Functional Capacity Evaluations

Understanding a Functional Capacity Evaluation (FCE)

A Functional Capacity Evaluation is a systematic process conducted to gauge an individual’s physical capacity. It involves an array of tests, practices, and observations that assess various facets of your physical function. The resultant report can illuminate the cumulative impact of your symptoms on your ability to perform essential work duties or daily activities.

These evaluations are beneficial for individuals experiencing physical conditions resulting in symptoms like:

• Abnormal or limited movements
• Muscle weakness
• Difficulty in positioning or balance
• Numbness or tingling sensations
• Chronic pain
• Poor dexterity or gross movements
• Fatigue with physical activities

Whether your physical abilities are compromised due to an injury or illness, the FCE offers a tangible manifestation of your restrictions and limitations. However, it’s pertinent to note that most FCEs are not tailored to measure the impact of visual or hearing impairments, or mental/cognitive issues.

Purpose and Indications for an FCE

The primary purpose of an FCE is to provide a standardized assessment of an individual’s functional capacity in relation to their job’s demands. This includes aspects such as lifting, carrying, pushing/pulling, balance, fine motor skills, and cardiovascular tolerance. The results of an FCE can inform decisions regarding job placement, rehabilitation, disability claims, and case settlements.

An FCE may be deemed appropriate in the following scenarios:

However, certain contraindications exist as well. Medical conditions involving cardiac, pulmonary, or psychological issues, and difficulty in understanding instructions or communication could pose challenges in effectively conducting an FCE.

Pre-Evaluation Considerations

Before the FCE process begins, several factors must be taken into account:

5. Safety: The examiner must ensure that the physical demands of the evaluation are within the patient’s abilities.
6. Medical Stability: Even though the patient may have a known medical condition, the examiner understands that the patient has reached a state of complete healing or the location of the symptoms remains consistent, even if the intensity varies.
7. Diagnosis: The diagnosis should be confirmed and ideally suited for the examination.
8. Chronic Pain: The examination may increase the intensity of pain but the patient remains medically stable.
9. Recent Surgery: The patient should have fully healed from any surgery performed and cleared by the attending surgeon.
10. Maximum Medical Improvement: The patient does not have to have reached this and might be deconditioned from the period of inactivity prior to the examination.
11. Medical Examination: This is performed by a qualified physician and can include clearance or contraindications for modifications needed for the examination.

Performing a Functional Capacity Evaluation

Functional capacity evaluations are typically administered by trained medical professionals like occupational therapists or physicians specializing in rehabilitative occupational medicine. The examiner will need information about your job, the duties you’re required to perform, your diagnosis, and ongoing medical treatment.

The design of an FCE varies based on several factors. The examination length can be as short as 2 hours, extending up to 5-6 hours over 2 days.

Components of an FCE

An FCE comprises the following key components:

12. History: This includes the patient’s medical, social, and work history, along with treatment history. Understanding the patient’s background helps build rapport.
13. Pre-evaluation screening: This is to determine the appropriateness of the patient for the FCE. It involves screening for any possible medical contraindications and potential impairments.
14. Functional testing: This component is the actual testing based on the vocational requirements. Activities should include graded material handling (lifting, carrying, pushing, pulling) and positional tolerance activities (sitting, standing, walking, balancing, reaching, stooping, kneeling, crawling, object manipulation, fingering, and hand manipulation).
15. Interpretation of results: A trained evaluator analyzes the results of each component of the examination to determine a return to work conclusion which may include modifications to the job activities.
16. Preparation of report: The report includes the patient’s medical history, social and job history, pre-evaluation screening results, and functional testing results. Finally, the patient’s physical abilities are compared to the physical demands or requirements for the job along with any potential recommendations.

During the material handling portion of the FCE, the examiner observes the person’s effort. Based on this perceived effort, a determination of the maximal safe lifting ability is made. Signs of reaching a maximal level may include muscle bulging of the prime movers, involuntary use of accessory muscles, altered body mechanics, loss of equilibrium, increased base of support, decreased efficiency, and smoothness of movement, and cardiovascular signs such as increased heart rate and breathing.

Interpreting the Results of an FCE

Research indicates a high reliability of a properly trained evaluator in assessing a person’s effort level. Studies have reported interrater reliability ranges from .95 to .98, suggesting that training is a crucial component in interpreting the results of an FCE.

However, the validity of a return to work recommendation following an FCE can vary. One study found that after several months, the recommendations were accurate for the majority of patients. The primary factor influencing a patient’s return to work was the employer’s ability to accommodate the recommendations.

Another study found that 62.1% of patients were able to successfully return to their job after a year. It was found that the difference in a person returning to work versus not was the person’s opinion they had a heavy disability.

Post-Evaluation Considerations

If you experience a temporary increase in symptoms following the evaluation, consider arranging for a ride to and from the evaluation. In cases where you’re recovering from surgery or currently undergoing rehabilitative therapy, communicate these circumstances to your FCE provider before scheduling your appointment(s).

The Role of a Long-Term Disability Attorney in an FCE

An experienced long-term disability attorney can assist in various ways during an FCE:

• Identifying whether an FCE may be beneficial.
• Recommending which tests should be performed.
• Providing the evaluator with all necessary background information and medical records.
• Review the FCE report to identify any inconsistencies and inaccuracies.
• Interpreting the report to assess whether it supports your long-term disability claim.

Conclusion

A Functional Capacity Evaluation is a powerful tool for understanding an individual’s physical capabilities and limitations, particularly in the context of workplace demands. While the process may seem daunting, it is a comprehensive and standardized method to determine your physical capacity following an injury or illness. It can also act as a Workplace Injury Prevention procedure. Always remember, it’s crucial to approach an FCE with honesty and openness about your symptoms and limitations. This will ensure the most accurate and beneficial results for managing your return to work or assessing your disability claim.

For assistance and guidance through the FCE process, consider reaching out to a long-term disability attorney. Their expertise and knowledge can help navigate this complex procedure, advocating for your needs and ensuring you receive the Disability Benefits you are entitled to.