The “Six Ws” of Functional Capacity Evaluations

Industrial RehabIndustrial Rehab May 20, 2014

6-questionsFunctional Capacity Evaluation (FCE) is a method by which Physical and Occupational Therapists may assess fo abilities and limitations while also assessing for behavioral obstacles that may be interfering with return to normal activity. Typically done with workers’ compensation patients, this testing will enable the therapist to provide a referring physician with the necessary information to move a medical/legal case to closure. The Back School features the BIO-ERGONOMICS FCE Method © which requires basic equipment and access to modest square footage. Here are some fast facts about Functional Capacity Evaluation:

WHAT ARE FUNCTIONAL CAPACITY EVALUATIONS?

  • A method to assess for abilities and limitations and for behavioral obstacles that may be interfering with return to normal activity:
    • Without the space and equipment expense required for large capital expenditures on unnecessary computerized equipment or cumbersome software programs:
      • Functional Capacity Evaluation equipment needs can be met for under $2500.00 (in addition to standard clinic equipment).
      • A method to assist a physician in moving a case to closure:
        • Functional – meaningful, useful.  In this context, functional indicates a purposeful activity that is an actual work movement.  Functional implies a definable movement with a beginning and an end, and a result that can be measured.
        • Capacity – maximal ability, capability.  Capacity indicates existing abilities for activities including the maximal function able to be used.
        • Evaluation – systematic approach including observation, reasoning, and conclusion.  Going beyond monitoring and recording, the evaluation process implies an outcome statement that is explanatory, as well as an objective measurement of the activity.
        • A method to increase Workers’ Compensation revenues by retaining patients formerly lost to providers with FCE services.

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WHY DO FUNCTIONAL CAPACITY EVALUATIONS?

  • Most medical evaluation processes are not functional.
    • FCE’s determine the subject’s level of function relative to a specific job target or relative to generic guidelines.
    • Physicians need to provide a final impairment rating.
      • FCE’s assist in a physician’s final impairment rating by determining the subject’s musculoskeletal status.
      • Most medical evaluations do not assess for effort or the presence of non-organic signs.
        • FCE’s determine subject’s level of willful participation in activity.

WHEN SHOULD FUNCTIONAL CAPACITY EVALUATIONS BE DONE IN A REHABILITATION PROGRAM?

  • After all necessary medical testing and treatment have been provided
    • Patient has reached Maximum Medical Improvement (MMI).
  • After plateau in physical therapy.
  • After participation in Work Hardening or Work Conditioning
  • Part of IME process
  • Fit-For-Duty Evaluation
    • Existing worker requesting a transfer into a different, more demanding job.

WHO CAN PERFORM FUNCTIONAL CAPACITY EVALUATION?

  • Licensed Physical or Occupational Therapist.
  • Other disciplines should check with their state board of professional registration for state specific guidelines.

WHERE CAN FUNCTIONAL CAPACITY EVALUATIONS BE DONE?

  • Traditional therapy clinic with the proper equipment:
    • Standard testing equipment:
      • Goniometers, inclinometers, dynamometers, tape measure, sensation testing kit, dexterity testing kit, exam table, treadmill.
  • Functional testing equipment:
    • Lifting (lift boxes, weights, lifting shelves)
    • Pushing/pulling (force gauge)
    • Climbing (sturdy ladder & stairs)
    • Positional tolerances (adequate space to allow for skills circuits – bending, squatting, crawling, kneeling tasks)

HOW IS FUNCTIONAL CAPACITY EVALUATION DONE?

  • The basic BIO-ERGONOMICS © FCE is 4 hours in length (including report-writing time)
    • Intake interview
    • Musculoskeletal screen
    • Cardiovascular testing
    • Static strength testing
    • Material handling tests
    • Non-material handling tests
    • Job-specific tests
    • Debriefing

Click here to learn about our Functional Capacity Evaluation Certification


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