Clinical Report: Functional Capacity Evaluation (FCE)
by Tiziano Marovino, DPT, DAAPM
 The functional capacity
evaluation (FCE) has evolved in many ways since its inception in the 1980s when the work
capacity test was becoming the normative test to evaluate disability and return to work
status.1 In our quest to be able to identify applicants who might be at higher
risk for lower spine injuries once employed, we began utilizing various forms of
pre-employment testing including radiographic screening.2 As we all know, this
specific practice was short-lived and pre-employment screening as an evaluation tool has
subsequently been abolished with the advent of research showing a poor correlation between
radiographic findings and risk of future injury.3 Radiologic abnormalities in
the musculoskeletal system have not been demonstrated to have any significant predictive
capabilities for future risk of injury and, along with legislative changes—most
notably the American with Disabilities Act (ADA) and it’s antecedents—have led
to the demise of pre-employment screening efforts.4
The most politically correct post-ADA terminology for workplace testing is
pre-placement screening. Today, the applicant is hired and then tested (in that order) and
a decision made as to whether they can safely and effectively perform the job. The
“fit for duty” assessment is performed after the hiring, and not before, as was
the case in the past. For the remaining sections of this report, the terms FCE, physical
capacity evaluation (PCE), and work capacity evaluation (WCE) will be used to denote
separate but distinct (although interrelated) testing formats. The PCE is a physical
capacity evaluation that identifies basic human motion parameters, both quantitatively and
qualitatively—such as muscle strength, endurance, flexibility, stamina, power,
balance, coordination and proprioception. It is important to distinguish these most basic
parameters since they are the foundation of the next level test—the FCE, or
functional capacity evaluation. This test examines functional limitations that are defined
by more complex multi-joint movements that require neuromuscular synergy to form
integrated and purposeful patterns aimed at task completions and could be anything from
climbing stairs to lifting a box or sweeping the floor. Within the context of an
occupational setting, the term WCE or work capacity evaluation implies a work related FCE
since the test evaluates the person’s ability to perform work-related functional
tasks, as opposed to home or recreation/social activities of daily living.
Please refer to the May 2010 issue for the complete text. In the event you need to order a back issue, please click here.
— May 2010
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