Pediatric Persistent Pain: Associations Among Sensory Modulation, Attachment, Functional Disability, and Quality of Life.

IMPORTANCE: Although attachment is associated with sensory modulation among children and adolescents and insecure attachment is associated with pain severity among adolescents, relationships among sensory modulation, attachment, and function have not previously been demonstrated in a clinical sample of children and adolescents with complex persistent pain. OBJECTIVE: To investigate relationships among sensory modulation, attachment, function, and quality of life (QOL) in a pediatric population with persistent pain. DESIGN: Cross-sectional quantitative design. From October 2015 to July 2017, all children, adolescents, and parents attending a clinic for assessment completed questionnaires and were provided information and consent forms. Those who consented completed sensory modulation and attachment questionnaires. SETTING: Tertiary pain management clinic. PARTICIPANTS: Children (ages 8-12 yr) and adolescents (ages 13-18 yr) with persistent pain (pain of >3 mo duration or a specific pain disorder) and the capacity to answer questionnaires independently. MEASURES: Standardized sensory modulation, attachment, pain intensity, functional disability, and QOL questionnaires. Hypotheses were generated before data collection. RESULTS: Of 152 children and adolescents, 114 children (30 girls, 9 boys) and adolescents (68 girls, 7 boys) met study criteria and consented to participate. Hierarchical multiple regression analyses revealed that sensory sensitivity predicted disability for children and adolescents, and attachment anxiety mediated the relationship between low registration and poorer school-related QOL. CONCLUSION AND RELEVANCE: Behaviors related to insecure attachment patterns provide a mediating pathway from sensory modulation to functional disability; addressing such behaviors clinically may facilitate engagement in daily activities for children and adolescents with persistent pain. WHAT THIS ARTICLE ADDS: Results support the need to consider the interactions between sensory modulation and attachment when addressing functional abilities with occupational therapy treatment.

Approach to activity engagement and differences in activity participation in chronic pain: A five-day observational study.

BACKGROUND/AIM: Activity pacing is one of the most widely endorsed interventions used by occupational therapists to assist clients to manage chronic pain conditions. It targets two behaviours that are thought to be maladaptive: activity avoidance and overactivity (activity engagement that severely aggravates pain). However, in more recent years, the potential for activity pacing to negatively impact activity participation has been recognised which deters habitually overactive individuals from adopting the self-management strategy. The main aim of this study was to evaluate if variances in activity participation can be explained by how individuals approach activity engagement when in pain. METHODS: Sixty-eight adults with chronic pain completed a demographic questionnaire, the Pain and Activity Relations Questionnaire (PARQ), and recorded their participation in activities for five days using a paper diary. Two of the authors independently coded the recorded activities into one of three time-use categories: rest, productivity or leisure/social. A MANCOVA model was produced to examine differences in time use across four 'approach to activity engagement' categories which were determined by scores on the PARQ. RESULTS: A significant multivariate effect was found. Univariate comparisons revealed that 'overactives' (high overactivity, low avoidance) and 'pacers' (low overactivity, low avoidance) spent a similar amount of time resting over the five-day period. 'Overactives' spent the most amount of time on productive tasks and the least amount of time on social/leisure activities out of the four subgroups. CONCLUSION: Results suggest that activity pacing does not negatively impact on activity participation in chronic pain populations. 'Pacers' spent a similar amount of time resting, and had a slightly better balance between productive tasks and leisure/social activities, when compared to 'overactives'. The results of this study can be incorporated into patient education and highlight potential treatment avenues for individuals with chronic pain who are habitually overactive.

"Not just a normal mum": a qualitative investigation of a support service for women who are pregnant subsequent to perinatal loss.

BACKGROUND: Following previous perinatal loss, women in a subsequent pregnancy may experience heightened emotions, such as anxiety and fear, with a range of longer-term implications. To support these women, the Mater Mothers' Bereavement Support Service in Brisbane, Australia, developed a Pregnancy After Loss Clinic (PALC) as a specialised hospital-based service. The present study investigated the experiences of mothers with previous perinatal loss in relation to: (a) their subsequent pregnancy-to-birth journey, and (b) the PALC service. Such research seeks to inform the ongoing development of effective perinatal services. METHOD: A qualitative interview-based research design was employed with a purposive sample of 10 mothers who had previously experienced perinatal loss and who attended the Mater Mothers' PALC during their subsequent pregnancy in 2015. All mothers had subsequently delivered a live baby and were in a relationship with the father of the new baby. Women were aged between 22 and 39 years, primiparous or multiparous, and from a range of cultural backgrounds. Semi-structured interviews, conducted either at the hospital or by telephone by an experienced, independent researcher, lasted between 20 min and one hour. All interviews were audio-recorded and transcribed verbatim, with participant names changed. Interviews were analysed using content analysis by two researchers who were not involved in the service delivery or data gathering process. RESULTS: Seven themes were identified from the interview material: The overall experience, The unique experience of first pregnancy after loss, Support from PALC, Experiences of other services, Recommendations for PALC services, Need for alternative services, and Advice: Mother to mother. CONCLUSIONS: Participants spoke positively of the PALC services for themselves and their families. Anxieties over their subsequent pregnancy, and the desire for other health professionals to be more understanding were frequently raised. Recommendations were made to extend the PALC service and to develop similar services to support access for other families experiencing perinatal loss.

Associations Between Maternal-Foetal Attachment and Infant Developmental Outcomes: A Systematic Review.

Objectives Infant developmental outcomes may be influenced by a range of prenatal maternal characteristics. While there is some evidence to suggest that maternal-foetal attachment may be associated with infant developmental outcomes, there is a need to systematically review this evidence to guide future research and clinical practice. Methods Five electronic databases were systematically scanned. Key journals and reference lists were hand-searched. Papers were included if: (1) pregnant women were assessed for maternal-foetal attachment; (2) the infants were later assessed, under 2 years old, for any developmental outcome (e.g., social-emotional, cognition, motor, language, adaptive behaviour); and (3) they were published in English. Two independent reviewers used the STROBE checklist to appraise the quality of each paper. Results Of the 968 papers identified, eight were included in the review, and four of these were of low quality (<60 %) based on the STROBE. The developmental domains that were examined included: infant temperament (n = 5), adaptive behaviour (e.g., colic, sleep) (n = 2), and milestone attainment (n = 1). There is some evidence to suggest that lower maternal-foetal attachment is related to suboptimal developmental outcomes. However, these results should be interpreted with caution due to the limited and low quality studies available. Conclusions Although maternal-foetal attachment may be associated with infant developmental outcomes, future research is required which: (1) considers a range of developmental outcomes, (2) has increased scientific rigour, (3) assesses mother-infant dyads at different prenatal and postnatal time points, and (4) examines different target populations.

Associations between adult attachment and: oral health-related quality of life, oral health behaviour, and self-rated oral health.

PURPOSE: Although adult attachment theory has been revealed as a useful theoretical framework for understanding a range of health parameters, the associations between adult attachment patterns and a range of oral health parameters have not yet been examined. The aim of this study was to examine potential associations between attachment insecurity and: (1) oral health-related quality of life (OHRQoL), (2) oral health behaviours, and (3) self-rated oral health. In association with this aim, sample characteristics were compared with normative data. METHODS: The sample in this cross-sectional study was comprised of 265 healthy adults, recruited via convenience sampling. Data were collected on attachment patterns (Experiences in Close Relationships Scale-Short Form, ECR-S), OHRQoL (Oral Health Impact Profile-14, OHIP-14), oral health behaviours (modified Dental Neglect Scale, m-DNS), and self-rated oral health (one-item global rating of oral health). Multivariate regression models were performed. RESULTS: Both dimensions of attachment insecurity were associated with lowered use of favourable dental visiting behaviours, as well as decreased OHRQoL for both overall well-being and specific aspects of OHRQoL. Attachment avoidance was linked with diminished self-rated oral health. CONCLUSIONS: This study supports the potential value of an adult attachment framework for understanding a range of oral health parameters. The assessment of a client's attachment pattern may assist in the identification of people who are at risk of diminished OHRQoL, less adaptive dental visiting behaviours, or poorer oral health. Further research in this field may inform ways in which attachment approaches can enhance oral health-related interventions.

Adult Attachment, Sensory Processing, and Distress in Healthy Adults.

OBJECTIVE: To better understand the ways in which adult attachment, sensory processing, and distress may be interrelated in healthy adults. METHOD: A cross-sectional study design was used with a convenience sample of 116 healthy participants who completed questionnaires before participating in a cold pressor pain-inducement task. RESULTS: Attachment anxiety was significantly positively correlated with sensory sensitivity as measured using the Highly Sensitive Persons Scale and the Sensory Profile and with distress (i.e., stress, anxiety, and depression). Associations between attachment anxiety and both sensory sensitivity variables were lost when controlling for stress. Attachment avoidance was correlated only with sensory sensitivity measured using the Sensory Profile, and this relationship was retained when controlling for stress. Neither the attachment nor the stress variables were associated with sensation seeking. CONCLUSION: Findings suggest that developing active coping approaches to deal with sensory sensitivities may be a valuable way to minimize distress. Recommendations for future research are provided.

Is previous history a reliable predictor for acute mountain sickness susceptibility? A meta-analysis of diagnostic accuracy.

PURPOSE: The goal of this meta-analysis was to determine the clinical utility of acute mountain sickness (AMS) history to predict future incidents of AMS. METHOD: 17 studies (n=7921 participants) were included following a systematic review of the literature. A bivariate random-effects model was used to calculate the summary sensitivity and specificity of the diagnostic test, and moderator variables were tested to explain the heterogeneity across studies. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) method was used to assess concerns for bias and applicability for the included studies. RESULTS: The history of AMS had a low diagnostic accuracy for the prediction of future AMS incidents: the summary sensitivity was 0.50 (95% CI (0.40 to 0.59)) and the summary specificity was 0.72 (95% CI (0.66 to 0.78)). There was significant heterogeneity in the sensitivity and specificity across studies, which we modelled using moderator analysis. Studies that restricted the use of acetazolamide and dexamethasone had not only a higher sensitivity (0.66) relative to those that did not (0.44; p=0.03) but also an increased false-positive rate (0.39 vs 0.23, p=0.03). The QUADAS-2 analysis showed that AMS histories were insufficiently detailed, and few studies controlled for prophylactic medication use or recent altitude exposure, leading to high risks of bias and concerns for applicability. CONCLUSIONS: The use of AMS history to guide prophylactic strategies for high-altitude ascent is not supported by the literature; however, the low sensitivity and specificity of this diagnostic test could reflect the quality of the available studies. Ensuring that the characteristics of the history and future ascents are similar may improve the clinical utility of AMS history.

Quiet about pain: experiences of Aboriginal people in two rural communities.

OBJECTIVE: This study explores communications experienced by Aboriginal people in health care encounters about pain. It examines barriers that can impact upon effective pain management for Aboriginal patients. (This article refers to Aboriginal people, as these were the study participants. It is not intended to exclude Torres Strait Islander people.) DESIGN: A qualitative study using focus groups. SETTING: Two Aboriginal communities in South East Queensland. PARTICIPANTS: The participants were 20 men and 20 women who identified a health condition with associated pain for which they had sought health care, including pain relief. Their conditions included arthritis, orthopaedic injuries, back pain and coronary artery disease. RESULTS: Physical pains associated with participants' health conditions were accorded a second place to deep emotional pain attributed to dispossession, dislocation and loss. At health facilities, prominent perceptions were that health professionals held a negative attitude towards them, and lacked respect and caring. Participants experienced that the language used by health professionals in consultations was complex. CONCLUSIONS: Aboriginal people often do not report pain, on the basis of previous negative encounters with the health system. Other perceived barriers to effective pain management included discriminatory attitudes of health professionals and communication problems.

The Experience of Pregnancy-Related Lumbopelvic Pain: A Qualitative Evidence Synthesis.

Background. Pregnancy-related lumbopelvic pain is common and can impact quality of life. Purpose. To synthesize existing qualitative research on people's experiences of pregnancy-related lumbopelvic pain in pregnancy and during the postpartum period. Method. A keyword search of four electronic databases between 2000 and 2022 was completed. Included studies were appraised and synthesized using a meta-ethnographic approach. Findings. Twenty-three studies were included. Analysis identified four core themes: (1) uncertainties about pregnancy-related lumbopelvic pain, (2) struggles to attain achieve treatment and pain management, (3) profound activity consequences, and (4) emotional wellbeing, relationship, and identity impacts of pregnancy-related lumbopelvic pain. Implications. The occupational therapy role with this population has not to our knowledge yet been described. Given the centrality of occupational disruption to the experience of this population we argue that developing and evaluating occupational therapy interventions to address functional, work, parenting and wellbeing outcomes for this population is warranted and should be prioritized.

Patients' expectations of acute low back pain management: implications for evidence uptake.

BACKGROUND: In many countries, general practitioner (GP) care of acute low back pain often does not adhere to evidence-based clinical guidelines. There has been little exploration of this deviation from evidence-based care from the patients' perspective, particularly in relation to patients' care expectations. The aim of this study was to explore the care expectations in patients who present to their GP with acute low back pain, influences on expectation development, and congruence of these expectations with clinical guideline recommendations. METHODS: Qualitative study in an inner urban general practice in Brisbane, Australia. Semi-structured interviews were conducted with 11 patients who presented to their GP with acute low back pain. RESULTS: Patients had a biomechanical understanding of back pain, how it should be tested and treated, and a poor understanding of its natural history. Most expected x-rays, believing they were necessary to identify the "cause of the pain" without belief of any downsides to x-rays. Patients' expectations were primarily influenced by the experiences of family and friends, their own previous experiences of low back pain care, and comments from other health professionals they were consulting. The GP-patient relationship was important in influencing patient satisfaction of care provided. Most patient expectations, and some of the care that they reported receiving, were incongruent with guideline recommendations. CONCLUSIONS: A biomechanical approach to management rather than an awareness of empirical evidence was evident in patients' expectations. Communication and education by the GP that includes specifically enquiring about patients' expectations, provides an opportunity to correct misperceptions, explain acute low back pain natural history, and the rationale for test and treatment recommendations.

'Talk to us like we're people, not an X-ray': the experience of receiving care for chronic pain.

Chronic pain is a commonly reported problem in primary care, and is Australia's third most costly health problem. Despite advances in the understanding and treatment of pain, many people with chronic pain do not receive the best available care. This paper examines the health care experiences of people with chronic pain and focuses discussion on the impact that institutional and cultural factors can have on individual experience. Unstructured narrative interviews were conducted with a convenience sample of 20 people with chronic pain. Participants' experiences pointed to several factors that can affect the outcome of the health care they receive, including: the belief that all pain is due to identifiable injury or disease; a commitment to finding a diagnosis and cure; problematic patient-provider communication; and poor integration of health services. Comprehensively addressing these factors cannot be achieved by focusing interventions at the individual level. A multifaceted response, which includes public health and systemic initiatives, is required.

Acceptability of a Pain History Assessment and Education Chatbot (Dolores) Across Age Groups in Populations With Chronic Pain: Development and Pilot Testing.

BACKGROUND: The delivery of education on pain neuroscience and the evidence for different treatment approaches has become a key component of contemporary persistent pain management. Chatbots, or more formally conversation agents, are increasingly being used in health care settings due to their versatility in providing interactive and individualized approaches to both capture and deliver information. Research focused on the acceptability of diverse chatbot formats can assist in developing a better understanding of the educational needs of target populations. OBJECTIVE: This study aims to detail the development and initial pilot testing of a multimodality pain education chatbot (Dolores) that can be used across different age groups and investigate whether acceptability and feedback were comparable across age groups following pilot testing. METHODS: Following an initial design phase involving software engineers (n=2) and expert clinicians (n=6), a total of 60 individuals with chronic pain who attended an outpatient clinic at 1 of 2 pain centers in Australia were recruited for pilot testing. The 60 individuals consisted of 20 (33%) adolescents (aged 10-18 years), 20 (33%) young adults (aged 19-35 years), and 20 (33%) adults (aged >35 years) with persistent pain. Participants spent 20 to 30 minutes completing interactive chatbot activities that enabled the Dolores app to gather a pain history and provide education about pain and pain treatments. After the chatbot activities, participants completed a custom-made feedback questionnaire measuring the acceptability constructs pertaining to health education chatbots. To determine the effect of age group on the acceptability ratings and feedback provided, a series of binomial logistic regression models and cumulative odds ordinal logistic regression models with proportional odds were generated. RESULTS: Overall, acceptability was high for the following constructs: engagement, perceived value, usability, accuracy, responsiveness, adoption intention, esthetics, and overall quality. The effect of age group on all acceptability ratings was small and not statistically significant. An analysis of open-ended question responses revealed that major frustrations with the app were related to Dolores' speech, which was explored further through a comparative analysis. With respect to providing negative feedback about Dolores' speech, a logistic regression model showed that the effect of age group was statistically significant (χ22=11.7; P=.003) and explained 27.1% of the variance (Nagelkerke R2). Adults and young adults were less likely to comment on Dolores' speech compared with adolescent participants (odds ratio 0.20, 95% CI 0.05-0.84 and odds ratio 0.05, 95% CI 0.01-0.43, respectively). Comments were related to both speech rate (too slow) and quality (unpleasant and robotic). CONCLUSIONS: This study provides support for the acceptability of pain history and education chatbots across different age groups. Chatbot acceptability for adolescent cohorts may be improved by enabling the self-selection of speech characteristics such as rate and personable tone.

Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the associations between different approaches to activity (ie, activity pacing, avoidance, or endurance) and indicators of patient functioning in chronic pain samples. DATA SOURCES: A key word search was conducted in PsycINFO, MEDLINE via Ovid, EMBASE, and PubMed up to March 2011. STUDY SELECTION: To be included, studies had to (1) be written in English, (2) report on an adult chronic pain sample, and (3) report a correlation coefficient between at least 1 measure of 1 of the 3 "approach to activity" variables and an indicator of patient functioning. DATA EXTRACTION: Two reviewers independently screened abstracts and full-text articles for eligibility and extracted the data. Results of correlation analyses were grouped on the basis of measure of approach to activity (pacing/avoidance/endurance) and the criterion variable measured (pain/physical functioning/psychological functioning), resulting in 9 categories. Random-effects modeling was then used to pool data across studies in each category. DATA SYNTHESIS: Forty-one studies were eligible for inclusion. Results demonstrated that avoidance of activity was consistently associated with more pain, poorer psychological functioning, and more physical disability. While enduring with activity was associated with enhanced physical and psychological functioning, these relationships appeared to be dependent on the measure used, with measures more reflective of persisting with activities to the point of severe pain aggravation (overactivity) linked to poorer outcomes. Pacing was generally linked to better psychological functioning but more pain and disability. CONCLUSIONS: Although causation cannot be determined, results of this study suggest that both avoidance of activity and overactivity are associated with poorer patient outcomes. Unexpected results relating to pacing may reflect either the ineffectiveness of pacing if not used to gradually increase an individual's activity level or the notion that individuals with better psychological functioning but more pain and disability are more inclined to pace activity.

Interprofessional supervision in an intercultural context: a qualitative study.

Our understanding of the qualities and value of clinical supervision is based on uniprofessional clinical education models. There is little research regarding the role and qualities needed in the supervisor role for supporting interprofessional placements. This paper reports the views and perceptions of medical and allied heath students and supervisors on the characteristics of clinical supervision in an interprofessional, international context. A qualitative case study was used involving semi-structured interviews of eight health professional students and four clinical supervisors before and after an interprofessional, international clinical placement. Our findings suggest that supervision from educators whose profession differs from that of the students can be a beneficial and rewarding experience leading to the use of alternative learning strategies. Although all participants valued interprofessional supervision, there was agreement that profession-specific supervision was required throughout the placement. Further research is required to understand this view as interprofessional education aims to prepare graduates for collaborative practice where they may work in teams supervised by staff whose profession may differ from their own.

A Comparison of Leximancer Semi-automated Content Analysis to Manual Content Analysis: A Healthcare Exemplar Using Emotive Transcripts of COVID-19 Hospital Staff Interactive Webcasts.

Effective consumer centred healthcare incorporates consumer and clinician perspectives into decision making, in addition to traditional quantitative measures. This information is usually captured in qualitative data that requires manual analysis. Healthcare systems often lack resources to systematically incorporate qualitative feedback into decision making. Semi-automated content analysis tools, such as Leximancer, provide an efficient and objective alternative to time consuming manual content analysis (MCA). Literature on the validity of Leximancer in healthcare is sparse. This study seeks to validate Leximancer against MCA on a broad emotive conversational dataset gathered in a healthcare setting. At the outset of the COVID-19 pandemic, a large Australian hospital and health service conducted interactive webcasts with staff to provide updates and answer questions. A manual thematic analysis and a Leximancer content analysis were conducted independently on 20 webcast transcripts. The findings were compared, along with the time required to the complete each analysis. The Leximancer analysis identified nine concepts, while the manual analysis identified 12 concepts. The Leximancer concepts mapped to five of the concepts identified in the manual analysis, which accounted for 74% of mentions tagged in the text through the manual analysis. Leximancer missed concepts which required an emotional or contextual interpretation. The Leximancer analysis took 21 hours (excluding time to learn the program), compared to 73 hours for the manual analysis. Semi-automated content analysis provides an efficient alternative to manual qualitative data analysis, shifting it from a small-scale research activity to a more routine operational activity, albeit with some limitations. This is critical to be able to utilise at scale the rich narratives from consumers and clinicians in healthcare decision making.

Student-resourced service delivery of occupational therapy rehabilitation groups: patient, clinician and student perspectives about the ingredients for success.

BACKGROUND: A number of innovative models of student practice placements are emerging due to pressures on universities to provide quality practice placements and on health services to deliver rehabilitation efficiently, safely and cost-effectively. The student-resourced service delivery (SRSD) group program is one such model in occupational therapy. There is a paucity of research evidence to guide services in planning, implementing and evaluating the SRSD model. OBJECTIVE: The study aimed to explore and identify the factors that key stakeholders perceived as contributing to the successful development and implementation of the occupational therapy student-resourced service delivery group programs. METHODS: Participants in this multi-site study were rehabilitation inpatients, clinicians, Clinical Education Liaison Managers and students completing practice placement in the student-resourced service delivery group program. Data were collected using face-to-face semi-structured interviews and focus groups. RESULTS: A total of 83 participants consented to the study. Four themes emerged from the data. Planning needs to be an iterative process that commences before and continues during the program. Support processes need to be established for students and clinicians during and across placements. The creation of an engaging, client-relevant and graded group dynamic is critical for success. Establishing a culture whereby groups are valued by the clients, therapy and multidisciplinary teams is important. CONCLUSIONS: The above-mentioned factors were perceived as contributing to successful operationalisation of a student-resourced service delivery group program, and may be helpful when developing student-resourced service delivery professional practice placements in other settings.IMPLICATIONS FOR REHABILITATIONStudent-resourced service delivery of groups are one way to achieve additional professional practice placements for students and delivery of therapy services for patients.Ongoing investment for planning and preparation, provision of continual support for students, a culture of valuing groups and students, and creating a group dynamic that engages group participants were perceived by stakeholders as key ingredients for successful implementation of the student-resourced service delivery group model.Clinicians and educators are encouraged to use the perceived success factors identified in this study as a resource for future student-resourced service delivery program development.

Can Sensory- and Attachment-Informed Approaches Modify the Perception of Pain? An Experimental Study.

Accumulating evidence linking pain with both attachment and sensory processing variables introduces the possibility that attachment- and sensory-informed strategies may modify pain experiences. The aim of this study was to investigate this proposition using an experimentally induced pain procedure. Pain perceptions of individuals using either a sensory-informed (weighted modality) or an attachment-informed (secure base priming) coping strategy were compared with those of individuals using no designated coping strategy. An independent measures experimental study design was used with a convenience sample of 272 pain-free adults. Experimental participants (n = 156) were randomly allocated to either an attachment (n = 75) or a sensory (n = 81) intervention group. Data from these participants were compared to those of 116 participants involved in an earlier cold pressor study in which no coping strategy was used. All participants completed the same sensory, attachment, and distress questionnaires and participated in the same cold pressor pain test. ANCOVAs revealed that participants in the sensory- and attachment-informed intervention groups reported significantly higher pain thresholds than the control group. Participants allocated to the sensory group also reported higher pain intensity scores than the control group. There were no significant differences in pain tolerance between the three groups after controlling for covariates. While further research is required, findings encourage further consideration of sensory- and attachment-informed strategies for people anticipating a painful experience.

Test-retest reliability of the GAPP functional capacity evaluation in healthy adults.

BACKGROUND: Functional capacity evaluations are commonly used in work rehabilitation practice to assess a person's capacity to perform work-related activities. PURPOSE: This study examined the test-retest reliability of participants' performance and administrator ratings using the Gibson Approach to Functional Capacity Evaluation (GAPP FCE). METHODS: Forty-eight healthy adults were evaluated twice on 12 recommended core items of the GAPP FCE and rated for overall performance. FINDINGS: The ICCs and 95% CIs for the Physical Level of Work and Alternative Physical Level of Work Ratings were 0.93 (0.87-0.96) and 0.86 (0.72-0.93) respectively. The ICCs for the core item-level ratings ranged from 0.15 to 0.94, and the ICCs for the actual loads handled in the manual handling items ranged from 0.88 to 0.95. IMPLICATIONS: The stability of an overall physical level of work rating shows potential for use in functional capacity evaluation practice and research. Further research is needed to investigate other measurement properties of the GAPP FCE using populations with injury or disability.