Functional Capacity Evaluation
Original Editor - Matt Huey
Definition[edit | edit source]
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[edit | edit source]
There have been indications set forth on when an FCE would be appropriate which are:
- There has been no progress with treatments
- Discrepancies between the subjective complaints given and objective findings present
- Patient shows difficulty in returning to gainful employment
- A determination of functional capacities is needed to plan for job placement and/or case settlement
- Medical conditions including cardiac, pulmonary or psychological
- Difficulty in communication or understanding of instructions
There are things that must be considered as well before performing the FCE.
- Safety. During the evaluation, the examiner must ensure that the physical demands are within the patient's abilities.
- 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.
- Diagnosis. Has the diagnosis been confirmed and is it a preferred diagnosis for the examination
- Chronic Pain. The examination may increase the intensity of pain but the patient remains medically stable
- Recent Surgery. The patient has fully healed from any surgery performed and cleared by the attending surgeon.
- Maximum Medical Improvement. Patient does not have to have reached this and may be deconditioned from the period of inactivity prior to the examination.
- Medical Examination. This is performed by a qualified physician and can include clearance or contraindications for modifications needed for the examination
Programming[edit | edit source]
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.
- 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.
- 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
- Functional testing: This component is the actual testing based upon the vocational requirements. Activities that should be included are graded material handling (lifting to various heights, carrying, pushing and pulling) and positional tolerance activities (sitting, standing, walking, balancing, reaching, stooping, kneeling, crawling, object manipulation, fingering, grasping with hand, and hand manipulation. Vocation specific activities or functions many be included as well. During this time, the patient's effort and pain levels are measured.
- 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.
- Preparation of report: The report includes the patient's medical history along with their social and job history. The evaluator presents the pre-evaluation screening results and the functional testing results. Finally, the patient's physical abilities are compared to the physical demands or requirements for the job along with any possible recommendations.
Research[edit | edit source]
There has been significant research both into the reliability of a properly trained evaluator in the perception of a person's effort level.
Several studies have looked at the reliability of an evaluators assessment of a person's perceived effort. During the material handling portion of the FCE, the evaluator is observing the person's effort. Based upon the perceived effort of the person, a determination of the maximal safe lifting ability is made. Signs that show a maximal level have been reached 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
- Cardiovascular signs such as increased heart rate and breathing
- Peripheralization of radicular or referred symptoms.
With these as the observed measures, it has been found interrater reliability ranges from .95 to .98  . Another study looked at reliability between trained evaluators with heavy and light lifting. It was found that the interrater reliability in determining a light or heavy lift was at .81 . This gives evidence that training is an important component to the interpretation of the results of an FCE.
There is conflicting information on the validity of a return to work recommendation following an FCE. One study did find after several months, the recommendations were accurate for the majority of patients . The factor that influenced several patient's return to work were the employer not being able to accommodate the recommendations.
Another study, found that 62.1% of the 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.
References[edit | edit source]
- Hart DL, Isernhagen SJ, Matheson LN. Guidelines for functional capacity evaluation of people with medical conditions. J Orthop Sports Phys Ther. 1993 Dec;18(6):682-6
- Gross DP, Battié MC. Reliability of safe maximum lifting determinations of a functional capacity evaluation. Physical Therapy. 2002 Apr 1;82(4):364-71. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-15-106
- Isernhagen SJ, Hart DL, Matheson LM. Reliability of independent observer judgments of level of lift effort in a kinesiophysical Functional Capacity Evaluation. Work. 1999 Jan 1;12(2):145-50.https://content.iospress.com/articles/work/wor00029
- Lechner DE, Page JJ, Sheffield G. Predictive validity of a functional capacity evaluation: the physical work performance evaluation. Work. 2008;31(1):21-5.
- Streibelt M, Blume C, Thren K, Reneman MF, Mueller-Fahrnow W. Value of functional capacity evaluation information in a clinical setting for predicting return to work. Archives of Physical Medicine and Rehabilitation. 2009 Mar 1;90(3):429-34. https://www.sciencedirect.com/science/article/abs/pii/S0003999308016675