Functional Capacity Evaluations

Question 1

What is a FCE?

Answer 1

• Primarily for work injuries

- Medical model unable to provide answers for longer term/serious injuries as to whether worker is ready to RTW

Question 2

Definition

Answer 2

A systematic process of measuring, recording and
analysing an individual’s ability to perform activities in
response to broadly defined work demands

Question 3

Stages of FCE

Answer 3

1. Preparation
2. Execution
3. Report writing

Question 4

Functional Ax?

Answer 4

used in conjunction with other medical and physical testing or examinations to strengthen the overall assessment

Question 5

Functional Testing?

Answer 5

used as a means to demonstrate and

measure changes over time

Question 6

Functional screening?

Answer 6

used as a means to screen large numbers to determine if further testing or investigation is required – usually Pre Employment testing

Question 7

Why is FCE conducted?

Answer 7

• RTW
• medico-legal
• pre-employment
• ongoing risk mgmt
• rehab planning

Question 8

Signs of fatigue?

Answer 8

1. Biomechanical slowing
2. Accessory muscle usage
3. Sliding the load over self or using lower extremity to push or nudge the load
4. Using lower extremity to nudge the load from the floor to a shelf
5. Trembling or muscle fatigue

Question 9

FCE limits reached by?

Answer 9

1. HR >= 85% max, or >70% if on Beta Blockers
2. Physical/biomechanical indicators - asymmetrical postures, muscle tremors, changes in cadence/pace, momentum, weight controls person, muscle tremor, accessory muscle use, NOT PAIN
3. Psychophysical limits - person identifies their own limits

Question 10

Contraindications??

Answer 10

1. Unstable medical condition, recent flu, infection
2. Recent surgery or injury (within 6wks)
3. Substantial psychiatric or behavioural issues
4. Communication barriers that prevent instructions being understood
5. Non-compensable medical co-morbidities restricting performance or exclusion from work
6. Inappropriately dressed

Question 11

If concerned about contraindications?

Answer 11

Medical clearance prior to proceeding

Question 12

Preparation stage includes..?

Answer 12

• gather medical reports, current medical certificate for restrictions, job analysis, progress reports from rehab providers,
  – purpose of FCE – to return to a job, or is employer uncertain of what worker is capable of; medico‐legal, no job but physical tolerances to be determined
  – Authority to exchange information
  – Informed consent

Question 13

Execution stage includes..?

Answer 13

-  Client/Patient interview
– Subjective Ax
– Objective Ax – brief neuromuscular, and physical screen,  functional testing, work specific activities
– Safety considerations
– Post test symptoms

Question 14

When should you always obtain medical approval?

Answer 14

If BP >195/100

Question 15

List the interview components (13)

Answer 15

---History, progress to date
 Medical History
 Diagnostic Tests 
 Types of Medical Treatment
 Medication
 Pain Description
 Contraindications
--Current ADL
 Employment History
 Training/Education
 Employment Goals
 Job Description Review
 Individual perception of abilities

Question 16

What equipment is required?

Answer 16

—Heart Rate Monitor
 Blood Pressure Cuff
 Hand dynamometer to measure grip strength
 Varying weights
 Items to be lifted – boxes, weights, specific work items
such as tools, cables,
 Equipment specific to persons work duties – ladder,
shovel, work tools
 Fitness Ax equip – bike, steps,
 Equipment depends on the type of FCE to
be performed

Question 17

What are some subjective tools?

Answer 17

1. VAS
2. Modified Borg
3. (optional) Oswestry, Roland Morris, Pain Disability Index, FABQ

Question 18

What does the objective assessment include? (4)

Answer 18

—Basic ROM (inclinometry, goniometry joint measures),
muscle strength, posture
 Neuro‐musculoskeletal
 Fitness tests – step up or bicycle ergometer
 Any other useful physical measurement that would be
appropriate to the purpose of the FCE

Question 19

What test do you use for motor dexterity?

Answer 19

Purdue Peg Board

Question 20

Determining end points of performance?

Answer 20

1. Biomechanical = strength, endurance, coordination, balance
2. Physiological = heart rate and blood pressure
3. Psychophysical = pain intensity, fear of
   movement/(re)injury, pain behaviours

Question 21

Can FCE predict RTW?

Answer 21

Floor to waist lift can predict RTW in short term

but not long term

Question 22

Choice of FCE protocol depends on…?

Answer 22

---Purpose of test
 Outcome expected
 Complexity of case
 Time
 Price
 Training available
 Equipment 
 Testing venue
 Evaluators professional background
 Political, corporate, legal climate

Question 23

The report includes…?

Answer 23

Word this VERY CAREFULLY
 Direct toward the purpose
 Participant’s overall level of work – sedentary to very
heavy
 Abilities on specific tasks
 Tolerance for an 8‐hr day
 Level of cooperation or sincerity of effort
 Comparison of current abilities with job demands
 Conclusion
 Recommendations

Question 24

Should you ask for a job description or should you assess job demands yourself?

Answer 24

YOU ASSESS - better understanding of demands of job

Question 25

Examples of FCE’s?

Answer 25

• F.A.S.T
• Blankeship
• WorkHab