Assessment to determine work capability

Posted 29th June 2009

The following research paper relates to Fibromyalgia and Chronic Fatigue Syndrome, and assessing their work capability, it was published in the Irish Medical Journal in September 2009, and involves members of the CMSUK in the research process.  Kindly provided to CMSUK by TIm Wright of FormHealth

Assessment of Fibromyalgia & Chronic Fatigue Syndrome: A new protocol designed to determine work capability - Chronic Pain Abilities Determination (CPAD)


Kelly M, Gagne R, Newman JD, Olney C, Gualtieri C, Trail D


Key Words: Fibromyalgia, Chronic Fatigue Syndrome, Work Disability


Abstract

The objective was to design a protocol to assess work ability in people suffering ill-defined painful and disabling disorders, the outstanding prototype of which is fibromyalgia/chronic fatigue syndrome (FM/CSF).


Following an extensive literature search, the most appropriate components of current methods of assessment of physical and cognitive abilities were incorporated into the protocol, occasionally with appropriate modification to suit the specific requirements of the individual.  The initial part of the assessment consists of a standard history taking, principally focusing on the patient’s self-reported physical and cognitive abilities and disabilities, as well as the completion of established pain and fatigue scales, and relevant disability questionnaires. Following this, physical and cognitive abilities are objectively assessed on two separate occasions, utilizing computerized hand-held dynamometers, inclinometers, algometers, and force dynamometers. Specific work simulation tests using the industrial standards Methods-Time-Measurement testing are availed of, as is aerobic testing using the Canadian Aerobic Fitness Test (CAFT).


Objective computerised neuro-cognitive testing are also utilised as an integral component of the

assessment.


All results are then subject to specific computerized analysis and compared to normative and standardised work-based databases.  The designed system produces reliable, consistent and reproducible results. It also proves capable of detecting any inconsistencies in patient input and results, in addition to being independent of any possible assessor bias.   


A new protocol has been designed to determine the working capability of individuals who suffer from various chronic disabling conditions, and represents a significant step forward in a difficult but rapidly expanding area of medical practice.  


Introduction

Chronic painful or debilitating disorders such as Fibromyalgia (FM) and Chronic Fatigue Syndrome (CFS) are a common cause of work disability. There are no pathological, radiological, or laboratory findings that establish diagnosis or degree of disability. This study is not structured to confirm or refute diagnosis but rather to assess ability to work as the individual variation in degree of disability between FM/CFS sufferers is so great. Traditional and even newer physical and psychological assessments used to detect degree of disability in other disease states, have severe limitations when applied to FM/CFS. Therefore improvement in quality and reliability of work assessments is a matter of great importance. Also necessary are more objective testings, in so far as can be achieved. These tests need to be reliable and reproducible. Furthermore they must be independent of patient variability of effort that is often not taken into account in such settings. At the very least, inconsistency of patient reliability must be readily detectable. Assessments should further be free of examiner subjectivity, a factor again which is not taken into account, and could explain the reason for very large discrepancies noted between the most eminent of doctors. Whilst there might be little difference in medical opinion with regard to diagnosis, there is often a substantial disparity in opinion on work capacity.  


To overcome these issues, many doctors use traditional Functional Capacity Evaluations (FCE) to assist them in their assessment of work capacity. The traditional FCE is however more suited to assess ability/disability in the better recognized diseases such as arthritis or discogenic spinal disease.


There are however a number of important concerns with using the FCE in more ill defined disorders such as FM and CFS, or indeed other chronic pain states.


The traditional FCE does not consider the ‘good day/bad day’ phenomenon, which this group of patients frequently complain of. Conclusions are drawn on the basis of a single assessment which may be on a good or bad day.  The traditional FCE does not address sustained work capacity over an eight-hour day in spite of the fact that easy fatigability is a common symptom.  Pain levels are not monitored pre- and post-exercise to document the effects of exertion on the patient.  Evaluations often do not include exercise capacity testing which is often a problem for FM/CFS patients and has an important role in determining cardiovascular endurance and abnormal fatigue.  Testing of reproducible physical activities to the limit of endurance and comfort are not performed.  Cognitive tests are not part of the current FCE protocols.


To read the full research article click here http://www.cmsuk.org/documents/tmp6E33.pdf

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