Functional Capacity Evaluation (FCE) and Legal Testimonial ServicesPhysical Therapy Expertise in the Clinic and in the Courtroom
What is a functional capacity evaluation?
A functional capacity evaluation (FCE) is an extensive test that we administer to determine a person’s ability to carry out specific daily and work tasks. We use a testing protocol that is based on the Matheson system for functional capacity evaluation. This exam typically requires 4 hours of testing time. We have been performing this test for the past 14 years. It is safe, pragmatic, objective, and unbiased.
What questions can a functional capacity evaluation answer?
An FCE aims to answer 3 fundamental questions about a worker or injured individual:
- What can he physically do at this time?
- What is her potential for work?
- Did she try her best?
A report is prepared that details objective data showing exactly what a person is able to do. The test seeks to show safety, reliability, validity, practicality, and utility. In addition to the fundamental 3 questions, a variety of other questions can be answered such as:
- What is an injured worker’s endurance over a typical work day (eight-hour)?
- Does the injured worker demonstrate full physical effort, during the course of the exam?
- What are the safe work restrictions for this injured worker?
- Is the injured worker able to perform unique activities specific to that job?
- Does the injured worker have the physical tolerance to return to work in a target job?
What do we examine in an FCE?
The exam contains testing elements that examine a variety of different activities. Through the process of testing these qualities we are able to obtain a full, whole body picture of the worker that takes into account the unique qualities associated with every diagnosis. These tests include:
- Musculoskeletal screening of the upper extremities (UE), lower extremities (LE), head, neck and trunk for range of motion (ROM) and strength
- Neurological screening of the upper extremities (UE), lower extremities (LE), head, neck and trunk for sensation and reflexive response.
- Material handling tests that examine a variety of lifting and carrying activities.
- Non-material handling tests that examine tolerance to sitting, standing, kneeling, squatting, bending, walking, latter climbing
- Cardiovascular endurance quantified in metabolic equivalents (METS) and correlated to physical demand category (PDC)
Call a Physical Therapist as a Medico-Legal Expert
There is no medical specialty more qualified to provide expert opinions on physical functioning than physical therapists. Physical therapy is the unfinished business of medicine. Physical therapy plays a pivotal role in the lives of patients who have sustained impairments leading to disability.
Ten Reasons to Use a Physical Therapist as a Medico-Legal Expert
- Establish the relationship between biomedical forces and the patient’s injury or condition.
- Determine medical necessity of physical therapy and rehabilitation interventions.
- Participate in both the design and execution of a function and evidence-based return-to-work programs.
- Establish if the current or proposed provided of physical therapy services is appropriately credentialed.
- Identify the most cost-effective and appropriate treatment setting for the patient’s condition.
- Evaluate whether the physical therapy services being employed meet recognized standards of care, treatment guidelines and evidence-based practice.
- Determine patient/client’s compliance with their treatment program.
- Determine worker/worksite match in terms of safe, but efficient performance of critical job demands.
- Establish if there is significant functional improvement in the patient’s condition within a reasonable time period.
- Determine whether clinical documentation supports the level of services rendered or proposed.
Physicians play a dominant role on the disablement continuum between disease and impairment while, physical therapists are the providers of choice when attempting to differentiate and manage conditions that range between impairment and handicap status. This is not to say that physicians and therapists do not treat along the entire continuum. It simply points out the greatest impact each professional group offers. Physicians make “medical diagnoses” which are typically disease, pathology and impairment-based.
Physical therapists make “physical therapy diagnoses” generally descriptive of physical function or dysfunction in activities of daily living/ADLs, critical job demands, and among athletes. The confluence of medical, legal and administrative policies & procedures produces conflict in virtually every insurance line when it comes to determining who is the best medical provider to ask a specific question or call as a medico-legal witness regarding a patient’s condition, work status, and physical function.
Physical therapists do not replace, supplant or displace the medical necessity for physician services. We simply augment what others do within the complex healthcare delivery model(s). Physical therapists are not “Medical Doctors” or “Doctors of Osteopathy”. Physical therapists are graduating increasingly with entry-level “Doctorates of Physical Therapy” or DPT. This is the becoming the standard in physical therapy.