FCE is a standardized evaluation

An FCE is a standardized evaluation and generally involves an array of functional tests of various work-related tasks.

Clinicians have historically struggled with making decisions and recommendations regarding a patient’s ability to return to work. This struggle is often precipitated by a lack of clear and objective information regarding a patient’s physical capability and the physical requirements of their job. As therapists, we understand the necessary abilities for performing activities of daily living and returning to sporting activities. It is with relative ease that we can simulate and replicate these types of functions in our clinics. Conversely, our understanding of work-related functions is less clear and often dependent on the information our patient or a company representative provides about a job. In an effort to arrive at a more objective decision-making process, therapists have been using functional capacity evaluations (FCEs) to assist with these decisions.

FCEs began to gain prominence in the 1980s in response to a growing push by workers’ compensation administrators, who were finding that physician restrictions did not supply adequate information to determine if a patient could return to work.1 Prior to FCEs, physicians were solely required to determine the ability of a worker to return to work.2 Physicians often became frustrated as they did not have enough time with patients or enough information to make these decisions. Thus, the FCE was designed to provide physicians and employers with work-related physical abilities and limitations. In addition to work decisions, FCEs are also used to determine an individual’s general level of physical functioning for cases of disability determination.

A FCE is a standardized evaluation and generally involves an array of functional tests of various work-related tasks. Since the evaluation is standardized, each patient will undergo the same or a very similar battery of functional tests. The evaluation often includes force generating tasks such as floor to waist lifting, elevated lifting, carrying, pushing, pulling, gripping, and pinching. It also involves positional testing such as standing, sitting, crawling, kneeling, forward bending, and elevated upper extremity positioning. A final category of testing involves mobility-related tasks such as walking and climbing. In general, FCEs are designed to be performed in either a 1-day or 2-day format with total testing time ranging from 2 hours to 5 hours. Specific length and selection of single or multiple day testing is based on a variety of parameters such as patient’s conditioning, job characteristics, and cost. Results of testing are then extrapolated to determine a client’s ability to perform various tasks for an 8-hour workday or a 40-hour workweek. Results of the FCE can be matched to the physical demands of potential targeted jobs. There are different FCE “systems” that a therapist can be trained to administer. Each system offers its own specific training program, testing components, and report format. As with all systems of evaluation or intervention, utilizing an evidence-based system is advised. Specific FCE systems have been studied for evidence of reliability and thus reproducibility.3-6

FCEs have played an important role in supplying the medical and occupational world with functional information to assist in deciding a client’s work-related ability. Further assistance can be provided with return to work decisions, by gaining specific knowledge of the worksite, the jobs, and potential job modifications. Additional information regarding potential job or job site ergonomic opportunities can also be discovered. This is most readily accomplished by performing a job site analysis in which the physical demands of a specific job are measured and documented. Specialized training in this form of job site analysis is available.

Ben Sanford, MS, PT, is a physical therapist and worksite strategies specialist at Advanced Rehabilitation Inc, Evansville, Ind. He can be reached at

REFERENCES

  1. Isernhagen S. Rehabilitation ergonomics. In: Marras WS, Karwowski W, eds. Fundamentals and Assessment Tools for Occupational Ergonomics. Boca Raton, Fla: Taylor and Francis/CRC Press; 2006:Chapter 22.
  2. Isernhagen S. Job matching and return to work: occupational rehabilitation as the link. Work. 2006;26:237-242.
  3. Isernhagen S, Hart DL, Matheson LN. Reliability of independent observer judgments of level of lift effort in a kinesiophysical functional capacity evaluation. Work. 1999;12:145.
  4. Reneman MF, Dijkstra PU, Westmaas M, Goeken LN. Test-retest reliability of lifting and carrying in a 2-day functional capacity evaluation. J Occup Rehabil. 2002;12:269-75.
  5. Reneman MF, Jaegers SM, Westmaas M, Goeken LN. The reliability of determining effort level of lifting and carrying in a functional capacity evaluation. Work. 2002;18:23-7.
  6. Gross DP, Battie MC. Reliability of safe maximum lifting determinations of a functional capacity evaluation. Phys Ther. 2002;4:364-71.
  7. Brouwer S, Reneman MF, Dijkstra PU, Groothoff JW, Schellekens JM, Goeken LN. Test-retest reliability of the Isernhagen Work Systems Functional Capacity Evaluation in patients with chronic low back pain. J Occup Rehabil. 2003;13:207-18.