Functional Capacity Evaluations Can Ensure a Safe Return to Work

Prior blog posts have examined strategies for injury prevention in the workplace. Utilization of Post Offer Employment Tests (POETs), as well as ergonomic considerations and pre-shift exercise routines, are all strategies that have shown to offer a return on investment to employers, in terms of money saved and improved employee health/retention. We have also discussed effective ways to manage injuries when prevention measures fail.

These strategies range from Early Symptom Intervention (ESI) to limit OSHA recordability, to formal physical therapy and work conditioning to ensure effective rehab and preparation for return to work. While physical therapy and work conditioning can certainly prepare an individual for return to work, this treatment intervention is often incomplete in terms of formally reassessing the injured worker’s functional status and providing specific recommendations to the physician and care team. In this blog post, we will discuss Functional Capacity Evaluation (FCE) and how this in-depth assessment can ensure safe return to work.

The FCE, by merit of its name, evaluates the Functional (indicating purposeful work activity) Capacity (indicating the maximum function the person is able to perform safely) of an individual through a thorough Evaluation (a systematic approach including observation, clinical reasoning, and conclusion). The FCE is not merely a recording of tests scores, but must go further to produce an easily understandable recommendation of an individual’s ability. This part is crucial, as it is the therapist’s recommendations that must convey to the treating physician in a clear, succinct fashion the following information:

1. Did the evaluee put forth good effort?
2. Are the subjective reports consistent with objective findings?
3. What frequency (Avoid, Seldom, Occasional, Frequent, or Constant) is appropriate for activities that do not require lifting?
4. What Physical Demand Level (Dictionary of Occupational Titles) recommendations (Sedentary, Light, Medium, Heavy, and Very Heavy) is appropriate for activities that involve lifting?
5. Did the evaluee demonstrate a consistent presentation throughout testing, or was there variability noted, suggestive of submaximal effort?
6. Did the individual demonstrate safe performance with essential job tasks (as outlined by a provided formal job description)?

As you likely noticed from some of the questions above, there is complexity in performing a Functional Capacity Evaluation; The provider is required to speak not only to the evaluee’s physical abilities, but must also defend such recommendations and comments on effort/consistency in an objective and clinically relevant fashion. Since FCE’s are routinely used as part of the litigation process, it is understandable that enlisting a qualified provider should be of paramount importance to employers, physician, and payers alike. This bring us to another question: Who should be performing your Functional Capacity Evaluations?

In short, the American Medical Association outlines that Physical and Occupational Therapists are preferred providers for performing FCEs because they possess the clinical skillset and experience to provide accurate recommendations. Since a key component of FCEs is to speak to the injured workers ability to return to work activities, having a qualified provider perform the assessment is crucial.

So how do therapists evaluate an injured worker’s ability? By actually testing job-specific tasks! This includes bending, walking, squatting, and overhead reaching (non-material handling tasks) as well as carrying, lifting, and pushing/pulling (material handling tasks). By testing each activity, the therapist is able to assess cardiovascular response (indicating if the evaluee is putting forth good effort) and biomechanical performance (assessing for compensations/breakdown). This allows the provider to place evidence-based recommendations regarding frequency and weight to various work-related tasks. By the end of the FCE, the therapist will be able to speak to what the injured worker can perform throughout the course of a work-day/work-week.

As you may imagine, this objective testing approach is far superior to simply releasing an injured worker to full duty and hoping that return-to-work goes without incidence. Yet, far too often we see this return-to-work (without an FCE performed) approach implemented, and then have to deal with the complications of re-injury (further delaying case closure or starting a new case, and certainly frustrating the injured worker). When FCEs are performed, should any deficit limiting safe return to work be identified, then work conditioning can be prescribed to remedy the deficit, or restrictions can be implemented to ensure the activity is avoided altogether.

Return to work after an injury can be a very uncertain and anxious time for an injured worker. The worker may have a particularly demanding job, and may have been off work for an extended period. Returning to a job without assessing if the worker is functionally ready can further compound these anxieties. FCEs, by nature of their thoroughness, can help minimize these concerns for employees and employers alike, and provide confidence that the injured worker is ready to safely return to work.