Functional Capacity Evaluation Elements

Version: June 2016

A standard FCE evaluation will need to include the following 6 elements:

1. Worker Information

 Worker subjective pain complaints

 Medications - related to injury or would impact test, was scheduled medication taken?

 Assistive devices used during evaluation

 Worker’s report of functional ability in self-care, chores, yard work, driving, shopping, recreation, exercise

 Worker’s self-reported goal(s)

 Height/Weight

 Blood Pressure, Oxygen saturation, Pulse

2. Musculoskeletal Screen

As determined by the evaluator. May include these areas: Balance, Posture, Range of Motion (Passive/Active),

Gait Abnormalities, Sensation, Extremity Edema Measurements (Pre/Post), Strength UE/LE, Other Clinical

Findings

3. Capacity Testing – Positional, Material

Handling, Non-Material Handling

Standard categories:

 Sit

 Stand

 Walk

 Climb Ladders

 Climb Stairs

 Twist Neck

 Twist Truck

 Bend/Stoop

 Kneel

 Squat Partial/Full

 Crawl

 Reach forward

 Reach waist to shoulder

 Work above shoulders

 Grasp (forceful)

 Handle/Grasp

 Fine Manipulation

 Lifting Floor to Waist

 Lifting Waist to Shoulder

 Lifting Shoulder to Overhead

 Push

 Pull

 Carry

Additional Categories if noted on any job

description/analysis to include:

 Perform work on ladders

 Keyboarding

 Wrist flexion/extension

 Operate Foot controls

 Vibration high/low

4. Cardiorespiratory Endurance Testing

Best practices are in development

5. Consistency/Level of Effort Testing:

a) Consistency

b) Level of Effort

Includes combined approach:

 Observational – hard and soft signs

 Consistency of test performance – distraction, placebo, test/retest

 Heart rate monitoring/response

 Isometric grip test battery

Version: June 2016

Developed by the members of the L&I Therapy Stakeholder Group

6. Musculoskeletal/Psychosocial Questionnaires:

 Include reliability as it relates to a worker’s report of pain and abilities

 Selection based on characteristics of the client

Available from: L&I’s Functional Scales resource:

https://lni.wa.gov/patient-care/advisory-committees/_docs/2018DocFuncImprovfunctionalscales.pdf

Oswestry (ODI)

Roland (RMQ)

Neck Disability (NDI)

Shoulder Pain and Disability (SPADI)

Patient Health (PHQ-9)

Fear-Avoidance Belief (FABQ)

Tampa Kinesiophobia (TSK-11)

EPIC Hand Function Sort

PACT Spinal Function Sort

Pain Disability Index (PDI)

McGill Pain Questionnaire (MPQ-SF)

World Health Organization Disability Assessment Schedule (WHODAS)

https://www.who.int/standards/classifications/international-classification-of-functioning-disability-

and-health/who-disability-assessment-schedule

Additional:

Dalles Pain Questionnaire

Orebro Musculoskeletal Pain Questionnaire (OMPQ)

Ransford Pain Drawing

Injustice Experiences Questionnaire (IEQ)

The Effect of Pain Scale (EOP)

MTAP (combines EPIC/PACT – requires a fee)

Version: June 2016

Functional Capacity Evaluation

Additional Testing Considerations for the Upper Extremity

Upper Extremity: Shoulder, arm, elbow, forearm, wrist, hand

 Additional testing to consider with the comprehensive evaluation elements

 Same battery of screening/testing for injured and uninjured side based on job demands

 Early/late day comparison testing (except for material handling)

1. UE musculoskeletal screen (may include cervical)

 Active/Passive Range of Motion

 Strength

o Grip

 Power

o Pinch

 Tip

 Palmer

 Lateral

 Sensibility: May include light touch, warm/cold, 2 point discrimination (Stereognosis if 2

point diminished; Monofilament testing if light touch/2 point discrimination is diminished.)

 Edema (circumference/volume)

 Skin: Inspection (cleanliness –presence of dirt, grease, etc.) color, temperature, integrity,

atrophy, callous formation

 Tone/Neural Tension

 Reflexes

 Quality of Movement

2. Coordination/dexterity testing (involved and uninvolved side based on job demands)

 Fine motor

 Gross motor

3. Unilateral and bilateral functional testing based on job demands

 Reach forward, reach waist to shoulder, work above shoulders, forceful grasping,

handle/grasp (power), fine manipulation, lift floor to waist, waist to shoulder, shoulder to

overhead, carry, push, pull.

 As needed: keyboarding, wrist flexion/extension, vibration high/low, handle/grasp (hook,

cylindrical, spherical)

 Unique job specific tasks for handling/grasping/coordination (consider awkward spaces)

4. Brace/Splint (if worn, type, fit)

Version: June 2016

Sample Testing Protocol:

1. Intake interview

2. Pain questionnaires

3. Seated resting blood pressure and heart rate

4. Brief active/functional range of motion screen for initial quality of movement

5. Volumetric/circumferential measurements

6. Inspection: color; temperature; trophic changes; atrophy; scar integrity, swelling, cleanliness (dirt/grease),

clubbing, color, callous formation, splint/brace

7. Sensory testing:

 Light touch

 Protective sensation to include temperature

 2-point discrimination

8. Full musculoskeletal screen of bilateral upper extremities to include:

 AROM

 PROM

 Muscle testing

 Reflexes

 Neural tension (Median, Radial, Ulnar)

 Provocative testing as indicated. (Purpose: to assess consistency)

9. Functional motion tests:

 Overhead reach - measured in inches, compare each side

 Forward reach bilateral upper extremity

10. Repetitive motion test/endurance testing: examples may include:

 Overhead reach

 Forward reach

 Elbow flexion/extension

11. Jamar Grip test: 5-position and Rapid exchange (Purpose: to assess consistency and to match tool usage)

12. Pinch Test:

 Palmar, Tip, Lateral

Version: June 2016

13. Functional Testing:

 Perform back to back MTM and time duration tests to measure repetitive fingering/fine

manipulation; grasping/handling for frequency tolerances

o May include: Purdue Pegboard; Minnesota Dexterity test: Valpar 7; Valpar 8; Valpar 9;

Valpar 1; Matheson panel system; Bennett Tool Task test; Bus Bench assembly/disassembly

14. Material handling based on job demands:

 Bilateral

 Unilateral

15. Maximum lift test:

 Occasional basis:

o Lifting: Floor to waist; waist to shoulder; shoulder to overhead; Carry

o Push-pull

 Frequent basis

o Lifting: Floor to waist; waist to shoulder; shoulder to overhead;

16. Work circuit: May include work simulation for Job of Injury/job goal/potential retraining goal: tool use;

impact tool use; vibratory tools use; keyboarding on computer; Repetitive and sustained reaching and

grasping/handling tasks

17. Post-test/repeat testing of:

a) Functional testing

b) Functional motion tests

c) Repetitive motion test/endurance testing

d) Jamar grip test on position of peak force

e) Sensory testing as appropriate

f) Volumetric/circumference measurements

**This sample is provided for educational purposes only. It is not meant to be an all-inclusive format. Use

your clinical reasoning and judgement to fully evaluate the client based on their individual needs and job

demands.

Developed by the members of the L&I Therapy Stakeholder Group