Functional Capacity Evaluation in Different Societal Contexts: Results of a Multicountry Study

Abstract

Purpose To examine factors associated with Functional Capacity Evaluation (FCE) results in patients with painful musculoskeletal conditions, with focus on social factors across multiple countries. Methods International cross-sectional study was performed within care as usual. Simple and multiple multilevel linear regression analyses which considered measurement's dependency within clinicians and country were conducted: FCE characteristics and biopsychosocial variables from patients and clinicians as independent variables; and FCE results (floor-to-waist lift, six-minute walk, and handgrip strength) as dependent variables. Results Data were collected for 372 patients, 54 clinicians, 18 facilities and 8 countries. Patients' height and reported pain intensity were consistently associated with every FCE result. Patients' sex, height, reported pain intensity, effort during FCE, social isolation, and disability, clinician's observed physical effort, and whether FCE test was prematurely ended were associated with lift. Patient's height, Body Mass Index, post-test heart-rate, reported pain intensity and effort during FCE, days off work, and whether FCE test was prematurely ended were associated with walk. Patient's age, sex, height, affected body area, reported pain intensity and catastrophizing, and physical work demands were associated with handgrip. Final regression models explained 38‒65% of total variance. Clinician and country random effects composed 1-39% of total residual variance in these models. Conclusion Biopsychosocial factors were associated with every FCE result across multiple countries; specifically, patients' height, reported pain intensity, clinician, and measurement country. Social factors, which had been under-researched, were consistently associated with FCE performances. Patients' FCE results should be considered from a biopsychosocial perspective, including different social contexts.

Do patient characteristics affect the predictive validity of Functional Capacity Evaluations?

“…For example, Gross and Battié ( 2005 ) found that “younger, male subjects who reported lower levels of perceived disability and pain intensity lifted at higher levels”. The last three criteria were confirmed in a multicountry study (Ansuategui Echeita et al 2019 ).…”

“…Due to a large number of days on sick leave, rehabilitation measures and pension applications that are related to musculoskeletal disorders (MSD) (Bevan 2015 ; Murray et al 2015 ; Deutsche Rentenversicherung Bund (DRV) 2019a ), the question of whether an individual's physical capacity meets the physical demands of work frequently arises in the context of occupational and rehabilitation medicine. To promote a valid assessment of the ability to safely perform activities required at work, Functional Capacity Evaluation (FCE) procedures became part of common clinical practice (Ansuategui Echeita et al 2019 ). These assessments are defined as “an evaluation of 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” (Soer et al 2008 ).…”

Return to work following shoulder arthroplasty: A systematic review

“…If a patient has reached MMI, but has failed to achieve their pre-injury or prior level of work status, then a physician can utilize a functional capacity evaluation to determine the patient’s ability and impose final work restrictions[ 69 ]. Although the results of the FCE are often used to set work limitations, some studies have questioned its utility as FCE does not take biopsychosocial factors into account and possibly measures a patient’s tolerance to an activity as opposed to the patient’s true ability[ 69 , 77 , 78 ].…”

Central sensitization and functioning in patients with chronic low back pain: A cross-sectional and longitudinal study

“…For research question 1, cross-sectional analyses with baseline data were performed. First, Spearman partial correlation analyses were performed, corrected for sex and age due to known differences in lifting capacity, HRV and QST [ 47 , 57 , 58 ]. Second, multiple regression analyses were performed, with each functioning measurement separately as dependent variable, one variable representative of each CS indicator as fixed independent variables, and participants’ characteristics as potential confounders (including the correction for age and sex).…”