Functional assessment in patients with chronic pain - Can physicians predict performance?

Objectives: To determine the appropriateness of using physicians to estimat e the functional abilities of patients with chronic pain. Specific objectiv es included the following: (1) to compare the physician's predicted perform ance on functional assessment with actual performance, and (2) to compare t he physician's predicted effort during functional assessment with an object ive measure of effort. Design: A total of 201 outpatients with chronic pain completed this prospec tive, multicenter, cohort study. Fifteen physicians, who were trained to ad minister the standardized evaluation, performed the evaluations and predict ed performance and effort on functional assessment. Therapists, blinded to the physician's evaluation, administered a functional assessment (maximal a nd sustained lifts [n = 3 types]; repetitive activities [n = 4 types]) and a grip dynamometry test (effort measure) on each subject. Results: Pearson's correlation testing demonstrated significant correlation s between the physician's predicted performance and the observed performanc e for all lifting items and repetitive activities in both men (0.52, 0.50, 0.55) and women (0.36, 0.40, 0.18). Analysis of variance and post hoc t tes ts showed agreement between the physician's predicted effort and the dynamo metry effort measure in only a small subset of patients (men were predicted to put forth absolutely no effort; n = 4). Conclusions: A trained physician, performing a standardized evaluation, can estimate with reasonable accuracy the work-related functional ability in p atients with chronic pain. The prediction of effort seems to be more proble matic.