What is a Functional Capacity Evaluation?

Jon Nettie, PT, MPT, DPT

Although there are many different types or brands of Functional Capacity Evaluations (FCEs), they all have the same goal - to help determine functional outcomes. There are several potential criteria for when an FCE should be used. A few such instances are when a patient has maximized all of the potential rehab (PT, OT, Chiropractic) and/ or medical interventions (injections, surgery, etc.) and there is a need to determine an individual’s ability to safely return to work full time or on modified permanent or transitional duty.

Based on the outcome measures and clinical recommendations by the physical therapist, the FCE can help the physician set the appropriate restrictions. If the restrictions will be permanent, then they are presented to the employer in order to help them decide which job would be most appropriate for the injured employee. If the restrictions are transitional, then a recommendation of work conditioning can be made to help the employee return to full, unrestricted duty.

A few additional ways an FCE can be used are for a disability assessment and to help assist a Vocational Counselor with a plan of care to help an individual find productive, safe employment within their limitations. The make-up of the FCE makes it a worthwhile assessment for physicians, case managers, insurance adjusters (TPAs), and the employer.

Built into the FCE are psychophysical and kinesiophysical endpoints. The psychophysical endpoint is when an individual stops an activity due to their own perceived abilities. These are usually set up by pain, lack of range of motion, lack of strength, their understanding of what their injury is, and mostly lack of confidence and fear of re-injury. The kinesiophysical endpoint is when an evaluator recognizes poor mechanics and stops and activity. The poor mechanics can be due to generalized or joint-specific weakness, lack of range of motion causing substitute movement patterns, and identification of poor endurance. Subjective pain is not a limiting factor under kinesiophysical endpoints.

Reliability of pain and consistency of effort is determined. Reliability of pain is determined from the patient taking psychometric tests, reporting of subjective pain as it relates to exertion scale, and heart rate. Additionally, clinical assessment of mechanical change, subjective pain rating, and physiological responses.

For example: if poor mechanics are noted, and pain is rated high (six out of ten or greater) there should be an associated physiological response of increased heart rate within eight to twelve seconds following the pain stimulus. Sweating or clamminess may occur. Additionally, the clinician will look for true pain behaviors such as facial grimacing, wincing, holding of a body part, crying. Consistency of effort is determined through clinical observation (General AROM and strength testing vs AROM and strength needed for testing) and research-based outcomes (Occasional vs Frequent lifting; Grip/Pinch assessments).

An FCE wants Reliability of Pain and Consistency of Effort to make sure the individual is putting forth full effort for the clinician to make an appropriate assessment of the outcomes. Ultimately, the assessment is to help determine what is best for the patient.

Team Rehabilitation Physical Therapy is committed to performing quality FCEs for its patients. We employ a highly skilled team of individuals to service the Workers’ Compensation sector of physical and occupational therapy in each of our participating states of Michigan, Illinois, Indiana, Wisconsin, and Georgia.

Jon Nettie has a Master’s in Physical Therapy from the University of Michigan-Flint and a Doctorate in Physical Therapy from Wayne State University. His experience is with a variety of orthopedic conditions and extensively with return to work programming. For information on our services please check out our website at www.team-rehab.com, call (888) OUR-TEAM, or email wc@team-rehab.com.