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

Jone Ansuategui Echeita, Matthias Bethge, Berry J. van Holland, Douglas P. Gross, Jan Kool, Peter Oesch, Maurizio A. Trippolini, Elizabeth Chapman, Andy S.K. Cheng, Robert Sellars, Megan Spavins, Marco Streibelt, Peter van der Wurff, Michiel F. Reneman

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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 3865% 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.

Original languageEnglish
Pages (from-to)222-236
Number of pages15
JournalJournal of Occupational Rehabilitation
Issue number1
Publication statusPublished - Mar-2019


  • Internationality
  • Occupational health
  • Sociological factors
  • Lifting
  • Chronic pain

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