Functional capacity evaluations in medico-legal contexts: a scoping review of best practices, limitations, and areas for improvement.
Lisa Schwab, Dominique Van de Velde, Lutgart Braeckman and 1 others
PMID 42558511WHAT IT FOUND
A scoping review of 51 studies finds that functional capacity evaluations in legal settings lack a gold standard and often ignore psychosocial context; some cited research reports return-to-work prediction accuracy as low as 10%.
Treat FCE scores as one input, not a verdict.
Key findings
01The review included 51 studies and clustered findings into six recurring themes for FCE practice in medico-legal settings: standardization and psychometrics, effort and motivation, psychosocial and contextual factors, job matching and functional relevance, practical considerations, and reporting and communication.
02A persistent gap is the absence of a gold standard for measuring work ability, and some cited research reports prognostic accuracy for return-to-work outcomes as low as 10%.
03Many FCEs rely heavily on isolated physical performance, failing to account for environmental barriers, social context, or workplace reality; the review recommends integrating psychosocial screening tools and formal job analyses to close this gap.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Only a minority of the 51 included studies met all critical appraisal criteria; the evidence base is dominated by descriptive studies, opinion papers, and cross-sectional designs rather than randomised trials. The review spans 36 years of publications (1990–2026) across different legal and social contexts, so findings reflect patterns across a heterogeneous body of work rather than conclusions for any one jurisdiction. Limited to four languages (English, German, Dutch, French), which may exclude relevant work from other regions. Grey literature (unpublished legal guidelines, policy briefs) was not included, and the search relied on a single primary term ('Functional Capacity Evaluation'), potentially missing studies using alternative nomenclature. The review did not stratify findings by jurisdiction or disability definition, so it cannot speak to how FCEs are used in any one legal system.
Declared interests
The authors declare financial support from KBS FRB Benevermedex (grant number: 2024-J1162090-0022952). No other conflicts of interest are stated.
The easy way to misread this
Do not read the 10% prognostic accuracy figure as a definitive verdict that FCEs are useless. It is one data point from 'some research' cited within a review of 51 heterogeneous studies of mixed quality, and the review's own conclusion is that FCEs have value when administered with standardization, job-specific tailoring, and psychosocial context. Conversely, do not treat this scoping review as a clinical guideline: it maps the landscape of evidence and identifies gaps, but does not prescribe a specific protocol or validate any particular FCE battery.