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Ansuategui Echeita J1, Bethge M2, van Holland B3, Gross D4, Kool J5, Oesch P5, Trippolini M6, Chapman E7, Cheng A8, Sellars R9, Spavins M10, Streibelt M11, van der Wurff P12, Reneman M1
1University of Groningen, University Medical Center Groningen, Groningen, Netherlands, 2University of Lübeck, Institute of Social Medicine and Epidemiology, Lübeck, Germany, 3Hanze University of Applied Sciences, Institute for Sports Studies, Groningen, Netherlands, 4University of Alberta, Department of Physical Therapy, Edmonton, Canada, 5Rehabilitation Centre Kliniken Valens, Research & Development, Valens, Switzerland, 6Rehaklinik Bellikon, Department of Work Rehabilitation, Bellikon, Switzerland, 7Toyota Motor Manufacturing Canada, Puslinch, Canada, 8Polytechnic University, Ergonomics and Human Performance Laboratory, Hong Kong, China, 9FCE Systems Ltd, Geraldine, New Zealand, 10Occupational Therapy Inc., Randburg, South Africa, 11German Federal Pension Insurance, Department of Rehabilitation, Berlin, Germany, 12Military Rehabilitation Center Aardenburg, Research & Development, Doorn, Netherlands
Background: The use of functional capacity evaluations (FCEs) has become part of common clinical practice in several areas of occupational and rehabilitation medicine on patients with musculoskeletal diseases. FCEs have been 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. Multiple factors including personal, health care, professional, legal, administrative, and cultural characteristics have been shown to influence work participation. The present study was designed to further examine determinants of FCE performance in patients from different societal contexts.
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: An 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 Lifting capacity. 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 walking capacity. 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(s): 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.
Implications: Patients' FCE results should be considered from a biopsychosocial perspective, including different social contexts.
Keywords: Occupational health, Sociological factors, Chronic pain
Funding acknowledgements: No external funding
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: An 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 Lifting capacity. 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 walking capacity. 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(s): 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.
Implications: Patients' FCE results should be considered from a biopsychosocial perspective, including different social contexts.
Keywords: Occupational health, Sociological factors, Chronic pain
Funding acknowledgements: No external funding
Topic: Occupational health & ergonomics; Disability & rehabilitation; Musculoskeletal
Ethics approval required: Yes
Institution: Approval from 8 institutions, one in each country
Ethics committee: Approval from 8 institutions, one in each country
Ethics number: Approval from 8 institutions, one in each country
All authors, affiliations and abstracts have been published as submitted.
