Four Items Every FCE Report Should Include

A Functional Capacity Evaluation (FCE) is a commonly utilized tool to assess an injured worker’s ability to perform work-related tasks. This evaluation is often performed towards the end of care, once it has been determined by the treating physician that the injured worker is at, or approaching, maximal medical improvement.

An FCE typically consists of a musculoskeletal evaluation and a series of functional tests. Despite the heavy prevalence of these tests being utilized within the workers’ compensation industry, wide variation in testing procedures and the content included within the finalized FCE report have been noted. This often confuses and frustrates physicians and other worker’s compensation stakeholders, as information within the report may be difficult to understand, buried within dozens of pages of documentation, or simply deemed incomprehensible to the reader.

This is particularly problematic as findings from an FCE are often used to guide physicians regarding permanent restrictions or to aid in the determination of an impairment rating. When the FCE report fails to be concise, easy to understand, and/or applicable to whether or not the injured worker can return to work, everyone associated with the injured workers’ claim can be negatively impacted.

So, let’s look at some of the fundamentals that should be included in an FCE report.

1. Recommendations on Functional Activities

This is the basis of why an FCE is often requested; to get an understanding of the injured workers’ functional capacity and how that would translate into a full day of work. This often requires a comparison between the essential functions of a job and the injured worker’s current functional ability.

In order to make an accurate comparison, it is important to test and document on all functional activities, not just activities that solely address the injured workers’ affected body part. For example, performing a floor-to-waist lift is often assumed to be a lower extremity or low back focused lift. However, the injured worker must still grasp the item being lifted, and must stabilize their shoulder complex.

Therefore, it is quite difficult for therapists to assess “lower or upper extremity only FCEs,” because most often, a functional task requires the use of multiple systems working synergistically to perform.

This is why a good functional capacity evaluation will assess all functional activities that may translate into work performance (both lifting and non-lifting tasks), and provide clinical guidance and insight into the injured worker’s ability to perform during the course of a work day. Tasks that will be evaluated during the functional activities section of an FCE include: bending, squatting, kneeling, crawling, overhead/forward reaching, balance, grasping/fine motor, floor to waist lifts, floor to shoulder lifts, pushing/pulling, and carrying.

The evaluator will be monitoring cardiovascular response and biomechanical factors as part of this assessment and will use this data when determining final recommendations, level of effort, and consistency of presentation. It should also be noted that injured workers who present with moderate/severe deconditioning can have recommendations downgraded due to their poor overall cardiovascular/cardiopulmonary status. This consideration must be prioritized prior to testing, and it’s advisable that any injured worker who has been out of work for an extended period consider work conditioning prior to testing to improve their tolerance to prolonged work.

2. Consistency Percentage

Across the course of the FCE testing procedure, the physical therapist will be testing and recording numerous data points and observations which will allow them to determine the consistency of the injured worker’s clinical presentation. Interpreting this data will allow the evaluator to make an assessment on the reliability and validity of the evaluation findings, and whether or not the results are appropriate for making a safe and appropriate return to work recommendations.

Items that are used to establish consistency include:

1. Consistent clinical presentation regardless of the position or activity
2. Consistent and appropriate physical exam findings
3. Appropriate correlation between occasional and frequent lift tests
4. Psychometric screening tools compared to clinical presentation
5. Standardized grip testing procedure

3. Level of Effort

While often viewed (albeit inaccurately) as synonymous with consistency, level of effort is a separate consideration entirely. While an injured worker’s consistency of presentation often correlates strongly with level of effort, there are instances when the two factors deviate. To understand how level of effort is determined, evaluators assess biomechanical, cardiovascular, and cardiopulmonary factors.

For example, if an injured worker is participating fully during a lifting task, the evaluator should see signs of biomechanical fatigue/breakdown. Furthermore, the injured worker should demonstrate an appropriate increase in heart rate and respiration. If these factors are not noted, and the injured worker is indicating that they cannot attempt additional tasks/weight secondary to fatigue or pain, then the level of effort put forth by the injured worker becomes a point of contention.

Should this self-limiting behavior be noted throughout significant portions of testing, it’s likely that the evaluator will have no choice but to articulate a poor level of effort throughout testing. This may occur even if the injured worker’s physical exam, clinical presentation, and grip testing all suggest good consistency.

4.Supportive Documentation

While making clear recommendations is extremely important, the FCE report should include narrative evidence that supports the recommendations made. There should be clear descriptions of each activity performed, including any limiting factors that impacted the injured worker’s performance.

Absence of this information can call in to question the recommendations given, particularly if this injured worker’s claim is involved in litigation. Each FCE report should provide a thorough descriptive narrative of each activity performed as well as how it ultimately impacted the final work recommendation.

The four items listed above are essential to creating a valuable FCE report that communicates the injured workers’ tolerance and participation. The absence of any of these items could limit the report’s ability to make clear return to work recommendations, and could result in a waste of the injured worker’s time and the responsible party’s money.

We offer the most thorough FCE in the industry, with the clearest recommendations and documentation to support them. To request more information about our workers’ compensation program, click here.