FCE, ACOEM & ODG
The ACOEM Guidelines:
It is important for physicians and others to understand the limitations and pitfalls of these evaluations. Functional capacity evaluations may establish physical abilities, and also facilitate the examinee /employer relationship for return to work.
However, functional capacity evaluations can be deliberately simplified evaluations based on multiple assumptions and subjective factors, which are not always apparent to their requesting physician. There is little scientific evidence confirming that functional capacity evaluations predict an individual’s actual capacity to perform in the day, at a particular time, or in the workplace. Functional capacity evaluations reflect an individual’s abilities under Official Disability Guidelines within controlled circumstances. As with any behavior, an individual’s performance on a functional capacity evaluation is probably influenced by multiple specific case factors other than physical impairments. For these reasons, it is problematic to rely solely upon one’s performance on their functional capacity evaluation, objective functional capacity evaluations are results for determination of current work capability and restrictions.
The initial conclusion from ACOEM is to be cautious for over-simplified subjective tests. As you will find out during your own examination of this area, objective testing is possible and produces reliable and reproducible results that are supported by ACOEM.
ACOEM discusses the current work capability and the current objective functional capacity of the examinee. “The examiner is responsible for determining whether the impairment results in functional limitations and to inform the examinee and the employer about the examinee’s abilities and limitations. The physician should state whether the work restrictions are based on limited capacity, risk of harm, or subjective examinee tolerance for the activity in question. The employer or claim administrator may request functional ability evaluations, also known as functional capacity evaluations, to further assess current work capability. These assessments also may be ordered by the treating or evaluating physician, if the physician feels the information from such testing is crucial.”
Also, in the chapter entitled Cornerstones of Disability Prevention and Management, ACOEM discusses managing the delayed recovery. “A number of functional assessment tools are available, including functional capacity exams.” Restoration program helps returning the patient back to work. “Such a program could include components of aerobic conditioning as well as strength and flexibility assessment where necessary.” Therefore, a FCE examination can support a post-injury or illness strength and endurance program.
Official Disability Guidelines (ODG):
Both job-specific and comprehensive FCEs can be valuable tools in clinical decision-making for the injured worker; however, FCE is an extremely complex and multifaceted process. Little is known about the reliability and validity of these tests and more research is needed. FCE as an objective resource for disability managers, is an invaluable tool in the return to work process. There are controversial issues such as assessment of endurance and inconsistent or sub-maximum effort. Little to moderate correlation was observed between the self-report and the Isernhagen Work Systems Functional Capacity Evaluation (FCE) measures. Inconsistencies in subjects’ performance across sessions were the greatest source of FCE measurement variability.
Overall, however, test-retest reliability was good and interrater reliability was excellent. FCE subtests of lifting were related to return to work (RTW) and RTW level for people with work-related chronic symptoms. Grip force was not related to RTW. Scientific evidence on validity and reliability is limited so far. An FCE is time-consuming and cannot be recommended as a routine evaluation. Isernhagen’s Functional Capacity Evaluation (FCE) system has increasingly come into use over the last few years. Ten well-known FCE systems are analyzed — All FCE suppliers need to validate and refine their systems. Compared with patients who gave maximal effort during the FCE, patients who did not exert maximal effort reported significantly more anxiety and self-reported disability, and reported lower expectations for both their FCE performance and for returning to work. There was also a trend for these patients to report more depressive symptomatology. Safety reliability was high, indicating that therapists can accurately judge safe lifting methods during FCE.
ODG Guidelines for performing an FCE:
If a worker is actively participating in determining the suitability of a particular job, the FCE is more likely to be successful. A FCE is not as effective when the referral is less collaborative and more directive.
It is important to provide as much detail as possible about the potential job to the FCE examiner. Job specific FCEs are more helpful than general assessments. The report should be accessible to all the return to work participants.
According to the ODG, consider an FCE if:
1. Case management is hampered by complex issues such as:
- Prior unsuccessful RTW attempts.
- Conflicting medical reporting on precautions and/or fitness for modified job.
- Injuries that require detailed exploration of a worker’s abilities.
2. Timing is appropriate:
- Close or at MMI/all key medical reports secured.
- Additional/secondary conditions clarified.
Do not proceed with an FCE if:
- The sole purpose is to determine a worker’s effort or compliance.
- The worker has returned to work and an ergonomic assessment has been arranged.
It is important to follow guidelines specific to your area. If you would like clarification of the regulations accepted in your district, please contact our office.