TITLE PAGEJob Specific Functional Capacity Evaluation to Facilitate Safe and

Sustained Return to Work

Anne Byrne & Jain HolmesOccupational Therapists

Functional Capacity Evaluation

Functional Capacity Evaluation “Towards Consensus on Operational Definitions in FCE”

A Delphi Study: 22 FCE experts - 6 different countries.

Definition with greatest consensus:

“A FCE is an evaluation of capacity of activities that is used to make recommendations for participation in work while considering the person’s body functions and structures, environmental factors, personal factors and health status”

Refined to:

A FCE evaluates an individual’s capacity to perform work activities related to his or her participation in employment”

Soer et al 2008

Types of FCE

Types of FCE

Evidence…

Job specific FCE shows high level of predictive validity, that could be used to evaluate employment status (Chronic LBP) Cheng & Cheng 2010

Job specific FCE shows a better predictive validity for RTW for patients with a specific injury, e.g. distal radius fracture. Cheng & Cheng 2011

Validity of FCE results is optimal with accurate job simulation and a detailed assessment of specific work tasks. When tests are unrelated to job performance the validity of results is questionable Pransky et al 2004

Numerous research points to the importance of matching the work capacity to the job demands

L. Matheson 2003

Job Specific FCE

Assesses occupational functioning and tolerances for a known job

Comparison & matching of demonstrated function to the specific intrinsic functions and associated demands of a target job.

Job Demands Analysis - Vital

A JDA is a systematic procedure to quantify the physical, cognitive and environmental demands of the essential and non-essential tasks of a job.

Job Specific FCE

Assesses occupational functioning and tolerances for a known job

Comparison & matching of demonstrated function to the specific intrinsic function and associated demands of a target job.

Job Demands Analysis - Vital

A JDA is a systematic procedure to quantify the physical, cognitive and environmental demands of the essential and non-essential tasks of a job.

Storeroom Worker- Intrinsic Function & Demands

Intrinsic Function: Stocking shelves

Physical Cognitive Psychosocial

Standing Attention Deadline pressure

Walking Memory Working

cooperatively

Reaching Computer literacy Attention to detail

Manual handling Listening to

instructions

High degree of

self supervision

Upper extremity Multiple tasks

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Intrinsic Job Functions & Demands

Equality Act in UK – employers can

ask about disability “…where the

question relates to a persons’ ability to carry

out a function that is intrinsic to a job…”

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Job Specific FCEAnalysis / Report Identifies:

Meets demands/ or meets demands with accommodations/does not meet the demands

Elements of the job that can be performed or not – informs the graded RTW plan – makes it meaningful

Necessary accommodations & ergonomics

Rehabilitation potential & efficacy or current/future rehab

Need for redeployment/IHR

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Hallmarks of a “good” FCE

Rigorous Assessment

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Triangulation of Findings

• Cornerstone of a rigorous assessment process

• Systematic analysis of the inter-relationship between qualitative and quantitative data

• To interpret and make judgements about performance

• Multiple methods & multiple sources inherent in a good FCE – never make decision on isolated findings

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A well designed Job Specific FCE Customised: should answer your questions - utility

Objective assessment of abilities, limitations and tolerances compared to the demands of the job and environment

Objective assessment of reliability of effort & of pain and disability reports – assessed on a continuum across the evaluation

Incorporate expert clinical judgement as well as standardised testing

Evidence of triangulation of findings – robust assessment

Practice Hierarchy

Utility

Practicality

Validity

Reliability

Safety

RMA 2001

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What a can be Evaluated?

Abilities, limitations & tolerances – what are the Individual’s functional abilities and limitations, and tolerances relative to the work demands?

Effort – did the individual provide high levels of effort during testing?

Reliability of pain & disability reports (RPDR) – were subjective reports of pain & associated disability reliable?

Rehabilitation potential – efficacy or current and future rehab

Work readiness & RTW - what needs to be considered

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Who can be Evaluated...

Individual with:

A musculo-skeletal condition – focus is on major physical tolerance abilities, strength, endurance and flexibility

A neuro-condition or in TBI - focus is on physical tolerances and also cognitive & perceptual

A mental health condition by combining assessment tools & elements

A chronic pain condition/fluctuating condition

Summary A credible and dependable assessment of occupational

functioning (FCE) facilitates RTW

Job-specific FCE is underutilised in the UK - yet research indicates it is an effective tool

Job-specific FCE can be used to identify: abilities & limitations, tolerances, effort, reliability, rehabilitation potential & all aspects of RTW

Job-specific FCE need not be a rigid process – Customisation is the key!

An FCE should combine expert clinical experience & objective assessment using standardised tests

Determining Capability for Work:

Questions please?