Journal of Occupational Rehabilitation

, Volume 25, Issue 2, pp 257–266 | Cite as

Functional Capacity Evaluation: Performance of Patients with Chronic Non-specific Low Back Pain Without Waddell Signs

  • Peter Oesch
  • Kathrin Meyer
  • Beatrice Jansen
  • Jan Kool


Purpose The primary objective of this study is to evaluate the effect of Waddell signs (WS) on Functional Capacity Evaluation (FCE) in patients with chronic non-specific low back pain (CNSLBP) undergoing fitness for work evaluation. If an effect is observed, the secondary objective is to report performance of patients without WS in a standardized 1 day FCE protocol. Methods Survey of patients with CNSLBP as their primary complaint, referred for fitness for work evaluation, age between 20 and 60 years. Main outcome measures were WS and performance during manual handling assessed with lifting from floor to waist, waist to crown, horizontal and one handed carry; grip strength with Jamar hand held Dynamometer; ambulation with stair climbing and six minute walking test; work postures with elevated work, forward bend standing, kneeling, and sitting. Results 145 male with a mean age of 44.5 years (±10.1), and 53 females with a mean age of 43.6 years (±11.0) were included. Mean days off work were in male 658 (±1,056) and in female 642 (±886). 33 % of all patients presented positive WS. FCE performance in male and female patients with positive and negative WS differed significantly in all comparisons except grip strength of the dominant hand and sitting in female. Performance of patients with negative WS indicated a mean physical capacity corresponding to lightmedium work in females and medium work in males for both age groups. Conclusions WS should be assessed for interpretation of FCE results. Despite long work absence, patients with CNSLBP with negative WS demonstrated a physical capacity corresponding to substantial physical work demands.


Chronic low back pain Work capacity evaluation Signs and symptoms Performance 


Ethical standards

Ethical approval was obtained from the responsible regional ethics committees (EKSG 08/029/2B; SPUK N°. 784, EKAG 08/058).


  1. 1.
    Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646–56.PubMedCentralPubMedGoogle Scholar
  2. 2.
    Wieser S, Horisberger B, Schmidhauser S, Eisenring C, Brugger U, Ruckstuhl A, et al. Cost of low back pain in Switzerland in 2005. Eur J Health Econ. 2011;12(5):455–67.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    OECD. Sickness, disability and work: breaking the barriers. A synthesis of findings across OECD countries. France: OECD Publishing; 2010.Google Scholar
  4. 4.
    Fordyce W. Back pain in the workplace: management of disability in nonspecific conditions a report of the task force on pain in the workplace of the international association for the study of pain. Seattle, WA: IASP Press; 1995.Google Scholar
  5. 5.
    Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2:S192–300.Google Scholar
  6. 6.
    Balague F, Mannion AF, Pellise F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482–91.Google Scholar
  7. 7.
    Abenhaim L, Rossignol M, Valat JP, Nordin M, Avouac B, Blotman F, et al. The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain. Spine. 2000;25(4 Suppl):1S–33S.CrossRefPubMedGoogle Scholar
  8. 8.
    Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075–94.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Milhous RL, Haugh LD, Frymoyer JW, Ruess JM, Gallagher RM, Wilder DG, et al. Determinants of vocational disability in patients with low back pain. Arch Phys Med Rehabil. 1989;70(8):589–93.PubMedGoogle Scholar
  10. 10.
    Cocchiarella L, Turk MA, Andersson G. Improving the evaluation of permanent impairment. J Am Med Assoc. 2000;283(4):532–3.CrossRefGoogle Scholar
  11. 11.
    Hunt DG, Zuberbier OA, Kozlowski AJ, Berkowitz J, Schultz IZ, Milner RA, et al. Are components of a comprehensive medical assessment predictive of work disability after an episode of occupational low back trouble? Spine. 2002;27(23):2715–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Bolderson H, Mabbett D, Hvinden B. Definitions of disability in Europe: a comparative analysis. Brussels: European Commission Directorate General for Employment and Social Affairs; 2002.Google Scholar
  13. 13.
    Isernhagen SJ. Functional capacity evaluation. Work injury: management and prevention. Gaithersburg: Aspen Publishers Inc; 1988. p. 139–91.Google Scholar
  14. 14.
    Isernhagen S. Contemporary issues in functional capacity evaluation. In: Isernhagen S, editor. The comprehensive guide to work injury management. Gaithersburg, MD: Aspen Publishers; 1995. p. 410–29.Google Scholar
  15. 15.
    SAR. Functional Capacity Evaluation—Course Manual. Bellikon, Switzerland: Verein IG Ergonomie SAR; 2007.Google Scholar
  16. 16.
    Oesch PR, Kool JP, Bachmann S, Devereux J. The influence of a functional capacity evaluation on fitness for work certificates in patients with non-specific chronic low back pain. Work. 2006;26(3):259–71.PubMedGoogle Scholar
  17. 17.
    Wind H, Gouttebarge V, Kuijer PP, Sluiter JK, Frings-Dresen MH. Complementary value of functional capacity evaluation for physicians in assessing the physical work ability of workers with musculoskeletal disorders. Int Arch Occup Environ Health. 2009;82(4):435–43.CrossRefPubMedGoogle Scholar
  18. 18.
    USDL. DOT—Dictionnairy of Occupational Titles. Washington: United States Department of Labor (USDoL) 1981.Google Scholar
  19. 19.
    Soer R, van der Schans CP, Geertzen JH, Groothoff JW, Brouwer S, Dijkstra PU, et al. Normative values for a functional capacity evaluation. Arch Phys Med Rehabil. 2009;90(10):1785–94.CrossRefPubMedGoogle Scholar
  20. 20.
    Reneman MF, Kool J, Oesch P, Geertzen JH, Battie MC, Gross DP. Material handling performance of patients with chronic low back pain during functional capacity evaluation: a comparison between three countries. Disabil Rehabil. 2006;28(18):1143–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Lackner JM, Carosella AM. The relative influence of perceived pain control, anxiety, and functional self efficacy on spinal function among patients with chronic low back pain. Spine. 1999;24(21):2254–60 (discussion 60-1).CrossRefPubMedGoogle Scholar
  22. 22.
    Reneman MF, Jorritsma W, Schellekens JM, Goeken LN. Concurrent validity of questionnaire and performance—based disability measurements in patients with chronic nonspecific low back pain. J Occup Rehabil. 2002;12(3):119–29.CrossRefPubMedGoogle Scholar
  23. 23.
    Gross DP, Battie MC. Construct validity of a kinesiophysical functional capacity evaluation administered within a worker’s compensation environment. J Occup Rehabil. 2003;13(4):287–95.CrossRefPubMedGoogle Scholar
  24. 24.
    Oesch P, Meyer K, Jansen B, Mowinckel P, Bachmann S, Hagen KB. What is the role of “nonorganic somatic components” in functional capacity evaluations in patients with chronic nonspecific low back pain undergoing fitness for work evaluation? Spine. 2012;37(4):E243–50.CrossRefPubMedGoogle Scholar
  25. 25.
    Waddell G, McCulloch JA, Kummel E, Venner RM. Nonorganic physical signs in low-back pain. Spine. 1980;5(2):117–25.CrossRefPubMedGoogle Scholar
  26. 26.
    Main CJ, Waddell G. Behavioral responses to examination. A reappraisal of the interpretation of “nonorganic signs”. Spine. 1998;23(21):2367–71.CrossRefPubMedGoogle Scholar
  27. 27.
    Apeldoorn AT, Bosselaar H, Blom-Luberti T, Twisk JW, Lankhorst GJ. The reliability of nonorganic sign-testing and the Waddell score in patients with chronic low back pain. Spine. 2008;33(7):821–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Isernhagen SJ. Functional capacity evaluation: rationale, procedure, utility of the Kinesiophysical approach. J Occup Rehabil. 1992;2(3):157–68.CrossRefPubMedGoogle Scholar
  29. 29.
    Isernhagen SJ, Hart DL, Matheson LM. Reliability of independent observer judgments of level of lift effort in a kinesiophysical functional capacity evaluation. Work. 1999;12(2):145–50.PubMedGoogle Scholar
  30. 30.
    Reneman MF, Jaegers SM, Westmaas M, Goeken LN. The reliability of determining effort level of lifting and carrying in a functional capacity evaluation. Work. 2002;18(1):23–7.PubMedGoogle Scholar
  31. 31.
    Reneman MF, Dijkstra PU, Westmaas M, Goeken LN. Test–retest reliability of lifting and carrying in a 2-day functional capacity evaluation. J Occup Rehabil. 2002;12(4):269–75.CrossRefPubMedGoogle Scholar
  32. 32.
    Brouwer S, Reneman MF, Dijkstra PU, Groothoff JW, Schellekens JM, Goeken LN. Test–retest reliability of the Isernhagen work systems functional capacity evaluation in patients with chronic low back pain. J Occup Rehabil. 2003;13(4):207–18.CrossRefPubMedGoogle Scholar
  33. 33.
    Reneman MF, Brouwer S, Meinema A, Dijkstra PU, Geertzen JH, Groothoff JW. Test–retest reliability of the Isernhagen work systems functional capacity evaluation in healthy adults. J Occup Rehabil. 2004;14(4):295–305.CrossRefPubMedGoogle Scholar
  34. 34.
    Gross D, Battié M. Reliability of safe maximum lifting determinations of a functional capacity evaluation. Phys Ther. 2002;82(4):364–71.PubMedGoogle Scholar
  35. 35.
    Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg [Am]. 1984;9(2):222–6.CrossRefGoogle Scholar
  36. 36.
    Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69–74.PubMedGoogle Scholar
  37. 37.
    ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–7.Google Scholar
  38. 38.
    King MB, Judge JO, Whipple R, Wolfson L. Reliability and responsiveness of two physical performance measures examined in the context of a functional training intervention. Phys Ther. 2000;80(1):8–16.PubMedGoogle Scholar
  39. 39.
    Kennedy DM, Stratford PW, Wessel J, Gollish JD, Penney D. Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskelet Disord. 2005;6(1):3.CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Shephard R. Aging and exercise. In: Fahey T, editor. Encyclopedia of Sports Medicine and Science. Internet Society for Sport Science; 1998.Google Scholar
  41. 41.
    Jay MA, Lamb JM, Watson RL, Young IA, Fearon FJ, Alday JM, et al. Sensitivity and specificity of the indicators of sincere effort of the EPIC lift capacity test on a previously injured population. Spine. 2000;25(11):1405–12.CrossRefPubMedGoogle Scholar
  42. 42.
    Robinson ME, Dannecker EA. Critical issues in the use of muscle testing for the determination of sincerity of effort. Clin J Pain. 2004;20(6):392–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Oesch P, Meyer K, Bachmann S, Hagen KB, Vollestad NK. Comparison of two methods for interpreting lifting performance during functional capacity evaluation. Phys Ther. 2012;92(9):1130–40.CrossRefPubMedGoogle Scholar
  44. 44.
    De Beeck R, Hermans V, editors. Research on work-related low back disorders. Luxembourg: Office for Official Publications of the European Communities; 2000.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Peter Oesch
    • 1
  • Kathrin Meyer
    • 2
  • Beatrice Jansen
    • 3
  • Jan Kool
    • 1
  1. 1.Kliniken ValensValensSwitzerland
  2. 2.Zurich University HospitalZurichSwitzerland
  3. 3.Rehaklinik BellikonBellikonSwitzerland

Personalised recommendations