Functional capacity evaluations (FCEs) are an important component of work injury management and work injury prevention. FCEs were developed in the 1980s primarily to assist workers' compensation companies with more efficient return-to-work of workers injured on the job.
The use of functional testing has expanded in scope since that time - both within the United States and in countries around the world. Industry leaders continue to work diligently to advance the design and usefulness of functional testing through creativity, collaboration and research. Leaders from around the globe will convene once again in October 2014 as they continue this important work.
The standardized FCE is comprised of a series of physical demands tests that are comparable to the work environment. Typically, an evaluee proceeds through each test item until either maximum ability is reached, the test is fully completed, or the evaluee chooses to end the test.
The FCE also examines results for consistency and reliability indicators (or lack thereof). The findings are reported and projections are made estimating the evaluee's ability to perform the physical demands over a work shift - typically eight hours.
Today, therapists commonly perform one of a variety of standardized versions in a traditional clinic setting. A small percentage of therapists perform them in an industrial clinic setting. This is currently the most recognized use of the FCE, and it is often requested at the "end stage" of medical intervention - when workers' compensation cases need to be settled or when disability insurance companies seek to determine whether benefits should continue.
A general-purpose FCE is also often requested to compare a worker's test results to the physical demand requirements of a particular job, and to make recommendations for return to work, rehab potential, etc.
Recently, questions have been raised as to whether it is indeed legal and/or ethical to test workers to their maximum work capacity in workers' compensation cases. Exposing workers to any potential risk of aggravating their condition or causing further injury has also been mentioned as a concern - since this testing may exceed what the worker's job requires. Privacy issues have also been mentioned.
As a result, job-specific functional testing is increasingly being used to address whether a worker can return to the job, or to determine whether a worker can perform work at levels he was capable of prior to the work-related injury or illness.
Moving to Job-Specific FCEs
Job-specific FCEs are on the rise. Work injury management can be further facilitated and expedited with job-specific functional testing. It increases the involvement of the employer, since job information must be obtained. This makes sense, since the employer is a major stakeholder. These FCEs also tend to take less time than the general FCE, which is appealing.
Job-specific FCEs are custom designed and based on the specific physical demands of a particular job. The physical demands testing ends at the point the job requirement is met, alleviating concerns about over-testing. Employer outcomes commonly show that this type of FCE results in significant decreases in workers' compensation costs and lost work days and restricted work days. An accurate job function description and functional test design create this opportunity.
Further efficiencies can be achieved by identifying which job tasks a worker can perform safely, and which job tasks require modification or avoidance. Job-specific FCEs that enable the evaluator to recommend specific tasks that can be performed within a job provide an excellent strategy to help employers return workers safely and productively to their own jobs as soon as possible.
Post-offer of employment functional testing has been in existence for some time. Employment laws, the ADAAA, and a variety of case laws indicate that all types of testing must be job specific and not discriminate against any population.
Employers have faced significant penalties when testing could not be correlated with jobs or proven to be consistent with business necessity, particularly when evidence revealed that testing was inaccurate. Documentation and validation of job tasks and physical demands plus accurate functional test design appear critical for the courts to recognize them as valid.
The responsibility of employers to address job modification as a part of the hiring process per federal and state employment laws has been made clear. Job-specific FCEs that incorporate task modification can be helpful when situations arise.
As the U.S. economy continues to show signs of strengthening, many regions don't have enough workers applying or qualified for jobs in manufacturing. The emphasis on post-offer testing can be expected to shift away from disqualifying workers who are willing to take a job. Thus the purpose of post-offer functional testing may need to change to meet the employer's goals. The role of post-offer functional testing can go well beyond rescinding offers of employment.
Therapists can emphasize how functional testing can identify where workers are a good fit, and where efforts will be needed to ensure safe and productive employees. The identification of such opportunities can lead to engineering changes, administrative changes, improved training methods, conditioning programs and work modifications - all of which benefit employer and employees alike.
'Early Intervention' FCEs
When employees routinely perform physically demanding work, an injury reduction strategy can be to have employees go through periodic job-specific functional testing as a part of the employer's safety program. This should be consistent with business necessity, and test results can be used to facilitate the employee's ability to work safely. Penalizing workers would be a detrimental use of this testing.
Workers can also be encouraged to request functional testing if they're having difficulty on the job for any reason. Encouraging early reporting can prevent needless suffering on the part of employees and expenses on the part of employers.
FCEs are of significant value in work injury management and continue to evolve as employers, employees, medical providers, insurers and case managers refine their goals. One challenge to providing job-specific FCEs is obtaining job-specific information. Getting therapists more involved in this vital work, and taking a leadership role, is crucial to moving this important work forward.
1. Occupational health physical therapy: Evaluating functional capacity guidelines. Accessed via www.orthopt.org/uploads/content_files/OHSIG_Guidelines/OHSIG_guidelines_2/Occupational_Hlth_PT_Evaluating_Functional_Capacity_040610_2_.pdf
2. EEOC Prohibited Employment Practices. Accessed via www.eeoc.gov/laws/practices/
3. Commentary on Georgia Pacific & Goodyear legal cases by Susan Isernhagen. Accessed via http://dsiworksolutions.com/newsletters/2010-02-25.htm
4. Hemphill TA, et. al. Labor and skills shortages in manufacturing. Wall Street Journal, Feb. 2012. Accessed via http://online.wsj.com/news/articles/SB10001424052970204880404577230870671588412/
Virginia (Ginnie) Halling is CEO of DSI Work Solutions Inc., Bowling Green, Ky. Contact: firstname.lastname@example.org.