Functional Capacity Evaluation

Of the thousands of acronyms associated with workers compensation, the term “FCE” might be the least recognizable, but easiest to explain.

FCE stands for: Functional Capacity Evaluation. It is a performance-based measure of a worker’s ability to meet the physical and/or cognitive requirements for the job.

“We provide data on what a worker can do,” said Dr. Denise Finch, “and what they can’t do.”

Dr. Finch is assistant professor of occupational therapy at Massachusetts College of Pharmacy and Health Science. She has conducted hundreds functional capacity exams in her 30-plus years as an occupational therapist, testing people with everything from back injuries to memory loss due to concussions.

But the key word in her simplified definition of an FCE is not “can” or “can’t.”

“It’s data,” she said. “Rather than guessing about a person’s ability to lift, push, pull, etc., we gather valid and reliable data that can be used in a productive way. This is a more accurate and objective measure of an individual’s capacity to complete work tasks.”

That is the real key to understanding a Functional Capacity Evaluation. It’s data that helps the interested parties in a workers compensation case – treating physician, insurance adjuster, claimant, claimant’s attorney – defend or dispute the future work capacity and medical care of the injured employee.

“Our data contributes to the decision-making process,” Dr. Finch said. “It’s just one piece of the process. I don’t think you can say it is THE deciding factor, but it can be an important piece.”

Why Would You Get an FCE Test?

Functional capacity evaluations are part of the healing process for an injured worker. There comes a point where a decision has to be made on whether the worker is going to get any better.  The FCE provides data that shows where the worker is with their recovery at that particular moment, then the parties involved decide what is the next step.

There are five primary reasons for getting an FCE test if you are involved in a workers compensation case:

1. The treating physician, insurance carrier or employer is looking for objective information to help them decide the safest way to return to work.
2. The treating doctor has determined that a worker has reached maximum medical improvement (MMI), but needs test results to determine the worker’s capacities or disability status to assist with claim closure.
3. To identify restrictions or job modifications that would help the return to work.
4. Physical and cognitive testing is needed for case management, disability determination, job placement decisions, future rehabilitation or vocational plans.
5. There is a disagreement between the parties on whether the worker has the physical skills or cognitive capacity to complete their job responsibilities.

FCEs usually are ordered by the physician treating the injured worker, but also could be requested by the insurance carrier or attorney representing the injured worker.

The data gathered in an FCE exam is compiled into a final report by the therapist conducting the tests and sent the referring party. It may be distributed to the other parties involved and could be used to defend or dispute recommendations.

There Are Two Types of FCE Tests

The list of jobs at any company, large or small, often varies dramatically and so do the requirements that go with them, so no, there isn’t one, standardized FCE test.

Instead, there are two types of FCEs, generic and job specific, with several proprietary tests for each one. The generic test is a measure of the worker’s overall job capacity and limitations. The job specific test, as the name suggests, will focus more on the demands and ability to perform tasks associated with a specific job.

The test for physically-demanding jobs like lifting, pulling, pushing or throwing bags of fertilizer, is not going to be the same as the test for the skillful use of power tools to assemble or disassemble machines; or the ability to follow multi-step directions in a noisy environment.

To make sure the right skills are being measured, therapists rely on job descriptions provided by the employer or insurance carrier that spell out the essential functions and responsibilities for the job. This is a crucial part of the process and should be treated with care.

If the employee has to stack 20-pound bags six feet or higher, but can only lift the bag to his waist – and the job description didn’t mention that he needs to be able to lift it over his head – that becomes a problem.

Most FCE tests will measure things like physical strength; range of motion; flexibility; and stamina. The critical tests are specific to the worker’s job. Can the loading dock employee lift a 20-pound bag over his head? Can the assembly worker use tools to complete a task? Can the manager effectively communicate with employees?

What Happens at a Functional Capacity Evaluation?

There are four major components in an FCE:

1. An intake interview
2. A review of medical records
3. A physical examination
4. Functional testing activities

Functional capacity evaluations usually are administered by occupational therapists or physical therapists. They start with intake interview to ask the worker questions and concerns about the injury and recovery process. The medical history is reviewed to look at the history of injuries or illnesses, their treatment and outcomes.

The functional skills tested are similar to what you see in work places every day:

• Walking on a treadmill
• Pushing or pulling a cart
• Lifting, moving or carrying objects
• Sitting or standing
• Communicating, organizing
• Manipulating objects with your hands
• Lifting various amounts of weight
• Kneeling, crawling, crouching
• Following directions

Therapists measure things like strength, balance, cardiovascular function, motion limitations, presence of pain, whether they can hear instructions or have problems seeing objects. The tests are done with the worker’s safety in mind.

The choices for activities to be tested are driven by essential job requirements. As the workers go through each task, therapists are measuring their capacity to do the tasks.

The tests are designed not to just pull or lift something once, but multiple times. Depending on the job they have, the patient could be asked to assemble things, demonstrate ability to follow directions and show if they can increase the level of performance in a specific exercise. For example, after lifting a 15-pount bag and walking across the room, could they lift a 20-pound bag and walk it all the way around the room.

In addition to measuring the worker’s performance on each test, the therapist may also gather information on the worker’s level of fatigue, pain and stress. The activities may be modified to accommodate the worker.

Therapists are trained to assess if the worker is giving their best effort during the testing. They are looking for consistency in performance. It is suggested by all sides that the patient give their best effort in every activity. If you feel discomfort during an activity, tell the therapist and adjustments should be made.

How Long Do FCE Tests Take?

A typical FCE test will last 4-6 hours, but varies based on the worker’s medical, physical and cognitive conditions and the types of tests administered based on job description.

In fact, more often, the tests stretch over two days. Much of that has to do with the patient’s stamina and pain tolerance. They likely haven’t been working for a long time and this may be the first time they’ve attempted some of the job duties that were daily functions before they were injured.

In the days after the test, the therapist usually makes a phone call to the patient as a follow up on how he/she is feeling. Therapists will ask how their bodies reacted to the tests; was there any discomfort or lingering pain; and did it have any effect on their sleep.

The answers may not change the overall evaluation, but it could lend to a recommendation that the patient have a gradual return to work and possibly a follow up with the treating doctor.

Who Conducts Functional Capacity Evaluations?

Occupational therapists and physical therapists usually conduct functional capacity evaluations, either in their own offices or in shared facilities with a medical practice or hospital.

Both therapists go through extensive education and training. A physical therapist must earn a Doctor of Physical Therapy degree that typically takes four years of undergraduate work, followed by three more years of doctorate study. Occupational therapists also have graduate level degrees – either a master’s or doctorate — and 6-7 years of schooling.

Therapists receive training in a wide range of clinical examination tools and performance measures related to administering FCEs and interpreting results.

Both must pass national certification exams and be licensed in the states they work in.

Are Therapists Biased in Compiling Results?

This is a fair question whenever there is a medical review. There is often a perception that the party ordering the test – and, more importantly, paying the bill – has an edge when the final report is written.

The fair answer is that the reports filed after an FCE are data to help someone else make a decision.  It’s not worth a hit to the therapists reputation to try and steer the results in one direction or the other.

Dr. Finch has a long list of credits, including Doctor of Occupational Therapy (OTD), Occupational Therapist, Registered and Licensed (OTR/L; Certified Hand Therapist (CHT); and Fellow of American Occupational Therapy Association (FAOTA). She spent 30-plus years as the owner and operator of a private practice specializing in workers rehab.

“Ethically, we need to remain unbiased and focused on providing a safe testing situation for the client,” she said. “FCE tests are selected based on their safety, reliability, validity and practicality. We conduct tests and report outcomes based on our findings, not on what the referring party or worker thinks the outcomes should be.”