Functional capacity evaluations in medico-legal contexts: a scoping review of best practices, limitations, and areas...

Functional Capacity Evaluations (FCEs) are commonly used to assess individuals' capacities in relation to work demands, with growing application in medico-legal contexts. Despite their broad use, various concerns persist regarding their administration, interpretation, and application within this setting.

This scoping review synthesized evidence on best practices, limitations, and areas for improvement and innovation in the medico-legal use of FCEs.

The review followed standard methodological frameworks for scoping reviews and PRISMA-ScR guidelines, searching six major databases for peer-reviewed articles published between 1990 and 2026. Studies were included if they addressed the use of FCEs in return-to-work, insurance, disability assessment, or legal contexts. Data were extracted using a standardized form and synthesized thematically across three domains: best practices, key limitations, and improvement opportunities.

Fifty-one articles were included. Best practices emphasized standardization and psychometrics, effort monitoring, psychosocial integration, job-specific relevance, practical feasibility, and clear reporting. Limitations included inconsistent protocols, limited validation, insufficient psychosocial integration, and concerns regarding bias and legal defensibility. Recommendations emphasized the development of modular, job-specific, and resource-sensitive protocols; stronger psychometric validation; improved evaluator training; and the establishment of interdisciplinary reporting standards aligned with international frameworks.

FCEs hold promise in medico-legal contexts, but variability and limited psychosocial integration undermine their defensibility. Progress requires both technical refinements, including standardized, validated protocols, and a shift toward biopsychosocial, person-centered approaches that reflect real work ability.

https://doi.org/10.17605/OSF.IO/TYEKR.