Factors Associated with Functional Capacity Test Results in Patients With Non-Specific Chronic Low Back Pain: A Systematic Review

Abstract

Introduction: Functional capacity tests are standardized instruments to evaluate patients’ capacities to execute work-related activities. Functional capacity test results are associated with biopsychosocial factors, making it unclear what is being measured in capacity testing. An overview of these factors was missing. The objective of this review was to investigate the level of evidence for factors that are associated with functional capacity test results in patients with non-specific chronic low back pain. Methods: A systematic literature review was performed identifying relevant studies from an electronic journal databases search. Candidate studies employed a cross-sectional or RCT design and were published between 1980 and October 2010. The quality of these studies was determined and level of evidence was reported for factors that were associated with capacity results in at least 3 studies. Results: Twenty-two studies were included. The level of evidence was reported for lifting low, lifting high, carrying, and static lifting capacity. Lifting low test results were associated with self-reported disability and specific self-efficacy but not with pain duration. There was conflicting evidence for associations of lifting low with pain intensity, fear of movement/(re)injury, depression, gender and age. Lifting high was associated with gender and specific self-efficacy, but not with pain intensity or age. There is conflicting evidence for the association of lifting high with the factors self-reported disability, pain duration and depression. Carrying was associated with self-reported disability and not with pain intensity and there is conflicting evidence for associations with specific self-efficacy, gender and age. Static lifting was associated with fear of movement/(re)injury. Conclusions: Much heterogeneity was observed in investigated capacity tests and candidate associated factors. There was some evidence for biological and psychological factors that are or are not associated with capacity results but there is also much conflicting evidence. High level evidence for social factors was absent.

Appendices

Appendix 1 Search Strategies

Medline (Pubmed version), Cinahl (EBSCO host), PsycINFO (EBSCO host)

• 1. (“Body Regions”[Mesh] OR “Musculoskeletal System/anatomy and histology”[Mesh] OR shoulder[tw] OR elbow[tw] OR hand[tw] OR extremity[tw] OR hip[tw] OR knee[tw] OR patellofemoral[tw] OR foot[tw] OR toe*[tw] OR arm[tw] OR leg[tw] OR back[tw] OR spine[tw] OR neck[tw])

• 2. “Pain/diagnosis”[Mesh] OR “Pain/epidemiology”[Mesh] OR “Pain/etiology”[Mesh] OR pain[tw] OR “Occupational Diseases/diagnosis”[Mesh] OR “Occupational Diseases/epidemiology”[Mesh] OR “Occupational Diseases/etiology”[Mesh] OR “Arm Injuries/diagnosis”[Mesh] OR “Arm Injuries/epidemiology”[Mesh] OR “Arm Injuries/etiology”[Mesh] OR “Back Injuries/diagnosis”[Mesh] OR “Back Injuries/epidemiology”[Mesh] OR “Back Injuries/etiology”[Mesh] OR “Hand Injuries/diagnosis”[Mesh] OR “Hand Injuries/epidemiology”[Mesh] OR “Hand Injuries/etiology”[Mesh] OR “Hip Injuries/diagnosis”[Mesh] OR “Hip Injuries/epidemiology”[Mesh] OR “Hip Injuries/etiology”[Mesh] OR “Leg Injuries/diagnosis”[Mesh] OR “Leg Injuries/epidemiology”[Mesh] OR “Leg Injuries/etiology”[Mesh] OR “Neck Injuries/diagnosis”[Mesh] OR “Neck Injuries/epidemiology”[Mesh] OR “Neck Injuries/etiology”[Mesh] OR “Tendon Injuries/diagnosis”[Mesh] OR “Tendon Injuries/epidemiology”[Mesh] OR “Tendon Injuries/etiology”[Mesh] OR “Fibromyalgia/diagnosis” [Mesh] OR “Fibromyalgia/epidemiology”[Mesh] OR “Fatigue Syndrome, chronic/diagnosis”[Mesh] OR “Fatigue Syndrome, chronic/epidemiology”[Mesh] OR “Fatigue Syndrome, chronic/etiology”[Mesh] OR “Myofascial Pain Syndromes/diagnosis” [Mesh] OR “Myofascial Pain Syndromes/epidemiology”[Mesh] OR “Myofascial Pain Syndromes/etiology”[Mesh] NOT osteoarthritis[Mesh] NOT “Rheumatoid arthritis”[Mesh] NOT.

• 3. “Physical capacity”[tw] OR “Physical performance”[tw] OR “Physical ability”[tw] OR “Physical activity”[tw] OR “Physical functioning”[tw] OR “Physical test”[tw] OR “Functional test”[tw] OR “Physical measures”[tw] OR “Functional performance”[tw] OR “Functional ability”[tw] OR “Functional health status”[tw] OR “Functional limitations”[tw] OR “Functional testing”[tw] OR “Disability evaluation”[Mesh] OR “Functional capacity”[tw] OR “Behavioural performance”[tw] OR “Activity level”[tw] OR “Activity limitations”[tw] OR “Work capacity evaluation”[Mesh] OR “Functional capacity evaluation”[tw] OR “Functional capacity assessment”[tw] OR “Functional assessment”[tw] OR “Physical capacity evaluation”[tw] OR “Task performance and analysis”[Mesh] OR “Employee performance appraisal”[Mesh] OR “Physical performance test”[tw] OR “Physical ability test”[tw] OR “Assessment/rehabilitation”[tw] OR Walking[tw] OR Lifting[tw] OR “Lifting capacity”[tw] OR “Reaching task”[tw] OR “Functional reach”[tw] OR “Exercise test”[Mesh] OR “Exercise test”[tw].

• 4. “construct validity”[tw] OR “measurement properties”[tw] OR OR “pain measurements”[tw] OR questionnaires[Mesh] OR evaluation[tw] OR evaluating[tw] OR relation[tw] OR relationship[tw] OR contribution[tw] OR contributing[tw] OR appraisal[tw] OR determinant[tw] OR determinants[tw] OR influence[tw] OR influencing[tw] OR kinesiophobia[tw] OR “fear avoidance”[tw] OR fear[tw] OR “activity avoidance”[tw] OR avoidance[tw] OR “pain-related fear”[tw] OR “illness behaviour”[tw] OR catastrophizing[tw] OR “psychological factors”[tw] OR.

  • a. “Comparative study” [Mesh] OR “Cross-sectional study”[Mesh] OR research support AND Limits: Humans, English NOT medication.

• 5. 1 AND 2 AND 3 AND 4.

Records Medline 5068, Cinahl 1337, Psycinfo 45

EMBASE (EMBASE.com - Elsevier. Records from EMBASE. Unique Medline is excluded)

• 1. ((‘shoulder’/exp OR ‘shoulder’) OR (‘elbow’/exp OR ‘elbow’) OR (‘hand’/exp OR ‘hand’) OR (‘extremity’/exp OR ‘extremity’) OR (‘hip’/exp OR ‘hip’) OR (‘knee’/exp OR ‘knee’) OR patellofemoral OR (‘foot’/exp OR ‘foot’) OR toe* OR (‘arm’/exp OR ‘arm’) OR (‘leg’/exp OR ‘leg’) OR (‘back’/exp OR ‘back’) OR (‘spine’/exp OR ‘spine’) OR (‘neck’/exp OR ‘neck’) OR (‘musculoskeletal system’/exp OR ‘musculoskeletal system’))

• 2. ((‘pain’/exp OR ‘pain’) OR (‘injury’/exp OR ‘injury’) OR (‘head and neck injury’/exp) OR (‘musculoskeletal injury’/exp) OR (‘musculoskeletal pain’/exp) OR (‘disability’/exp))

• 3. ((‘cohort analysis’/exp OR ‘cohort analysis’) OR (‘expectancy’/exp OR ‘expectancy’) OR (‘prevalence’/exp OR ‘prevalence’) OR (‘probability’/exp OR ‘probability’) OR (‘risk’/exp OR ‘risk’) OR (‘epidemiology’/exp OR ‘epidemiology’) OR (‘disease course’/exp OR ‘disease course’) OR (‘prognosis’/exp OR ‘prognosis’) OR (‘prediction’/exp OR ‘prediction’) OR (‘epidemiological data’/exp OR ‘epidemiological data’) OR (‘prospective study’/exp OR ‘prospective study’) OR (‘retrospective study’/exp OR ‘retrospective study’) OR (‘longitudinal study’/exp OR ‘longitudinal study’) OR (‘case study’/exp OR ‘case study’) OR (‘epidemiology’/exp OR ‘epidemiology’) OR (predict* OR prognos*))

• 4. ((‘meta analysis’/exp OR ‘meta analysis’) OR (‘systematic review’/exp OR ‘systematic review’))) AND [humans]/lim AND [embase]/lim AND [2000-2007]/py

• 5. 1 and 2 and 3 and 4

Records Embase 1487

Appendix 2

See Table 5.

Table 5 Overview associations for level of evidence