1.0

Introduction

A Functional Capacity Evaluation (FCE) is a comprehensive battery of performance based tests that is used commonly to determine ability for work, activities of daily living, or leisure activities.¹

The need for functional evaluation was identified in the 1980s by workers' compensation systems that required specific information about worker functional capacities and limitations to expedite the return-to-work process. Historically, return-to-work decisions were based upon diagnoses and prognoses of physicians, but did not include objective measurements of worker functional abilities and job match demands. Physical therapists, whose core competencies include functional evaluation, began to develop functional capacity tests for comparison to the physical demands of jobs and occupations. These functional tests initially examined and evaluated the ability of a worker to perform physical job match conditions as described by the US Department of Labor in Selected Characteristics of Occupations as Defined in the Revised Dictionary of Occupational Titles² and The Revised Handbook for Analyzing Jobs.³ Functional examination/evaluation, combined with diagnoses and prognoses by physical therapists has emerged as a valid and effective tool to support safe return to work, activities of daily living or leisure activities after an injury or illness.

The Functional Capacity Evaluation today quantifies safe functional abilities, and is a pivotal resource for:

1.1 Return-to-work and job-placement decisions

1.2 Disability evaluation

1.3 Determination of how non-work-related illness and injuries impact work performance

1.4 Determination of function in non-occupational setting

1.5 Intervention and treatment planning

1.6 Case management and case closure

2.0

Purpose of Document

The purpose of this document is to establish guidelines for performance of Functional Capacity Evaluations (FCEs) in an a manner that promotes excellence, accountability and consistency. The ue of the term guidelines is consistent with the current APTA definition, Guideline: A statement of advice (APTA Bylaws, Standing Rule #16). This document is to be used in context with the APTA Standards of Practice for Physical Therapy and the Accompanying Criteria,⁴ the APTA Guide to Physical Therapist Practice, Second Edition,⁵ and the standard language and framework for health and health-related states that is described in The International Classification of Functioning, Disability and Health, known more commonly as ICF⁶. The 2008 APTA House of Delegates voted unanimously to endorse the ICF Model, which uses a broad view of health-related states from biological, personal, and social perspectives. The ICF includes a "robust and rich taxonomy that describes, rather than classifies, individuals according to their functioning and provides a standard language that includes positive and negative aspects of functioning."

These guidelines for evaluating functional capacity are intended for use by:

2.1 Physical therapists to design and perform functional evaluations

2.2 Referral sources to facilitate appropriate referral for FCE and to integrate the findings into case management

2.3 Insurance companies, managed care organizations, and claims review organizations, that authorize, monitor, and remunerate for FCEs

2.4 State Workers' Compensation regulatory agencies as definitions and guidelines for evaluees on workers' compensation

2.5 Disability management systems and regulators, including the Social Security Disability Administration and disability insurance companies, as a resource document

2.6 Employers, employees, organized labor, educators, students, researchers, and others as a resource document

3.0

Definitions

3.1 Ability⁷. A present competence to perform an observable behavior or a behavior which results in an observable product.

3.2 Activity⁶. An activity is the execution of a task or action by an individual.

3.3 Activity limitation⁶. Activity limitations are difficulties an individual may have in executing activities.

3.4 Capacity⁶.The highest probable level of functioning of an individual in a given domain at a point in time.

3.5 Content validity⁷. Demonstrated by data showing that the content of a selection procedure is representative of important aspects of performance on the job.

3.6 Environmental factors⁶. Environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives.

3.7 Evaluation⁵. A dynamic process in which the physical therapist makes clinical judgments based on data gathered during the examination.

3.8 Examination⁵. A comprehensive screening and specific testing process leading to diagnostic classification or, as appropriate, to a referral to another practitioner.  Examination has three components: history, systems review, and tests/measures.

3.9 Functional capacity activity. Any examination activity that generically or specifically simulates a work or practical lifestyle task.

3.10 Functional Capacity Evaluation (FCE). An FCE is a detailed examination and evaluation that objectively measures the evaluee's current level of function, primarily within the context of the demands of competitive employment, activities of daily living or leisure activities. Measurements of function from an FCE are used to make return-to-work/activity decisions, disability determinations, or to design rehabilitation plans. An FCE measures the ability of an individual to perform functional or work-related tasks and predicts the potential to sustain these tasks over a defined time frame. This supports tertiary prevention by preventing needless disability or activity restrictions. 

There are two types of functional capacity evaluations:

3.10.1 General Purpose FCE. The evaluation protocol consists of standardized tests and measures that are applied to all evaluees. This type is appropriate when a targeted job does not exist, or functional job requirements have not yet been determined. The results from this type of FCE may be used to evaluate an evaluee's compatibility with specific job or occupational demands when more information or options become available for consideration.

3.10.2 Job-specific FCE. The evaluation protocol is designed with emphasis on content validity to measure an evaluee's ability to perform the physical demands of a specific, identified job. This type of FCE may include participation in representative work samples in a clinic or monitoring the evaluee while performing critical job tasks at the work-site to determine the evaluee's ability to safely perform the required work tasks and to determine whether there are participation restrictions.

3.11 Functional Capacity Evaluation Examiner. A physical therapist licensed in the jurisdiction in which the services are performed, who is able to demonstrate evidence of education, training, and competencies specific to the delivery of FCEs.

3.12 Impairments⁶. Impairments are problems in body function or structure such as a significant deviation or loss.

3.13 Job analysis. The process of analyzing job duties and responsibilities to quantify functional job demands or performance expectations.

3.14 Job description. A general statement of job duties and responsibilities.

3.15 Participation⁶. Participation is involvement in a life situation.

3.16 Participation Restrictions⁶. Participation restrictions are problems an individual may experience during involvement in life situations.

3.17 Performance. What an individual does in his or her current environment. Performance is affected by a number of factors including behavioral attitudes, injury, pain and environmental and social stressors.

3.18 Job Match Condition. A type of functional capacity that may be used to systematically match and classify worker functional capacities and job demands in a worker job-match taxonomy.  Examples of physical job match conditions defined by the Department of Labor2.3 that are commonly referenced by occupational health professionals include, but are not limited to:

3.18.1 Balancing. Maintaining body equilibrium to prevent falling when, walking, standing, crouching or running on narrow, slippery, uneven or erratically moving surfaces; or maintaining body equilibrium when performing gymnastics feats.

3.18.2 Carrying. Transporting an object, usually holding it in the hands or arms or on the shoulder.

3.18.3 Climbing. Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs or hands and arms. Body agility is emphasized.

3.18.4 Crawling. Moving about on hands and knees or hands and feet.

3.18.5 Crouching. Bending body downward and forward by bending legs and spine.

3.18.6 Far Vision. Clarity of vision at 20 feet or more.

3.18.7 Feeling. Perceiving the attributes of objects, such as size, shape, temperature, or texture.

3.18.8 Finger dexterity. Ability to move the fingers and manipulate small objects with the fingers rapidly or accurately.

3.18.9 Fingering. Picking, pinching, or otherwise working primarily with fingers rather than with the whole hand or arm as in handling.

3.18.10 Handling. Seizing, holding, grasping, turning, or otherwise working with hand or hands. Fingers are involved only to the extent that they are an extension of the hand, such as to turn a switch or shift automobile gears.

3.18.11 Hearing. Perceiving the nature of sounds by ear.

3.18.12 Kneeling. Bending legs at knees to come to rest on knee or knees.

3.18.13 Lifting. Raising or lowering an object from one level to another (includes upward pulling).

3.18.14 Manual dexterity. Ability to move the hands easily and skillfully. To work with the hands in placing and turning motions.

3.18.15 Motor coordination. Ability to coordinate eyes and hands or fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly.

3.18.16 Near acuity. Clarity of vision at 20 inches or less.

3.18.17 Pulling. Exerting force upon an object so that the object moves toward the force (includes jerking).

3.18.18 Pushing. Exerting force upon an object so that the object moves away from the force (includes slapping, striking, kicking, and treadle actions).

3.18.19 Reaching. Extending hand(s) and arm(s) in any direction.

3.18.20 Sitting. Remaining in a seated position.

3.18.21 Standing. Remaining on one's feet in an upright position at a work station without moving about.

3.18.22 Stooping. Bending body downward and forward by bending spine at the waist, requiring full use of the lower extremities and back muscles.

3.18.23 Talking. Expressing or exchanging ideas by means of the spoken word to impart oral information to clients or to the public and to convey detailed spoken instructions to other workers accurately, loudly, or quickly.

3.18.24 Walking. Moving about on foot.  It is acknowledged that not all physical job match conditions have well established, objective tests and measures for testing evaluees. This may limit the usefulness of including some factors during a functional capacity evaluation or job analysis process.

3.19 Job Modification. Change in a task to allow the demands of the job to match the abilities of the evaluee.

3.20 Medically stable⁵. Medical stability is defined as that state in which primary healing is complete, or the progression of primary healing is not compromised. Clinically, medical stability refers to the consistent presence of a set of signs and symptoms. Consistent means that the location of the symptoms and the presence of the signs have reached a plateau. The intensity of the symptoms may vary with activity or intervention/treatment, but the location or pattern of change of symptoms remains consistent.⁵

3.21 Physical Demand Characteristic Levels for physical job match conditions of occupations listed in the Revised Dictionary of Occupational Titles include:²

3.21.1 Categories of Strength physical demand levels:

3.21.1.1 Sedentary. Exerting up to 10 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are Sedentary if walking and standing are required only occasionally and all other Sedentary criteria are met.

3.21.1.2 Light. Exerting up to 20 pounds of force occasionally, or up to 10 pounds of force frequently, or a negligible amount of force constantly to move objects. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing or pulling of arm or leg controls; or (3) when the job requires working at production rates pace entailing the constant pushing or pulling of materials even though the weight of those materials is negligible.

3.21.1.3 Medium. Exerting 20 to 50 pounds of force occasionally, or 10 to 25 pounds of force frequently, or greater than negligible up to 10 pounds of force constantly to move objects.

3.21.1.4 Heavy. Exerting 50 to 100 pounds of force occasionally, or 25 to 50 pounds of force frequently, or 10 to 20 pounds of force constantly to move objects.

3.21.1.5 Very Heavy. Exerting in excess of 100 pounds of force occasionally, or in excess of 50 pounds of force frequently, or in excess of 20 pounds of force constantly to move objects.

Job match conditions that may be interpreted using strength physical demand levels include lifting, carrying, pushing and pulling.

3.21.2 Categories of Aptitude levels² relevant to some physical job match conditions are:

3.21.2.1 Markedly Low. The lowest 10 percent of the population. This segment of the population possesses a negligible degree of the aptitude.

3.21.2.2 Lower. The lowest third exclusive of the bottom 10 percent of the population. This segment of the population possesses a below average or low degree of the aptitude.

3.21.2.3 Medium. The middle third of the population. This segment of the population possesses a medium degree of the aptitude ranging from slightly below to slightly above average.

3.21.2.4 High. The highest third exclusive of the top 10 percent of the population. This segment of the population possesses an above average or high degree of the aptitude.

3.21.2.5 Extremely High. The top 10 percent of the population. This segment of the population possesses an extremely high degree of the aptitude (exceptional). Examples of functional capacity conditions that may be interpreted using the aptitude work demand levels include finger dexterity, manual dexterity, balancing and motor coordination.

3.21.3 Categories of work tolerance levels^2,3 during an 8-hour day as defined by the Department of Labor^2,3 are:

3.21.3.1 Not Present (Never). Activity or condition does not exist

3.21.3.2 Occasionally. Activity of condition exists up to 1/3 of time

3.21.3.3 Frequently. Activity or condition exists from 1/3 to 2/3 of time

3.21.3.4 Constantly. Activity of condition exists 2/3 or more of time. 

Examples of functional capacity conditions that are appropriate to evaluate by work tolerance levels include sitting, standing, bending.

Additionally, given that some jobs require exposure that is more than an 8-hour work-shift, the functional capacity examiner may need to assess an evaluee's work tolerances for such work situations that involve extra time or exposure above an eight-hour shift. For example, an over-the road truck driver may sit and drive for up to 12 hours during a given day. A higher level of sitting tolerance representing extra time above an 8-hour shift would be required for truck drivers exposed to whole bodyvibration, compared to SEDENTARY office workers that may sit for up to 8 hours per day.

3.22 Physical Demands of the Job. Those physical abilities required to perform work tasks successfully. Physical demands as used in this document include work postures positions), body movements, forces the worker applies to job tasks, repetition of the work tasks, and other work stressors.

3.23 Skill⁷. A present, observable competence to perform a learned psychomotor act.

3.24 Work behavior⁷. An activity or function performed to achieve the objectives of the job. Work behaviors involve observable (physical) components and unobservable (mental) components. A work behavior consists of the performance of one or more tasks.