307 research outputs found
State of Vocational Rehabilitation and Disability Evaluation in Chronic Musculoskeletal Pain Conditions
No full textLife satisfaction questionnaire (Lisat-9): reliability and validity for patients with acquired brain injury
Full text linkThe aim of this study was to determine the reliability and discriminant validity of the Dutch version of the life satisfaction questionnaire (Lisat-9 DV) to assess patients with an acquired brain injury. The reliability study used a test-retest design, and the validity study used a cross-sectional design. The setting was the general rehabilitation centre. There were 159 patients over 18 years of age, with an acquired brain injury, in the chronic phase. The main outcome measures were weighted kappa of test and retest data on the nine questions of the Lisat-9 DV and significance levels of differences between subgroups of patients who are expected to differ in terms of Lisat-9 scores, on the basis of other instruments. The results were as follows: the reliability was moderate, with the weighted kappa ranging from 0.41 to 0.64. In terms of validity, subgroups of patients who were expected to differ in terms of the Lisat-9 domains did indeed differ significantly, except for the difference in the Lisat score for 'contact with friends and acquaintances' between subgroups defined by higher or lower scores on the corresponding domain of the Frenchay Activities Index. As there was a plausible explanation for not finding a significant difference between subgroups defined by one of the Frenchay Activities Index domains and significant differences were found between the subgroups defined by other instruments corresponding to the same domain, we conclude that the discriminant validity is good. The reliability was not clearly affected by cognitive disorder or aphasia. The conclusions were that the reliability of the Lisat-9 DV for patients with an acquired brain injury was moderate; the discriminant validity was good
Capturing case complexity:is clinician selected dose of vocational rehabilitation related to questionnaire results?
Full text linkBACKGROUND: To establish an optimum dosage interdisciplinary vocational rehabilitation, it is important to be able to reliably and validly assess case complexity. Assessment of case complexity is currently clinician based because no validated means to assess case complexity is presently available. Indices assumed to associate with case complexity can contribute to the choice of dosage. The objective of this study was to explore the extent in which results of questionnaires were associated with the choice of treatment dosage in vocational rehabilitation.METHODS: Design: cross-sectional study of observational data. The study population consisted of workers on part-time or full-time sick leave due to chronic multifactorial problems. Thousand eighty-nine patients who were referred to a privately owned organization with outpatient vocational rehabilitation centers in the Netherlands between July 2016 and March 2017 were allocated to one of the three programs based on case complexity as determined by clinicians based on clinical interview and questionnaires.RESULTS: Questionnaires accounted for 13% of the variance in the total group, 13% in patients with chronic musculoskeletal pain (n = 662) and 29% in patients with chronic fatigue (n = 235).CONCLUSION: The results of the questionnaires contribute little in the assessment of case complexity and dose recommendation. Implications for Rehabilitation Assessment of case complexity of patients with chronic multifactorial complaints and disability is complex. The results of this study suggest that case complexity and choice of treatment dose is slightly explained by questionnaire results. It is largely determined on heuristics developed by knowledge and experience of clinicians. No reliable and validated means to assess case complexity is presently available in the field of rehabilitation and optimum treatment dose cannot be determined transparently. Routinely collected clinical data of baseline characteristics, process measures and results are a valuable source that can be used to answer research questions.</p
State of Vocational Rehabilitation and Disability Evaluation in Chronic Musculoskeletal Pain Conditions
No full textPhysical activity should be the primary intervention for individuals living with chronic pain : A position paper from the European Pain Federation (EFIC) 'On the Move' Task Force.
Full text linkBackground: There is clear evidence demonstrating the benefits of physical activity (PA) on pain and overall health, however, PA is challenging for many individuals living with chronic pain. Even non-exercise specialists can (cost) effectively promote PA, but many health professionals report a number of barriers in providing guidance on PA, suggesting that it is not consistently promoted. This expert position paper summarizes the evidence and provides five recommendations for health professionals to assess, advise and support individuals living with any chronic pain condition with a long life expectancy in adopting and sustaining physically active lifestyles. Methods: This position paper was prepared by the ‘On The Move’ Task Force of the European Pain Federation EFIC. Final recommendations were endorsed by the European Pain Forum, Pain Alliance Europe and the Executive Board of EFIC. Results: We recommend that all health professionals (1) Take a history of the persons' PA levels, and put PA on the agenda, (2) Advise that PA is important and safe for individuals living with chronic pain, (3) Deliver a brief PA intervention and support individuals living with chronic pain in becoming physically active, (4) Discuss acceptable levels of PA-related soreness and pain and (5) Provide ongoing support in staying physically active. Significance: Physical activity is safe and offers several advantages, including general health benefits, low risk of side effects, low cost and not requiring access to healthcare. Adoption of these recommendations can improve the quality of care and life of individuals living with chronic pain and reduce their overall health risks.</p
Venetian cardinals at the Papal Court during the pontificates of Sixtus IV and Innocent VIII : 1471-1492
Full text linkThe histories of particular cities and states within that myriad-faceted
slice of civilisation, the Renaissance in Italy, have received
more scholarly attention than have the diplomatic, ecclesiastical and
cultural connections between them. This study is part of a balance-redressing
process. Senior clerics traversed frontiers, owing
allegiance to their native state, their benefices and, above all, to
the Papacy. The purpose of this exploration of the curial careers of
four later quattrocento Venetian cardinals is essentially twofold : to
account for relations between Venice and the Papacy with reference to
individuals who were at once Venetian patricians and princes of the
Church; and to examine the cardinals' responses to this situation in
terms of political, ecclesiastical and cultural patronage. Where did
their loyalty lie? To Venice, with its perennial suspicion of the
Church and peculiar notion of the characteristics of a Venetian
cardinal? Or to the Pope, expressing overt hostility towards the
Republic in the War of Ferrara and placing it under an interdict?
Chapter one sets Merco Barbo, Pietro Foscari, Giovanni Michiel and
Giovanni Battista Zeno in a Venetian context. Chapters two and three
chart relations between the two powers, from the exposure of Cardinal
Zeno's involvement in a scheme to transmit Venetian state secrets to
Rome in exchange for ecclesiastical preferment, through to Ermolao
Barbaro's controversial appointment to the patriarchate of Aquileia,
via the short-lived Papal-Venetian league negotiated by Cardinal
Foscari in 1480. The fourth chapter considers their proximity to the
Supreme Pontiff and how their material fortunes varied under popes
Sixtus and Innocent, after which an assessment of the nature, extent
and effectiveness of their patronage is divided between chapters five
and six, focussing pa.rticularly on Venetian connections. Despite
diverging careers, it is concluded that all were bound by variations
of the Venetian inheritance
Integration and application of the International Classification of Functioning, Disability and Health (ICF) in return to work
No full textThe experience of work and employment is universal; hence any form of disability that may affect work (i.e., work disability) becomes crucial. In this chapter, the International Classification of Functioning, Disability and Health (ICF) model of the World Health Organization (WHO) will be discussed, focusing on how the ICF model can help us understand and examine the broader context of work disability, vocational rehabilitation, and return to work process. The use of the ICF will be illustrated by state-of-the-art examples to concretize the ICF’s application, integration, and utility in return to work.The ICF was intended by the WHO to be a universal reference framework when describing the functioning of an individual, which includes work functioning. With the biopsychosocial approach of the ICF, the conceptual definition of vocational rehabilitation has been recently provided. Also, the ICF Core Set (an essential set and short list of so-called ICF categories or domains of functioning) for Vocational Rehabilitation has been developed based on evidence and relevance to vocational rehabilitation. This ICF Core Set was the basis for the development of a recent patient-reported questionnaire called the Work Rehabilitation Questionnaire (WORQ) (www.myworq.org). Challenges in the measurement and operationalization of the ICF Core Set are presented and the opportunities and recent developments in using the ICF in other areas of return to work (such as functional capacity evaluation) are also discussed
Work capacity of patients with chronic musculoskeletal pain
No full textMusculoskeletal pain is caused by risk factors for acquiring pain and prognostic factors for the persistence of prolonged pain and is the number one causal reason for restricted participation at work. Many studies have been performed on the reasons for acquiring and the continuance of musculoskeletal pain, however, a comprehensive overview does not exist. Musculoskeletal pain may result in a reduction of the ability to perform physical work. To determine whether a person’s functional capacity is high enough to perform work, standardized functional capacity tests can be executed. One example of functional capacity tests is to measure lifting capacity. These tests are defined as an evaluation of the capacity of activities that is used to make recommendations for participation in work while considering the person’s body functions and structures, environmental factors, personal factors and health status. How many of the latter components that should be taken into account are unclear. The results of this study can support health care professionals providing care to patients in the field of work participation by making informed decisions during diagnostic procedures
Functional capacity and work ability in patients with chronic musculoskeletal pain
Full text linkPatients suffering from chronic low back pain (CLBP) and whiplash associated disorders (WAD) may experience many problems, including in work. Work ability is considered a balance between work demands and personal resources. Functional Capacity Evaluations (FCE) can be used to measure aspects of work ability. The main aim of this thesis was to obtain a better understanding of functional capacity and workability in patients with chronic musculoskeletal pain. Some FCEs claim to be able to detect submaximal capacity when maximal capacity is requested. This claim was studied in a systematic review. Three of seven studies were of good quality and demonstrated the ability to detect submaximal capacity. These tests used a lumbar motion monitor or visual observations accompanying a FCE lifting test. In a cross-sectional study the relationship between self-reported disability and functional capacity was investigated. The conclusion is that self-reported disability and functional capacity are related but different. Both constructs are complementary and both should be measured to comprehensively assess disability in patients with WAD. A small randomized controlled trial assessed whether adding a Short-Form FCE to a brief cognitive behavioral intervention could improve work ability. Eleven patients with chronic musculoskeletal pain were included. The intervention group improved 3.2 points on work ability (scale 0-10), while the control group improved 2.5 points. The improvements were clinically relevant in both groups. Feasibility was established. Clinical relevance of the addition of a Short-Form FCE is unconvincing. A cross-sectional study was used to determine how work ability is associated with pain, self-reported disability, quality of life and claim status in 438 patients with WAD and CLBP. Physical functioning and self-reported disability were both associated with both CLBP and WAD, but the amount of explained variance is different. Ten rehabilitation expert-professionals were interviewed to explore their opinions about injury compensation in patients with WAD. All expert-professionals acknowledged that injury compensation can influence rehabilitation, health and disability. The expert-professionals provided three causal pathways; a pathway through prolonged distress, a behavioral pathway, and patient characteristics that may either attenuate or worsen their response
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