PHED 3806

1. PHED 3806 Functional Capacity Evaluation (FCE) - General (non job-match)

2. Purpose: • To provide an objective measure of a person’s ability to work. Specifically related to strength, power, endurance, flexibility, posture, safety and fitness. • Note: an FCE does not measure a person’s intellectual ability to perform specific work tasks.

3. Method: • Many commercially available ‘methods’ or ‘systems’ have different methods. • Big names include Key, Blankenship, Matheson (RMA). See article for comparison: • King PM, et al. A critical review of functional capacity evaluations. Phys Ther. 1998 Aug; 78(8): 852-866.

4. Population: • Appropriate: Injured workers having completed normal treatment process. May include WCB cases or private insurance cases (automobile crashes). • Inappropriate: Injured workers who have not completed basic treatments, people demonstrating “symptom magnification syndrome”.

5. Force gauge Carrying crates, buckets Lifting device Push/pull cart Various sized weights Hand grip dynamometer Dexterity Tests Stopwatch Ladder Weigh scale Tape measure Treadmill Bicycle ergometer Chair Stairs Equipment:

6. Lifting - Static & Dynamic Carrying - Bilateral & Unilateral Push/Pull - Static & Dynamic Sitting Standing Walking Climbing - Stairs & Ladders Low level - Stooping, Squatting, Kneeling, Crawling Balance Reaching - Forward, Overhead, Bended Handling Fingering Range of Motion Fitness What to measure:

7. What to observe/comment on: • Timeliness • Quality of movement • Productivity • Shortness of breath • Pain behaviours • Effort - MVE • Body mechanics • Safety • Inconsistencies • Weight bearing (R or L foot, using hands for support)

8. Introduction: Functional Capacity Evaluation (FCE) is an objective process for determining an individual's ability to work based on his current medical, physical, psychological, and motivational status The FCE will determine the worker's feasibility to work as it relates to strength, power, endurance, flexibility, posture, safety, coordination, cardiovascular fitness, symptoms, and motivation.

9. Introduction: Work Capacity Evaluation is a broader term including the worker's physical attributes, educational level, skills, interests, aptitudes, financial status, psychosocial status, and other related matters. In most cases, however, the primary question will relate to whether or not the patient has the physical strength and endurance to meet the job demands, in which case Work Capacity and Functional Capacity become synonymous.

10. Introduction: This FCE process meets the need to obtain objective information in a concise manner. It allows the evaluator the option of following a specific protocol or deviating to meet specific needs not found in a standardized process. The FCE process adds objectivity to the evaluation process which enhances the total rehabilitation process and improves the outcome.

11. Maximal Effort: • The FCE process contains tests and checks which help determine if the patient is cooperating fully and exerting a maximum effort.

12. Benefits: • Functional Capacity Evaluation benefits many of the healthcare team members. Listed below are some of those benefits. Examining this list will help one appreciate why Functional Capacity Evaluation has recently emerged as a powerful evaluation tool.

13. Benefits: Physician • Assists with the evaluation of the effects of organic pathology • Assists with Impairment ratings • Relieves much of the guesswork from the return-to-work prescription • Helps evaluate “malingering” • Helps return the injured worker to work sooner • Establishes a safe return to work level

14. Benefits: Therapist • Helps evaluate the effect of pathology on the patient’s function • Adds a new clinical specialty which broadens the professional base • Elevates him in the esteem of other healthcare professionals • Helps establish contact with industry • Gives data which is admissible in court • Establishes a new profit centre

15. Benefits: Compensation Carrier (Insurer) • Validates the injury • Indicates "malingering" • Documents data for the establishment or a settlement • Reduces compensation cost by an earlier return to work, the reduction of re-Injury, and the identification of "malingering" • Helps get the case moving

16. Benefits: Employer • Provides faster return to work • Reduces the risk of re-injury by establishing safe work limits • Gives data regarding job modifications

17. Benefits: Patient • Teaches safe work limits • Teaches proper material handling techniques • Verifies organic pathology • Returns him to work sooner • Returns him to work with safe limitations • Documents the problems which affect his ability to work

18. Who may refer? • WSIB case manager • Rehabilitation management personell • Lawyer • Physician