Peg Hau, APTSM

Are they worth their weight??
Peg Hau OT/CHT
Advanced Physical Therapy & Sports Medicine
 In developing diagnostic tests, we must remember
that it is better to miss an insincere individual than
to classify a sincere patient as insincere. Tests must
be chosen carefully, and if multiple tests are used,
they must be administered in a logical order.
 Ahmer, 2007
History of the FCE
 A functional capacity evaluation
is set of tests, practices and
observations that are combined
to determine the ability of the
evaluated to function in a variety
of circumstances, most often
employment, in an objective
 1970’s beginning
 2001critized as not being job
Reneman et al, 2001
What is an FCE
 Evaluates and individuals ability to perform work ax’s
related to his/her employment
 Similar types of testing
 Consists of standardized assessments
 Administered with care and safety in mind
(Kuijer et al., 2011; Soer, et al., 2008).
Why are they ordered
 Baseline
 Pre employment
 Job Specific
 Medical/legal
 Assisting with case closure
Who can benefit from an FCE
 Individual injured on the job
 Applying for Social Security Disability
 Seeking to return to work after extended leave
 Someone seeking vocational rehabilitation
 Transition from school to work setting
 FCEs are done on a one-on-one basis and may range in
length from 4 to 6 hours.
 The FCE may take place over 2 consecutive days.
Components of an FCE
History review – medical, vocational, social
Screening tests – musculoskeletal
Physical functional testing – based on DOT
Job simulation – when identified job is
Behavior assessment
Results, data compilation, and
Types of FCE’s
Ergo Science
Isernhagen Work System
Ergos Work Simuolator and Ergo Kit Variation
Hanoun Medical
Ergo Science
 Developed in 1988 by Deborah Lechner PT,MS
 Administrators must complete 24 hours of instruction
 Used in 850 clinics
ARCON Science
 30 years of development
and refinement.
 1,000 clinics nation wide
ARCON continued
 The Arcon system includes:
Computerized hand and pinch gauges.
Electronic goniometer.
Dual range of motion inclinometers.
Dynamic and isometric lifting system.
Carpal tunnel testing attachment.
Computerized heart rate monitor.
Testing protocols includes:
Dynamic lifting.
Isometric testing extremities & back.
Range of motion testing.
Dexterity testing.
Endurance testing.
Activities of daily living.
Iserhagen Work System
 Susan J. Isernhagen PT created the first functional capacity
evaluation in the mid 1980’s.
Redeveloped in 2004
Objectivity of results to replace the subjective estimates that
were currently being used
Medical base to tie the functional capacity and limitations into
current diagnoses
Information on level of effort, to identify those who used full
effort and those who did not use full effort.
Safety in functional tests so that this information could lead to
safe return to work
Work relatedness to determine abilities to perform specific
Iserhagen continued
 The Relevance for Nondiscrimination Compliance by
Susan Iserhagen - 2010
 A unique FCE
 called the WORKEVALTM and it helps Physicians, Case Managers and
Employers determine what work limitations are appropriate for the
injured worker.
 We also provide Physicians with the objective data they
need to determine the injured worker's Permanent and Partial
Disability, or PPD. The name for
 this evaluation, which was developed and published by the American
Medical Association, is a Permanent Impairment Evaluation. This
evaluation process determines the percent of Permanent, Partial
Impairment and that percentage
 is used to help Patients, Employers, Insurers and Attorneys negotiate
the settlement of the Workers' Compensation Case.
Ergos Work Simulator
Hanoun Medical
 Strength & dexterity testing
 Protocols
 Fatigue analsyis software
 ????????????
 Functional Medicine Evaluation (FME) vs. Functional
Capacity Evaluation (FCE)
 Key
 Glenda Key
Founder and President
 1987
 300 clinics & 42 states
 Double blind testing
Physical Examination
Heart rate and blood
Posture and gait
Range of motion
Other special testing as
Functional Testing continued:
•Sustained overhead activity
•Climbing ladders
Functional testing
Floor to waist/
shoulder/overhead lift
Functional Testing cont:
•Grip strength
•Pinch strength
•FMC/9 hole peg/Purdue
Less than Full Effort Performance
 Reasons for ……..
 1. Medically determined impairments
 2. Malingering
 3. Factitious disorder
 4. Learned illness behavior
 5. Conversion disorder, pain disorder
Matheson, 2003
Depressive disorder
 7. Test anxiety
 8. Fear of symptom exacerbation or injury
 9. Fatigue
 10. Medication & psychoactive substance
 11. Lowered self-efficacy expectations
 12. Need to gain recognition for symptoms
 6.
Methods to identify inconsistancy
 Intra test inconsistency
 Absence of expected relationships among measures.
 Completion of tests and willingness to do more
 Coefficient of variation
 Rapid exchange grip
 Correlation of heart rate with reported max effort
 Correlation of impairment (range of motion, manual
muscle tests, etc. ) to function
Non-Organic Signs
 Pain Questionaire
 Waddell
 McGill Pain Questionaire
 Ransford
 Numeric pain scale
 Million Visual Analogue
Million Visual Analogue Scale
 The Million visual analogue scale
 The Million visual analogue scale (MVAS) (Table 15) is a 15-item
questionnaire about disability and pain intensity in patients with
LBP.38The 15 questions investigate the body functions (pain,
sleep, stiffness and twisting), daily activities (walking, sitting,
standing and work) and social life. Information about item
selection process is not available. Score is given on a 100 mm
visual analogue scale(VAS). For example, if patients are asked to
quantify the severity of his pain (like the first question), they
mark a point on a 100-mm line in which the end points are
labelled as ‘no pain’ and ‘intolerable’. In each question, it is
possible to obtain an index of severity of symptoms in a patientspecific fashion measuring the distance of the marked point
from the origin of the line. The final score is calculated by
adding up the equally weighted scores.
Physical Demand Characteristics
of Work
Chapman-Day, K. M., Matheson, L. N., Schimanski, D., Leicht, J., & DeVries, L. (2011). Preparing
difficult clients to return to work. Work (Reading, Mass.), 40(4), 359-367. doi:10.3233/WOR-20111247; 10.3233/WOR-2011-1247
Gouttebarge, V., Kuijer, P. P., Wind, H., van Duivenbooden, C., Sluiter, J. K., & Frings-Dresen, M. H.
(2009). Criterion-related validity of functional capacity evaluation lifting tests on future work
disability risk and return to work in the construction industry. Occupational and Environmental
Medicine, 66(10), 657-663. doi:10.1136/oem.2008.042903; 10.1136/oem.2008.042903
Gouttebarge, V., Wind, H., Kuijer, P. P., Sluiter, J. K., & Frings-Dresen, M. H. (2010). How to assess
physical work-ability with functional capacity evaluation methods in a more specific and efficient
way? Work (Reading, Mass.), 37(1), 111-115. doi:10.3233/WOR-2010-1084; 10.3233/WOR-20101084
Streibelt, M., Blume, C., Thren, K., Reneman, M. F., & Mueller-Fahrnow, W. (2009). Value of
functional capacity evaluation information in a clinical setting for predicting return to work. Archives
of Physical Medicine and Rehabilitation, 90(3), 429-434.
Westbrook, A. P., Tredgett, M. W., Davis, T. R., & Oni, J. A. (2002). The rapid exchange grip strength
test and the detection of submaximal grip effort. The Journal of Hand Surgery, 27(2), 329-333.
Wind, H., Gouttebarge, V., Kuijer, P. P., Sluiter, J. K., & Frings-Dresen, M. H. (2009). Effect of
functional capacity evaluation information on the judgment of physicians about physical work ability
in the context of disability claims. International Archives of Occupational and Environmental
Health, 82(9), 1087-1096. doi:10.1007/s00420-009-0423-8; 10.1007/s00420-009-0423-8

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