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
-
c
ase
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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Physical Therapy
Associates of Schenectady, P.C.
specializes 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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