Let’s look at 2 case examples to illustrate.
- An employer may ask “can our employee safely return to their normal duties?” Employers can naturally be concerned about having a worker return to physically demanding duties after suffering an injury. Let’s consider a truck driver returning to work after knee surgery. Employers want to ensure they take care of their workers and fulfil their obligation to provide safe work. This question of functional capacity is answered by talking with the worker about their recovery, talking with their GP or specialist and reviewing background medical information. It includes assessment of joint range of motion, muscle strength, postural endurance and balance. Assessment should ideally include observing the worker perform relevant duties such as climbing in/out of their truck and on/off the trailer. This comprehensive assessment definitively answers the question of fitness for duties and when relevant, includes recommendations to support the worker’s successful return.
- An insurer may ask “can our client return to work of any kind”? Life and income protection insurers exist to help their clients through tough times when they are sick or injured and unable to work. Often people recover and return to their normal work but unfortunately some people develop long term problems that affect their function. Let’s consider a nurse who suffered a stroke. An insurer will need to understand what can be reasonably expected given the nature of injury or illness. FCE in this case may include evaluation of psychosocial tolerances such as memory, concentration and decision-making as well as physical activities such as walking, standing and hand function. FCE may explore the physical demands of different types of nursing work comparing work in aged care and other locations such as lighter work in an outpatient department. For someone who has not yet returned to work FCE is conducted in the clinic but for some people who are unable to drive or mobilise freely in the community it may be conducted in their home. These two examples show how the FCE varies according to the circumstances of the individual and on the question/s being asked by the referrer.
So, FCE testing varies according to the person and their circumstances as well as the questions being asked. Referrers should provide the questions they want answered and forward relevant background medical reports along with the person’s consent to share their information. FCE will generally include an interview to establish a person’s function at work or in daily activities as well as a series of objective physical tests to establish aerobic fitness, flexibility, strength, postural tolerances and manual lifting capacity.
People are often very anxious about undergoing FCE and have many questions. It can be useful for them to know:
- That their safety is our priority. Testing is always conducted within their physical capabilities. Although we encourage their best effort there is no requirement for ‘superhuman’ performance.
- We are experienced clinicians and our advice is based on objective testing and information.
- It does not matter if they are having ‘a good day or a bad day’ in terms of symptoms. Their overall function will be considered and any variability in presentation considered.
- They are encouraged to wear what is comfortable for them, but active wear is often best.
- They are welcome to bring any supporting medical information.
- They are welcome to bring a support person.
- If they are unable to drive or travel, we can go to them.
At Back on Track, FCE is conducted by an experienced, tertiary qualified physiotherapist or occupational therapist. We offer independent, fair and impartial advice based on clinical assessment and objective observations. This independence is key to promoting return to work when it’s a fair and reasonable option. When people are not able to return to their normal work or perhaps to any kind of work, objective and comprehensive assessment detailing the barriers is critical to effective claim management. Either way, an independent FCE can provide the clarity and optimise outcomes for all stakeholders.