Upstream Rehabilitation and our family of brands have been delivering high quality Functional Capacity Evaluations (FCEs) to our customers for several years. We are fortunate enough to have one of the most experienced FCE Experts on our team in south Knoxville, Tennessee named David Davenport.
David graduated from University of Indianapolis Krannert School of Physical Therapy in December 1986, and began his first job as a physical therapist in January 1987. He took his first Functional Capacity Evaluation training later that year under Keith Blankenship and has been actively involved in the occupational health community since that time. He served as president of the Middle Tennessee Case Management Association for a period of 11 years and during that time performed over 4,000 FCEs for case managers, attorneys, physicians, and employers. He began working with Results Physiotherapy in 2007 as Occupational Health Director and has since relocated from Nashville to Knoxville. Results Physiotherapy joined the Upstream Rehabilitation family of brands in 2021.
We took the opportunity to sit down with David and ask him some frequently asked questions about FCEs.
Upstream Rehabilitation (UR): When do you feel an FCE is most indicated for an injured worker? Are there any injured workers where an FCE should be avoided or cautioned?
David Davenport (DD): “There are 2 main times that I would look to recommend an FCE for a work comp patient. Firstly, the injured worker has been thoroughly treated and has reached a plateau but is still not ready physically or behaviorally to return to their normal work duties. The other is when there is significant discrepancy between subjective and objective presentation. The FCE will help to elucidate the true physical abilities or the degree of consistency of their physical and symptom presentation. In terms of the question of when an FCE should not be done, I would remind the readers that the criteria for referring an injured worker for an FCE include medical stability. As a consequence, a person who is not medically stable, such as recent surgery or extreme blood pressure elevation would not be appropriate for the FCE process, as would the person who is unable to understand the process or the instructions for safe performance of the activities.”
UR: What are the most common errors you see from an inexperienced FCE provider?
DD: “Once a therapist gains confidence with the FCE process but has not yet become proficient, it can be difficult to remain engaged with the injured worker’s total presentation, noting those things that happen on arrival, during unscripted movements, or after completion of the formal testing and making sure that those all make sense when compared to the formal testing results. We teach our therapists to give each injured worker the benefit of the doubt when evaluating consistency and injury presentation but also to be fully aware of those things that don’t make sense.”
UR: What types of practitioners are best suited to perform FCEs?
DD: “Physical and Occupational Therapists are recognized as experts in the area of evaluating physical abilities and identifying abnormal movement patterns and abnormal responses to activity. Because of their training, these therapists have a unique ability to evaluate consistency and maximum vs. sub-maximum effort on functional activities. There are specific licensing guidelines and regulatory oversight, resulting in consistent education and training. Other professionals who may provide FCEs but who might not be the best fit include PTAs, who are not licensed to perform evaluations, exercise physiologists, who do not have standard licensing oversight, and athletic trainers, who are licensed to work with healthy or injured individuals in a sporting context and have less training in pathology and pharmacology. ”
UR: Should an FCE be able to determine if an injured worker is “malingering”?
DD: “The purpose of an FCE is to determine an individual’s ability to perform work related tasks and to evaluate consistency of effort. In this capacity, we often make observations of conflicts between subjective and objective presentation, but the therapist is not able to assess the injured worker’s intent and is not licensed to give a medical or psychiatric diagnosis such as malingering.”
UR: What observations could be made during the test that would be considered inconsistent?
DD: “The most common is observing a discrepancy between measurements that have been taken and the injured worker’s ability to perform the same movement to a greater degree when performing an automatic movement such as reaching for a purse on the floor. Other things that I have observed over the years include limps that change or vanish when outside of the clinic, grip strength that is less than what is required to lift and carry a box, lack of correlation between subjective and objective presentation, poor correlation between heart rate and activity, responses to psychometric questionnaires, and specific tests such as Waddell’s signs or rapid exchange grip.”