1. FCE Grid and Test Correlations WorkWell Prevention & Care

2. Webinar Objectives: Participants will understand:
All sections of the FCE Test Results Document (“Grid”)
How to complete the FCE Grid
How to correlate test items

3. Webinar Courtesy
Your phone system may disturb all others participating in the webinar.
Please DO NOT put your phone on “hold” – we will hear your music or advertising
Eliminate background noises if on speaker we will hear your co-workers talking, laughing, etc.

4. Webinar
“WorkWell’s FCE Professional Guidelines and Advanced Documentation” seminar
Based on years of working as a Clinical Therapist for WorkWell
Webinar is based on a portion of this seminar
8 hour seminar
Interactive – discussions, questions and answers
Seminars are listed in the Newsletter

5. “FCE Grid”

6. “FCE Grid”
#1- Results based on specific work factors. #2 Interpretation of observed function #3 Test results

7. WorkWell FCE Test Results
The interpretation of WorkWell’s standardized functional testing is based on assumptions including normal breaks, basic ergonomic conditions and that the tested functions are usually not required more than 2/3 of a normal working day. If a function is required continuously, job related testing should be performed.

8. Based on Assumptions # 1 - Normal breaks 8 hour working day
(2) 15 min. breaks
30 min. to an hour for lunch
Example: If working a 7:00 – 3:30 shift (8.5 hours)
2 hours work – 15 min. AM break
2 hours work min. Lunch
2 hours work min. PM break
2 hours work - Home

9. Based on Assumptions #2 – Basic ergonomic conditions
Ergonomic Risk Factors:
Repetitions
Forces
Awkward postures
Vibration - direct contact trauma
Temperature

10. Based on Assumptions
#3 – Testing function not required more than 2/3 of the day (frequently)
If an activity is required continuously % of the day, job related testing should be performed.
How many activities can be performed continuously?

11. FCE test results (grid)
Interpretation of observed function regarding activity during a normal work day.
Interpretation of observed function regarding activity during a normal work day.
Frequency
Weighted Activities
Observed Physiologic
Effort Level
Position/Ambulation Quantitative +
Qualitative Results
% of
Workday
Never
Contraindicated
Not Possible 0%
Rarely
Maximum
Significant
Limitation
1-5%
Occasionally
Heavy
Some Limitation
6-33%
Frequently
Low
Slight/No
34-66%
Self-limited
Client stopped test, submaximum effort level
Submax %

12. FCE test results (grid)
Frequency
Weighted Activities
Observed Physiologic
Effort Level
Position/Ambulation Quantitative +
Qualitative Results
% of
Workday
Timeframes in 8 hr. workday
Never
Contraindicated
Not Possible 0%
Rarely
Maximum
Significant
Limitation
1-5%
1- 24 min.
Occasionally
Heavy
Some Limitation
6-33%
25” - 2’ 40”
Frequently
Low
Slight/No
34-66%
2’ 41” - 5’ 15”
Self-limited
Client stopped test, submaximum effort level
Submax %

13. FCE test results (grid)
Frequency
Weighted Activities
Observed Physiologic
Effort Level
Position/Ambulation Quantitative +
Qualitative Results
% of
Workday
Timeframes in 8 hr. workday
Never
Contraindicated
Not Possible 0%
Rarely
Maximum
Significant
Limitation
1-5%
1- 24 min.
Occasionally
Heavy
Some Limitation
6-33%
25” - 2’ 40”
Frequently
Low
Slight/No
34-66%
2’ 41” - 5’ 15”
Self-limited
Client stopped test, submaximum effort level
Submax %

14. Quantitative and Qualitative Results
Quantitative – defined by test protocols
Amount of weight
Distance
Time completed
Example: Standing Work
Never: Unable to perform, totally contraindicated
Rare: Significant limitation < 10 min.
Occasional: Some limitation 10 min. - < 30 min.
Frequent: Slight / No limitation 30 min.

15. Quantitative and Qualitative Results
Qualitative – observed objective aspects of performance
Antalgic gait
Frequent weight shifting
Limited strength / giving way / compensates
Pace
Stability – compensatory movement
Balance
Using support

16. Final Score Quantitative + Qualitative Results Considerations
Individual test result per protocol
Magnitude of observed difficulty
Based on observation
Consider % of workday definitions

17. Review of the FCE Test Results and Interpretation - “Grid”
NEVER
RARELY
OCC.
FREQ.
Lifting, Strength
Lbs or kg (circle)
Unable
Max.
Heavy
Low
Limitation
Recommendation
Waist to Floor
Waist to
Crown
Front Carry
Push (static)
Pull (static)
There are numerous variables impacting Push/Pull including load, equipment, surface, etc. This is not meant to indicate the “weight that is move”

18. FCE Grid NEVER RARELY OCC. FREQ. Posture, Flexibility, Ambulation
Unable
Significant Limitation
Some Limitation
Slight or No Limitation
Limitation
Recommendation
Elevated Work
Fwd Bend Standing
Sitting
Standing Work
Walking 6MWT
Crouch

19. Limitations
Observation – increased lumbar lordosis and frequent weight shifting
Limitation –
decreased core trunk strength
limited LE strength
decreased hip flexibility – tight hip flexors
dermatome radicular pattern L4-5 pain

20. Recommendations Think “ergonomics”
Use of carts, ladders, dollies, wheelbarrow, etc.
Frequent, short rest breaks when doing this activity
Alternate job tasks to decrease duration of heavy lifting
Raise work surface

21. FCE Grid Examples Maximum performance in a return to work FCE
Client with poor outcome in a R RCR
Client that Self –limits
Correlating FCE Test Results

22. “Grid” Patient referred for return to work determinations
NEVER
RARELY
OCC.
FREQ.
Lifting, Strength
Lbs or kg (circle)
Unable
Max.
Heavy
Low
Limitation
Recommendation
Waist to Floor 75 65 40
Waist to
Crown 50 20
Front Carry 70
Push-Pull
(Static)
Force Generated
Limitations
Recommendations
Push (static)
100
Pull (static)
120
There are numerous variables impacting Push/Pull including load, equipment, surface, etc. This is not meant to indicate the “weight that is move”

23. Return to work FCE Get a job description prior to testing
Add job specific testing
Use the job match grid

24. FCE Grid Patient with poor outcome from R RCR
NEVER
RARELY
OCC.
FREQ.
Lifting, Strength
Lbs or kg (circle)
Unable
Max.
Heavy
Low
Limitation
Recommendation
Waist to Floor 75 65 40
Waist to
Crown 15 10
Decreased R shoulder strength and ROM
Use step ladders for crown or overhead work. Limit duration of working above shoulder level.
Front Carry 70
Push-Pull
(Static)
Force Generated
Limitations
Recommendations
Push (static)
100
Pull (static)
120

25. FCE Grid Patient with poor outcome from R RCR
NEVER
RARELY
OCC.
FREQ.
Lifting, Strength
Lbs or kg (circle)
Unable
Max.
Heavy
Low
Limitation
Recommendation
Waist to Floor 75 65 40
Waist to
Crown (hands on handles) X
Decreased R shoulder strength and ROM. Unable to reach to shoulder level. .
Waist to Crown (Preferred Method) 15 10
Modified to use of L arm only secondary to decreased R shoulder ROM, strength.
Use a step ladder to place objects between waist and chest when lifting.
Front Carry 70

26. FCE Grid X Posture, Flexibility, Ambulation Elevated Work
NEVER
RARELY
OCC.
FREQ.
Posture, Flexibility, Ambulation
Unable
Significant
Limitation
Some
Slight
or No
Recommendation
Elevated Work X
Decreased R shoulder strength and ROM. Unable to reach to shoulder level
Client is able to do elevated work with L arm (see job specific testing)
Fwd Bend Standing
Sitting
Standing Work
Walking 6MWT
Crouch

27. Patient with poor outcome from a R RCR
What would you expect to read in this FCE?
Diagnosis and history to support R RCR
Patient reporting problems in ADL’s and work at chest level or higher
Decreased ROM and Strength in the Physical Exam.
Difficulty with Waist to Crown lifting, Elevated work, and any job simulation that requires working at chest level or higher

28. Self-limiting
Client stops the test activity prior to therapist observing maximum effort.
Generally due to pain or fear of reinjury
Be clear in your report which tests were self-limited
Watch for confliction statements
Client gave maximum effort on all tests
Client had limitations on some tests
Client self-limited some tests

29. Self-limiting FCE Grid
NEVER
RARELY
OCC.
FREQ.
Lifting, Strength
Lbs or kg (circle)
Unable
Max.
Heavy
Low
Limitation
Recommendation
Waist to Floor
Self-limited with c/o LBP Observed ability 10# low effort.
Waist to
Crown (hands on handles) 20 15 5
Waist to Crown (Preferred Method) 25
Front Carry

30. Self-limiting FCE Grid
NEVER
RARELY
OCC.
FREQ.
Posture, Flexibility, Ambulation
Unable
Significant
Limitation
Some
Slight
or No
Recommendation
Elevated Work X
Decreased core trunk strength and stability
Provide ladder when doing elevated work to keep objects between waist and chest height
Fwd Bend Standing
Client self-limited. Observed ability indicates ability to perform this activity at least rarely
Sitting
Client self-limited. Observed ability indicates ability to perform this activity at least occasionally.
Standing Work
Walking 6MWT

31. Correlating test items
The 6MWT - walking
Rare – must have an appropriate corresponding diagnosis to support this low distance. Rare = min. in a workday, an average of 3 min. per hour.
Review protocol –
must walk “fast”
Frequent turns may cause a lower score
Review “factors associated with a shorter 6MWT

32. Walking correlations
If a client is limited in walking, then activities that require walking will also be limited.
What other tests require walking?
Carrying an object (front, L or R carries)
Stairs
Ladders

33. FCE Grid – Walking Limitations Final analysis with correlations
NEVER
RARELY
OCC.
FREQ.
Lifting, Strength
Lbs or kg (circle)
Unable
Max.
Heavy
Low
Limitation
Recommendation
Waist to Floor 75 65 30
Waist to
Crown 50 40 20
Front Carry 70
Client unable to carry frequently due to walking limitation
Push-Pull
(Static)
Force Generated
Limitations
Recommendations
Push (static)
100
Pull (static)
120
There are numerous variables impacting Push/Pull including load, equipment, surface, etc. This is not meant to indicate the “weight that is move”

34. FCE Grid – Walking Limitations Final analysis with correlations
NEVER
RARELY
OCC.
FREQ.
Posture, Flexibility, Ambulation
Unable
Significant
Limitation
Some
Slight
or No
Recommendation
Elevated Work X
Fwd Bend Standing
Sitting
Standing Work
Walking 6MWT
Antalgic gait, balance deficits. Uses a cane to ambulate

35. Correlations for Standing Work
If a client is limited in standing work, then other activities that require this will also be limited.
What other tests require standing work
Waist to floor lift
Waist to crown lift
Short carry
Forward bending – standing

36. Standing work
Standing work is tested during the lifts and carries (30 min.) The test results may be limited due to the client being unable to tolerate the extra load imposed with lifting and carrying weight. You may restart the standing work timer after lifts and carries to determine standing work ability when weight is not involved.

37. FCE Grid – Standing Work Limitations Final analysis with correlations
NEVER
RARELY
OCC.
FREQ.
Lifting, Strength
Lbs or kg (circle)
Unable
Max.
Heavy
Low
Limitation
Recommendation
Waist to Floor 75 65
Client unable to lift frequently due to standing work limitations
Waist to
Crown 50 40
Front Carry 70 20
Push-Pull
(Static)
Force Generated
Limitations
Recommendations
Push (static)
100
Pull (static)
120
There are numerous variables impacting Push/Pull including load, equipment, surface, etc. This is not meant to indicate the “weight that is move”

38. FCE Grid – Standing Work Limitations Final analysis with correlations
NEVER
RARELY
OCC.
FREQ.
Posture, Flexibility, Ambulation
Unable
Significant
Limitation
Some
Slight
or No
Recommendation
Elevated Work X
Fwd Bend Standing
Sitting
Standing Work
Decreased core trunk strength, radicular pain consistent with L4-5 HNP
Walking 6MWT

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