Functional Capacity Evaluation
What Is the FCE?
A Functional Capacity Evaluation (FCE) is an all-encompassing term to describe the physical assessment of an individual's ability to perform work- related activity. It can also be known as a Functional Capacity Assessment (FCA), Physical Capacity Assessment or Evaluation (PCA or PCE), or Work Capacity Assessment or Evaluation (WCA or WCE). A well-designed FCE should be comprehensive in terms of encompassing the physical demands of work as defined by the U.S. Department of Labor in the Dictionary of Occupational Titles (DOT.)1, have standardized instructions and operational definitions, be practical regarding space and length of time for administration, be objective in minimizing examiner bias, and, most importantly, be reliable and valid.2 An FCE must also be administered with care for the patient's safety and well-being, with due diligence to minimize the chance for injury during the course of the evaluation.
What Are the Purposes and Applications of the FCE?
The FCE may be used to determine:
- Goals for rehabilitation or readiness for discharge
- Return to work status (including full duty, modified/transitional duty)
- Case settlement
- Disability status
- Ability to meet job demands as part of a hiring process(for preemployment/post-offer testing)
What Are the Components of an FCE?
An FCE usually consists of:
- Medical record review
- Musculoskeletal screening
- Physical ability testing
Physical testing may include graded strength activities such as lifting, carrying, pushing and pulling; position tolerance activities such as standing, sitting, and stooping; and mobility activities such as walking, crawling, and climbing. An FCE may also include information about an individual's dexterity, coordination, balance, endurance, and other job specific testing. The FCE report includes an overall level of work, a summary of physical abilities that is usually couched in the language used by the DOT1, information about consistency of effort, job match information, and recommendations, if requested.
FCEs are done on a one-to-one basis and may range in length from 4 to 6 hours. An FCE may take place over two consecutive days.
Who Is Qualified to Perform an FCE?
The occupational therapy practitioner has the unique combination of skills and abilities necessary to assess the physiological, psychophysical, and biomechanical function of the individual engaged in occupation. Occupational therapy practitioners also have the observational skills, training, and experience to perform complex task analysis and assessment of environmental factors affecting work performance. Physical therapists, exercise physiologists, athletic trainers, and those in other disciplines may also perform FCEs. Advanced certification in FCE is available from many vendors.
Who Pays for the FCE?
- Worker's compensation insurance plans
- Self-insured plans
- Individual insurance plans
- State and/or local agencies
- Managed care plans
- Private pay
Rates can and do change based on geography. Precertification of the service and verification of the state fee schedule is advised.
Who Can Refer/Recommend the FCE?
- Physicians
- Case managers
- Other therapists
- Insurance carriers
- Employers/human resource personnel/risk managers
- Attorneys
Revised by the Work Programs SIS, January 2007
Jill Page, Jeff Clinger, Matthew Dodson, Kathy Maltchev
Updated 3/2007
1. U.S. Department of Labor, Employment and Training Administration (1991). Revised dictionary of occupational titles, Vol.I & II. (4th ed., Vols. 1-2). Washington, DC: U.S. Government Printing Office.
2. King P, Tuckwell N, & Barrett T. (1998, August). A critical review of functional capacity evaluations. Physical Therapy, 78 (8), 852-866.