There is a perception that FCEs are used as a marketing tool for work conditioning. In many of the invalid (and some valid) FCEs, work conditioning is offered as one recommendation. However, let’s examine some reasons why this is so.
Using the FCE at MMI solely for the purpose of determining need for permanent restrictions is way too late and underutilitizing a great tool for optimizing RTW. The value of the FCE is to determine that the worker is being compliant in providing accurate information as to their level of disability, determine what work deficits exist in relation to the physical demands of the job, determine rehab goals to abate those deficits and provide accurate information if vocational rehabilitation services are needed. It is a legal document and a legal tool to provide either quantification of disability or lack of effort.
If the FCE is invalid, have any questions been answered as to the true ability of that patient? Has it facilitated a return to work for that patient? The only question that has been answered at that point is that the patient is not putting forth effort in returning to work. In a daily work conditioning program, the FCE can be expanded to determine the day-to-day abilities the patient demonstrates and provide an opportunity to improve those abilities as they relate to work. If the patient still does not put forth effort, then the lack of effort is documented, and the patient may be released to work based on objective evidence of disability. If there is no objective evidence of disability, a release to regular work may be indicated. Periodic evaluations prevent the continuance of unnecessary visits for the worker who is insincere in their effort.
Many physicians, adjusters, case managers and employers think that because someone has had a lot of physical therapy that they will not need work conditioning. However, if medical treatment and physical therapy have been completed, and the patient is still not back to work, then we must ask why and what is preventing that person from returning to work. Physical therapy is not designed to facilitate return to work; physical therapy’s goals are reducing pain, increasing range of motion and increasing strength, which may or may not be met and ultimately may have no relation to the injured worker’s ability to return to work.
A functional assessment or Fit for Duty (FFD) test is an effective tool for return to work and should be ordered as soon as a worker is medically safe to participate. It should answer the following questions: What job-related deficits are present?; what can the worker safely perform with return to transitional work if available?; and what rehab is appropriate to meet the goal of returning to work? Repeat functional assessments during the course of the rehab are needed to identify if treatment is reducing functional deficits and increasing work tolerance and to ensure that the worker’s pattern of behaviors are still compliant with the goal of returning to work. The FFD tests should indicate a progression in rehab and return to work, but if not, then the information can be used by healthcare providers to focus rehab on those deficits which prevent the worker from returning to work. If any “red flags” or insincere effort is indicated, it can be assessed early on, instead of weeks, months or years later with an invalid FCE.
Work conditioning, implemented early on in the process, not only promotes an earlier, safer return to work, but may eliminate the need for an FCE altogether. Having a daily accountable program specifically designed to return an injured worker to work will result in an objective picture of that person’s physical abilities as well as their ability to sustain those tasks on a daily basis.
Other reasons work conditioning may be recommended in an invalid FCE:
- Injured worker (IW) may have had “work conditioning” in the past, but the program was ineffective (perhaps because it was not daily or because it was really just more physical therapy).
- IW may not have ever had the opportunity to try to improve work abilities on a daily basis.
- IW is de-conditioned and the FCE is only a “snapshot” of that person’s abilities after having been out of work for so long.
- IW does not meet all physical demands required to do their job.
- More objective information is needed as to their true abilities, especially if vocational rehab is needed (invalid FCE does not indicate IW’s physical abilities).
Test injured workers early and often to objectively determine their abilities and whether they are complying with medical treatment; refer for work conditioning early, when IW has reached a plateau in treatment; and avoid waiting for MMI to determine return to work. Question your providers about their testing and work conditioning services. For more information about work conditioning, FCEs and what to look for in a good work conditioning program, give us a call or visit our website.