Functional Capacity Evaluation

Are they worth their weight??

Peg Hau OT/CHTAdvanced Physical Therapy & Sports Medicine

In developing diagnostic tests, we must remember that it is better to miss an insincere individual than to classify a sincere patient as insincere. Tests must be chosen carefully, and if multiple tests are used, they must be administered in a logical order.

Ahmer, 2007

History of the FCEA functional capacity

evaluation is set of tests, practices and observations that are combined to determine the ability of the evaluated to function in a variety of circumstances, most often employment, in an objective manner

1970’s beginning2001critized as not being

job specificReneman et al, 2001

What is an FCE

Evaluates and individuals ability to perform work ax’s related to his/her employment

Similar types of testingConsists of standardized assessmentsAdministered with care and safety in mind

(Kuijer et al., 2011; Soer, et al., 2008).

Why are they ordered

BaselinePre employmentJob SpecificMedical/legalAssisting with case closure

Who can benefit from an FCE

Individual injured on the jobApplying for Social Security Disability Seeking to return to work after extended

leaveSomeone seeking vocational rehabilitationTransition from school to work setting

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.

Components of an FCE History review – medical,

vocational, social Screening tests – musculoskeletal Physical functional testing – based

on DOT Job simulation – when identified job

is known Behavior assessment Results, data compilation, and

recommendations

Types of FCE’sMathesonErgo Science www.ergoscience.comARCON FCE http://fcesoftware.com/home.htmlIsernhagen Work SystemBlankenshipErgos Work Simuolator and Ergo Kit VariationHanoun MedicalWEST-EPICKeyAssessAbility

Ergo Science

Developed in 1988 by Deborah Lechner PT,MS

Administrators must complete 24 hours of instruction

Used in 850 clinicswww.ergoscience.com

ARCON Sciencewww.fcesoftware.com30 years of

development and refinement. 

1,000 clinics nation wide

ARCON continuedThe Arcon system includes:

* Computerized hand and pinch gauges.* Electronic goniometer.* Dual range of motion inclinometers.* Dynamic and isometric lifting system.* Carpal tunnel testing attachment.* Computerized heart rate monitor.

Testing protocols includes:

* Dynamic lifting.* Isometric testing extremities & back.* Range of motion testing.* Dexterity testing.* Endurance testing.* Activities of daily living.

Iserhagen Work SystemSusan J. Isernhagen PT created the first functional capacity

evaluation in the mid 1980’s. Redeveloped in 2004Objectivity of results to replace the subjective estimates that were

currently being used• Medical base to tie the functional capacity and limitations into

current diagnoses• Information on level of effort, to identify those who used full effort

and those who did not use full effort.• Safety in functional tests so that this information could lead to safe

return to work• Work relatedness to determine abilities to perform specific jobs, • http://dsiworksolutions.com/history.htm

Iserhagen continued

The Relevance for Nondiscrimination Compliance by Susan Iserhagen - 2010

BlankenshipA unique FCE called the WORKEVALTM and it helps Physicians, Case

Managers and Employers determine what work limitations are appropriate for the injured worker.

 We also provide Physicians with the objective data they

need to determine the injured worker's Permanent and Partial Disability, or PPD.  The name for

this evaluation, which was developed and published by the American Medical Association, is a Permanent Impairment Evaluation.  This evaluation process determines the percent of Permanent, Partial Impairment and that percentage

is used to help Patients, Employers, Insurers and Attorneys negotiate the settlement of the Workers' Compensation Case.

Ergos Work Simulator

Hanoun Medical

Strength & dexterity testingProtocolsFatigue analsyis software????????????

Assessability

http://www.assessability.net/fme-vs-fce.htmlFunctional Medicine Evaluation (FME) vs.

Functional Capacity Evaluation (FCE)

Key

Glenda KeyFounder and President

1987

300 clinics & 42 states

Double blind testing

Physical ExaminationHeart rate and blood pressurePosture and gaitRange of motionStrengthBalanceOther special testing as warranted

Functional Testing continued:•Sustained overhead activity

•Climbing ladders

•Crouching/squatting/ stooping

Functional testing Floor to waist/

shoulder/overhead lift

Carrying

Push/pull

Functional Testing cont:•Grip strength

•Pinch strength

•FMC/9 hole peg/Purdue

•Stereognosis

Less than Full Effort PerformanceReasons for ……..1. Medically determined

impairments2. Malingering3. Factitious disorder4. Learned illness behavior5. Conversion disorder, pain

disorderMatheson, 2003

Continued:6. Depressive disorder7. Test anxiety8. Fear of symptom exacerbation or injury9. Fatigue10. Medication & psychoactive substance

effects11. Lowered self-efficacy expectations12. Need to gain recognition for symptoms

Methods to identify inconsistancyIntra test inconsistencyAbsence of expected relationships among

measures.Completion of tests and willingness to do moreCoefficient of variationRapid exchange gripCorrelation of heart rate with reported max

effort Correlation of impairment (range of motion,

manual muscle tests, etc. ) to function

Non-Organic Signs

Pain Questionaire Waddell McGill Pain Questionaire RansfordNumeric pain scaleMillion Visual Analogue

Million Visual Analogue ScaleThe Million visual analogue scaleThe Million visual analogue scale (MVAS) (Table 15) is a 15-item

questionnaire about disability and pain intensity in patients with LBP.38The 15 questions investigate the body functions (pain, sleep, stiffness and twisting), daily activities (walking, sitting, standing and work) and social life. Information about item selection process is not available. Score is given on a 100 mm visual analogue scale(VAS). For example, if patients are asked to quantify the severity of his pain (like the first question), they mark a point on a 100-mm line in which the end points are labelled as ‘no pain’ and ‘intolerable’. In each question, it is possible to obtain an index of severity of symptoms in a patient-specific fashion measuring the distance of the marked point from the origin of the line. The final score is calculated by adding up the equally weighted scores.

Physical Demand Characteristics of Work

References Chapman-Day, K. M., Matheson, L. N., Schimanski, D., Leicht, J., & DeVries, L. (2011). Preparing

difficult clients to return to work. Work (Reading, Mass.), 40(4), 359-367. doi:10.3233/WOR-2011-1247; 10.3233/WOR-2011-1247

Gouttebarge, V., Kuijer, P. P., Wind, H., van Duivenbooden, C., Sluiter, J. K., & Frings-Dresen, M. H. (2009). Criterion-related validity of functional capacity evaluation lifting tests on future work disability risk and return to work in the construction industry. Occupational and Environmental Medicine, 66(10), 657-663. doi:10.1136/oem.2008.042903; 10.1136/oem.2008.042903

Gouttebarge, V., Wind, H., Kuijer, P. P., Sluiter, J. K., & Frings-Dresen, M. H. (2010). How to assess physical work-ability with functional capacity evaluation methods in a more specific and efficient way? Work (Reading, Mass.), 37(1), 111-115. doi:10.3233/WOR-2010-1084; 10.3233/WOR-2010-1084

Streibelt, M., Blume, C., Thren, K., Reneman, M. F., & Mueller-Fahrnow, W. (2009). Value of functional capacity evaluation information in a clinical setting for predicting return to work. Archives of Physical Medicine and Rehabilitation, 90(3), 429-434. doi:http://dx.doi.org.ezproxy2.library.drexel.edu/10.1016/j.apmr.2008.08.218

Westbrook, A. P., Tredgett, M. W., Davis, T. R., & Oni, J. A. (2002). The rapid exchange grip strength test and the detection of submaximal grip effort. The Journal of Hand Surgery, 27(2), 329-333.

Wind, H., Gouttebarge, V., Kuijer, P. P., Sluiter, J. K., & Frings-Dresen, M. H. (2009). Effect of functional capacity evaluation information on the judgment of physicians about physical work ability in the context of disability claims. International Archives of Occupational and Environmental Health, 82(9), 1087-1096. doi:10.1007/s00420-009-0423-8; 10.1007/s00420-009-0423-8