FCE's for Nurse Case Managers and Insurance Professionals Brent Webber PT, CEAS II 10/15/12

Objectives Understand the rational for FCEs Understand basic components of an FCE Understand applications of FCE findings

What is an FCE? According to Wikipedia: A series of tests measuring physical strength, ''range of motion'', stamina, and tolerance to functional activities, including lifting and carrying. These tests can be used to evaluate work tolerance, and the necessity for work restrictions. Related terms include ''Physical Capacities Evaluation'' (''PCE'') or Functional Capacity Assessment (FCA) or Work Capacity Evaluation. An evaluator skilled in Functional Capacity Evaluation will use a battery of standardized tests, designed around key factors that include diagnosis, impairment, pain and functional limitation, referral questions, and, in some instances, the case resolution goal. FCE's value to the injured individual is the focus on functional ability instead of the pain limitation associated with an impairment. It considers speed, flexibility, endurance, skill and strength through the use of functional testing, MTM, and standardized measurements to assess job-fit status. Functional Capacity Evaluation is not only a useful clinical tool, but a baseline for industry-standard results that clearly define an individual's transition from injury to employment, and from disability to deployment.

What is an FCE? You could just say that it is a tool to assess function, impairment, and or disability What is the difference? Function implies what they are able to do regarding a specific task or physical demand category. Functional limitation is a derivative of this as well. Impairment is defined by the AMA as an alteration of an individual's health status that has been assessed by medical means Disability encompasses all things aspects including psychological, educational, socioeconomically, etc. and relates to an individuals ability to complete a specific task, function or role. Concert pianist versus brick mason Must answer the referral question

FCE as Defined by Workwell FUNCTIONAL: Meaningful, useful, purposeful activity that is actual work movement. Functional implies a definable, measurable movement with a beginning and an end. CAPACITY: Maximal safe ability/capability (AOTA, APTA). Capacity means the maximal safe function possible. EVALUATION: Systematic approach including observation, measurement, reasoning, and conclusion. Beyond monitoring and recording, evaluation implies there will be an outcome statement and, if appropriate, recommendations. FUNCTION

Is There a Standard? The short answer is no. Multiple systems that include Isernhagen/Workwell, Blankenship, Matheson, Ergo work system, Ergo kit system just to name a few…. Clinic specific designs Validity? Reliability?

What are Some of the Differences Research Standardization Kinesiophysical vs. Psychophysical Safety and effort are main differences

Differences Explained

Who Can Do an FCE? It depends… Clinic short cuts Rationalization of cost and misunderstanding of role PWS is not an FCE and vice versa

Confusing Terminology PCE FCE WCE EFT PDT Short form FCE vs Long form FCE The list goes on and on….

What are the Referral Questions? RTW/placement? Disabled? Physical demand category? Limitations? Non referral based limitations? MMI? Work tolerance? Self limiting?

Physical Work Tasks per the DOL and DOT pationalinfo.org/a ppendxc_1.html# STRENGTH Standing Sitting Walking Lifting Carrying Pushing Pulling Climbing Balancing Crouching and squatting Kneeling Bending Crawling Reaching Handling and fingering, grasping and pinching Feeling Trunk rotation Vision Tasting/smelling Hearing

1 Day Versus 2 Day Research shows that over 80% of applicants have no significant changes between day 1 and 2 The 20% that are appropriate for 2 day are typically for Medical-legal Disability Radicular neurological involvement Specific disease processes where duplicate work exposure may be relevant Long time away from work/complicated medical history Vocational testing Self limitation

Disabled? Any occ? Own occ? Does it matter?

Frequency of Work

Physical Demand Levels

Questions / Comments