What is a Functional Capacity Evaluation (FCE)?

THE FUNCTIONAL CAPACITY EVALUATION (FCE)

Our peer-reviewed functional capacity evaluation (FCE) is based on the Dictionary of Occupational Titles-Residual Functional Capacity (DOT-RFC) Battery.^1,2 The DOT-RFC Battery was created by Dr. Fishbain to identify the medical impairment of a person, express it in terms of functional limitations, and ultimately calculate the person’s actual work capacity.¹ The Dictionary of Occupational Titles (DOT) is used in the evaluation process and defines numerous occupations and categorizes them into one of five progressively increasing strength classifications: sedentary, light, medium, heavy, and very heavy.³

The DOT-RFC Battery tests over 30 different job-related tasks (such as climbing, balancing, stooping, crouching, crawling, walking, kneeling, etc.) that an individual may be required to perform for any given occupation. The Battery measures an individual’s functional capacity based on peer-reviewed norms. In other words, the norms for each job-related task tested along with the strength classification of a given occupation must be obtained in order for a person to return to that particular occupation in a safe and dependable manner.

This FCE is used in conjunction and in compliance with the most current versions of the APTA Standards of Practice for Physical Therapy⁶, the APTA Guide to Physical Therapist Practice, the AOTA Occupational Therapy Practice Framework: Domain & Process⁷, the International Classification of Functioning, Disability and Health⁸, AMA Guide to the Evaluation of Functional Ability: how to request, interpret, and apply functional capacity evaluations⁹, and Current Concepts in Functional Capacity Evaluation: A Best Practices Guideline Adopted April 30, 2018, APTA.¹⁰

DOT-RFC BATTERY IS EVIDENCE BASED.
The DOT-RFC Battery was found to demonstrate:

• Excellent Face and Construct Validity_^2,4
• Good Test/Re-Test Reliability^1,5
• Good Intra-Rater Reliability^1,5
• Strong Content Validity^2,4
• Predictive Validity²

ADDITIONAL TESTING FEATURES (COMPONENTS)
DOT-RFC BATTERY includes additional tests & measurements such as consistency of effort (reliability & validity testing), full-time work tolerance, work simulation option, outcome measurements, and cardio-respiratory testing that are critical to creating a comprehensive & complete report that assists in determining a client’s actual functional abilities and work capacity. A list of all tests and measurements are as follows:

• Pre-Screen – Vital Signs, Physical Activity Readiness Questionnaire (PAR-Q), Medical History
• Dynamic Material Handling Testing (Push, Pull, Lift, Carry) utilizing Heart Rate Monitors throughout the FCE and endpoint determinations for safety: Physiological (Cardiovascular/Metabolic), Biomechanical (Safety, body Mechanics), Psychophysical, and External.
• Work Simulation Testing
• Full-Time Work Tolerance Test
• Sit, Stand, Walk Testing
• Systems Review/Physical Examination
  • Inclinometer Range of Motion Manual Muscle Testing
  • Orthopedic/Neurological Specials Testing
  • Volumetric/Circumference Testing
  • Palpation Screen
  • Gait Screen/Motor Screen/Cognition Screen
• Functional Activity Testing – climbing stairs, ladders, stooping, kneeling, crouching, crawling, repetitive reaching, foot controls, forward bending.
  • Plus Several Standardized Testing Procedures:
    • Stair Climbing Test
    • Stooping/Forward Bending Test
    • Kneel Tolerance Test
    • Repetitive Squat Test
    • Repetitive Crouching Tests
    • Overhead Reaching Tests
    • Side to Side Reaching Test
    • Repetitive Standing Heel Rise Test
    • Lower Extremity Motor Coordination Test
• Sensory Testing
  • Texture, Temperature, & Object Recognition Testing
  • Semmes Weinstein Monofilament Testing
  • Two Point Discrimination Testing
• Balance Testing – Static & Dynamic
  • Function Reach Test
  • Single Leg Stance Test
  • Standing/Walking Balance
  • Crouching Balance
• Gross & Fine Motor Testing
  • Grip strength
  • Pinch Strength Testing
    • Tip Pinch
    • Key Pinch
    • Chuck Pinch
  • Moberg Pick-up Testing
  • Purdue Pegboard Testing
  • Box & Block Testing
  • Minnesota Manual Dexterity Testing
• Job Demand Analysis
• Pain/Psychosocial Screening and other outcome scales:
  • Craniomandibular ADL Scale (CADL)
  • Neck Disability Index
  • Oswestry Low Back Disability Index
  • Disability of Arm, Shoulder & Hand
  • Lower Extremity Function Scale
  • Body Mechanics Scale
  • Posture Scale
  • Mental Status Exam
  • SF-36 Health Survey
  • Lifestyle Risk Questionnaire
  • Beck Depression Scale
  • McGill Pain Questionnaire
  • Pain Drawing
  • Carpal Tunnel Questionnaire
  • Headache Disability Inventory
  • Dizziness Handicap Inventory
  • Resumption of Activities of Daily Living Scale
  • Functional Abilities Confidence Scale
  • Rivermead ADL Scale
  • Barthel ADL Index
  • Borg Scale: 0 to 10 Scale
  • Borg Scale: 6 to 20 Scale
  • Spinal Function Sort Test
  • Hand Function Sort Test
• Occupations Compared to the Dictionary of Occupational Titles (DOT) database &/or ONET Database.
• Consistency of Effort Testing
  • Observation Methods
  • Lifting Heart Rate Methods
  • AMA Observable Pain Behavior Scale
  • Rapid Exchange Grip Test
  • 5 Position Grip / Bell Shape Curve Test
  • Hoover Test
  • Waddell Non-organic Signs Test
  • Horizontal Strength Change Tests
  • Borg CR-10 Visual Observation Scale
  • Credibility Assessment Tool
  • Performance APGAR Scale
  • Several Reliability Checkpoints
• Cardio-respiratory fitness testing
  • YMCA Step Test
  • Queens Step Test
  • Astrand-Ryhming Step Test
  • Arm (UBE) Crank Test
  • 6 Minute Walk Test
  • Cooper 12-Minute Walk/Run Test
  • 3 Minute Bike Test
  • Fox Ergometer Test
  • Astrand Ergometer Test
  • Single Stage Walking Test

REFERENCES

1. Fishbain DA, et al. Measuring residual functional capacity in chronic low back pain patients based on the Dictionary of Occupational Titles, SPINE 1994;19(8)872-880.
2. Fishbain DA, et al. Validity of the Dictionary of Occupational Titles-Residual Functional Capacity Battery. Clin J Pain 1999;15(2):102-110.
3. U.S. Department of Labor, Employment and Training Administration. Dictionary of Occupational Titles, 4th edition: Supplement. Washington, DC: U.S. Government Printing Office, 1986.
4. Innes E, Straker L. Validity of work-related assessments. WORK 1999;13(2):125-152.
5. Innes E, Straker L. Reliability of work-related assessments. WORK 1999;13(2):107-124
6. Guide to Physical Therapist Practice 3.0. 2014; http://guidetoptpractice.apta.org/.
7. Association AOT. Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy. 2014;68(Suppl. 1):S1-S48.
8. International Classification of Functioning, Disability and Health (ICF). http://www.who.int/classifications/icf/en/. Accessed 11/17/17.
9. Genovese E, Galper J. Guide to the Evaluation of Functional Ability: how to request, interpret, and apply functional capacity evaluations. American Medical Association. 2009.
10. Current Concepts in Functional Capacity Evaluation: A Best Practices Guideline Adopted April 30, 2018, Academy of Orthopaedic Physical Therapy, April 30, 2018:1-43.
11. Konz S. NIOSH lifting guidelines. Am Ind Hyg Assoc J. 1982;43(12):931-933.
12. Dictionary of Occupational Titles. Vol II. Fourth ed: US Department of Labor; 1991.
13. The Revised Handbook for Analyzing Jobs. Washington, DC: US Department of Labor; 1991.

Schedule an FCE in Columbus, Georgia. Call (706) 225-2525