A functional capacity evaluation of a 57-year-old male patient determines his inability to perform his job tasks independently.

A functional capacity evaluation (FCE) is required when barriers to return to work are present, requiring further testing and determination of functional capabilities. The FCE measures endurance and activity tolerance, and provides objective documentation that estimates the individual’s ability to perform physical demands at different levels over periods of time.

Case Report

An FCE evaluation was conducted on a patient whose job consisted of sedentary and sedentary-light tasks that involved testing and hooking up various electronic equipment in various departments. There was a requirement to perform tasks classified as light to medium duty, including lifting more than 25 pounds, overhead lifting of more than 25 pounds, and squatting, which exceeded the patient’s capabilities and required assistance. The patient also needed assistance when putting on and removing clean room uniforms, which is also an essential job responsibility.

He performs these tasks at a slower rate then preinjury, and also requires frequent breaks due to pain and fatigue. It is not clear if this production rate is adequate. The patient was very pleasant, cooperative, and motivated. His full-duty job tasks require occasional to frequent physical demands in the light to medium-heavy job level. He presently demonstrates a functional capacity level in the sedentary-light level of duty with poor stamina.

The patient’s primary diagnoses was Cervical HNP and lumbar pain, with a secondary complaint of bilateral shoulder pain. The patient also reported continued neck and left-shoulder pain that had been ongoing for approximately 2 years. He reported that his low back pain appeared to be improving slowly and his right shoulder pain was nearly completely resolved, following a cortisone shot. However, his neck and left-shoulder pain limited his daily activities and work capabilities.

In recent testing, the patient demonstrated a physical-demand capacity at the sedentary to sedentary-light duty level, reflecting the inability to safely lift any weight from either the floor-to-waist position or the 12-inch-to-waist position. A maximal safe lift of 17 pounds from waist to shoulder height was determined, and overhead lifting was limited to only right-hand lifting, therefore limiting safe lift overhead to 10 pounds. A maximal safe carry weight of 25 pounds was observed for 30-foot distances. Push and pull was observed as safe with moderate loads. Lifting and carrying tests were limited due to the patient’s increased low back pain, left-shoulder pain, limitation of available spinal range of motion (ROM), and loss of proper body mechanics. No limitation was observed with pushing and pulling tasks with available moderate loads.

In performing nonmaterial-handling tasks, prolonged activity limitations including sitting, standing, and walking were significantly limited with frequent postural changes. In addition, forward bending was limited to approximately only 50% of full spinal ROM, with repeated forward bending increasing his pain and thus reducing his available spinal ROM. The patient was unable to perform a full squat. Limitations were observed with crawling and kneeling activities, as he could crawl for the standard test length of 10 feet and kneel indefinitely. However, he required assistance from a chair or other furniture to get down and back up off of the floor. Both horizontal and overhead reaching was unlimited on the right upper extremity. The left upper-extremity ROM was significantly restricted, resulting in a limited horizontal reach range and duration and an inability to reach over shoulder height on the left side. Gait and all nonmaterial-handling tasks were observed as bradykinetic, frequent breaks were required, and tasks took longer than expected. Static and dynamic balance were assessed as fair.

After observing the patient’s job tasks as an electronics technician, it was determined that he does not demonstrate the capacity to perform his full-duty job tasks completely independently. He can perform the majority of essential job tasks within the sedentary-light classification. However, assistance was required with lifting any equipment more than 22 pounds, overhead lifting, and donning clean room uniforms. In addition, he could perform the majority of these tasks with additional time, frequent breaks due to pain and fatigue, and compensatory body mechanics.

Musculoskeletal Assessment

Movement quality. Normal movement quality was observed with functional testing with the exception of bradykinesis and frequent breaks following exertion and walking short distances (200 to 300 feet).

Range of motion. Active range of  motion (AROM) was limited in forward flexion to approximately 50% of full range; this did limit additional nonmaterial and material-handling tests. Spinal extension, bilateral spinal rotation, and lateral bending were all limited to 50% to 75% of full ROM due to pain. Bilateral lower-extremity AROM was within functional limits. Right upper-extremity AROM was within normal limits in all joints and planes. Left-shoulder AROM was significantly limited as follows: Flexion 70°; Abd 70°, Extension 35°; Internal Rotation 50°; and External Rotation 0°.

Strength. Strength per manual muscle test of the right upper and lower extremity was assessed as 5/5, no pain with resistance testing. Strength of left shoulder was limited to 2-/5 to 3+/5 due to pain increase with AROM and resistance testing. Left lower extremity was assessed at 4/5 to 5/5 with reports of increased left-side low back pain with resistance testing. Spinal trunk strength was assessed at 3+/5.

Grip strength. The average grip strength on his right hand was measured at 64 pounds; the average grip strength on the left hand was measured at 58 pounds. The normative data for grip strength average on level 2 for a 57-year-old male is 101 pounds on the right hand and 83 pounds on the left. The coefficient of variance is measured as less than 10%. It should be noted that at a wider span level, grip strength did increase in both hands. A maximal grip strength of 95 pounds on the right hand, and 70 pounds on the left hand, was measured.

Neurologic. Sensation appeared intact. Proprioception and both static and dynamic balance were assessed as good.

Endurance. Endurance was rated as poor to fair with functional testing. Activities appeared to be limited due to pain and fatigue. Frequent breaks were required.

The FCE provided some recommendations to ensure a comfortable work environment for the patient. The evaluation determined that the patient should seek assistance with lifting, seek alternate positions to reduce spinal strain, investigate the possibility of using a cane for prolonged walking for energy conservation, and use a stool or footrest for prolonged standing to reduce pain and fatigue from prolonged activities. The FCE also recommended that the patient conduct sedentary to sedentary-light duties at his workplace.

Nicole Matoushek, MPH, PT, has 13 years of collective experience in physical therapy, ergonomics, worker rehab and utilization management in workers’ compensation.