What is a Functional Capacity Evaluation?
 A
Functional Capacity Evaluation (FCE) is a comprehensive evaluation that
provides an objective measure of an individual's safe maximum physical
capability to perform work. The detailed examination and evaluation
process is designed to measure the individual's current level of
function, like a 'snapshot in time,' within the context of the physical
demands of employment. An FCE measures the ability of an individual to
perform functional or work-related tasks and predicts the potential to
sustain these tasks over a defined period of time. The physical
capabilities achieved during the FCE are compared to the physical
demands of a job or other functional activity and are used to make
return to-work/activity decisions, disability determinations, or to
generate a rehabilitation plan.
What type of
information will I receive if I refer my patient for an FCE?
FCE recommendations are valuable
to assist the physician or referral source in a more objective
determination of:
- the individual's ability to
perform the essential physical tasks of their job or alternative job
options
- return-to-work feasibility
- appropriate job modifications or
job placement
- disability considerations
- rehabilitation potential
- appropriate ergonomic
intervention
- case management and case closure
The FCE evaluator is also able to use the
information from the FCE to assist the physician in completing insurance
paperwork requesting documentation of physical capabilities.
Communication is the key to a successful FCE. Appropriate referrals
should have a specific purpose and this purpose should be indicated to
the FCE evaluator at the time of referral. Please include what
information you expect the FCE to provide and what questions need to be
answered to progress an individual through an efficient continuum of
care. Our FCE evaluators will be happy to discuss any patient's case
prior to referral if you are unsure whether an FCE is appropriate or
will provide you with the information you are seeking.
What type of patient
or case would benefit from an FCE?
The following suggestions may help
determine if an FCE would be beneficial for your patient. Consider
referral if the individual:
- has
achieved maximum medical/functional benefit from medical or
rehabilitation intervention
- has not
resumed work or functional responsibilities in regular job or
modified capacity
- is ready
to return to work but limitations need to be delineated
- is
working but exhibits difficulty performing essential job tasks or
functional activities
- exhibits
a discrepancy between subjective complaints and objective physical
findings
- requires
objective or predictive information for vocational planning,
alternate job placement or future rehabilitation decisions
- requires
objective or predictive information for disability determination,
litigation, case management or case resolution
- is
requested to demonstrate safe ability to perform essential job tasks
prior to return to work by employer
- requires
determination of function in a non-occupational situation
Are there any contraindications to performing
an FCE?
When considering whether your
patient is appropriate for an FCE remember, the individual must
be medically stable and
agree to participate in the evaluation through an informed
consent. A functional capacity evaluation
should not be ordered, and will not be performed, if the
individual's safety or medical condition could be
compromised. The following contraindications should be observed:
surgery without adequate healing time or
unhealed fractures, blood pressure above 150/100, recent
abdominal or inguinal hernia, specific cardio
respiratory concerns or pregnancy. Pregnancy referrals should be
postponed until at least 3 months post
partum.
In our physical therapy practice, a
musculoskeletal screening including vital signs is performed at
the
beginning of the FCE. Although it is not
necessary to include the musculoskeletal examination in a FCE,
it assists us to determine precautions that should be followed
during the evaluation. On occasion, we may also identify 'red
flags' which increase the potential of compromising an
individual's medical condition or safety.
Are all FCEs the same?
Confusion may arise when providers
use different Functional Capacity Evaluation protocols (e.g.
Isernhagen,
ErgoScience, Blankenship, Key), but the
information they provide is actually very similar. The majority
are
based on the 20 Physical Demands of Work
identified by the US Department of Labor in the Dictionary of
Occupational Titles (D.O.T.).
These include:
Lifting Kneeling
Pulling Talking Standing
Crouching Walking
Crawling Climbing Feeling
Sitting Reaching Balancing
Hearing
Carrying Handling Stooping
Seeing Pushing Fingering
In a comprehensive FCE, all of these
tasks are generally tested. However, a job-specific FCE can also
be
designed to determine an individual's
ability to perform the physical demands of an identified job or
a specific task.
Most FCE reports will provide you with
the frequency the individual should perform each task, based
upon
their current safe physical capabilities
and endurance. The D.O.T. defines the frequency of work demands
as
follows:
Never -
0% of the day
Occasional -
up to 1/3 (1-33%) of the day
Frequent - 1/3
to 2/3 (34-66%) of the day
Constant - 2/3
to the full (67-100%) day
This helps to document whether an
individual has the endurance to complete an
8 hr. day of work and allows us to match
their current capabilities with the
requirements of their job.
The final D.O.T. classification you
should be aware of is the Physical Demand Classification of the
work. This describes the physical level the worker is expected
to be able to maintain for the duration of their day.
Physical Demand Level is described as
follows:
Sedentary Light Medium
Heavy
Very Heavy
Occasional
10lb. 20lbs. 50lbs.
100lbs. Over 100lbs.
Frequent
Negligible 10lbs. 20lbs.
50lbs. Over 50lbs.
Constant
Negligible Negligible
10lbs.
20lbs.
Over 20lbs.
All FCE reports will provide you with an
overall level of work the employee is currently capable of
performing. The written or verbal job description provided by
the employer will provide the actual physical demand level
of the job. These are 'matched' as a
whole and task by task to ascertain whether the person may
return to their job
without restrictions, with modifications or possibly to a
different job. The physical demand level also
helps predict whether additional conditioning, healing time,
task simulation, etc. will allow the person to
ultimately achieve the physical capabilities necessary to return
to their job.
Physical
Therapy Associates of Schenectady, PC evaluators are certified
to perform the ErgoScience (PWPE) Physical Work Performance
Evaluation, for which research has shown excellent inter-rater
reliability and predictive validity. We have attempted to make
our reports as 'user-friendly' to the physician and case manager
as possible, providing the results in a concise manner and
including a simple chart to match the individual's current
capabilities to the actual job requirements.
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We specialize in orthopedic and general physical therapy care
along with the following services:
- Return to Work Programs
- Functional Capacity
Evaluations
- Business Onsite Physical
Therapy
- Ergonomic
Consultation/Onsite Job Analysis and Workplace Modifications
- Home Care
- Back Schools
- Spine Class-Education and
Exercise
- Post Op Back Surgery
Class
- Prenatal and Postpartum
Physical Therapy
- Aquatics/Therapeutic Pool
Programs- Buoyant environment to initial flexibility, gait
training, strengthening
- Sports Rehabilitation
Screening
- Neurological, Orthopedic,
Sports Medicine
- Fit For Golf Program
- Women's
Health-Incontinence, Pelvic Pain
- Present Local Educational
Programs with CME/AMA credit hours
- Modalities that include
iontophoresis/phonophoresis
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