Marks of a Useful Functional Capacity Evaluation

Without a reliable FCE, making these determinations can be a bit like looking into a crystal ball. And not all FCEs are created equal. Useful and dependable FCE conclusions depend on the components of the evaluation and the skill level of the evaluator.

A thorough FCE that provides meaningful conclusions is based on a job description and includes a musculoskeletal screen, strength testing, cardiovascular tolerances, and work simulation.

Before the testing starts, the evaluator must choose appropriate tests. Such tests will yield pertinent data that will lead to meaningful conclusions related to the injured worker and his or her job. A job description will guide these choices. The entire testing protocol should also be tailored specifically to the individual who is being evaluated.

A musculoskeletal screen establishes range of motion and movement patterns, and it assures the safety of the person being evaluated. It also provides an opportunity for distraction-based testing to observe for consistency of verbal reports compared to actual demonstrated ability.

Strength testing determines a person’s work level (sedentary, light, medium, heavy or very heavy). It is a central component of most FCEs, as the results can make or break the future occupational career. Here are a few things to note with strength testing:

• Ability to lift on an occasional basis and on a frequent basis should be tested separately.
• Frequent lifting ability should never be determined by a formula or by extrapolation.
• Lifting must be thoroughly tested and considered against effort tests and reliability of verbal reports in order to assure accurate outcomes.

Cardiovascular testing (metabolic equivalent testing) reveals whether the person’s cardiovascular capacity supports the ability to work in the tested work level. For example, a person who has the strength to lift in the “heavy” work category must also have the cardiovascular capacity to support that level of work.

Work simulation provides important information about a person’s ability to return to his or her job. Based on the job description, the work simulation portion of the test assesses positional tolerances that are critical to the job in question, such as sitting, standing, reaching or dexterity. Sufficient time must be allowed to determine a person’s ability to sustain the posture or task, if necessary.

A primary concern throughout the evaluation process is whether the evaluee is giving full effort, often referred to as “validity.” Some FCE protocols call for an isometric grip test to offer validity information, leaving the evaluator to offer an opinion of a person’s effort based on one single test. Reliable protocols, however, call for a battery of effort tests that include isometric tests, behavioral tests and cardiovascular investigations, as well as clinical observations. Effort tests only reveal a person’s inclination to give full effort and are not meant to catch “malingerers.” Low effort findings, often called “invalid” testing, do not prove a person is “faking it.” A thoughtful, skilled evaluator uses all of the resources at his disposal to provide an unbiased effort assessment.

Tests that reveal how well verbal reports match actual behavior will tell how much one can rely on the injured worker’s reports of pain. This is done through various self-report tests and clinical observations. A thorough FCE includes this type of testing, and the skilled evaluator will consider the results when putting the whole picture together.

In the world of industrial rehabilitation, there are a plethora of FCE products that promise to make the evaluation process quick and easy. Several protocols promise to “automate” the process, choosing the testing protocols, calculating the results and creating the conclusions. With these protocols, critical-thinking skills are not required by evaluators because they are “spoon feed” the conclusions, requiring little more than a technician to operate the tests. Clearly, a reliable FCE is more than scientific data spewed forth in charts and diagrams, but requires instead a highly trained and skilled evaluator to offer well-thought-out conclusions. Conscientious interpretation of the data distinguishes the professional, thinking evaluator from a technician, or even the automatically produced conclusions offered by computerized protocols.

Skill levels of FCE evaluators vary from the novice to the expert level. A skilled evaluator demonstrates the training and expertise required to offer thoughtful outcomes and is essential to provide useful, meaningful and accurate evaluation outcomes. There is no doubt that a knowledgeable evaluator has the option to use computer programs and computerized equipment as tools to complete the task of evaluating a person, but these should be considered only as tools in the hands of the skilled practitioner.

FCE outcomes often have far-reaching legal and occupational consequences. Thorough testing by a well-trained, knowledgeable evaluator is essential to deliver accurate, unbiased information to the physician, who will determine permanent work restrictions. With so much riding on the outcome of an FCE, we should expect nothing less.