly reduced so that the final samples consisted of 183, 188 and 176 men. At the time of the study the ages of the cohorts were 31-35, 51-55 and 71-75. The study included postal questionnaires, interviews and laboratory examinations. The basic questionnaire dealt with the background information, living conditions, life history, occupational history, social contracts and social participation, close human relations, use of time, health status and living habits. The second postal questionnaire dealing with psychic capacity included the following main items: life changes, self-realisation, personal trait anxiety, social fears, coping, self-respect, and the purpose of life. The basic questionnaire was checked in an interview when the subjects came for the laboratory examinations. The entrance interview also included questions about the most important events of previous 24 hours. In addition the subjects filled in a questionnaire on situational anxiety. The laboratory examinations included the following tests: cognitive capacity (4 tests), audiometry, speech understanding, visual tests, vibration threshold, posture control, reaction and movement time, tapping rate, leg extension velocity, anthropometric measurements, skin measurements, bone mineral density, physiotherapist's examination, physician's examination, blood analyses, isometric strength of muscles (5 muscles), anaerobic power, aerobic power and anaerobic threshold.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1992

[Effect of nutrition on the functional capacity of a group of elderly Spaniards].

The present study analyzes the influence of the nutritional status on the functional capability of 11 institutionalized elderly living in Madrid (Spain). Nutritional status was evaluated by dietetic, anthropometric, hematological and biochemical data and functional status was evaluated considering adiposity, strength in hands and legs bent and stretched and flexibility. The most important nutritional problems that conditional functional wastages are obesity, hypercholesterolemia and protein and micronutrient deficiency. The adverse influence of obesity and hypercholesterolemia on the functional capacity of the elderly is shown by the inverse relationship between flexibility and strength in hands and legs with the adiposity degree, with the thickness of skin folds and the cholesterolemia. In reference to the diet's influence, there are positive correlations between food intake and most of the nutrients with hand and legs strength, and there are statistical significances for proteins, iron, zinc, magnesium and pyridoxine, and also for vitamin C, niacin, thiamin, folic acid and vitamin E. For blood values, the mayor correlation exists between functional parameters and iron, ferritin and vitamin C levels. Our results contribute to confirm the influence of nutrition on the functional capacity of the influence of nutrition on the functional capacity of the elderly and manifest the necessity of improving the elderly's diet, to prevent micronutrient deficiency and also the necessity of increasing their physical activity. Both measures will mean an important help for sanitary and functional improvement of the elderly.

Aged↗

PubMed2002

Oral status, cognitive and functional capacity versus oral treatment need in nursing home residents: a comparison between assessments by dental and ward staff.

OBJECTIVES: The aim of this study was to study the relationships between cognitive and functional capacity versus oral health and treatment need and to compare oral status assessments and oral treatment need, assessed by nurses and dental professionals, respectively. DESIGN: Cross-sectional survey. SETTING: Nursing home. SUBJECTS: One hundred and ninety-two nursing home residents were examined in 1997. MAIN OUTCOME MEASURES: Cognitive and functional capacity in different groups of residents regarding oral health and treatment need, measured by a comprehensive assessment with the Resident Assessment Instrument (RAI) and dental status in a separate examination protocol, recorded by a dentist. RESULTS: There was a significant correlation between being dentate and having need of oral treatment. Those who were able to chew also had significantly better cognitive and functional capacity. Oral treatment need was identified most often by the dentist, intermediately by the RAI assessment and least frequently by the residents themselves. CONCLUSIONS: Being dentate and having a loss of cognitive and functional capacity is predictive of oral treatment need among nursing home residents. Enhanced interaction between nurses and dental professionals needs to be promoted for better awareness of preventive measures and better regular oral care for frail and dependent elderly persons.

Activities of Daily Living↗

PubMedDate not supplied

Functional capacity evaluation as a performance measure: evidence for a new approach for clients with chronic back pain.

OBJECTIVES: To report the research and development of a new approach to Functional Capacity Evaluation, the Gibson Approach to Functional Capacity Evaluation (GAPP FCE) for chronic back pain clients. METHODS: Four studies, including pilot and feasibility testing, expert review, and preliminary interrater reliability examination, are described here. Participants included 7 healthy young adults and 19 rehabilitation clients with back pain who underwent assessment using the GAPP FCE. Thirteen therapists were trained in the approach and were silently observed administering the Functional Capacity Evaluations by at least 1 other trained therapists or the first investigator or both. An expert review using 5 expert occupational therapists was also conducted. RESULTS: Study 1, the pilot with healthy individuals, indicated that the GAPP FCE was a feasible approach with good utility. Study 2, a pilot using 2 trained therapists assessing 5 back pain clients, supported the clinical feasibility of the approach. The expert review in Study 3 found support for GAPP FCE. Study 4, a trial of the approach with 14 rehabilitation clients, found support for the interrater reliability of recommendations for return to work based on performance in the GAPP FCE. DISCUSSION: The evidence thus far available supports the GAPP FCE as an approach that provides a sound method for evaluating the performance of the physical demands of work with clients with chronic back pain. The tool has been shown to have good face and content validity, to meet acceptable test standards, and to have reasonable interrater reliability. Further research is occurring to look at a larger interrater reliability study, to further examine content validity, and to examine predictive validity.

Adult↗

PubMed1985

The relationships of functional capacity, pain, and isometric and isokinetic torque in osteoarthrosis of the knee.

Thirty-nine patients suffering from osteoarthrosis of the knee were repeatedly measured. The relationship was studied for two groups of variables. The first group consisted of subjective assessments of functional capacity and pain and a walking test. The second group consisted of isometric knee extension torque and isokinetic knee flexion and extension torque at 30 degrees/sec, 60 degrees/sec, 120 degrees/sec and 180 degrees/sec. High correlations between each of the static and dynamic torque values were found. Multiple regression analysis showed that isometric and isokinetic torque measures are unsatisfactory predictors of functional capacity, since only 23-35% of the variation of functional capacity, pain and walking test variables was explained by the variation of torque variables. Dynamic torque measurements had very little advantage over static torque tests. It is concluded that outcome measures in studies of osteoarthrosis should be problem-oriented and include direct assessments of functional capacity, pain and walking ability.

Female↗