Functional Capacity Evaluations (FCEs) are a valuable tool in Occupational Rehabilitation. For workers recovering from an injury or illness — and for the employers, insurers, and treatment providers supporting them — an FCE provides a clear, objective snapshot of a person’s functional abilities, work capacity, and rehabilitation needs [1, 2]. This article explores the value of an FCE, when it is most appropriately used in the workers’ compensation space, what a worker can expect during an FCE, and how the resulting report can inform stakeholders, such as employers, insurers, and treating health professionals.
What is a Functional Capacity Evaluation?
A Functional Capacity Evaluation (FCE) is a standardised, comprehensive assessment of an individual’s physical and/or cognitive abilities in relation to the functional demands of work and daily life [3, 6]. Conducted by qualified allied health professionals — typically Occupational Therapists or Physiotherapists trained in FCE methodologies — these assessments aim to determine an individual’s current capabilities following an injury or illness [6].
An FCE may assess a wide range of functional domains depending on the individual’s presentation, and the referral questions. This may include:
- Strength and endurance (e.g. lifting, carrying, pushing, and pulling);
- Postural tolerance (e.g. sitting, standing, and walking);
- Mobility and flexibility;
- Hand and upper limb function;
- Coordination and balance;
- Cognitive and psychosocial aspects (e.g. attention, memory, pace, and fatigue).
It is important to note that an FCE is not a diagnostic tool. Instead, it is a performance-based measure that answers specific questions about what the individual can do now, how consistently they can perform tasks, and how this compares to the requirements of their pre-injury role, or other vocational options [8].
The Value of an FCE in Workers’ Compensation
FCEs provide objective, clinically reasoned information that supports decision-making around Return to Work (RTW), capacity management, and future planning [7]. They are particularly valuable when:
- Clarifying Work Capacity
When a worker has been recovering from an injury or illness for some time, but there is uncertainty around their current capabilities, an FCE offers a clear, independent picture of what they are able to do functionally [2]. - Supporting Return to Work (RTW) Planning
An FCE can identify functional strengths and limitations relevant to a specific job. This allows for realistic goal setting, job matching, or graded return-to-work planning that is safe, sustainable, and evidence-based [9]. - Assessing Capacity for Redeployment
In cases where a return to the pre-injury role is unlikely, the FCE supports decisions around vocational redirection, transferable skills, and potential retraining needs [8]. - Determining Permanent Impairment
When a worker reaches maximum medical improvement, an FCE contributes objective input to decisions on case closure, or ongoing entitlements [6]. - Supporting Claims and Disputes
When differing opinions arise between stakeholders, an FCE by an independent provider can offer a neutral, evidence-based perspective to help resolve disputes [7].
When Should an FCE Be Requested?
Timing is important to consider to ensure the assessment yields meaningful results. An FCE is commonly recommended when:
- The worker is medically stable, or has plateaued in treatment;
- There is uncertainty about the functional capacity, despite rehabilitation;
- A return-to-work plan requires detailed functional information;
- Legal, claim, or vocational decisions hinges on the capacity [8].
What Can a Worker Expect During an FCE?
At Ascent Rehabilitation, we understand that many workers feel anxious about FCEs. Our approach is respectful, collaborative, and transparent.
- Pre-Assessment Interview
The FCE begins with a structured interview to understand the worker’s medical and work history, participation in their activities of daily living, as well as their rehabilitation history, current symptoms, goals, and perceived limitations. [4]. - Standardised Testing
Depending on the referral, this may include physical or cognitive assessments — or both. Physical testing evaluates lifting, carrying, posture, mobility, and fine motor function. Cognitive FCEs involve assessments of memory, attention, reasoning, and visual-spatial processing using standardised tools [5]. - Clinical Observations
Throughout the assessment, the clinician observes behaviours, pacing, fatigue management, and any inconsistencies between the reported and observed performance. These observations are not about discrediting the worker, but gathering a holistic picture of function [8]. - Debrief and Feedback
Workers are given the opportunity to ask questions and discuss the assessment experience at the end of the session. - Duration
Most FCEs last for two to four hours. Cognitive or dual-focus assessments may require longer, or multiple sessions, depending on fatigue and complexity. The assessment may take place over one or two days, depending on the worker’s endurance, the complexity of the case, or to compare consistency on two different days. This approach is particularly beneficial in chronic pain conditions where functional abilities may vary from day to day.
What Does the FCE Report Contain?
The report typically includes:
- Referral context and purpose;
- Summary of the medical and work background;
- Worker-reported symptoms and goals;
- Objective data from functional and/or cognitive testing;
- Clinical observations;
- Analysis of the consistency and reliability;
- Work capacity conclusions and recommendations.
Who Uses the FCE Report?
Employers
To tailor the duties, manage RTW safely, and plan redeployment, if needed.
Insurers and Case Managers
To support claims decisions, vocational planning, and treatment approvals [9].
Treating Professionals
To refine treatment plans, track progress, or adjust any goals based on objective data [3].
Workers
To understand their own capacity, receive clear feedback, and regain confidence.
Key Considerations
- Transparency: Workers are informed about the purpose and the use of the assessment.
- Ethics and Safety: Clinicians ensure all tasks are safe and consented to [7].
- Respect and Trust: The process is collaborative — not confrontational.
- Customisation: Assessments are tailored to the worker’s condition, role, and goals.
Final Thoughts
A Functional Capacity Evaluation can serve as a turning point in a worker’s rehabilitation journey. By providing objective, functional insights, FCEs support a safe and sustainable return to work, reduce ambiguity, and promote collaboration between stakeholders.
At Ascent Rehabilitation, we are proud to offer comprehensive FCEs — physical, cognitive, or combined — conducted with clinical excellence, empathy, and ethical rigour. Contact us to learn more about how we can support your workplace, or the worker.
References
- Reneman, M. F., Jorritsma, W., Dijkstra, S. J., & Dijkstra, P. U. (2002). A review of the literature on functional capacity evaluation: Measurement properties and application in different patient populations. Clinical Rehabilitation, 16(6), 640–648. https://doi.org/10.1191/0269215502cr522oa
- Gross, D. P., Battié, M. C., & Cassidy, J. D. (2005). Reliability of FCE measures in injured workers. Journal of Occupational Rehabilitation, 15(3), 273–283. https://doi.org/10.1007/s10926-005-5942-5
- Isernhagen, S. J. (1992). Functional capacity evaluation: Rationale, methodologies, legal aspects, and uses. Journal of Occupational Rehabilitation, 2(3), 157–171. https://doi.org/10.1007/BF01053688
- Innes, E., & Straker, L. (1999). Attributes of physical work performance tests: A review. Work, 13(3), 163–184. https://pubmed.ncbi.nlm.nih.gov/24441650/
- Matheson, L. N., Kane, J., & Fry, D. K. (2002). Reliability of a functional capacity evaluation using the Isernhagen Work System. Work, 18(1), 45–52. https://pubmed.ncbi.nlm.nih.gov/12441488/
- Soer, R., van der Schans, C. P., Geertzen, J. H., Groothoff, J. W., & Dijkstra, P. U. (2008). Do functional capacity evaluation results correlate with recovery in workers with musculoskeletal disorders? Archives of Physical Medicine and Rehabilitation, 89(11), 2106–2113. https://doi.org/10.1016/j.apmr.2008.03.022
- Frings-Dresen, M. H. W., & Sluiter, J. K. (2000). The applicability of the Functional Capacity Evaluation (FCE) in occupational health practice. Occupational Medicine, 50(4), 257–260. https://doi.org/10.1093/occmed/50.4.257
- Safe Work Australia. (2015). Principles of practice for the implementation of work capacity assessments. https://www.safeworkaustralia.gov.au/doc/principles-practice-implementation-work-capacity-assessments
- VicHealth & WorkSafe Victoria. (2019). Supporting return to work: A guide for health practitioners. https://www.worksafe.vic.gov.au/resources/supporting-return-work-health-practitioners