4.0

Knowledge Base

For safe FCE administration and useful interpretation, the FCE examiner should meet competency criteria to ensure a high standard of service provision through adequate knowledge and skills in the following areas:

4.1 Examination (includes history, systems review, and tests and measures) of the following systems⁵:

4.1.1 Cardiovascular/pulmonary

4.1.2 Integumentary

4.1.3 Musculoskeletal

4.1.4 Neuromuscular

4.2 Administration of FCEs and interpretation of tests results.

4.3 Evaluation of physical demands of the job.

4.4 Identification of evaluee behaviors that interfere with physical performance.

4.5 Biomechanical components of safe work practices.

4.6 Impact of relevant laws and regulations on FCE administration, including, but not limited to:

4.6.1 Americans with Disabilities Act

4.6.2 Code of Uniform Guidelines for Employment Selection⁷

4.6.3 Occupational Safety and Health Administration

4.6.4 Social Security Disability Administration

4.6.5 Workers' Compensation

4.6.6 Health Insurance Portability and Accountability Act (HIPAA)

5.0

Admission Criteria

5.1 The purpose(s) for performing an FCE should be defined.

5.2 Admission criteria require that both of the following be present.

5.2.1 The evaluee must be medically stable⁵ or the FCE test protocol should be administered within the safe confines of the evaluee's health condition.

5.2.2 The evaluee must consent to participate.

5.3 A decision-making process should be used to determine whether a functional capacity evaluation is appropriate. Indications for an FCE may include, but are not limited to, situations in which objective functional information is required:

5.3.1 Evaluee reaches a point where he/she is not making functional gains with intervention/treatment.

5.3.2 Evaluee has not returned to full or modified duty.

5.3.3 Evaluee is working, but having difficulty maintaining job/activity function is reported or demonstrated.

5.3.4 Healthcare examiner's report that evaluee displays discrepancy between subjective complaints and objective findings.

5.3.5 Supporting documentation is required for disability determination, determination of loss of earning capacity, litigation settlement or case resolution.

5.3.6 Supporting documentation is requested to assist with future rehabilitation or vocational planning.

5.3.7 Supporting documentation is requested to help render a job-placement decision.

5.3.8 Evaluee requires an opportunity to demonstrate safe performance of functional task.

5.4 Contraindications for an FCE include any one or more of the following:

5.4.1 Performance of the test would compromise the evaluee's safety or medical condition⁸.

5.4.2 Communication barriers preclude understanding instructions, communicating concerns, and interpreting the evaluee's responses during the FCE.

5.4.3 Evaluee does not give consent to participate in an FCE.

6.0

Test Components

Components of an FCE should include but are not limited to appropriate administration and documentation of:

6.1 Intake Information/Referral Issues

6.1.1 Referral source and relationship to the evaluee

6.1.2 Reason for the referral

6.1.3 Underlying medical conditions that may impact work abilities.

6.1.4 Medical restrictions for safety during the FCE

6.1.5 Documentation of job demands when a job match is being requested.

6.1.6 Review of records, especially objective diagnostics.

6.2 Informed consent

6.2.1 Review reason(s) and objective(s) of the functional capacity evaluation, for example:

6.2.1.1 Support return to work planning

6.2.1.2 Improve communications between all parties.

6.2.1.3 Structured process to explore worker abilities or limitations.

6.2.1.4 Confirm suitability of a specific job option.

6.2.2 Explain what is involved during the FCE, what the worker can expect, including that if any inconsistencies in performance occur, they will be discussed with the worker as they arise and are documented.

6.2.3 Address the risks for injury, aggravation of symptoms, or possibility of soreness in response to testing and explain exam procedures that will help reduce such risks.

6.2.4 Obtain release of information for involved parties and explain how the evaluee will receive the FCE information, when appropriate or required.

6.2.5 Address any evaluee's concerns before proceeding with evaluation.

6.3 Job duties and related physical demands.

Review evaluee's most recent job duties and related physical demands to ensure agreement by the evaluee with information provided by employer (if available).

6.4 History

6.4.1 Mechanism of injury

6.4.2 Treatment to date

6.4.3 Objective diagnostic tests

6.4.4 Surgeries

6.4.5 Other relevant claims/medical history

6.4.6 Evaluee's report of current symptoms and work/leisure limitations.

6.4.7 Current medications

6.5 Systems Review

6.5.1 Cardiovascular/pulmonary

6.5.2 Integumentary

6.5.3 Musculoskeletal

6.5.4 Neuromuscular

6.5.5 Communication, Affect, Cognition, Language and Learning Styles

6.6 Physical examination appropriate for health condition(s) and referral questions.

6.7 Conduct functional capacity tests as appropriate to address the referral questions

6.7.1 Static strength tests to evaluate consistency of effort (e.g. grip, pinch, pull)

6.7.2 Dynamic balance/agility

6.7.3 Finger dexterity tests

6.7.4 Manual dexterity tests

6.7.5 Cardiorespiratory endurance tests⁸

6.7.6 Postural tolerance tasks

6.7.7 Lift/carry strength and endurance tests

6.7.8 Simulated or actual work tasks

6.8 Observation of evaluee

6.8.1 Cooperation during participation.

6.8.2 Consistency and level of effort.

6.8.3 Behaviors that interfere with physical performance.

6.8.4 Body mechanics/safety.

6.8.5 Physiological responses and clinical findings.

6.9 Evaluation of history, records, and test results to recommend safe work abilities.

6.10 Comparison of evaluee's safe work abilities with job or task demands (if known and requested by the referral source).