The Benefits of a Quality Functional Capacity Evaluation
By Joseph Castronovo, DPT, MTC Illinois Bone and Joint Institute, LLC
In recent months, I have participated in multiple conversations regarding Functional Capacity Evaluations (FCEs) and how the results have weakened the defense’s case. Several defense attorneys have suggested that a FCE generally causes further problems in litigation, and they prefer to work with just the physical therapy notes and reports. Often, they feel the patient performs at a lower level during the FCE than they do in therapy, and yet the test comes out valid. As a seasoned physical therapist and a veteran of over 500 FCEs, I concur with this observation. In my capacity as an expert witness, I have seen first hand how a subpar FCE has labeled a capable human being, who can cast a fishing pole and launch his boat, to total and permanent disability and entitled to a lifelong pension. However, a quality FCE can be beneficial to all parties. So, what to look for when finding a quality FCE and when should a client be referred for a FCE?
First, a FCE is needed to determine a person’s ability to work safely, however, all WC injuries do not need to be referred for a FCE. I agree with the notion that the physical therapist’s notes throughout therapy and work conditioning are generally sufficient to determine a person’s work ability. However, there are several additional factors to consider. The longer a person has been off work, the more likely they will need a FCE to determine function, due to “deconditioning syndrome.” Deconditioning syndrome according to Mayer and Gatchel in Functional Restoration For Spinal Disorders” represents the loss of physical capacity attendant upon disuse that leads to many manifestations of chronic disability.” In essence, the longer the time of disability and the more extensive the surgical procedure, the greater the postoperative physical capacity deficits that need to be addressed as part of the recovery process. Thereby, a therapist is no longer simply addressing deficits in a knee, for example, but dealing with multiple issues from disuse. If a therapist has a prescription for a knee, documentation will be mainly on the knee, and will not address all of the physical deficits needed for work duty.