title: Factors that affect functional capacity in patients with musculoskeletal pain: a Delphi study among scientists, clinicians, and patients.
abstract: OBJECTIVE
  To reach consensus on the most important biopsychosocial factors that influence functional capacity results in patients with chronic nonspecific musculoskeletal pain, arranged in the framework of the International Classification of Functioning, Disability and Health.
  
  
  METHODS
  Three-round, internet-based Delphi survey.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Participants were scientists, clinicians, and patients familiar with functional capacity testing. Scientists were invited through purposive sampling based on the number of relevant publications in peer-reviewed journals. The scientists recruited clinicians and patients through snowball sampling.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Consensus was reached if at least moderate influence (25%) was achieved and an interquartile range of no more than 1 point was reached.
  
  
  RESULTS
  Thirty-three scientists, 21 clinicians, and 21 patients from 9 countries participated. Participants reached consensus on 6 factors that can influence the outcome of the lifting test, having a median of severe influence (50%-95%): catastrophic thoughts and fear, patient adherence to "doctor's orders," internal and external motivation, muscle power, chronic pain behavior, and avoidance behavior. Motivation, chronic pain behavior, and sensation of pain were the top 3 factors affecting postural tolerance and repetitive movement functional capacity tests. Furthermore, participants reported 28 factors having a median of moderate influence (25%-49%) that could influence the outcome of lifting, postural tolerance, and repetitive movement tests.
  
  
  CONCLUSIONS
  Overall, chronic pain behavior, motivation, and sensation of pain are the main factors that can influence functional capacity results. We recommend that scientists and clinicians, respectively, consider the most important factors when planning future studies and when interpreting functional capacity test results.
authors.affiliation: Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands. a.e.jorna-lakke@pl.hanze.nl
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Lakke
authors.forename: Harriët
authors.initials: H
authors.lastname: Wittink
authors.forename: Jan H
authors.initials: JH
authors.lastname: Geertzen
authors.forename: Cees P
authors.initials: CP
authors.lastname: van der Schans
authors.forename: Michiel F
authors.initials: MF
authors.lastname: Reneman
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D000367:Age Factors; D001519:Behavior; D002908:Chronic Disease; D003697:Delphi Technique; D006233:Persons with Disabilities / Q000523:psychology; D005239:Fear; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009042:Motivation; D059352:Musculoskeletal Pain / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation*; D010146:Pain; D017288:Pain Threshold; D010349:Patient Compliance; D010361:Patients / Q000523:psychology; D012108:Research Personnel; D012737:Sex Factors