Functional Capacity Evaluations (FCE) were introduced to the workers’ compensation community to help objectively measure a patient’s level of function within the context of their work environment.
Today, there are a number of validated FCE programs in the marketplace, including:
Isernhagen (WorkWell™) *
Epic Lift Capacity™
Ergo-Kit FCE™
Ergoscience™
Blankenship™
Arcon™
Key Systems™
Isernhagen is, to date, one of the most intensely and independently researched FCE tools available, primarily because of its use by the Canadian and Dutch government social medicine systems. A well respected brand, research shows that the Isernhagen offers ‘good-to-excellent’ test/retest reliability for material handling.
However, recent research is starting to question the need for two-day testing since some studies show that the floor-to-waist-lift test proves as reliable an indicator of return-to-work prediction as data from the entire FCE test.
The point? No matter what testing program you use, it cannot mimic the average work day or week:each person and job is unique; outside factors influence progress and the complex nature of job demands are difficult to predict; and, last but not least, any evaluation is subject to interpretation.
How can you be sure you’re making the most of your FCE?
Providers need to define and execute best-practice FCE administration. Physicians, employers, case managers and claims professionals need to be aware of how the quality of administration, timing, and outside influencing factors can affect FCE results.
Below are some best practices to keep in mind before performing, reviewing and/or requesting the next FCE:
Best practice tip #1: Understand the Purpose
It is important to understand the purpose of FCEs. According to the American Physical Therapy Association an FCE is defined as follows:
“…a detailed examination and evaluation that objectively measures the patient’s current level of function, primarily within the context of the demands of competitive employment. Measurements of function from an FCE are compared to the physical demands of a job or other functional activities, and are used to make return-to-work/activity decisions, disability determinations, or to generate a rehabilitation plan. An FCE measures the ability of an individual to perform functional or work-related tasks and predicts the potential to sustain these tasks over a defined time frame.”
The ideal purpose, therefore, for administering an FCE is to:
a) Determine the presence and degree of disability.
b) Improve role performance through the identification of functional decrements.
c) Improve the likelihood of safe return to work job/task performance.
Best practice tip #2: Timing The timing of FCE administration is critical. For example, administering the material handling test too early will result in scores that will not be indicative of full capacity. If administered too late, the treating provider will not have sufficient time to change treatment plans or address psychosocial factors.The FCE should be administered in the middle of the episode of care so that possible changes to the intervention plan can be made before the patient completes the care.
Best practice tip #3: Outside Factors FCE data must be considered in context with the entire patient; it must consider outside factors such as employer, payer, and co-worker influences. It must examine family, social and economic resources and identify any psychosocial problems.
Best practice tip #4: Documentation Thorough documentation during the FCE is as critical in helping to develop the treatment plan as it is to affecting positive outcomes and the appropriate management of the claim. The patient, provider and payer all benefit from clear, consistent, and thorough documentation that delivers information regarding the history of treatment, the effect of outside influencers, progress and expectations.
Best practice tip #5: Communication Regular communication between the referring physician, the treating therapist, the claims professional and the employer is critical in aligning expectations and promoting a positive experience for the injured worker.
Understanding the nature and purpose of FCEs and then identifying and implementing best-practices for administration is the first step in developing an effective treatment plan for the improvement of FCEs. The benefit to all workers’ comp disability patients, their providers, and payers will be enormous.
