The FCE is a comprehensive objective battery of tests to measure an individual's physical and functional capabilities. Its purpose is to assess whether the worker can meet the physical demands of a current or prospective job.
A functional capacity evaluation is performed by a certified evaluator and is designed to be safe and to provide impartial information. The FCE tests will evaluate a worker's range of motion, physical strength, flexibility, and other abilities required for the job.
Uses of FCE
The FCE can be used for assessment of:
Ability to return to work: FCE can help assess the worker's capacities to return to the current job safely after recuperation from an injury. If the worker has some functional deficits, FCE should help to document these deficits objectively and prescribe appropriate accommodations at work.
In the circumstances that the individual has only subjective complaints, exhibits symptom exaggeration, or is not motivated to return to work, FCE could provide additional data to reinforce return-to-work decisions.
However, the FCE can only predict an employee's capacity to perform work tasks, not return to work. In addition, many psychosocial and workplace factors play an important role in an employee's return to work decision, especially after prolonged disability and absence.
Need for rehabilitation: In the protracted recovery of an injured worker, especially after a musculoskeletal trauma, FCE is often helpful to provide information about the worker's current functional limitations and justify the need for additional rehabilitation, such as physical therapy or work conditioning, for the safe return to work.
General employability: If a worker has lost their job due to permanent impairment or other reasons, a comprehensive FCE can help determine the worker's current capacities to return to the general workforce using the U.S. Department of Labor guidelines.
Job-specific capacities: When an adequate job description is available, a job-specific FCE can help assess whether an individual's current functional capacities are well-matched with the specific physical needs and other demands of the individual's prospective job.
Comprehensive versus Focused FCE
A comprehensive FCE needs to provide information on about 20 physical demands of work described by the Dictionary of Occupational Titles (DOT). The level of work the employee can perform is classified as sedentary, light, medium, heavy, and very heavy. Levels of tolerance are also rated according to whether the client can perform them constantly, frequently, occasionally, or never.
A focused FCE is preferred when the worker's job description is available. The test should provide a clear narration of the client's physical capabilities and limitations regarding the job's critical demand levels. Suppose the appropriate job description is not available. In that case, the test should compare the client's capabilities with the estimated job demands as determined through self-reporting by the employee or by consulting DOT with verification from the injured employee or their employer. The resulting report should provide specific recommendations particular to the job.
Validity and Reliability of FCE
The validity of FCE is essentially a measure of how accurately it assesses the true functional capabilities of the claimant. Validity issues commonly occur due to poor characterization of the demands of the job and inaccurate measurement of a worker's actual performance capability concerning these demands.
Reliability refers to the consistency of measures taken. Intra-rater reliability refers to the consistency of evaluations of a client performed by the same examiner during a period. Inter-rater reliability refers to the ability to achieve similar results on the assessment of a client when administered by different evaluators.
The validity and reliability of FCEs are critical to reaching a proper decision about the physical capabilities of a worker. Without validity, an FCE cannot be considered trustworthy; without reliability, it will be difficult to determine which test to believe if the FCE results are different with different test administrators.
Submaximal Effort
An FCE is an effort-dependent test. Therefore, the assessment should also provide information regarding the client's sincerity of effort in performing various test components. Submaximal effort can be defined as any effort that is not 100% or less than the best possible effort.
The submaximal effort of an examinee may be unintentional due to pain, fear of exacerbation of injury, or fatigue. Or it may be intentional due to symptom magnification or malingering.
When an individual's pain and other symptoms are consistent with objective medical evidence and the individual has demonstrated honest effort during testing, the evaluator should consider the symptoms in formulating recommendations about the individual's functional capacities and need for accommodations. However, suppose an individual's pain and other symptoms are not consistent with objective medical evidence, and the individual's test performance showed submaximal effort. In that case, the evaluator should not give too much weight to the individual's self-reports of pain or other symptoms when determining their functional capacities and return to work fitness.
The best effort on the test underpins the validity and reliability of the FCE test results. Consequently, it is required that the patient gives their full effort and that less than full effort is recognized and documented when it occurs. Conversely, failure to identify submaximal effort on the test may exaggerate disability findings and appraisal of impairment.
However, despite several scientific and practical limitations, when combined with other sources of information, FCE results contribute valuable information for disability, impairment rating, and return-to-work decision-making in workers' compensation cases.
King PM, Tuckwell N, Barrett TE. A Critical Review of Functional Capacity Evaluations. Physical Therapy, 1998; 78 (8); 852-866.
Lechner DE, Bradbury SF, Bradley LA. Detecting Sincerity of Effort: A Summary of Methods and Approaches. Physical Therapy, 1998; 78 (8); 867-888.
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