A Functional Capacity Evaluation can provide valuable information about your client’s ability to perform activities of daily living and work. It encompasses the entire human experiencee including physical, cognitive, emotional, visual perceptual, and social skills required to handle the demands of today’s home, community, and occupational environments.
Main assessment areas:
· Positional Tolerances
· Lifting Abilities
· Manual Speed and Dexterity
· Level of Effort
· Cognitive/Emotional Status Abilities
A full narrative report is provided with understandable terminology that gives you a perfect snapshot of the client’s performance. It provides details of how your client’s injury has impacted all aspects of function, including quality of life.
A Three-day Functional Capacity Evaluation Format Rationale
Starting Point uses the “Matheson” approach to testing where protocols are chosen and implemented in a specific way in order to get the most useful, reliable, and valid information possible. It does not promote using the same sub-tests in the same order on each and every client as some other, more rigid systems promote. Rather, they should be chosen and strategically administered in the appropriate order to get the most useful and accurate information. For instance, when evaluating someone with back pain, it would be important to avoid too much lifting in the beginning of the testing order which could exacerbate symptoms, affecting the client’s ability to perform subsequent sedentary types of activities.
The definition of a functional capacity evaluation (FCE) assigned by Lenoard Matheson back in 1986 is as follows: “A systematic process of measuring and developing an individual’s capacity to dependably sustain performance in response to broadly defined work demands.” The key words in this definition are “dependably sustain” as any employer expects dependability, reliability, and consistency in a worker’s performance.
The three day format involves 3 hours of testing on the first day, 7 hours on the second day, and 3 hours on the third day. Having a client come to the clinic on 3 consecutive days simulates the same type of schedule any worker would have. It requires them to get up early, go through a morning routine, drive, and arrive to the job on time (often after disrupted sleep). It allows the evaluator to observe how the effects of pain or other symptoms affect someone’s ability to show up everyday on time and to see what impact, if any, driving has on the person. A one day FCE could not possibly take these factors into account.
The second, longest day of testing involves a combination of sitting and standing activities over 7 hours. It takes 7 hours to determine how long one can consistently sit and stand while maintaining acceptable symptoms levels. A shorter 4-5 hour FCE cannot assess this reliably as the evaluator has to allow the client to sit and stand to full tolerance several times throughout the day. The second day of testing also includes a meal preparation activity where 4 clients (all going throught he 3 day evaluation at the same time) interact together to prepare a meal. This allows the evaluator to objectively measure tolerances for home making activities such as meal preparation and light cleaning rather than relying on subjective reports by the client. For those with cognitive impairments or high pain levels, cooking can be quite difficult and they also have problems socializing which is an important part of functioning in most work environments. Also, over the course of 7 hours, the evaluator has more opportunity to try different accommodations which could help improve function such as providing back support, inclined work surfaces, etc.
The third day of testing will often reveal a decrease in positional tolerances. This is valuable information which should not be excluded. As clients fatigue more with each day, tests can be repeated to objectively measure any decrease in strength or speed of movement, or if there is a decrease in cognitive processing speeds or accuracy.
Evaluating human function is extremely complicated and involves measuring positional tolerances, strength, cognition, emotional affect, fatigue, effects of pain, effects of medication, etc. all of which fluctuate over the course of hours, days, and weeks. Ample time must be allotted to ensure an accurate assessment of one’s ability to perform various types of work in a dependable, reliable, and consistent manner across time.
The functional capacity evaluator has the responsibility of providing information about human performance which ultimately has major impacts on the client’s quality of life, their employment opportunities, and their ability to earn an income. But many don’t realize that the evaluator also has a responsibility to any future employer in that an employer has the right to hire a person who can safely perform a job to acceptable standards without being a liability to that company. The evaluator has a responsibility to the client’s physicians who rely heavily on this information to make future medical recommendations or conclusions regarding employ-ability. A three-day FCE provides a “gold standard” format that is undoubtedly more valid than any other format.
Starting Point believes in providing an environment for testing that is less “formal” where personal rapports can be established. Often clients can be distrusting of healthcare professionals because of negative past experiences. Having more time to foster a trusting relationship, moving cautiously and carefully through the FCE is very helpful in allaying any fears a client may have in terms of getting re-injured, or that they may be pushed past safe work limits. It often results in getting more out of the client in terms of function because we work as a team with the client. We can be confident that our FCE process will conclude with a client who is satisfied that they have been evaluated in a professional, caring, and thorough manner and that the report will reflect the highest level of accuracy possible in describing all of their abilities and limitations.
Functional Capacity Guidelines Colorado Department of Labor & Employment
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