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WHY WOULD ONE USE A FUNCTIONAL CAPACITY EVALUATION? What does a functional capacity evaluation test consist of? What is a Functional Capacity Evaluation (FCE)? What Are the Components of the FCE? WHY WOULD ONE USE A FUNCTIONAL CAPACITY EVALUATION? Functional Capacity Evaluations are used for a variety of reasons. One can use an FCE to develop a treatment program, to measure the physical abilities of patients before and after a rehabilitation program, to modify a rehabilitation treatment, to evaluate whether an injured worker can work, and to determine when he/she can return to work. What does a functional capacity evaluation test consist of? ”’Functional Capacity Evaluation:”’ A series of tests measuring physical strength, ”range of motion”, stamina, and tolerance to functional activities, including lifting and carrying. These tests can be used to evaluate work tolerance, and the necessity for work restrictions. Related terms include ”Physical Capacities Evaluation” (”PCE”) or Functional Capacity Assessment (FCA) or Work Capacity Evaluation. An evaluator skilled in Functional Capacity Evaluation will use a battery of standardized tests, designed around key factors that include diagnosis, impairment, pain and functional limitation, referral questions, and, in some instances, the case resolution goal. FCE’s value to the injured individual is the focus on functional ability instead of the pain limitation associated with impairment. It considers speed, flexibility, endurance, skill and strength through the use of functional testing, MTM, and standardized measurements to assess job-fit status. Functional Capacity Evaluation is not only a useful clinical tool, but a baseline for industry-standard results that clearly define an individual’s transition from injury to employment, and from disability to deployment. Overview of the Physical Demand Levels of Work •Sedentary •Light •Medium •Heavy •Very Heavy Sedentary Work •10 pounds of force occasionally and/or •negligible amount of force frequently or constant •sitting most of the time •walking or standing occasionally may be required Light Work •Up to 20 pounds of force occasionally and/or •Up to 10 pounds of force frequently •Walking and/or standing usually required for more extended periods of time Medium Work • Up to 50 pounds of force occasionally and/or • Up to 20 pounds of force frequently and/or • Up to 10 pounds of force constantly to move objects Heavy Work • Up to 100 pounds of force occasionally and/or • Up to 50 pounds of force frequently and/or • Up to 20 pounds of force constantly to move objects Very Heavy Work •> 100 pounds of force occasionally and/or •> 50 pounds of force frequently and/or •> 20 pounds of force constantly to move objects Frequency of Work Demands •Occasional: 0 - 33% of the workday or up to 2 ½ hours per day. •Frequent: 34 - 66% of the workday, 2 ½ to 5 ½ hours per day. •Constant: 67 - 100% of the workday, > 5 ½ hours per day. FCE Testing Components Intake Interview Musculoskeletal Exam Aerobic Capacity Assessment Performance Consistency Testing Material Handling Positional Tolerance Testing Exit Testing Intake Interview •Patient Demographics •Medical History •Treatment History •Subjective Pain Report •Subjective Capabilities/Limitations •Vocational History •Sitting Tolerance •Baseline HR , BP, Respiratory Rate –HR <100 –BP <160/100 FCE Musculoskeletal Screen Assessment with objective measurements compared to functional abilities throughout testing •Gait •Posture •Flexibility •Range of Motion •Muscle Strength •Neurological •Special Tests •Waddell’s Example: Lumbar ROM •Flexion: The individual is asked to forward bend as far as possible. The reading from the inclinometer at S1 is subtracted from the reading of the inclinometer at T12. •Extension- The individual is asked to extend backward from the waist as far as possible. The inclinometers are read from the inclinometer at S1 is subtracted from the reading of the inclinometer at T12 •Side Bending: The inclinometers are read from the inclinometer at S1 is subtracted from the reading of the inclinometer T12. Waddell’s Testing •Non-Organic Physical Signs –Tenderness –Simulation –Distraction –Regional Disturbance –Over-Reaction •Scoring: If three or more of the categories are positive, then the findings are clinically significant for non-organic low back pain. Aerobic Capacity/Endurance Test PURPOSE: •Determine patients cardiovascular response to stressful activity •Predict Max VO2 for classification of aerobic capacity for age and gender. •Determine Functional MET level in comparison to an 8 hour work day Isometric Consistency Testing Statistical consistency: Coefficient of Variation (CV) •The coefficient of variation represents the ratio of the standard deviation to the mean, and it is a useful statistic for comparing the degree of variation from one data series to another. •Isometric – push, pull •Hand grip strength •Hand pinch strength Material Handling Tasks •Lifting is described by research as a whole body activity that is a synthesis of biomechanical, cardiovascular, metabolic and psychophysical aspects. –Occasional –Frequent and/or Job Specific •Pushing •Pulling •Carrying –Occasional –Frequent Lifting •Lifting: Upward displacement of an object with a mass that is accelerated vertically through the application of force along the direction of the left. •Lowering: Downward displacement of an object with a mass that is decelerated vertically through the application of force against the direction of the lower. •Progressive loading format. Lifting Assessment Progressive lift capacity testing is terminated for the primary reasons: •Physiologic limitation - exceeds safe HR limit or has abnormal HR or BP response; has difficulty breathing or hyperventilates. •Biomechanical limitation - inability to maintain safe body mechanics. Kinesiophysical changes consistent with safe limit. Capacity: Validity of Determining Effort Level by Means of Observation. Spine 30(2), 2005. •Psychophysical limitation –Self-perceived as being too heavy to lift safely –Symptom limitation - pain, numbness, pins and needles, nausea, dizziness Positional Tolerances •Sustained or repetitive positioning with negligible force or weight involved. •Positions/actions required for daily job or living tasks •Test may involve generic approach for Any Occupation or a job-specific approach for Own Occupation Positional Tolerance Tasks •Sitting •Standing •Walking •Bending •Stooping •Kneeling •Crouching •Crawling •Climbing (stairs, ladders) •Balancing •Reaching multiple levels •Object Handling •Fingering •Grasping (simple/firm) •Gross/Fine Hand Manipulation Upper Extremity Coordination, Speed and Strength •Manual Dexterity •Fine Finger Dexterity •Hand Grip Strength •Finger Pinch Strength What is a Functional Capacity Evaluation (FCE)? A. POSTURAL LIMITATIONS: Continuously Frequently Infrequently Never (4-6 hrs./day) (2-6 hrs./day) (0-2 hrs./day) Sitting G G G G Standing G G G G Walking G G G G Bending G G G G Climbing G G G G Reaching G G G G Squatting/Stooping G G G G Crawling G G G G Kneeling G G G G B. PHYSICAL EXERTION LIMITATIONS: Up to 10 lbs. 10 lbs. to 25 lbs. 25 lbs. to 50 lbs. Over 50 lbs. Lifting G G G G Carrying G G G G Pushing/Pulling G G G G C. MANIPULATIVE LIMITATIONS: Unlimited Limited Handling (gross) G G Fingering (fine) G G Feeling (skin receptors) G G D. MENTAL LIMITATIONS: Unlimited Limited Understanding G G Remembering G G Sustained concentration G G Following through on instructions G G Decision making G G Responding appropriately to workplace pressures G G Receiving supervision G G Relating to co-workers G G E. VISUAL/COMMUNICATIVE LIMITATIONS: Unlimited Limited Acuity (near/far); Depth; Color; Field G G Hearing G G Speaking G G F. NON-PHYSICAL EXERTION LIMITATIONS Pain (frequency; degree; objective signs) Environmental restrictions (exposure to dust, fumes, smoke, heights, heat/cold, noise; other) Rest periods (frequency/duration) Side effects of medication Is it administered by a health care professional or someone trained by a health care professional? • Are the results interpreted by a health care professional or someone trained by a health care professional? • Is it designed to reveal impairment or physical or mental health? • Is it invasive (for example, does it require the drawing of blood, urine or breath)? • Does it measure an applicant's performance of a task, or does it measure the applicant's physiological responses to performing the task? • Is it normally given in a medical setting (for example, a health care professional's office)? • Is medical equipment used? What Are the Components of the FCE? The components of the FCE will vary based on the purpose of the assessment. The FCE typically begins with a client interview, medical record review, and musculoskeletal screening. Functional testing may include graded material-handling activities such as lifting, carrying, pushing, and pulling; and positional tolerance activities such as sitting, standing, walking, balancing, reaching, stooping, kneeling, crouching, crawling, object handling/manipulation, fingering, hand grasping, and hand manipulation. Pain monitoring is frequently performed during the FCE to document client-reported levels of pain during various activities as well as to manage pain. The FCE may also include evaluation of an individual's hand dexterity, hand coordination, endurance, and other job-specific functions. The FCE report includes an overall physical demand level, a summary of job-specific physical abilities, a summary of performance consistency and overall voluntary effort, job match information, adaptations to enhance performance, and treatment recommendations, if requested. Some FCEs are designed to also report on the worker's ability to meet the cognitive demands of the job in question. FCEs are done on a one-on-one basis and may range in length from 4 to 6 hours. The FCE may take place over 2 consecutive days. Here are further guidelines. |