The varied responses from other chiropractors never cease to amaze me when I ask if they are performing Functional Capacity Evaluations (FCE) in their offices. Some say they do not know what they are. Others get the “deer in the headlight” look and yet others go into a long dissertation of their office programs. So let us start at the beginning and work our way into what an FCE really is.
1. What is the background of the FCE?
The history of the FCE dates back to the 1920’s. It was originally used by occupational therapists to develop work programs for war veterans. Throughout the years many changes and adaptations have taken place. The terminology has undergone numerous transformations from Work Capacity Evaluation (WCE), a Physical Capacity Evaluation (PCE), a Work Ability Assessment (WAA) and finally, Functional Capacity Evaluation.
2. How do FCEs and chiropractic inter-relate?
Chiropractic’s basic premise that structure determines function can easily be determined with FCEs.
3. Are FCEs only for work-related injuries?
No. The FCE was initially used for evaluating human performance as it related to work demand; however, no longer is it isolated to this specific area. We all have had patients who have been injured in one form or another. They were taken off work so that the healing process can begin.
The question that used to drive me crazy was, “Doctor Arkfeld, can I go back to work?” My simple response was, “I do not know, do you think you are ready?” Now, with the ability to perform FCEs, I can answer that question and many others with reliable objective diagnostic testing.
4. What are the basic definitions of FCEs?
There are specific definitions that you will need to know when performing FCEs. These are the three basic ones used daily.
1. Critical Demands
The associated physical properties that must be performed in order to complete the essential functions.
2. Essential Functions
The tasks that must occur in order for a given job task to be completed.
3. Dictionary of Occupational Titles (DOT)
Created by the US Department of Labor, the directory provides a description of the nature of work for a given industry or job duty, required skills and education and identifies the physical demand level of the job position. The first publication was in 1939 and contained 17,500 job definitions.
5. Is a job description necessary?
To perform an FCE, it is helpful to have some knowledge of the patient’s job description. This way you can tailor your FCE to see if this person can meet the critical demands of the job.
6. Are all FCEs alike?
No, you will perform the evaluation based upon the job description.
7. Do you always need a job description?
No, in that case you will not be performing an FCE, but a Physical Demand Level (PDL).
8. What are the five current PDLs?
That which requires exerting up to 10 pounds of force occasionally (0-33% of an eight-hour workday) or primarily seated work.
Exerting 20 pounds of force occasionally or negligible weight frequently (34% – 66% of an eight-hour workday), and may also involve standing and walking to a significant degree.
Exerting up to 50 pounds of force occasionally, 20 pounds frequently or up to 10 pounds constantly (67% to 100% of an eight-hour workday).
Exerting up to 100 pounds occasionally, 50 pounds frequently or 20 pounds constantly.
5. Very Heavy
That which requires exerting greater than 100 pounds of force occasionally, greater than 50 pounds frequently and 20 pounds constantly.
9. What type of practice can benefit from performing FCEs?
Every type of practice can benefit from performing these evaluations. Cash practices can use this as a patient education tool. Managed care, personal injury and worker’s compensation practices gain valuable insight as to what the patient can and cannot do.
The outside marketing of FCEs to insurance companies, attorneys and to industry is wide open.
10. What are the financial opportunities?
The additional revenue center for clinics is limitless. Never again will chiropractors have to worry about where new patients will come from. By having the software and equipment capable of performing FCEs, the referrals will be at a constant rate.
11. Who else performs FCEs?
At this time physical and occupational therapists (PTs and OTs) are taking the leading role in this arena. They are working closely with industry in post-employment screening, baseline testing and FCEs. As Doctors of Chiropractic, the function of a patient always has been our greatest concern. Technology has given us the tools to measure how patient’s structure can determine their function. No longer can we take a back seat to the PTs and OTs in this area. Chiropractors all over the country have a wonderful opportunity in this market and the time is now.