FCEs have been around a long time. Some of us in the industry have been around long enough to see FCEs come into vogue again, 20 years later. Kind of like some of my neck-ties.
FCEs are not rocket-science and we’re not…well, rocket-scientists. An FCE should simply be a set of medically-accepted, legally-defensible tests and procedures very much like the ones we “physical rehab-folks” use on a daily basis. We want to know what, if anything, is wrong with the claimant’s ability to perform normal every-day activities and those required by their jobs. If we were dealing with athletes, we’d want to know what was hurting and what was needed to get them back into the ballgame as soon as possible.
If we find anything wrong or abnormal, we measure it. Limited neck or back range of motion…measure it with the method required by the local jurisdiction. Limited shoulder strength, finger-pinch, lifting strength? Measure it, record it, report it as it impacts the daily work or personal functions of the claimant.
Most jurisdictions have some guidelines, some others have actual requirements regarding FCEs. We strive to exceed all these in providing comprehensive testing and reporting of musculoskeletal status from head to toe. Typical elements suggested or required are:
Current Complaints and Subjective Pain
Musculoskeletal Evaluation (Range of Motion, Joint, Soft Tissue status)
Activities of Daily Living and Job-Related Activities (Sit, Stand, Walk, Bend, etc…)
Job-Specific Task Capability
We add: This is what makes it a TrueCapacity Evaluation (TCE)
Sincerity of Effort (Validity) Testing
Cross-Referenced Activity Analysis
“What’s the point in doing a FCE if you don’t know if the claimant is giving their best safe effort?” You need to get the TRUE CAPACITY of each claimant, not a self-limited, subjective FCE.
We try to keep all testing reasonably related to the issue at hand, but we will “clear” uninvolved joints and body-areas to make sure there are no safety limits in completing the FCE or that might limit the claimant’s safe ability to perform work in some other capacity, just in case they can’t return to their usual and customary job. No fancy equipment, no computerized technologic “thing-a-ma-gig.” Just simple devices and activities to see what one can do and how much.
Speaking about “How Much”; Determining or projecting the “frequency”, “duration”, or “endurance” for someone to perform activities across an 8-hour shift…There is virtually NO currently available research that suggests this can be done. This is one area where we still are doing “educated guessing” when we try to say, “Joe can lift that 7-lb. widget at a “Constant” frequency throughout his 8-hour shift. Technically, unless we watch Joe do that all 500 times (definition of “Constant”) per day, we really don’t know. And any attempt to short-cut that may result in inaccurate prognostications. But we’ll do the best we can, trying to break it down into a “per-hour” or some other understandable recommendation. If one needs, Occasional, Frequent, or Constant, we’ll do our best. Until the research is done, that’s the best anyone can do. But we’re working on it!