Functional Capacity Evaluations:
Measuring the Injured Worker’s Recovery

At NSG, assisting injured workers to return to work in a timely manner requires diligent processes for measuring the patient’s progress throughout recovery. 

A Functional Capacity Evaluation (FCE) is a useful tool in making recommendations for return to work, disability determinations, and rehabilitation plans of care.  It is the single most reliable measure to determine if a successful return to work is possible through an accurate evaluation process that documents:

  1. the individual's residual physical abilities
  2. the level of effort expended during testing
  3. the reliability of reported pain and limitations

Primarily, this test evaluates the employee’s current level of functionality as it pertains to the demands of competitive employment and activities of daily living. Objective in nature, it measures the ability of an individual to safely perform functional or work-related tasks and predicts the potential to sustain these tasks over a defined time frame. 

FCEs are performed by physical therapists demonstrating evidence of education, training, and competencies specific to the delivery of FCEs. The time required is determined by case complexity, extent of injury, job responsibilities, and functional abilities of the patient being tested. Administering a general purpose or job-specific FCE may range from 3-6 hours for a single exam.  Durations may also be controlled by state-specific regulations or rules.

There are two types of FCEs: 

  1. General Purpose FCE. Here, standardized tests and measures are applied to all individuals. This type of FCE is appropriate when a targeted job does not exist or functional job requirements have not yet been determined. Results may be used to evaluate an individual’s compatibility with a specific job or occupational demands when more information or options become available for consideration.
     
  2. Job-specific FCE. This type of FCE is designed to measure an individual’s ability to perform the physical demands of a specific, identified job. Testing takes place either in a clinic or at the work-site to determine the individual’s ability to safely perform the required work tasks and to determine whether there are participation restrictions.

The Purpose of an FCE

An FCE may be used to determine several key pieces of information including:

  • Quantification of safe functional abilities
  • Return-to-work and job-placement decision status (including full or modified duty)
  • Disability evaluation
  • The impact of non-work-related illness and injuries on work performance
  • Function in non-occupational settings
  • Medical intervention and rehabilitation plan of care / readiness for discharge
  • Case closure
  • Ability to meet job demands as part of hiring process (for pre/post-offer testing)
  • Symptom magnification behaviors in individuals who have a history of subjective complaints without objective findings.

The Primary Components of an FCE:

  • Medical record review
  • Musculoskeletal screening
  • Physical ability testing
  • Summary

Physical testing monitors the employee’s ability to handle materials as well as the employee’s positional tolerances in order to identify physical demands as defined in the Revised Dictionary of Occupational Titles. This may include:

  • Graded strength activities such as lifting, carrying, pushing, and pulling
  • Position tolerance activities such as standing, sitting, stooping, and repetitive activities of push/pull/carry/squat
  • Mobility activities such as walking, crawling, and climbing stairs or stepladders
  • Information about an individual's dexterity, coordination, balance, endurance, consistency of effort, and job match information

When performing a functional assessment, the evaluator is required to identify the specific functional activities that need to be assessed, determine the ability of the individual to perform the functional activity, and determine at what level or capacity the individual can perform the activity safely. If there are any noted limitations of function, the evaluator must determine the reason for the limitation and identify any potential accommodations, additional risk factors, and precautions that will facilitate and improve the successful return to work or activity.


Completing the FCE Summary:

The FCE Summary is an impartial, independent, evidence-based statement and opinion that should address the following:

  • Purpose of performing the FCE and specific referral questions
  • Recommended safe work abilities and leisure activity limitations
  • Limiting factors to FCE performance and whether recommended functional capabilities are temporary or permanent (when appropriate)
  • Physical abilities of the patient to the physical demands of the job (when appropriate)
  • Documented level of patient’s participation and consistency during the FCE
  • Appropriate recommendations to promote return to work, including modification of the environment, tasks, or tools to permit the patient’s return to the job or activity
  • Further interventions or referrals needed (if requested)

NSG currently offers its FCE program in 21 states across the country. NSG’s FCE appointments are guaranteed to be scheduled within 96 hours of initial patient contact, and the completed FCE reports are sent to the client within 10 business days.

If NSG can assist you with scheduling your next FCE, please contact our office at 1-888-533-0727 or submit a referral at www.network-synergy.com.