I've learned many things over the years as an Industrial Rehab Specialist. My clinical training as an Occupational Therapist ingrained in me the importance of restoring function with the patients or clients that I work with, whether that is restoring function with ADL, or restoring function with essential job functions. I began my work with the industrial rehab population doing FCEs, as a relatively new grad, and to say it was overwhelming is an understatement. This feeling of being overwhelmed is often what I hear from therapists in my courses who are learning how to perform and administer an FCE. "There is so much to remember", "there is no way I'm going to remember all of this!"
If this sounds familiar, rest assured you are not alone. FCEs are challenging! Not only due to the legal and medical considerations for those clients seeking disability, or compensatory settlement for work comp cases, but also due to the complexity of many of the cases you may be presented with. Unfortunately, few clients you will evaluate are straightforward cases that fly through the FCE without any difficulty, or without any pain. Many of the clients that you are dealing with may have had a complex injury, chronic pain issues, prolonged time off work, secondary gain issues, and are not in a good place in their personal lives due to the disruption the injury has caused. As evaluators, we need to be aware of the underlying issues with our clients, so we can help put them at ease with the testing process to facilitate the best results for them. I was pleased to see the "Current Concepts in Functional Capacity Evaluation — A Best Practices Guideline" published by the Occupational Health Special Interest Group of the American Physical Therapy Association address this in their section titled "Psychosocial Screening and Comprehensive Pain Assessment"
I have a few tips that I want to share with you that will help you, as a clinician, to be an effective FCE evaluator.
Be prepared
Know the 'Referral Questions' prior to doing the FCE. It is important that you know what type of FCE you will need to perform to assist the referral source with this case. Some questions to ask:
- Is the client anticipated to return back to their job? Or going back to work in a modified duty position?
- Is this client being referred for vocational rehab?
- Is this client applying for disability?
Also, make sure you obtain the medical records, therapy records, and job description so you have as much information as possible before you even meet the client.
A thorough Musculoskeletal Evaluation needs to be done
This is one of the most important aspects of the FCE, as the musculoskeletal findings will help you predict their function, help you to distinguish whether the client is demonstrating symptom magnification, and will help you connect the dots if the client is not presenting as expected. Some specific clinical findings to look for that substantiate musculoskeletal and functional deficits:
- Erythema
- Edema/swelling
- Muscle atrophy
- Muscle fasciculations
- Decreased strength
- Decreased Active and Passive ROM
- Antalgic postures and movement patterns
- Increased joint temperature
- Special Tests
For spinal patients, there is great value in having a therapist with this specialty conducting the M-S evaluation or greatly expanding your knowledge to be able to evaluate diagnosis outside of your present comfort level.
Don't be afraid to ask questions.
No matter whether you are a seasoned FCE evaluator or a rookie, there will always be a situation that comes up that does not make sense. So please ask a colleague or a mentor that can help you navigate the situation. If you take an FCE course through OccuPro we would be happy to help you in the beginning get your first FCEs under your belt. For our thousands of software customers worldwide, we provide unlimited clinical support, and can help you determine the best course of action with any of your difficult cases.
I have found that the three tips listed above have helped me immensely to be a more effective evaluator. If you are thinking about incorporating FCEs into your practice, or are currently an FCE provider these tips will serve you well.
For any questions about FCE training or software, please do not hesitate to reach out to us at OccuPro to assist you in your FCE journey. Our contact info is 866.470.4440 or info@occupro.net.