What is a Functional Capacity Evaluation?

A Functional Capacity Evaluation (FCE) is a series of assessments designed to gauge consistent, safe, and functional performance for specific movements or activities. The FCE often is not limited to testing a specific body part or region, but will look at the person as a whole. Areas commonly assessed include posture, mobility, flexibility, strength, balance, activity tolerance, body mechanics, coordination, and the ability to multitask.

FCEs are performed for a variety of reasons, and each is geared towards the needs of the individual participating in the assessment. Some FCEs are used to determine a baseline functional status after injury or illness, while others are geared toward assessing the ability to perform essential components of a specific job.

Will my insurance/benefits cover the cost of the FCE?

Many insurance companies do not cover the full cost of the FCE, but some will cover a portion of it, if it is considered medically necessary. Some companies may deny coverage initially, but may cover a portion of the FCE after an appeal.

How much does an FCE cost?

Depending on the length and complexity of the assessment, the cost can range from several hundred to over $1,000. FCEs are expensive to perform, as they often require specific equipment, a skilled clinician, and extensive one-on-one time. Many facilities will offer a discount on services, sometimes anywhere from 5% to 15%, if the individual is paying out of pocket. Larger organizations are often willing to implement payment plans, and might have some type of financial assistance fund for qualified individuals.

How will the results of the FCE be used?

The FCE is commonly mistaken as a test or evaluation that shows what you cannot do. A thorough FCE can provide very useful information to physicians and insurers regarding a person’s potential to return to a previous level of function or previous job. The FCE is designed to test a wide variety of skills and tasks to determine the boundaries for activities an individual can perform regularly and safely without restrictions, which activities require restrictions or reasonable accommodations to be performed consistently and safely, and activities that are unable to be performed.

The purpose of the FCE is to gauge overall function. A person who does poorly on lifting and carrying tasks may do well on more sedentary tasks or vice versa. Someone with a right limb injury may not do well with tasks focusing on the right limb, but may do well with tasks using the left limb. This information can be useful for determining the ongoing appropriateness of the treatment plan or it might alter the intensity of rehabilitation, resulting in a shift from emphasis on returning to a previous activity to being retrained for alternate activities and functions. Accurate results can yield better quality of care. It is important for an individual to perform to his or her best ability on the FCE in order to obtain accurate results. The assessment is designed in such a way that if a person is not providing his or her best efforts, it can skew the results. It’s absolutely normal to be nervous or apprehensive about performing tasks that might be difficult or painful, especially when those tasks are unknown. The therapist performing the FCE will generally describe each of the tasks prior to testing, and answer any questions to improve understanding and lessen anxiety.

I’m worried that I’m not going to have enough strength or endurance for the FCE. Should I take frequent breaks so that I can finish the test?

It is acceptable to utilize pain management, especially nonpharmacologic strategies or energy conservation techniques, during the FCE. However, it is also important to use these strategies as needed and not magnify needs or symptoms. An inaccurate or invalid FCE result due to self-limiting performance reflects poorly on the individual participating in the FCE, and can impact a physician’s willingness to continue a particular course of treatment or an insurer’s continuation of benefits or coverage.

It is important to communicate with the FCE therapist about any pain, discomfort or fatigue experienced during the FCE. It is not necessary, however, to exaggerate symptoms in order to ensure they are taken into account regarding your performance. The FCE therapist is trained to read participants well and will be able to gauge the impact that fatigue, pain, frustration, difficulty concentrating, and other factors have on overall performance, during various parts of the FCE. At the same time, the therapist also needs to challenge the person during the FCE, to ensure that the boundaries being identified during the evaluation are accurate.

Melanie E. Swan, OTR/L, is an occupational therapist and the former Clinical Manager of the Rehabilitation Institute of Chicago Chronic Pain Care Center.

RSDSA Review. Winter 2008. Volume 21, Issue 1.