Functional capacity evaluation

A functional capacity evaluation (FCE) evaluates an individual's capacity to perform work activities related to his or her participation in employment (Soer et al., 2008).  In essence, an FCE's primary purpose is to evaluate a person's ability to participate in work, although other instrumental activities of daily living that support work performance may also be evaluated. Similar types of testing may also be called a functional capacity assessment (FCA), physical capacity assessment or evaluation (PCA or PCE), or work capacity assessment or evaluation (WCA or WCE). A well-designed FCE consists of a battery of standardized assessments that compare the demands of a job to an individual's physical functioning and can predict their ability to return to work.  Traditionally, FCEs measured an individual's ability to perform the physical demands of a job, but a Cognitive Functional Capacity Evaluation includes evaluation of cognitive demands if such testing is requested, e.g. if a worker sustained a TBI. The FCE is administered with care for the client's safety and well-being and next-day follow-up is standard procedure.

Who Can Benefit From an FCE?

  • Someone who has been injured on the job to determine his or her ability to return to the job or alternate work
  • Someone applying for Canadian Pension Plan or Long-Term Disability benefits (Great West Life or SunLife)
  • Someone injured in a catastrophic accident (i.e., motor vehicle accident) to determine readiness to initiate a graduated return to work (GRTW)
  • Someone seeking vocational rehabilitation services to re-enter the workforce after prolonged disability

Occupational Therapy's Role in FCEs
The ability to analyze job demands and determine the individual physical skills that make up each task is a unique core skill of occupational therapists, based on their education and training. FCEs typically require the evaluator to determine the worker's capability to perform various work-related tasks and whether there is a match between these abilities and the essential job performance components. Occupational therapy practitioner are trained to bring a holistic view that considers the complex and dynamic interactions between the person, the environment, and the occupation.

The FCE may be used to determine:

  • Goals for rehabilitation or readiness for return to work
  • Ability to safely return to work status (including full duty, modified duty, or transitional duty)
  • Ability to consider alternate forms of employment in the same career (e.g. moved to supervisory position to lessen physical work)
  • Ability to consider any other form of employment or need to consider re-training
  • Work ability status for vocational rehabilitation
  • Capacity or Disability status

What Are the Components of the FCE?
The methodology of the FCE is consistent, but the components of the FCE will vary based on the individual's injury and job demands. The FCE typically begins with a medical record review, client interview, medical record review and musculoskeletal screening. Functional testing may include graded material-handling activities such as lifting, carrying, pushing, and pulling; and positional tolerance activities such as sitting, standing, walking, balancing, reaching, stooping, kneeling, crouching, crawling, object handling/manipulation, fingering, hand grasping, and hand manipulation. Pain monitoring is frequently performed during the FCE to document client-reported levels of pain during various activities as well as the ability to manage pain. The FCE may also include evaluation of an individual's hand dexterity, hand coordination, endurance, and other job-specific functions.

The FCE report includes an overall physical demand level (U.S. Department of Labor, n.d.), a summary of job-specific physical abilities, a summary of performance consistency and overall voluntary effort, job match information, adaptations to enhance performance, and treatment recommendations. Upon request, FCEs are designed to also report on the worker's ability to meet the cognitive demands of the job.

FCEs are done on a one-on-one basis and may range in length from 4 to 7.5 hours. The FCE may take place over 2 consecutive days.

Referral and Payment for FCEs
People are generally referred for an FCE by physicians; allied health professionals; insurance representatives; case managers; employers, human resources personnel, and risk managers; or lawyers (for either the plaintiff or defense). Individuals can also self-refer.

FCEs are paid for by insurance plans; provincial agencies; individuals themselves, employers, or law firms.

Rates for rehabilitation purposes are $1,750.

Please feel free to contact us to discuss your need for an FCE.