Under Scrutiny: The FCE Peer Review

Jun 14, 2016
Vic Zuccarello, OTR/L, CEAS II
Magnify glass focused on Functional Capacity Evaluation

What is a Peer Review?

Do you perform functional capacity evaluations? There are many varieties of FCEs - some established protocols and some "home-grown". While research tells us that none are completely valid and reliable, some are better than others. I am often asked by an attorney, a case manager, or an insurance adjuster to review a functional capacity evaluation and offer an opinion as to its scientific merit and consistency with current standards of practice. This is called an FCE Peer Review and will reveal whether the FCE Evaluator was acting as a scientist or enabler. Poor FCE’s do not pass the Daubert Test and will not be admitted into evidence at a workers’ compensation hearing.

Components of a Peer Review:

The process I follow includes the following steps and requires 5 to 8 hours depending upon the FCE report.

  • Review of the FCE report and the protocol(s) used.
  • Research on the Evaluator, referral source, and payer source.
  • Selection of supporting research and Peer Review report preparation.

Peer Review Fundamentals:

A Referral Question

FCE should answer a three-part referral question:

  • Can the subject work?
  • Does the subject have musculoskeletal impairment?
  • Did the subject try their best?

The Methodology/Philosophy Used

  • Psychophysical – The subject controlled the FCE (a subjective test).
  • Kinesiophyiscal – Evaluator controlled FCE (objective) based on observable changes in biomechanics. This superior methodology is better supported in the peer-reviewed medical research.

Is the Evaluator Certified in Performing FCE’s?

If not, they will not pass the Daubert Test as an expert and their opinion will be considered inadmissible.

Potential Referral Source/Payer Source Bias

  • Does the Evaluator work in a physician owned practice that referred the subject for testing?
  • Did the plaintiff attorney pay or instruct the subject to pay?

A Clear FCE Target

  • If there is a pre-injury job, did the Evaluator make an effort to secure an employer job description or rely solely on the subject’s description and/or the outdated Dictionary of Occupational Titles?
  • If not, was the full battery of potential material handling and non-material handling tasks assessed?

Facts Supporting a Logical Conclusion

  • Was data collected that allows for examination of consistency and quality of effort?
  • Was data collected for determination as to whether the subject’s symptom response was expected or unexpected?
  • Was that data used to guide the final recommendation?
    • If the subject participated fully, the Evaluator can project work capacity from the FCE data.
    • If not, the subject likely could perform higher, so no formal restrictions should be recommended.

How OccuPro Holds Up:

OccuPro offers a pathway to a recognized certification in functional capacity evaluation making you credible in the Forensic arena. Our targeted, evidence-based evaluation protocols provide a medically researched, kinesiophysical determination of effort and participation in testing. Your FCE data will support a logical, final conclusion that is within a reasonable degree of professional certainty. In short, your FCE will pass a Peer Review test.

Want to know more? We’d love to see you in class at our National Training and Education Center in Kenosha, Wisconsin! We also take our show on the road to train your staff. To learn more contact us at 866.470.4440.

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