Functional Capacity Evaluation

Original Editor - User Name

Top Contributors - Matt Huey, Kim Jackson, Lucinda hampton and Ewa Jaraczewska  

Definition

A Functional Capacity Evaluation (FCE) is an evaluation of a person's functional capacity in relation to a job's demands. The FCE involves aspects of lifting, carrying, pushing/pulling, balance, fine motor, and cardiovascular tolerance. In accordance to the response to these activities, a capacity is determined which is based upon the US Department of Labor's Dictionary of Occupational Titles (DOT).

Indications, Contraindications, and Considerations

There have been indications set forth on when an FCE would be appropriate which are:

1. There has been no progress with treatments
2. Discrepancies between the subjective complaints given and objective findings present
3. Patient shows difficulty in returning to gainful employment
4. A determination of functional capacities is needed to plan for job placement and/or case settlement

Contraindications include

1. Medical conditions including cardiac, pulmonary or psychological
2. Difficulty in communication or understanding of instructions

There are things that must be considered as well before performing the FCE.

1. Safety. During the evaluation, the examiner must ensure that the physical demands are within the patient's abilities.
2. Medical Stability. The patient may have a known medical condition, however, 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.
3. Diagnosis. Has the diagnosis been confirmed and is it a preferred diagnosis for the examination
4. Chronic Pain. The examination may increase the intensity of pain but the patient remains medically stable
5. Recent Surgery. The patient has fully healed from any surgery performed and cleared by the attending surgeon.
6. Maximum Medical Improvement. Patient does not have to have reached this and may be deconditioned from the period of inactivity prior to the examination.
7. Medical Examination. This is performed by a qualified physician and can include clearance or contraindications for modifications needed for the examination

Programming

The design of an FCE can vary based upon several factors. The examination length can be as short as 2 hours up to 5-6 hours over 2 days. There are basic aspects that should be included in the examination.

1. History: This includes the history of the patient's medial, social, and work history, along with treatment history. The goal of this is to understand the patient's background along with building rapport.
2. Pre-evaluation screening: This is to determine of the patient is appropriate to perform the FCE. There is screening for any possible medical contraindications and any potential impairments along with information to compare against functional limitations
3. Functional testing: This component is the actual testing based upon the vocational requirements. The