Are the FCE’s You are Getting as Good as You Want or Need
The Functional Capacity Evaluation (FCE) method has clearly been established as the best means possible for testing and measuring a person’s physical and functional ability, at this given time. The FCE has been used throughout occupational medicine to assess many patients in a variety of circumstances and employment settings. King, et.al (1998) reviewed ten currently marketed FCE systems and presented “A critical review of functional capacity evaluations”. The most widely utilized reason for ordering an FCE is to perform a current assessment of an injured workers readiness to for returning to work following a work related injury or illness. King, et.al identifies other reasons for FCE’s to be performed which include; post offer pre-employment screenings, to determine levels of current disability, identifying deficiencies and setting treatment goals for industrial rehabilitation, and most importantly case closure.
Regardless of reason, the goal of the FCE is to identify physiological hindrances for returning to work, establishing the safe physical demand level capability of the worker, and to identify deficiencies which may predispose the worker to harm or risk in certain postures/positions of work activities. This is accomplished by compiling subjective patient reporting, objective measurable data, physiological response of vital signs to activity, the given diagnosis, what the essential job demands are from the job description (which should be accurate and up to date), and the clinical experience of the allied healthcare professional who has become certified to deliver this type of evaluation and render judgment based on what information they have been provided (Schonstein, 2001).
The Blankenship testing method, developed by Keith Blankenship, is the second longest system which has been utilized within occupational medicine for the past thirteen years. Within the scientific world of evaluation testing and measurement, normative and criterion referenced data along with reliability and validity of the testing process are critical components to the foundation of how the patient is evaluated. King et. al, identified the Blankenship method as one of three (out of the ten they reviewed), FCE testing systems utilizing both the normative and criterion referenced data. The Blankenship method was also the only FCE testing system identified as being developed based upon published medial research. Brubaker et.al, (2007) identified four components of the Blankenship FCE system to demonstrated good sensitivity and specificity for detecting submaximal effort.
Southeastern Orthopaedic Specialists, Lendew Campus back in 2001 chose the Blankenship method based on these and many other factors. Director of Industrial Rehabilitation, John O’Halloran who is one of three certified evaluators on-site shares “my goal was to create a seamless and transitional process to meet the markets needs while assisting in better case direction or quicker case resolution”. With a twenty-four hour turn around time on reporting the SOS Industrial rehabilitation staff at Lendew feels that extrapolating workers ability from a 2-4 hour test to an 8+ hour physically demanding job is predictably difficult to measure and is one of the fallacies facing FCE systems. However based upon vitals signs, objective observable changes (increase or decrease), and presented symptoms during the test gives the certified evaluator the functional ability to render an accurate and professional judgment based upon these factors which should correlate to the given diagnosis.
By utilizing the specific data and testing methods within the Blankenship model clearly establishes sound and relevant testing techniques that closely replicate what the employee is required to do while working. Other FCE testing systems and providers may indiscriminately take a patient who has been diagnosed with a ‘low back injury’ and test their hand strength for a back injury? The Blankenship method allows the certified evaluator to test the patient for what there true job demands are and how they correlate to the physical nature of the job being performed. Dave Van Zandt, SOS Industrial Rehabilitation Coordinator, shares “We have had great success in case closure with our traveling FCE. The traveling FCE is a combination of an FCE and job site analysis assessing the actual activities the patient was/will need to perform”. Van Zandt goes onto share, “by testing the actual body part as it relates to the job demands gives a more accurate depiction and assessment of the workers ability to return to work”.
References
Brubaker, P. N., F. J. Fearon, et al. (2007). “Sensitivity and specificity of the Blankenship FCE system’s indicators of submaximal effort.” Journal of Orthopaedic Sports Phys Therapy 37(4): 161-8.
King, P. M., N. Tuckwell, et al. (1998). “A critical review of functional capacity evaluations.” Physical Therapy 78(8): 852.
Schonstein, E. (2001). “The value of functional and work place assessments in achieving a timely return to work for workers with back pain.” Work 16(1): 31-38.
Simons, G. (2006). “Credibility Crisis in FCEs.” PT Products ONLINE(Oct): 24-26.
Tuckwell, N. L. (2002). “Test-retest reliability on nine tasks of the Physical Work Performance Evaluation.” Work 19(3): 243-253.
Reneman, M. F., W. Jorritsma, et al. (2002). “Concurrent Validity of Questionnaire and Performance-Based Disability Measurements in Patients with Chronic Nonspecific Low Back Pain.” Journal of Occupational Rehabilitation 12(3): 119-129.
