Functional

Capacity
◤
Evaluation

A beginner's guide to FCEs

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What is a Functional Capacity
Evaluation (FCE)?

▪ FCEs are assessments containing a series of tests to determine a

client’s ability to meet the functional demands associated with their
occupation.

▪ Matches the client’s abilities with job demands, thus ensuring

appropriateness of role for the injured worker.

▪ A typical evaluation will include performing tasks with weights and

completing specific movements such as lifting and bending.

▪ These tasks will replicate the requirements and demands of your role
as referenced in your job description, or after a job task analysis and
worksite assessment.
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What does an FCE usually cover?

▪ Client’s history and background (including social, psychosocial,

physical domains)
▪ Medical history and current medical concerns
▪ Job task analysis (if available) or breakdown of day-to-day tasks
expected as part of the job requirement
▪ The tasks/assessments may involve using weights and specialized
equipment and look at specific movements such as bending and lifting.
▪ FCEs can take 2-6 hours depending on the demands and expectations
of the job, and clients should be encouraged to wear their usual
workwear or clothing that they can complete tasks in (e.g., a worker in
the mines should bring their own steel cap boots and hard hat to
assessment as they would be expected to complete tasks wearing this
equipment).
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Who would usually complete a
Functional Capacity Evaluation (FCE)?

A FCE should be completed by an accredited and registered Allied Health

professional – some examples of these include:
▪ Occupational Therapists
▪ Physiotherapists
▪ Exercise physiologists
▪ Accredited Nurses
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When should an FCE be used?

▪ To determine safety of worker’s performance in current role

▪ Current capacity for suitable duties following injury or illness

▪ To determine capacity for full duties before receiving a full

medical clearance

▪ Where a client's treating doctor is unable to provide clear and

specific return to work medical guidelines

▪ To identify a suitable return to work plan

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Components of an FCE
Typical Components of a Functional Capacity Evaluation

▪ Initial interview

▪ Musculoskeletal exam (this could include assessment of gait, posture,

flexibility, range of motion, muscle strength, and neurological testing)

▪ Predictive aerobic capacity assessment (this could include a small endurance

test)

▪ Static/Consistency (Isometric) testing (examples include pinch, pull and push,

grip strength)

▪ Manual handling & dynamic lifting tasks (e.g., lifting, bending)

▪ Non-Lifting/Positional tolerance testing (e.g., sitting, standing, walking)

It is worth noting that different providers will have different standardised tests they prefer and that this is a general guide only.
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Subjective Vs Objective Assessment
▪ Subjective (What the patient says) — Information or data from the client’s point of
view. This will usually include feelings, perceptions, or concerns vocalised during
initial assessment or subsequent meetings.

▪ Subjective assessments usually involve open-ended questions and are client led.
▪ Example: A client reports pain at a 5/10 level when completing lifting and twisting activities after a
right shoulder injury.

▪ Objective (What the health professional observes or sees) — Information or data

that is observed (actually seen) and measurable. This will usually include
observations from physical examination, standardised assessments, or diagnostic
testing.
▪ Example: A client completes a hand grip strength assessment using the JAMAR tool (equipment
used to measure grip strength) and scores 50, 49 and 53 over three attempts.
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Initial interview

During an initial interview, it is important to gather as much information as possible to

help shape your evaluation and recommendations. During this interview, the therapist
will try and get an overview of:

▪ Subjective pain report and rating

▪ Subjective history of capabilities and limitations – what the client reports they can
do vs what they report they cannot do

▪ Work history – Have they previously been employed elsewhere? What are their
transferable skills?

▪ During this initial interview, the therapist will also complete their own observations,
such as how the client entered the facility, their sitting/standing tolerance during
the interview, and if their perceived abilities match the observed abilities.
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Musculoskeletal Exam

▪ The musculoskeletal exam sets out to understand the client’s physical capacity and
identify any areas of concerns. It may include:

▪ Posture (sitting & standing)

▪ Range of motion (ROM)

▪ Muscle strength – Is manual muscle testing consistent with the injury? What are the
compensatory patterns observed?

▪ Gait (walking pattern) – Did the client use an assistive device? Consider the speed and
rhythm of movement.

▪ Flexibility
▪ The next slide consists of example tasks that may be completed during an FCE on a manual
labour worker that assess any of the above that correlate to work-based activities.
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Example of Musculoskeletal tasks.

Assessment/Task Procedure What is being assessed?

Single leg stance Three reps of standing on a single leg Measures balance and stability
for five seconds on each leg
Forward bend at hips Forward flexion at hips Assesses flexibility

Dynamic lunges 10 reps per leg Assesses endurance and muscular

strength

Straight leg raise Flexion at hips whilst maintaining Assesses flexibility

straight leg

Cobra pose Lying on stomach, pushing up with Assesses Range of motion

hands, extending the back without lifting
hips from the floor

Plank hold followed by push ups 15-second plank hold on hands Assesses core strength, stability and
followed by 10 push ups (can be on endurance
toes or knees)

Posture observation Observations of general posture in Assesses postural alignment indifferent

standing and sitting positions
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Aerobic capacity/Endurance testing

▪ Helps determine maximum VO2 levels (VO2 is your maximum

aerobic capacity).

▪ Examples of this can be completing a repetitive task and

observing when Client’s heart rate raised or a step-up or
treadmill-based task.

▪ Most employees in an average workday will not be required to

meet their maximum VO2 rate and so it is important to take this
into consideration when setting the task/test. The key
component to look for here is the ability to complete tasks
without excessive fatigue or exertion.
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Isometric testing

▪ Isometric testing is used to assess muscle strength.

▪ Strain testing (pinch, grip, push and pull).

▪ Standardised assessments that can be measured and repeated.

▪ The results can be compared to age and gender norms for reference.

▪ For example: Hand grip strength test using the Hand Grip
Dynamometer tool. Hand grip strength is often used as an indicator of
a person’s overall strength.
▪ Completing this test ensures the client has enough strength to complete
the rest of the functional assessments (including manual handling tasks).
 ◤ Manual handling tasks
▪ During a Functional Capacity Evaluation, a number of common
manual handling tasks are assessed.

▪ The common tasks that would be assessed include:

▪ Lifting
▪ Pushing
▪ Pulling
▪ Dragging
▪ Carrying
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Manual Handling Tasks

▪ The client would be expected to complete a series of manual handling tasks that
formed part of their day-to-day work.

▪ The therapist or assessor would also be looking for demonstration of correct manual
handling techniques when completing these tasks to reduce the risk of injury going
forward.

▪ Dynamic lifting tasks would also be expected to be completed, such as carrying a set
weight over a set distance.
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Positional Tolerance

▪ The tasks will be set to observe a client's ability to sustain a

postural position for the required amount of time. These can be
generic or job task related.

▪ A therapist will also observe a client throughout the evaluation to

assess their positional tolerance.
▪ An example of this would be sitting tolerance, taking note of how
long the person was seated during the initial interview and any
behaviours that may suggest difficulty sustaining for a longer
duration (e.g., scooting on chair, weight shifting, relieving pressure
constantly).
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Positions used commonly in day-to-day activities

▪ Standing
▪ Sitting
▪ Walking
▪ Bending
▪ Squatting
▪ Kneeling
▪ Balancing
▪ Reaching

This Photo by Unknown Author is licensed under CC BY-ND

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Completion of the FCE

▪ Once the series of tasks concludes, a report must be

completed.
▪ The assessor will sit down and review the collected data and
analyse results.
▪ The performance analysis will look at all factors that could
influence data, including effort, self-limitations (did the person
self-terminate the task despite nil observed physiological or
biomechanical indications?) and inconsistent performance
(observations not meeting expected outcomes).
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FCE report
▪ Clearly identify current capacities applicable to their work
▪ A performance analysis which encompasses not just the data but clinical reasoning
on the data and how and why this will impact work.
▪ The report would also set out recommendations on return to work, modified duties,
and interventions.
▪ The report should be objective in nature.
▪ Summary of capacity to perform objective functional tasks, including lifting, carrying,
dynamic and positional tolerances
▪ Summary of capacity to perform job-specific tasks completed during FCE
▪ Opinion and recommendations on the employee’s ability to perform pre-injury duties
▪ Opinion and recommendations with regards to suitable duties or modified duties as
well as transferable skills
▪ Opinion and recommendations on any future rehabilitation needs identified