Functional Capacity Evaluations

Advocates of the use of FCEs suggest that they are:

• An objective assessment of a person's ability and motivation to safely perform physical work.
• An essential tool in the prevention of work related injuries and in the rehabilitation and classification of those who have been injured. That they:
• Define current physical status of an individual though tailored tests to meet the needs of the referral source - e.g. employer of insurance company.
• Identify safe working limits for an individual.
• Provide an assessment of body mechanics and safe work practices.
• Reduce cost due to unsafe early return to work and other costs associated with possible re-injury.
• Improve success for safe return to work.
• Provide data which is admissible and defensible in court or other legal proceedings. There are approximately 28 different types of FCEs currently in use, but the one that is most commonly used in the UK is The Blankenship System.

The system was created in 1984 by Keith Blankenship, P.T. It is a computerised system whereby the evaluator assesses strength, endurance, motivation, cardiovascular fitness and physical impairment. It is suggested that the Blankenship FCE System has wide testing tools necessary to objectively evaluate pathology and scientifically document functional or musculoskeletal defect.

Practitioners claim that the system has over one hundred and sixty tests for validity checks to measure how consistent a person's effort is.

The system measures:

• Functional strength deficits.
• Musculoskeletal deficits. It provides :
• A physical demands classification.
• Validity profiles.
• A profile on symptom exaggeration and inappropriate illness behaviour.
• Recommendations regarding employment, such as full-time, part-time, job modifications
• Recommendations for rehabilitation and/or further medical assessment.

The Blankenship system uses equipment which tests a range of movements through inclinometry. Static lifting ability is tested using the Blankenship lifting station and the ability to lift static weights is also measured. Other tests include pain mapping and repetitive actions, such as squatting or reaching. Patients are observed throughout the "test" to establish whether they are "exaggerating" their lack of ability and motivation.

The results are "computerised" i.e. consistency, for example in muscle strength, is measured by a computer which cannot be "fooled".