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Post-Injury Progress

PTs can help patients return to work safely by performing functional capacity evaluations

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Vol. 19 • Issue 25 • Page 18

The functional capacity evaluation-a standard test used on patients returning to work following an injury-originated in the 1980s when workers' compensation systems demanded detailed functional information to accelerate the return-to-work process, according to the APTA.

Commonly referred to as an FCE, the evaluation was developed by physical therapists and examines a patient's ability to perform physical work functions. The APTA states that a patient's functional measurements are compared to the physical demands of their job (or other functional activity) to make return-to-work decisions, disability determinations or to generate a rehab plan.

ADVANCE spoke with two experts-Richard Sova, DPT, director of physical therapy and Monica Lynch, director of the functional capacity evaluation department at Kinematic Consultants, Inc., Point Pleasant, NJ-who have 18 combined years of experience in the field of FCEs.

ADVANCE: Describe your background in ergonomics and functional capacity evaluations.

Richard Sova: I have been with the company for six years, and in that time have been performing Kinematic Functional Capacity Evaluations. My training has occurred primarily on the job.

Monica Lynch: I have been with the company for 12 years. I was employed by the company initially for my bioengineering background with concentration in biomechanics as a bioengineer, performing Kinematic FCEs. I have been employed as the director for 10 years. My college studies in bioengineering covered the technology that we employ for Kinematic Functional Capacity Evaluations, as well as ergonomics and biomechanics.

ADVANCE: For those who may be unaware, explain what a functional capacity evaluation is.

Sova: A functional capacity evaluation is a specialized test consisting of various subtests (physical therapy evaluation, strength testing, lifting abilities, movement analysis testing, balance tests, grip strength testing, etc.) that are designed to provide physicians, therapists, patients/examinees, employers, insurance carriers, nurse case managers, etc., an objective evaluation of the examinee's functional movement, strength and balance abilities, and limitations, due to their post-injury status. This information can be used for application of return-to-work qualifications, determination of residual functional strength/movement issues or for further focus of care.

ADVANCE: What patient population would require this type of evaluation?

Lynch: The primary patient population that is referred for a Kinematic Functional Capacity Evaluation is those who have occupational injuries. On a lesser percentage are those who have been injured in motor vehicle accidents, personal injuries or pre-work assignment screening.

ADVANCE: Why is it important for employees to get an FCE before returning to work?

Sova: It is important for employees to get an FCE before returning to work to not only make sure that they are capable of performing the job duties that are required, but that they are capable of performing those tasks safely.

ADVANCE: Why is it important for employers to make their employees get an FCE before returning to work?

Lynch: It is important not only for the safety of employees (to ensure that employees will not place themselves at risk for re-injury when performing their job tasks), but also for the safety of others. For example, an injured corrections officer who has limited strength should probably not be sent back to work where he would be required to defend himself, and be relied upon by fellow corrections officers in a precarious situation.

ADVANCE: What types of injuries do you most often see?

Sova: The injuries that are primarily evaluated are typically orthopedic injuries. To a lesser degree, neurologic conditions/injuries are evaluated strictly to determine how the neurologic condition affects an examinee's abilities for work abilities. We have also evaluated examinees with amputations of fingers or lower-extremity amputations (below-knee and above-knee).

ADVANCE: Do you ever perform job-specific FCEs? If so, what types of jobs usually require this type of evaluation?

Lynch: Typically, we do not perform job-specific FCEs. Kinematic Consultants performs body part-specific Kinematic Functional Capacity Evaluations.

If the employer, physician or insurance carrier asks that a specific task be evaluated, every effort is made to simulate and evaluate that task for the examinee to see if the task can be safely performed. We can also use our technology to perform worksite evaluations and then use that information to perform a Kinematic FCE catered to that specific job.

ADVANCE: Are physical therapists the only health care providers who perform FCEs?

Sova: Occupational therapists can perform FCEs, although Kinematic Consultants does not have any occupational therapists in our office.

ADVANCE: Are all PTs capable of performing an FCE, or do you need special training?

Sova: All PTs are capable of performing an FCE. PT education is to provide and evaluate for functional deficits, impairments and disabilities. Special training is dependent on the kind of FCE being performed.

ADVANCE: If a patient doesn't pass an FCE, can he still return to work? Why might he be advised not to return to work if this happened?

Lynch: There is no real "pass or fail" for a Kinematic Functional Capacity Evaluation. The examinee is evaluated and asked to demonstrate maximum movement, balance and strength abilities. Kinematic Consultants outlines in the report the safe work capabilities of the examinee based on his demonstrated abilities. If the examinee does not demonstrate adequate strength or movement for his present job, Kinematic Consultants will still suggest the examinee is capability of performing work, but at a lower work category or with accommodations to movement/strength abilities. Whether the employer is able to accommodate altered duty employment or alternate work is up to the employer and their employment policies.

Kinematic Consultants' functional capacity evaluation consists of 3-D video analysis, kinetic ground reaction force plates and surface dynamic EMG electrodes to accurately analyze the examinee's movement, strength and balance.

Beth Puliti is associate editor and Web editor at ADVANCE. She can be reached at epuliti@advanceweb.com

Evaluating Functional Capacity

On their Website, the APTA lists guidelines for physical therapists who perform evaluations of a patient's functional capacity. According to the association, physical therapists should use the guidelines to design and perform functional evaluations.

These evaluations-which provide an objective measure of a patient's safe functional abilities-are an essential resource for:  

• Return-to-work and job-placement decisions;

• Disability evaluation;

• Determination of work function with non-work-related illness and injuries;

• Determination of function in non-occupational settings;

• Intervention and treatment planning;

• Case management and case closure.

Resource: American Physical Therapy Association. (2008). Guidelines: Occupational Health Physical Therapy: Evaluating Functional Capacity. Retrieved from the World Wide Web, www.apta.org

FCE Defined

Capacity-The ability of the client to work safely at maximal or sub-maximal levels over a selected period of time.

Evaluation-A dynamic process in which the physical therapist makes clinical judgments based on data gathered during the examination.

Examination-A comprehensive screening and specific testing process leading to diagnostic classification or, as appropriate, to a referral to another practitioner.   The examination has three components:  patient/client history, systems reviews, and tests and measures.

Functional Activity-Any physical activity that generically or specifically simulates a work or practical task.

Resource: American Physical Therapy Association. (2008). Guidelines: Occupational Health Physical Therapy: Evaluating Functional Capacity. Retrieved from the World Wide Web, www.apta.org




     

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