Functional capacity evaluations can be performed for a variety of reasons.
The primary reason is to determine a person's abilities versus limitations as it
relates to the physical demands of work. These physical demands are then
directly tied to the essential functions of a particular job. FCEs have evolved
over time based on changes to medicine, research, government legislation, and
Supreme Court precedent.
FCE testers consistently express concerns that they may be deposed or called to
testify based on the results of their FCE. The various reasons you might perform
an FCE have varying levels of risk as it relates to you being asked to answer
the legal question associated with that FCE. If and when your FCE crosses over
into the legal arena and you are asked to present your findings in deposition or
as an expert you need to know if you are practicing in a Frye Standard or a
Daubert Standard state.
If you are practicing in a Frye Standard state your FCE has to be interpreted by
the courts to have been "generally accepted" by a meaningful segment of the
scientific community. The remaining Frye Standard states include: California,
Illinois, Kansas, Maryland, Minnesota, New Jersey, New York, Pennsylvania, and
Washington.
The Daubert Standard is used in federal cases and in all of the remaining
states. For your FCE to be admitted as evidence in a Daubert Standard state the
following criteria need to be met.
• The methodology must have been or could be tested empirically.
• The methodology must have been subjected to peer review and publication.
• The methodology has a known or potential error rate.
• The methodology has been accepted within the relevant scientific community.
To satisfy the empirical testing criteria your FCE would need to have been
scientifically tested in regards to intra-rater and inter-rater reliability as
well as various types of validity. This scientific research then needs to
available for your peers to read the research. The sensitivity and specificity
of the tool needs to be known and overall your FCE needs to have been accepted
within the relevant FCE scientific community.
There is no perfect Functional Capacity Evaluation testing system on the open
market. There are quite a few good ones. Many medical practices make up their
own FCE and base it off of previously researched testing items but rarely
perform empirically based research on their overall battery of tests.
The challenge with FCEs as a whole is their lack of full validity in all areas.
One of the areas that is lacking in regards to FCEs is content validity. Content
validity is defined as performing a scientific-based evaluation that verifies
that the method of FCE measurement actually measures what it is supposed to
measure. The reason that FCEs lack content validity is because when taught how
to perform a standard FCE a clinician is told to use some apparatus that is
standard within the test to perform lifting. Sometimes it is a milk crate, a
wooden box, an isometric force gauge, a lever arm, or even some box with
handles. The problem with content validity is that if the person does not
actually lift something even close to the prescribed apparatus it would be
difficult to obtain a level of content validity necessary. An FCE tester should
never rely specifically on the standard method and equipment they were told to
use in the FCE training course they attended and should always modify their FCE
to use equipment that as closely as possible approximates the equipment used on
the job.
This was evident in the recent court case in United States Court of Appeals 9th
Circuit. In Indergard v. Georgia Pacific, the Functional Capacity Evaluation
methods were called into question. There were standard tests done in this FCE
that could not be attributed to an essential function of the job. The patient
being tested did not pass the standardized tests and thus was denied employment.
Upon further review by the courts, some of the tests that were not passed could
not be pinned to an essential function of the job and thus raised many
questions.
The Americans with Disabilities Act of 1990 as Amended in 2008 should have also
caused Functional Capacity Evaluation testers to take pause. One of the primary
changes this legislation has done for FCE testers is stress the importance of
employer accommodation. When performing a job specific Functional Capacity
Evaluation you should be acutely aware of the bridge between abilities,
limitations and making job accommodation recommendations. FCE testers could take
a job specific FCE a step further and recommend a job accommodation analysis in
their recommendations. This may help protect that employer from questionable
practices associated with the amended ADA due to that employer not looking at
accommodation potential.
The early design of a patient's ability to perform lifting, carrying, pushing
and pulling testing was loosely designed based off the 1978 research project
performed by Snook, S. H., titled "The Design of Manual Handling Tasks". This
research was performed psychophysically, meaning that "Subjects were given
control of either weight or force variable". The first FCEs were also performed
based on a psychophysical approach in which the patients were given control of
how much they felt they would be able to lift, carry, push and or pull. Other
measures were put into place to determine if the amount of weight they performed
could be deemed their maximum output. As research and general advances in
medicine occurred, FCEs began incorporating a kinesiophysical approach in which
a patient's ability was determined based on biomechanical changes/deficits. From
a practical perspective, this is considered the means in which the clinician is
looking to see a kinesiophysical endpoint during testing. No matter which
approach you have been trained in, all approaches use a combination of both
psychophysical and kinesiophysical to come to the endpoint of this medical test.
It has been argued that the more kinesiophysical your approach is, the more your
test can be deemed a medical test.
Functional Capacity Evaluations as a whole have progressed significantly since
the early 1980s and they require further research and improvement. Never pick
one training session or approach to learn how to perform FCEs. Every approach
and course provides excellent knowledge to improve your skills as an expert
Functional Capacity Evaluation tester.
Last revised: October 17, 2013
By Jim Mecham, MSIE, OTR/L,
CPE
