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Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 4 - 4
1 Sep 2019
Gross D Steenstra I Shaw W Yousefi P Bellinger C Zaïane O
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Purposes and Background

Musculoskeletal disorders including as back and neck pain are leading causes of work disability. Effective interventions exist (i.e. functional restoration, multidisciplinary biopsychosocial rehabilitation, workplace-based interventions, etc.), but it is difficult to select the optimal intervention for specific patients. The Work Assessment Triage Tool (WATT) is a clinical decision support tool developed using machine learning to help select interventions. The WATT algorithm categorizes patients based on individual, occupational, and clinical characteristics according to likelihood of successful return-to-work following rehabilitation. Internal validation showed acceptable classification accuracy, but WATT has not been tested beyond the original development sample. Our purpose was to externally validate the WATT.

Methods and Results

A population-based cohort design was used, with administrative and clinical data extracted from a Canadian provincial compensation database. Data were available on workers being considered for rehabilitation between January 2013 and December 2016. Data was obtained on patient characteristics (ie. age, sex, education level), clinical factors (ie. diagnosis, part of body affected, pain and disability ratings), occupational factors (ie. occupation, employment status, modified work availability), type of rehabilitation program undertaken, and return-to-work outcomes (receipt of wage replacement benefits 30 days after assessment). Analysis included classification accuracy statistics of WATT recommendations for selecting interventions that lead to successful RTW outcomes. The sample included 5296 workers of which 33% had spinal conditions. Sensitivity of the WATT was 0.35 while specificity was 0.83. Overall accuracy was 73%.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 125 - 125
1 Jul 2014
Boissonneault A Lynch J Wise B Segal N Gross D Nevitt M Murray D Pandit H
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Summary

Anatomical variations in hip joint anatomy are associated with both the presence and location of tibiofemoral osteoarthritis (OA).

Introduction

Variations in hip joint anatomy can alter the moment-generating capacity of the hip abductor muscles, possibly leading to changes in the magnitude and direction of ground reaction force and altered loading at the knee. Through analysis of full-limb anteroposterior radiographs, this study explored the hypothesis that knees with lateral and medial knee OA demonstrate hip geometry that differs from that of control knees without OA.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 489 - 489
1 Aug 2008
Reneman M Kool J Oesch P Geertzen J Battié M Gross D
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Purpose: Functional Capacity Evaluations (FCEs) are batteries of tests designed to measure patients’ ability to perform work-related activities. Although FCEs are used world-wide, it is unknown how patients’ performances compare between countries or settings. This study was performed to explore similarities and differences in FCE performance of patients with chronic low back pain (CLBP) between three international settings that utilise the same FCE protocol.

Methods: Standardised FCEs were performed on three cohorts of patients with CLBP: a sample from an outpatient rehabilitation context in the Netherlands (n=121), a Canadian sample in a Worker’s Compensation context (n=273), and a Swiss sample in an inpatient rehabilitation context (n=170). Patients were undergoing FCE as part of their usual clinical care. Means and standard deviations of maximum performance on the FCE material handling items were calculated and differences compared using ANO VA. Multivariable linear regression was used to determine the relationship between country of origin and FCE performance while controlling for potential confounders including, age, sex, duration of back pain problems, and self-reported pain and disability ratings.

Results: Compared to the Dutch sample, the mean performance of patients in the Canadian and Swiss samples was consistently lower on all FCE items. This association remained statistically significant after controlling for potential confounders.

Conclusions: Considerable differences were observed between settings in maximum weight handled on the various FCE items. Future FCE research should examine the effects of a number of potentially influential factors, including variability in evaluator judgements across settings, the evaluator-patient interaction and patients’ expectations of the influence of FCE results on disability compensation.

Accepted: Disability & Rehabilitation 2006