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.