Functional Capacity Evaluation in Different Societal Contexts: Results of a Multicountry Study.
Jone Ansuategui Echeita, Matthias Bethge, Berry J van Holland and 11 others
PMID 29802582WHAT IT FOUND
Functional capacity test scores in patients with musculoskeletal pain were consistently linked to height, reported pain, and the specific clinician and country conducting the test.
These contextual factors must be considered when interpreting results for return-to-work decisions.
Key findings
01Clinician and country differences accounted for approximately 39% of the residual variance in lift test results and 25% in right handgrip strength, showing that who performs the test and where it is done significantly influences the score.
02Greater weight lifted and longer walking distances were associated with taller stature, male sex, and lower reported pain intensity and disability, while higher observed effort predicted better lifting performance.
03Social factors, including the healthcare environment and cultural background, were consistently related to all functional capacity test outcomes, independent of biological and psychological variables.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study used snowball sampling and recruited from a limited number of facilities per country, which may affect the generalizability of the results to all patients undergoing FCEs. Questionnaires were translated for non-English speaking countries without testing the validity of those translations, introducing potential measurement bias. The Back Beliefs Questionnaire was adapted for musculoskeletal pain without re-validating the modified version. As a cross-sectional design, the study identifies associations but cannot determine causality between biopsychosocial factors and FCE performance. A substantial portion of the variance in FCE results remained unexplained, indicating that other relevant factors were not captured in this study.
The easy way to misread this
Do not treat FCE scores as objective, context-free measures of physical capacity. The results show that the clinician performing the test and the country where it is conducted significantly influence the outcome, meaning identical patients may receive different scores depending on the testing environment.