A Functional Capacities Evaluation, or FCE, is theoretically a test that fairly and accurately evaluates a person’s capacity to work at certain levels over a lengthy period of time. There are a number of different FCE systems in place but they share certain things in common.
First, a therapist will likely explain what is expected and tell you that you do not need to perform any tasks that you feel you cannot safely do. She or he will interview you to confirm what your injury is.
Second, the therapist will likely perform a series of physical tests moving you around and asking you to do things while distracting you by speaking to you or having you answer questions. The purpose of this is to see if you unconsciously move without pain when you have already told them it hurts to move.
Third, the therapist will perform an extensive number of validity tests. Some, such as a test that tests your ability to squeeze a handgrip, are designed to see if you are giving full effort, have a significant support among medical literature. Others, such as a series of tests given to people complaining of back pain, have been repudiated by the designer of the test.
Fourth, the therapist will prepare a report which will be given either to your doctor or to your rehabilitation nurse. While we have seen an instance of a rehabilitation nurse falsifying the FCE results before giving them to the doctor we believe this to be a rare occurrence.
An FCE can be very beneficial to an injured worker to the extent that it demonstrates to a doctor what you can and cannot do. The downside of the FCE, in our experience, is that the therapist has a tremendous amount of flexibility in deciding if you’ve given full effort. Nothing, we repeat, nothing will destroy your relationship with a doctor like a FCE report which says you gave less than full effort.
What causes us a lot of concern is that some physical therapy groups aggressively market their FCEs to insurance adjusters as a way to bring claims to a close. That, to us, seems like a thinly veiled promise to either recommend little to no restrictions or to declare someone to be giving submaximal effort. We reviewed a report from one such group that stated in the opening and closing paragraphs that the patient had failed some validity tests and had given submaximal effort. When we combed through the full report (which, by the way, was not given to either the doctor or us… we had to subpoena it) we discovered that the client had passed 27 of 30 validity tests. So yes, it was true that he had failed three. And yes in English “three” is “some” but we believed this to be a clear effort to paint a negative picture about a very honest injured worker. Another example we’ve seen repeatedly is a therapist asking a patient about his pain level before and then after the test was done. According to this particular FCE protocol if your pain is 5/10 when you start the FCE your pain should be no more than a 7/10 when you finish. If you say it’s an 8/10 then you get dinged for symptom magnification. Why? Because the FCE protocol says your pain should only go up by two points. Huh?
A substantial amount of literature supports the theory that an FCE should be performed twice. It’s well documented that a person’s performance may appear submaximal strictly due to the unfamiliarity of the situation. We’ve personally had many clients whose second performance has no trace of submaximal effort reported – even though the overall demonstration of strength did not change one bit.
Finally, many believe that indisputable evidence such as temperature, blood pressure, and heart rate are more reliable indicators of effort than the subjective impression of therapists who market their testing to workers’ compensation adjusters.
