Functional Capacity Evaluations (FCE) are a series of tests performed in a controlled environment, usually a physical therapy facility, to measure strength, stamina, and tolerance of work activities including lifting, reaching, bending, carrying. There are different types of FCEs including general and job specific tests. General tests evaluate the strength, positional tolerance and mobility tolerance as it pertains to the most common essential work tasks. Job specific tests require a detailed job description and an onsite job analysis to determine essential functions of the job. These functions are then tested by performing the evaluation on site or simulating the functions in the clinic.
An FCE is a subjective test to determine an individual’s ability to safely return to work. Injured workers are advised to perform the test to the best of their ability without causing pain or re-injury. Because of the subjective nature of the test, there are serious issues as to reliability and validity. Test results that question validity generally blame malingering or other intentional attempt to manipulate the outcome. However there are a number of legitimate scenarios that may contribute to reliability and validity of the test results. Those may include: conversion disorder, pain disorder, or other somatoform disorder, depressive disorders, test anxiety, fear of symptom exacerbation or injury, fatigue, medication and psychoactive substance effects, patient’s misunderstanding of instructions, poor test administration technique, and the use of poorly calibrated equipment. In order to increase reliability and validity, the following areas should be included in the testing: complete patient history, cardiovascular response to activity, pre and post testing pain questionnaire, assessment of fine motor skills and balance, positional tolerance testing and material handling, musculoskeletal evaluation if there is evident of symptom magnification or sub maximal effort, psychological screening or testing including distraction testing. Improvement in testing procedures and adequate training for providers is necessary to obtain the optimal benefit of FCEs. In the New Jersey Workers’ Compensation system, FCEs are generally prescribed by the treating physician as the injured worker approaches maximum medical improvement to determine any limitations that should be placed on the individual in order to safely return to work. An FCE is unnecessary in the case where a worker has returned to work in his full capacity prior to discharge from treatment and is working without incident or re-injury.