Assessing EFFECTIVE Occupation Rehabilitation

Functional evaluations (FEs) have been called several names over the years such as “functional abilities evaluation” (FAE), “functional capacity evaluation” (FCE), and “physical demands evaluation” (PDE). Regardless of the terminology, these evaluations are an objective assessment tool designed to document an individual’s safe ability to perform activities or work tasks in a controlled environment.

However, for a functional evaluation to be effective, these assessments must document the consistency of the individual’s presentation in direct relation to their injury or condition. They must address the validity and reliability of the data obtained to ensure that an accurate “snap shot” of the individual’s safe functional abilities is obtained at the time of the assessment. Finally, the assessment tools and protocols should be based on peer reviewed, published research to ensure validity, reliability, and defensibility of the report.

This article identifies several key factors referral sources should be aware of before utilizing FE in the management of cases. Specifically, what information should be covered in a functional report, when to use a FE, and how to help your provider supply a product that addresses your needs.

Demystifying FEs

There are numerous methods and systems available in today’s market to assess an individual’s functional ability. All these systems claim to be the most efficient and reliable method of objectively documenting functional ability. This can be confusing and referral sources may become overwhelmed with the promotions of each individual testing system or protocol. When choosing a methodology or system to assess a client, referral sources should be made aware of what a FE can and cannot do to ensure that the right information is obtained to make the right decisions regarding a case file.

The FE report should be clear, concise, easy to read, and directly address the referral source’s needs. Specifically, the FE report should directly answer the referral questions in an easy-to-read format. Reports should specifically address the individual’s overall functional ability, limitations, and work tolerances with specific reference to the compensable injury or condition. All comments and recommendations made during an assessment should be objectified and supported by existing and accepted peer reviewed research and industrial standards.

In addition, comprehensive or return to work assessments should utilize information obtained from objective measurements of the required activity/work tasks such as a work site assessment or physical demands analysis. This will increase the content validity and reliability of the report results.

Please note that a FE is not a “faker finder”, nor can it determine the underlying cause or pathology of any functional limitations identified during the course of an evaluation. However, it can document the sincerity of effort put forth as well as the validity and reliability of test results with respect to the individual’s overall presentation and performance levels.

Accurate data

In order to assist the FE provider, referral sources should provide the following information to ensure that their needs are being met:

This should include date of loss and a brief summary of circumstances surrounding the loss. In addition, other assessments or reports regarding the client’s overall status is beneficial, (surgical notes, hospital notes, ambulance call report, other evaluation reports, doctors notes, x-ray or imaging summaries, etc.).

Purpose of the evaluation — why do you need the assessment?

Specific questions which should be put forward include: What are Ms/Mr. Sample’s functional abilities, limitations, and activity/work tolerances? What are Ms/MR. Sample’s functional abilities, limitations, or activity/work tolerances with respects to their pre-loss occupation or any occupation? If not are they functionally able to participate in a graduated return to work program? Based on the findings of your assessment of Ms/Mr. Sample, what treatment would you recommend, if any, that would facilitate the client’s return to function? Can Ms/MR. Sample perform activities of normal living?

Is the objective data collected during your assessment a valid and reliable indication of Ms/MR. Sample’s current functional abilities?

Other pointers

When reading FE reports, the referral sources should familiarize themselves with the current lingo or definitions utilized by providers to define work. Based on the “Dictionary of Occupational Titles”, the 4th Edition, work can be defined into three main categories:

Occasional (0 to 33% of the work shift);

Frequent (34% to 66% of the work shift); and

Constant (67% or greater of the work shift). Tasks such as sitting, weight bearing, lifting, carrying, pushing/ pulling, reaching, stooping, kneeling, crouching, handling, and fingering can be defined in this fashion.

Using this type of classification system allows a provider to compare an individual’s demonstrated capabilities to industrial standards and group their safe physical abilities into known categories. However, this general classification system has limitations and should not be solely depended upon to define work. The more specific a work task can be defined, the more reliable the outcome measures of the assessment will be.

For example, information regarding lifting should include duration/cycle time, work range, frequency, load, a specific description of the object being handled, and if there are any barriers affecting the freedom of movement during the lift. Evaluators use this information to further assess the safe abilities of an individual and without this information those abilities may be over estimated. For the referral source this may lead to inaccurate decisions regarding return to work readiness and potential injury/re-injury cases.

A prime case of where this may occur can be illustrated by using a parcel courier occupation. If one reports that the courier is required to lift and carry up to 20 lbs, 60 times a day and the lifting frequency (number of lifts per hours or minute) is vaguely defined as “throughout the work day”. The actual classification of the lift and carry requirements for this occupation would be rated at the “light level” of work capacity and the lift frequency as “occasional”. However, if the provider was informed that the courier was required to load their truck in 30 minutes at the beginning of their shift. The critical cadence of the lifting portion of this occupation dramatically changes, where the worker would be required to perform a lift once every 30 seconds for that 30 minutes period. The metabolic or muscular endurance needs would be much higher when lifting at the faster pace as the amount of rest time between lifts was greatly reduced. The importance of this information can been seen such that if all information regarding an occupation is not disclosed to the provider, the outcome measurements of that assessment may be inaccurate and place the worker in a situation where the work demands exceed their current safe abilities.

What this means

The bottom-line is that referral sources and providers must talk the same language and work together to obtain objective and accurate information regarding the testing parameters. The ultimate goal being a completely valid and reliable assessment, so that accurate and defensible decisions can be made regarding a case file. A proactive approach to improving communication between the referral source and provider is essential, as without this communication assessments may not accurately measure an individual’s safe work abilities and could lead to detrimental outcomes and prolonged claims.

Furthermore, referral sources should feel comfortable with their providers and ask questions regarding work definitions, methods of testing, how work tolerance extrapolations are made, and what research is used for the basis of the testing methodologies and protocols. Referral sources are also recommended to seek demonstrations and educational sessions from their providers so that FE reports can be easily understood and used effectively in claims management.