Value of Functional Capacity Evaluation Information in a Clinical Setting for Predicting Return to Work

Abstract 

Streibelt M, Blume C, Thren K, Reneman MF, Mueller-Fahrnow W. Value of functional capacity evaluation information in a clinical setting for predicting return to work.

Objective

To evaluate the quality of Functional Capacity Evaluation (FCE) information in predicting return to work (RTW).

Design

Prospective cohort study.

Setting

Inpatient rehabilitation clinic.

Participants

Patients (N=220) with chronic musculoskeletal disorders (MSD) conducting a medical rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Patients filled in questionnaires at admission and 1-year follow-up. An FCE was performed on admission. RTW was defined as a combination of employment at 1-year follow-up with a maximum of 6 weeks sick leave because of MSD in the postrehabilitation year. As predictive FCE information, the physical capacity (Dictionary of Occupational Titles categories 1–5), the number of test results not meeting work demands (0–25), and the tester's recommendation of work ability in the actual job (≥6h/d) were analyzed. Logistic regression models (crude and adjusted for the concurrent predictors employment, preadmission sick leave, and patient's prognosis of RTW) were created to predict RTW.

Results

Complete data were obtained for 145 patients. The sample showed a non-RTW at 1-year follow-up for 37.9%. All FCE information showed significant relations to RTW (r=.28–.43; P<.05). In the crude as well as in the adjusted regression models, all FCE information predicted RTW, but the models' quality was low. The integration of FCE information led to an increase of 5%. The predictive efficiency was poor. The adjusted model for failed tests showed a substantial improvement compared with the reference model (concurrent predictors only).

Conclusions

There was a significant relation between FCE information and RTW with and without concurrent predictors, but the predictive efficiency is poor. Primarily, the number of failed tests seemed to be of significance for patients with ambiguous RTW prognosis. A first proposal for a prediction rule was discussed.

Key Words: Musculoskeletal diseases, Rehabilitation

List of Abbreviations: DOT, Dictionary of Occupational Titles, FCE, Functional Capacity Evaluation, IWS FCE, Isernhagen Work System Functional Capacity Evaluation, MSD, musculoskeletal disorder, PRE_ref, proportional reduction of error, RTW, return to work, WHO, World Health Organization