Health Care providers are routinely asked to comment on the functional ability of their patients. This need can present for a variety of reasons, ranging from return to work clearance, need to objectively quantify activity restrictions for current/future employment, and at times in cases where discrepancies may exist between the subjective report and objective presentation. From a physical perspective, perhaps the most clinically exhaustive way to evaluate an individual is with the Functional Capacity Evaluation (FCE). This exam, by merit of its name, evaluates the Functional (indicating purposeful work activity) Capacity (indicating the maximum function the person is able to perform safely) of an individual through a thorough Evaluation (a systematic approach including observation, clinical reasoning, and conclusion). The FCE is not merely a recording of tests scores, but must go further to produce an easily understandable recommendation of an individual’s ability.
An FCE may be ordered for a variety of reasons. Most commonly FCEs are ordered to determine a patient’s ability to safely return to work when they have been off of work for an extended period of time. But they can also be performed to help in determining a baseline for future treatment, when there are noted differences in a patient’s subjective and objective presentation or they have plateaued in their treatment and are no longer making functional gains. A physician may also use the results of the FCE when determining an Impairment Rating.
The evaluation typically is about a 4-hour process and involves a thorough subjective history, musculoskeletal examination and testing of both material and non-material handling activities. There is also an assessment of the evaluee’s psychosocial response to pain through a series of written surveys and observations.
Considering the potential long-term implications surrounding the results of such an evaluation, it is important to ensure that the exam is both comprehensive in its scope and performed by qualified clinicians. Often, there is some confusion surrounding who should be performing these evaluations. While athletic trainers, exercise physiologists, and physical therapist assistants are qualified to perform the various activities that make up an FCE, the physical and occupational therapy professions stand out as the preferred FCE evaluator.
Furthermore, the American Medical Association’s “Guide to the Evaluation of Functional Ability” is clear in its recommendation: “To maintain the quality of FCEs and to create awareness of definition and use, guidelines were developed within the therapy professions [physical and occupational therapy] performing FCEs. Nevertheless, FCEs are also performed by people who are not therapists and are often unable to provide an equivalent level of clinical assessment.” This is not to disparage those other professions, but rather to outline that the comprehensive scope of understanding needed to perform a test of this magnitude is simply not covered within the didactic coursework of many health professions.
Physical and occupational therapists have educational backgrounds in neuromusculoskeletal anatomy, pharmacology, and pathology, combined with an understanding of various medical diagnoses, and how these conditions, along with co-morbidities, may ultimately affect the physiology and kinesiology of the individual participating in the FCE. Since physical and occupational therapists possess this level of understanding, they are poised to be most capable of providing the highest quality FCE product and ensuring that the recommendations provided are accurate so that physicians, employers, and patients are capable of safely operating within their workplaces and the community.
