The Role of Functional Capacity Assessment in Return-to-Work Planning

Getting injured or ill workers back on their feet quickly and safely is a priority for everyone involved. It can be common practice to seek medical input from the worker’s treating practitioners, however, this is not always accessible nor reliable for the employer. In such cases, incorporating a Functional Capacity Assessment can provide valuable insights into the worker’s physical abilities and limitations, aiding in the development of effective return-to-work strategies.

Employers are required to manage injured or ill workers in accordance with workplace health and safety legislation along with organisational policies and procedures. Obtaining independent opinion is common as sometimes this is their only method of gaining clarity and direction for decision making.

A Functional Capacity Evaluation (FCE) evaluates an individual’s capacity to perform work activities related to his or her participation in employment. 

Sometimes also called a Functional Capacity Assessment, this blog discusses how they work and why they are essential for successful return-to-work planning. 

Evaluating Physical and Cognitive Abilities

Functional Capacity Evaluations (FCEs) are vital for return-to-work planning after an injury or illness. They are generally carried out by one of the following allied health professionals: Occupational Therapist, Exercise Physiologist, Physiotherapist or Clinical Psychologist. The focus of the evaluation is to assess a person’s physical and psychological (inc cognitive) capacity with reference to the inherent requirements of their job duties.  The FCE process compares the individual’s health status, and body functions and structures to the demands of the job and the work environment.

In essence, an FCE’s primary purpose is to evaluate a person’s ability to participate in work, although other instrumental activities of daily living that support work performance may also be evaluated.

The Role of the Allied Health Practitioner

The ability to analyse an activity in detail to determine the necessary components to perform the task competently is a core skill of many allied health practitioners, based on their education and training.

This is contrary to what many referring customers believe, and it is common for a medical specialist such as an orthopaedic surgeon or occupational and environmental physician to provide opinion on a worker’s fitness for work through an independent medical examination.

The Evaluation:

During a Functional Capacity Assessment the practitioner observes physical and behavioural responses to determine an individual’s safe capacity to perform the inherent role requirements. 

For FCEs relating to physical injuries or conditions, physical testing is performed which mimics the job demands (i.e. manual handling – overhead reach, lifting, pushing etc) to assess the functional ability of the individual.

For FCEs relating to psychological conditions, psychological testing is undertaken to evaluate an individual’s cognitive capacity to perform their tasks at work. The specific testing used will evaluate the individual’s ability to manage the cognitive tasks and psychosocial demands of their role.

A Functional Capacity Assessment commonly includes: 

• Strength testing through weightlifting, pushing/pulling objects, or carrying items.
• Endurance/sustained physical activity like walking or climbing stairs for a set time.
• Flexibility to determine the range of motion in different joints through reaching, bending, or twisting exercises.
• Maintaining balance tasks, such as walking on a balance beam or catching objects.
• Fine motor skills such as writing or manipulating small objects.
• Cardiovascular fitness through the measuring of blood pressure at rest and after activity.
• Manual handling technique through demonstrated lifting and task completion.

The practitioner considers the position description, job demands and clinical findings to help determine an individual’s:

• Fitness for duty / work capacity
• Ability to safely return to work including hours per day / week
• Suitability for alternative roles
• Suitable duties and graduated return to work plans
• Alternative duties or role modifications
• Ergonomic and equipment needs
• Ability to meet job demands as part of a recruitment process (pre-employment) or following injury or illness (work related or non-work related)
• Rehabilitation and treatment needs.

Matching Abilities with Job Demands

It is standard practice for the assessor to consider the inherent requirements of the worker’s role when evaluating their work capacity. 

The assessor will use the position description and job task analysis as provided by the employer along with any other documentation when evaluating the worker. This information is vital for the assessor as it helps them identify the required testing and helps them to understand the inherent requirements of the role. Once the assessor has completed the testing component of the FCE they will use the results of the physical and/or cognitive testing to determine whether the employee’s current abilities match the role requirements.

If there are any incongruencies, the assessor will provide a report which documents the functional restrictions and limitations along with any recommendations they have associated with the employees fitness for duty and return to work. They can also provide recommendations on suitable duties and or environment adjustments, which the employer can utilise when determining next steps. This might involve changes in equipment, work schedules, or practices.

Additional resources or support, such as ergonomic assessments, assistive devices, or training on modified work tasks, may be needed to help the employee perform their job effectively and safely.

Promoting a Human-Centred Approach

It can be a challenging time for both an employee and employer when navigating illness and injury whether it be work-related or not. Both are often faced with a scenario that is unfamiliar to them which creates a level of concern, worry and frustration.

The employee’s understanding of an employer’s WHS obligations can be limited and often they may be unsure of why medical input is required beyond that provided by their treating practitioner/s. Speaking about their medical condition and how it impacts them may be embarrassing and upsetting, especially where they are being asked to share with their manager or someone who they aren’t familiar with from the workplace.  

An employer is commonly restricted by the access of information which makes decision making challenging and difficult, particularly when they must adhere to legislative or policy requirements.

They often feel in the dark and this is especially the case if an employee is uncomfortable about sharing details of their medical condition. Human Resource, and People and Culture Managers can feel out of their depth when dealing with matters relating to injury or illness as they are concerned, they will worsen the situation by saying or doing something that upsets the worker.

Open and transparent communication between parties with a splash of compassion is the most effective approach when dealing with illness or injury within the workplace. Employers should attempt to involve the employee from the early stages right through to the return-to-work planning process. Keeping them informed about the steps being taken and why they are required helps to reduce worry and can make them feel heard.

Ensuring Long-Term Success for RTW

A sudden return to full duties can be overwhelming, so a gradual return-to-work plan helps the employee safely and confidently ease into their role and work hours. This graduated method is commonly recommended as it is effective. It also gives the employee the opportunity to condition themselves to their role which reduces the risk of further injury or exacerbation of their symptoms. 

After the initial return to work, regular monitoring is crucial and can be done through follow-up reviews with treating practitioners, check-ins with supervisors and adjustments to the plan as needed. Emotional support and mental health resources may also be beneficial for a smooth transition. This may be reminders to utilise services such as well-being or EAP services.

We recommend that an employer:

• Maintains open communication  
• Promotes a culture of safety
• Focuses on overall well-being
• Gives positive reinforcement and recognition

Effective Outcomes with a Functional Capacity Assessment

A Functional Capacity Assessment is an effective and reliable tool that provides employers with an accurate and affordable opinion on an employee’s ability to safely perform the inherent requirements of their role.

It offers the employee the opportunity to understand how their medical condition may impact them at work and why their employer needs to implement strategies to support them at work. Through the use of allied health practitioners, employers are able to access practical tools that help navigate the management people.

Where medical input may be necessary, Red Health has additional services which may be suited to your situation. These include our Red Assess Plus Service which involves the use of a medical specialist in conjunction with a Functional Capacity Assessment. Learn more here.