Functional Capacity Evaluations: Importance of Consistency and Effort

Amy Dockter, MPT, CEAS, National Product Manager, Select Medical’s Functional Capacity Evaluation

Did you know a study by Virginia Commonwealth University identified more than 700 different methods of assessing function?  As a physician, insurance representative, vocational counselor, attorney, employer or patient, it is important that the method used to assess function, return to work or disability decisions is based on the most clinically relevant research and offers safety, reliability and validity.

In 2018, the Occupational Health Special Interest Group of the American Physical Therapy Association (APTA) developed a best practices guideline for Functional Capacity Evaluations (FCE)to promote clinical excellence, accountability and consistency.

Select Medical’s FCE product meets all the standards published in the guideline. Our adherence to the best practices include:

  • FCEs are performed by physical or occupational therapist who demonstrate evidence of education, training and competencies regarding the design, administration and interpretation of data.
  • The examination includes:
    • Cardiovascular/pulmonary system
    • Musculoskeletal system
    • Neuromuscular system
    • Psychosocial principles
    • Body mechanics and work behaviors
    • Integumentary system
  • While administering the evaluation, clearly defined end points including physiological, biomechanical and psychophysical factors are monitored and documented.
  • Aerobic response is an important factor in determining an individual’s ability to sustain work activity. The preferred method of reporting is METs which can be compared to functional activity.
  • It is recommend that force exertion testing (lifting, carrying and push/pulling) follow established protocols which are designed to be progressive and include monitoring of the cardiorespiratory, musculoskeletal and psychophysical responses to testing.
  • Positional tolerance work tasks address the individual’s ability to assume, maintain and return from the position are incorporated and functional by including reaching and manipulating tasks.
  • When interpreting the results, determinations about exertion are based off the preponderance of data. Although a number of methods exist to determine exertion, no one component alone should provide the conclusion for sincerity of effort. Instead, conclusion is based on the presence of physiological and biomechanical signs (e.g., heart rate, respiration rate, muscle recruitment and consistency of movement patterns) in combination with clinical examination findings and symptom reports.
  • Pain or other symptoms are correlated with objective changes in physical signs, including heart rate, blood pressure, muscle spasm, joint warmth and/or swelling.
  • If it is determined an individual’s pain/symptoms are consistent with objective medical evidence, and the individual has demonstrated signs associated with significant effort during testing, the examiner adjusts the final recommendations to reflect activity levels that are expected to better accommodate safe work tolerances and be sustainable over time in a productive work environment.

In addition to being consistent with the guideline published by the APTA and other best practice evidence, Select Medical’s proprietary program assures quality assurance be performed on each report prior to finalization. We believe we have one of the best FCE products in the industry, but are always interested in feedback from our customers.

If you would like to read more from Current Concepts In Functional Capacity Evaluation: A Best Practice Guideline, please click here:

Complimentary Webinar:
Join us on November 9 at 2:00 p.m. eastern for a one hour complimentary webinar on Functional Capacity Evaluations for CCM, CRC and nurse CEU credits. Register today:

  1. CURRENT CONCEPTS IN FUNCTIONAL CAPACITY EVALUATION: A Best Practices Guideline (Adopted April 30, 2018) Steve Allison, P.T., DPT, MHS; Jill Galper, PT, MEd.; David Hoyle, PT, DPT, MA; Jim Mecham, OTR/L, MS