Functional Capacity Evaluations
Posted by Alison on September 14, 2006
This morning I performed an FCE on a Hispanic man who had a devastating work injury. An 18-wheeler rolled over his leg causing a traumatic amputation. When I asked him what his goals are as far as work, he replied “I don’t know, I can’t do anything now”. He is a 24 year old, otherwise fit and healthy young man. Whilst I am completely sympathetic to the trauma he has suffered, both mentally and physically, I am still left wondering why people are so willing to just sit back and essentially write off the rest of their lives. He did really well during the FCE testing and was able to lift 30# and demonstrated good upper extremity strength and good eye-hand co-ordination. There are many, many jobs this man could now do. Has no-one sat down and educated him on his options or is he just thinking that he’s going to receive millions of dollars in compensation and he can retire to his yacht on the Cayman Islands?? The moral is – I know it’s life changing – but really – come on – be realistic – look for alternatives and move forward.
Brandon, PT, DPT said
I feel ya’ on this one! I’ve only been a PT for just under 2 years, and having dived right into the industrial rehabilitation setting, including dozens of FCEs, I’ve become depressed myself listening to these sob stories!! I have to remain a poker-faced, unbiased, uncommenting evaluator while performing the test, but afterwards, I do my best to tell them about how much they DID, rather than what their limitations were. I’ve found it helps boost their ego a little while they’re dragging their handicapped butts out of my clinic and begging for their pain pills and muscle relaxers! I think you’re right though…most of my FCE’s (return to work and disability) have chalked their lives up in the loss column and have aspirations of beaches, martinis, and yachts hidden behind their solemn scowls. My favorite part is when I ask them the history of what type of treatments they have sought for their injury. I love the answers that consist of…”well, I tried physical therapy for my bulging discs…but it didn’t work”. My response…”how long did you receive physical therapy?” Their response…”two or three sessions…it didn’t help anything, so I quit going.” I feel like I’m an educator more than a clinician!
Chanel said
Hi Brandon and Alison! I enjoyed reading your experiences with FCE’s and working with patients. I understand how you both feel.
We are physical therapy clinic in Idaho and focus on Industrial Rehab as well as orthopedic physical therapy.
Hey, I was curious, one of our biggest problems is finding enough therapists for our growing practice. As soon as we hire one therapist, we are in need for another one. We are a family owned, private practice and I am seeking advice on the best ways to recruit therapist. Any of you know anyone looking for a great job as a PT?
Thanks!
kate said
the guy doesn’t know what his goals are? that’s partly up to you to talk with him about what’s possible. i think he was speaking from frustration and confusion, it’s a life shattering thing to lose a limb. a PT has a responsibility to have a bit of bedside manner as well, no? don’t assume someone is out to retire off disability and a lawsuit settlement…
John Ratcliffe DC DACRB said
I have incorporated a few tools into my QFCE as well as IME’s. Modified Zung Depression Tool and the Somatic Perception Tool can be used in combination to score a DRAM ( Distress Risk Assessment). This is a great tool for early identification of the people who could also benefit from some kind of counseling. FABQ’s (Fear Avoidance Questionnaire), Orebro Yellow Flag Questionnaire. The key is to not wait till they have been under care for such a long time but to early identify these chronic cases. If all else fails whip and they are just plain malingering document with the Waddell’s stuff. Great Blog!
thanks,
Dr. Ratcliffe DC DACRB
Board Certified Rehabilitation Specialist
prodeDPT said
I am a DPT and have been doing FCE’s for 15 years I have seen the gambit from overachievers to self limiting clients… those motivated to return to work and those willing to accept the status quo. I use the ErgoScience FCE system because it helps me remain objective and avoid the battles being discussed above with subjective interpretations and biases no matter how my client presents. As a PT working in the work comp setting it is not usually well received to recommend counseling in my FCE report as it increases the $$ and is beyond my scope of pracice,but I will often call and speak directly to a case manager or MD and tell them my recommendations for pain management which often includes such. I try to stick to the facts when discussing functiona ability vs inability and make appropriate work modifications to safely return the worker to work. I am a great fan of the FABQ especially with acute low back pain and helps itentify patients for appropriate treatment categories. I would like to hear more from your blog on FCEs
PRode DPT
Doctor of Physical Therapy
Eric Montgomery said
Check out this excellent article on how Physical Therapist need to be part of the Healthcare Reform Equation. http://www.lighthousecareeragents.blogspot.com
Grace said
I’m a PT in CT. This is my take on the subject at hand—My brother was injured years ago and is on disability. I don’t think anyone could even come close to a beaches and martinis lifestyle on his disability income. I believe the average person would be lucky to pay the rent and put a little food on the table! Job re-training and counseling are important tools for the disabled, and they should be encouraged to pursue those links if they can’t return to their former occupation.
Grace
CT
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