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?