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

INTRODUCTION: 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. OBJECTIVES: This scoping review synthesized evidence on best practices, limitations, and areas for improvement and innovation in the medico-legal use of FCEs. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SYSTEMATIC REVIEW REGISTRATION: https://doi.org/10.17605/OSF.IO/TYEKR.