Thinking outside the box when planning an FCE can expedite patients’ return to work.

A functional capacity evaluation (FCE) is a great opportunity for physical and occupational therapists to expand their practice and skills into new areas. FCEs are a step into the specialized world of industrial rehabilitation and they are complementary services to a private practice, an outpatient clinic, or a hospital-based rehabilitation facility. Therapists may find themselves stressed with a daily schedule of treating a dozen or more patients per day. Completing FCEs allows a therapist to learn a skill that will generate income and expand the focus and services of the business, while providing a break from the daily routine of numerous treatment sessions.

An FCE can be 2–6 hours in length and may be completed over consecutive days. The opportunity for direct patient-to-therapist contact can be challenging for physical and occupational therapists. The following case study is a sample of the FCE process.

Referral Information

Jared (not his real name) was referred by a workers’ compensation insurance carrier for an FCE for the purpose of evaluating physical capacities for rating permanent impairment and residual functional capacity, and for determining permanent work restrictions. The FCE took place in 2004 and lasted 12 hours over 3 days. The insurance carrier provided both medical records and a job analysis to be incorporated into the evaluation and report.

Background

Jared is a 5-foot, 11-inch tall, 190-pound, left-dominant, 29-year-old male who is employed as a state trooper. He sustained an on-the-job injury to his lumbar spine in 2003 when he was struck by a car while assisting someone along the freeway. He reports that he had little warning, as he looked up just in time to see a vehicle approaching. He was struck in the left lower leg and fell into some vegetation along the side of the freeway. He did not require any medical attention at the scene of the accident, but he did seek medical attention at an urgent care clinic the following day due to lower-back pain. He underwent an x-ray and MRI that revealed a herniated L5-S1 disc. He eventually underwent a microlumbar discectomy in 2003. He completed a treatment course of physical therapy and returned to his regular work duties.

He did well and performed the duties of his position until 2004, when he began to notice increasing stiffness and soreness at the lumbar spine. He was seen by his surgeon and underwent an MRI and a second lumbar spine surgery in 2004. He completed physical therapy and work hardening, and he was released for temporary, alternative work duty. Concerns about his ability to tolerate his regular job duties by his surgeon, insurance company, and employer necessitated a referral for an FCE.

Evaluation

Jared was cooperative with the evaluation process and welcomed the opportunity. He was concerned about reinjury to himself, and he did not want to place himself or others at risk. He was positive and upbeat during the evaluation. It should be noted that he gave full effort and was cooperative during this evaluation. There were no concerns with regard to his level of effort or malingering. Jared reported minimal symptoms during the 2–3-day FCE. The only symptom that he reported was occasional “tightness” through his lumbar spine. In addition to generic tests of grip, pinch, dexterity, range of motion, manual muscles, positional tolerances, and materials handling, special emphasis was placed on more physically demanding duties. Jared demonstrated the ability to jump, jog, hop, lift 110 pounds from floor to waist, and drag a 105-pound dummy 75 feet without pain or symptoms.

Work Site Simulation

Since Jared was performing at a high level, and the confines of the clinic did not allow for the simulation of necessary postures and duties, an on-site visit was scheduled on the third day. This session focused on those duties that could not be simulated in the clinic. Gradually increasing simulation and tasks were structured. Information was taken from a knowledge base that included patient reports, employer-provided information, videotape analysis of job demands, and components of pre-employment police officer physical agility tests.

An obstacle course was set up that involved light jogging for 400 meters; climbing over a 6-foot fence; climbing and jumping over a picnic table; crouching behind a tree to take cover; rolling, dragging, and handcuffing a 145-pound dummy; and sprinting 40 yards. This sequence was completed for a total of five circuits. Between each circuit, additional duties were completed, such as changing a flat tire, sitting in a patrol car to write reports, setting up police barricades, and controlling traffic.

Results and Recommendations

Jared completed the 3-day FCE with few symptoms. The only symptom he reported was occasional tightness across his lumbar spine that was relieved with stretching exercises. During the 3-day evaluation, he demonstrated physical abilities that exceeded those detailed in the written job analysis. Recommendations were made that included a plan for him to gradually transition to his regular duties, including a 2-week period when Jared would work with a partner instead of working alone. Typically, the trooper would work alone. However, working with a partner would allow a successful transition to regular duty and allow for the reacquisition of the officer-safety skills needed in this position. In addition, a flare-up plan was developed to address any symptoms that presented. A routine home exercise program was also developed and implemented in the department gym.

FCE Specialty Certification

This case study provides a brief snapshot of the thoroughness and creativity needed when completing an FCE. Before you perform one, continuing education is necessary. Consideration can also be given to specialized certification in FCEs. This is particularly helpful if you are completing FCEs for personal injury cases. The certification requirements vary from one organization to the next, as well as between standardized FCE systems.

A literature search through the Internet will lead physical and occupational therapists to some excellent resources (see Recommended Resources below).

Christopher A. Park, OTR, FABDA, works at The Evaluation Center in Springfield, Ore, and is a member of Physical Therapy Products’ Editorial Advisory Board. He can be reached at ctpark@aol.com.

Further Reading

Functional Capacity Evaluation Certification Course Materials. Keene, NH: Roy Matheson and Associates; 2003.

Gibson L, Strong J. Expert review of an approach to functional capacity evaluation. Work. 2002;19(3):231–42.

Innes E, Straker L. Workplace assessments and functional capacity evaluations: current practices of therapists in Australia. Work. 2003;20(3):225–36.

King PM, Tuckwell N, Barrett TE. A critical review of functional capacity evaluations. Phys Ther. 1998 Aug;78(8):852–66.