By Dr. Philip Conway BPE DC FCCPOR(C)
There are numerous Functional Capacity Evaluation (FCE) protocols and systems, some of the more popular systems are Arcon, Matheson and Issernhagen to name a few. An FCE is a short-term intensive evaluation that examines or evaluates major physical tolerance abilities that are related to musculoskeletal strength, endurance, speed and flexibility.
There are 3 common applications for FCEs:
- Baseline Evaluation – This usually lasts 3 to 4 hours and addresses the full range of physical tolerances
- Job Specific – This averages 5 to 6 hours and focuses on the physical tolerances in comparison to the task demands of the target job.
- Medical-Legal – This on average lasts 5 to 6 hours and can be spread over two days. The Medial-legal FCE addresses the residue physical tolerances, loss of ability and potential for rehabilitation in preparation of determining loss of earning capacity and future cost of care.
Interestingly, these 3 common FCEs have been modified and have evolved over time. For example the Job Specific FCE which averages 5 to 6 hours has evolved into much shorter and more specific tests, designed to address very specific questions and abilities of the job in question. The employer has 5 to 10 critical components of a job that are evaluated and the client usually has a pass/fail result. Where as the Medical-Legal FCE has evolved to include a full physical examination, addresses several questions that are forward by third parties and will address physical tolerances, deficits, abilities, pain, motivation, effort, non-organic signs, placebo test and reports vs. observations. Another evolution is the addition of a clinical examination. The end result is a Clinical Functional Capacity Evaluation. This enables the examiner to make clinical correlations to client presentation, to understand the underlying diagnosis and determine how the clinical presentation will affect the functional capacity and physical tolerances of the client.
The key to a good FCE is documentation. As evidence based methodologies are the gold standard these days, subjective reporting does not meet standards. Objective measurements and accurate testing are extremely important. For example, Arcon testing very accurate and there is very little that is subjective. Effort, heart rate, strength, range of motion for example are all electronically measured and immediately compared to normalized data and can then be determined as deficits or poor efforts.
Another major component of an FCE is the importance of the forwarded questions by the third party. By providing accurate and specific questions, the FCE evaluator can then direct the testing specifically and can answer each question. It is also very important that the FCE evaluator be fully trained and be trained in diagnosis and clinical examination. This will ensure that the FCE was completed by fully trained evaluator and not just a technician.
