A Functional Capacity Evaluation (FCE) documents a client's current ability to perform work from a medical, behavioral, physical, and ergonomic perspective. The FCE is flexible enough to meet the needs of a wide variety of patient populations. The FCE will help to measure work readiness and provide baseline information for successful rehabilitation, as well as safe guidelines leading to attainment of gainful employment. The FCE will therefore be an important asset in formulation of realistic work goals. The FCE is also an essential tool that will provide documentation required to resolve disability issues.
Benefits of an FCE
The FCE provides many benefits. For the client, it identifies safe working limits, accelerates the return to work process, and improves the chance of successful rehabilitation.
For the physician, it assists with evaluation of medical impairments, provides a baseline for successful rehabilitation, and establishes safe physical demands for the return to work.
For the compensation carrier, it validates the injury, helps to document data for disability settlement, and helps to resolve one's case.
For the employer, it provides faster return to work, and gives data regarding ergonomic solutions and job modifications.
For the attorney, it gives objective data for establishment of functional status.
Overall, the FCE includes multiple tests that focus on strength, flexibility, lifting, pushing, pulling, bending, and manipulatory tasks. The FCE is flexible, depending on the client's situation. For example, a job specific FCE is designed to closely simulate a job that a client will return to, or performed at the time of injury. It is done when a specific skill or physical demand is in question, and can screen for conditions that may place the worker at risk. A generic FCE can be done when there is no specific job designated to return to.
An FCE usually takes four hours. However, in certain situations, an FCE can be completed in as little as one hour if only a small number of tasks needs to be observed. For example, establishment of baseline information for lifting, carrying, pushing, and pulling can be completed in a one hour test. The evaluation is performed by either an occupational or physical therapist. The following is a general outline for an FCE. Though the evaluations are individualized, they typically include:
- Intake Interview: Information obtained regarding medical history, general health, mechanism of injury, job description, and vocational goals. Information on pain, effect on activities of daily living, and psychological impact of injury is gathered.
- Musculoskeletal Evaluation: This provides insight into understanding of the client's behavior during the functional evaluation. It includes evaluation of range of motion, strength, sensation, and volumetric measurements. It may provide clues to possible symptom magnification. For example, static strength testing, as done with the Jamar Hand Dynamometer, can assist with determining consistency of effort.
- Physical Demand Testing: This is the "meat and potatoes" of the evaluation. The evaluator observes the client in using the involved part and whole body in tasks. Both standardized and non standardized tests can be used. Non standardized tests are used to obtain data about the client's participation in critical demands of a job.
- Material Handling: This determines a client's ability to exert force in order to move items. This includes lifting, carrying, pushing, and pulling. Lifting to and from various heights can be tested with the EPIC lift station. Pushing and pulling capacities are usually tested with a sled. The evaluator can then match the client to one of five categories as determined by the U.S. Department of Labor for the respective task. The categories are sedentary, light, medium, heavy, or very heavy. Therefore, material handling tasks will determine if a client meets the strength requirements for work tasks in question.
- Non Material Handling: This includes, but is not limited to, tasks requiring bending, crawling, kneeling, squatting, and climbing ladders. These include any tasks that do not require a significant amount of force.
- General Conditioning: This may include walking and stair climbing endurance in order to ascertain overall aerobic capacity.
- Specific Job Simulation: Examples include participation in clerical, housekeeping, patient care, and law enforcement job components.
- Psychological Factors: There are several tests that can give insight into a client's behavior. For example, placebo tests can determine if a client is a symptom magnifier. The Spinal Functional Sort is a test of perceived level of capability. With this test, we can assess if perceived level of capability matches actual level of capacity.
Upon completion of a full FCE, a report is generated. This report includes a summary of the client's assets and limitations in regard to work potential. Recommendations will provide safe guidelines for return to work, rehabilitation, and case resolution. For short FCE's that last one hour, a physical capacities form can be completed that will generate information on general material and non material handling abilities. This will also assist with safe rehabilitation, work potentials, and case resolution.