A Functional Capacity Evaluation (FCE) is a unique tool that can be utilized to help determine a person’s overall function through the performance of designated activities. FCEs can be administered for a better understanding of an employee’s return to work or to determine the level of disability.
Who Completes Functional Capacity Exams?
An FCE is an extensive evaluation administered by a licensed healthcare provider. Commonly, it is carried out by an Occupational or Physical Therapist, and, in some states, Certified Athletic Trainers. Due to the extensive nature of this test, which requires a clinical understanding of musculoskeletal dysfunction and physiological responses to aerobic and anaerobic stresses, a qualified clinician must perform an FCE. Please check with your state’s medical licensing board to verify who can perform FCEs.
What to Expect During an FCE
FCEs can take up to 4 hours, but in some instances, depending on occupational requirements, it can take even longer. As with most medical appointments, there will be paperwork to fill out. Information such as past medical history, injury history, subsequent treatment, employer information, and job description will be necessary for the FCE. There will also likely be some questionnaires to fill out to help you and the tester understand the pain and nature of your current function. Like your workday, rest breaks are given. Water or snacks can also be provided to help you through the test. Feel free to bring some with you too!
What Tests are Completed?
A musculoskeletal exam will be conducted using various dynamic (action) and static (still) tests. If it’s a job-specific FCE, the session will be tailored to meet as much of the worker’s day as possible based on their job description. Specific activities will be selected by the employer, worker, and test provider. These activities can include sitting, standing, walking, lifting, ladder climbing, and stairs. Determining the frequency of activities completed during a workday is also important. Common terms used to do this are occasional, frequent, and constant. Once a frequency is decided upon for an activity, then the intensity is established. This can be done by designating a weight to a particular activity, such as lifting. Each test can be further customized for a specific height or distance as well. For a general or baseline FCE, the tests may be less specific in some of the activities but will still be comprehensive.
How difficult will the tests be?
FCE testing is performed using a Kinesiophysical approach. This is a fancy way of saying: “How hard should I push the patient?”. An FCE is utilized to get the maximum effort out of the patient for each individual test. This, in turn, helps the clinician to illustrate the most accurate snapshot of the patient’s function. The tester will always test with patient safety in mind while getting them to their endpoint, all while evaluating a patient’s mechanics.
This means that the test will be difficult. By nature, the FCE is a comprehensive test to show the patient’s functional capability and must consider all factors.
Is an FCE painful?
All people are different and have different pain tolerances. During FCE testing, pain, heart rate, and blood pressure will all be monitored. The clinician will carefully evaluate each activity for biomechanics, technique, and safety. A functional pain scale is commonly used during the test so that the patient can communicate their pain and how it affects them while doing the activity. Commonly, patients do have some pain when performing an FCE. The pain is likely due to long-term deconditioning, and the stage of the healing process they are in.
Communication between the physician ordering the test and the clinician providing the test will help to clearly outline the procedure and expectations. This can provide reassurance that some pain is okay during an FCE.
We’re Here for You
The Ivy Rehab Network specializes in treating patients with work-related injuries. The goal is to efficiently rehabilitate injured workers and to lessen the number of days lost to work-related injuries. When you’ve been injured at work, we are here to help you get back to feeling like yourself as quickly as possible. We offer personal one-on-one care that will allow you to reach your goals and return to work safely. Our team at Ivy Rehab is ready to help administer your FCE and give you a safe and comprehensive functional snapshot. Click here to find a location near you that offers FCEs.
Article By: Marcus Shelton, MSPT, Cert. MDT
Marcus began his Physical Therapy career 25 years ago. He loves working with the outpatient orthopedic population and believes in the importance of providing highly functional and goal-oriented treatment programs. He currently specializes in spinal intervention with an emphasis on sports and occupational medicine. He enjoys working with patients of all ages with musculoskeletal deficits to reach their pre-injury function. He currently treats patients at Ivy Rehab in Fair Lawn, NJ.
