What Does a Functional Capacity or Functional Ability Evaluation Cover?
A functional capacity evaluation (FCE) or functional ability evaluation (FAE) evaluates an examinee’s capacity to perform physical functions and/or cognitive functions, and work simulation activities related to employment. The FCE or FAE then compares the individual’s physical musculoskeletal and/or cognitive functions to the demands of a specific job, group of jobs, or generally to a work and/or non-work environment. In essence, the primary purpose of an FCE or FAE is to evaluate an individual’s functional ability to participate in work activities, although other instrumental activities of daily living that support work performance may also be evaluated.
The FCE or FAE will examine an individual’s physical or cognitive abilities using a review of the existing medical documentation, a thorough interview processes and objective physical and/or cognitive testing, as well as work or non-work simulated activities.
When is a Functional Capacity or Functional Ability Evaluation Needed?
There are a number of scenarios where a FCE or FAE would be needed, such as:
Someone who has been injured on the job to determine their ability to return to the pre-injury job or to an alternate work situation, such as an accommodated position
Someone applying for short-term or long-term disability benefits
Someone seeking to return to work or activities of daily living after an injury or illness
Someone injured in an accident (i.e., automobile collision or slip and fall event) for whom an FCE/FAE can determine residual abilities related to resuming a former job, new employment or activities of daily living
How does a Physical Functional Capacity or Functional Ability Evaluation Work?
The components of the FCE or FAE will vary based on the purpose of the assessment. The FCE or FAE typically begins with a client interview of 15-60 minutes, and musculoskeletal screening (a check of bone, muscle, ligament and nervous system health). A healthcare professional will lead you through functional tasks such as sitting, standing, walking, and climbing stairs, as well as gripping, lifting, pushing and pulling objects. Repetitive activities and those requiring fine motor skills are often both a part of the tests. By simulating everyday life skills and job-specific skills, the FCE or FAE will evaluate overall functional abilities, determine physical functional limitations and outlined any impediments to return to function.
Specific functional testing may include
Material-handling activities such as lifting, carrying, pushing, and pulling
Positional tolerance activities such as sitting, standing, walking, balancing, reaching, stooping, kneeling, crouching, crawling,
Object handling/manipulation, fingering, handling, and fine motor manipulation
Pain and fatigue monitoring are performed during the FCE or FAE to document the examinee’s reported levels of pain and fatigue during various activities as well as to manage symptom response. The FCE or FAE report includes an overall physical demand level, a summary of job-specific physical abilities, a summary of performance, consistency and overall effort, job match information, adaptations and accommodations to enhance overall performance, and may include treatment recommendations, if requested. An FCE or FAE is done on a one-on-one basis and may range in length from 4 to 8 hours and may also take place over two consecutive days.
How does a Cognitive Functional Capacity or Functional Ability Evaluation Work?
Following an interview, a healthcare professional will lead the interviewee through a series of cognitive functional tasks that may look a lot like work activities. Repetitive activities and those requiring fine motor skills are often a part of both the physical and cognitive tests. By simulating everyday life skills and job-specific skills, the FCE or FAE will evaluate overall functional abilities, determine cognitive functional limitations and outline any impediments to return to function.
The components of the FCE or FAE will vary based on the purpose of the assessment. The FCE typically begins with a client interview, and brief cognitive screening.
Specific cognitive functional testing will include:
a step wise approach assessing work related cognitive abilities
may include cognitive work simulation activities
Things To Consider
Following a work or non-work injury or accident, the insurance provider, employer, legal representative or a worker’s compensation board (WSIB, WCB, Worksafe BC etc) can request an FCE or FAE be conducted. The FCE or FAE allows objective collection of information on the interviewee’s abilities and limitations, and provides data interpreted for use in compensation matters, as well as a work reintegration process. While treatment is not part of the evaluation process it can also be used to predict potential improvements to abilities if a rehabilitation program is implemented.
From a Legal Perspective
Legal counsel should seek well qualified, credentialed FCE or FAE providers who have taken additional training and ideally have been mentored by a skilled clinician in the area. Qualification as an expert in the court within the practicing jurisdiction of the court is preferred. Occupational Therapists, Physiotherapists, Kinesiologists and Nurses are all generally adequately clinically trained to conduct physical FCEs or FAEs. Traditionally, Cognitive Functional Capacity Evaluations have been the domain of but are not restricted to completion by Occupational Therapists.
From a Claims Perspective
Disability claims adjudicators often procure an FCE or FAE for the determination of disability benefit eligibility. The definition of disability as stated in the policy should be provided with a clear list of questions to be addressed by the examiner prior to the FCE or FAE. If determination of disability related to own occupation is required, at a minimum, a job description and ideally a job demands analysis should be provided in the medical brief. If the determination of disability related to any occupation is required, the clinician can be asked to summarize the functional test results in a manner useful to the claims adjudication process.
From an Employers or Unions Perspective
Employers and unions should always first reflect on how the FCE or FAE information will be used post-examination. When requesting an FCE or FAE, a job description is necessary, and a cognitive or physical job demands analysis is typically very useful. Outlining your policy for and available accommodations is helpful in having the healthcare professional determine appropriate recommendations. An employer should seek legal advice as to whether they are entitled to receive full medical disclosure or fitness to work information only, and they should have pre-existing clarity of policy and practice with respect to consent. Ensuring an employee understands the purpose of the examination through open and transparent communication will facilitate a smooth process for all stakeholders.
Integra is experienced in all aspects of Functional Capacity Evaluations or Functional Ability Evaluations and maintains an understanding of the position of all stakeholders as they help facilitate the processes in the clearest and most efficient way possible.