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Written by:
Kevin
J. Cassidy PT, Clinical Operations Director
NovaCare
Indianapolis
In
the medical profession, life-altering decisions are made every day. For
the physician, case manager and therapist, one of the most important
decisions is the evaluation and treatment of the Worker's Compensation
patient. Consideration of employability, disability and residual
functional capacity are all crucial decisions that have enormous
implications for the worker and the employer. Of these decisions, the
role of the rehabilitation team in determining the functional ability of
a client is by far one of the most important decisions that will be made
during the course of treatment.
A
functional capacity evaluation is a comprehensive, objective measurement
of the patient’s/client’s abilities and disabilities. It is a test
that provides valuable information that will save time and provide
critical objective data in the decision-making process. Without
an FCE, the rehabilitation team and the employer must rely on
the patient’s self-report and/or make impairment decisions based on
imaging studies or general impressions.
With an FCE, the rehabilitation team will have the most
objective data available to assist them in making quality decisions.
An
accurate FCE should be comprehensive in scope by covering the physical
demands as defined by the D.O.T. The FCE should be standardized and
provide objective data for the physician, case manager and employer.
Likewise, a quality FCE should be safe to administer so as not to put
the patient at risk, as well as being practical to complete in a timely
manner. Most
importantly, the FCE should be research-based due to the importance of
the data contained in the report and the need to have supporting data
should a case be litigated.
A
quality FCE will also cover 4 main sections: Dynamic Strength (lifting,
carrying, pushing and pulling), Position Tolerance (sitting, standing,
crouching, stooping, kneeling and reaching), Mobility (walking,
climbing, crawling, and repetitive movement) and Endurance (ability to
tolerate an 8 hour day, % change in heart rate, and % change in
performance). When all 4
sections are combined, the rehabilitation team will have the most
comprehensive and objective “picture” of their client and should be
confident in making return to work decisions.
In
summary, the FCE should answer the following questions:
-
What
is the client’s overall level of work?
-
What
is the client’s tolerance to an 8-hour day?
-
What
was the client’s level of cooperation?
-
What
are the client’s specific limitations?
-
Do
the client’s abilities match the job demands?
-
What
specific interventions need consideration for the client?
An
FCE is without question the most comprehensive examination performed in
the therapy setting. It
provides objective data for the rehabilitation team, establishes client
abilities and disabilities and determines if the client will be able to
successfully return to work and meet the demands of the job.
In
today’s market, it is worth the time and effort to seek functional,
objective data that will help you make decisions for your patients.
It is worth the time to objectively determine if your client will
have a safe and productive return to work.
It is worth the time to seek a provider who administers quality,
standardized and validated FCE’s that will support your decisions and
underscore an accurate picture of your client’s abilities.
If you would like to learn more about the
Functional Capacity Evaluation and how it can assist you in making
return to work decisions, please contact Kevin J. Cassidy PT, COD @
(317) 846-3531.
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