Dr. Capitano is a Certified ARCON Evaluator and a Certified EPIC Lift Capacity Evaluator. He has performed well over 1000 FCE's. Dr. Capitano uses the Arcon FCE state-of-the-art evaluation tool to collect objective information about the person’s physical abilities. The ARCON FCE protocol is based on published peer-reviewed research. The protocol is designed to provide a comprehensive assessment of the client's performance on a comprehensive series of standardized tests, and comparing that to a specific occupation or to general occupational requirements. This evaluation process may also be referred to under the terms: Functional Ability Evaluation, Work Capacity Evaluation, or Work Tolerance Screening. A typical evaluation takes approximately 3-4 hours, and is comprised of a variety of components that objectively predict a client’s specific safe physical abilities over the course of an 8-hour day. While the ARCON system allows clinicians flexibility in the selection of component tests, a typical FCE includes the following sections.
Intake Interview: The intake interview is an opportunity for the evaluator to describe the functional evaluation procedure and to identify expectations through the use of an informed consent document. It is also an opportunity to develop a rapport with the client and allay any fears associated with functional testing. The evaluator is able to collect the client's perception of current capabilities and compare those to demonstrated functional abilities observed later during the evaluation. The evaluator is also able to measure tolerance for sustained sitting during this time.
Musculoskeletal Screen: The client undergoes a brief general screen of functional movement as well as an optional diagnostic specific assessment of injured areas. Range of motion, strength, stability, sensation and other diagnosis specific testing can be correlated with demonstrated functional abilities performed later in the evaluation for consistency. The screen confirms diagnostic criteria, ensures that the client is safe to proceed with more physically demanding portions of the exam and identifies specific deficits. Also during this component of the evaluation, grip and pinch strength data is collected. This data is compared to population norms based on gender and age, and is also is used in determining the client’s reliability of effort.
Strength Testing: Whole body lifting, pushing, pulling and carrying capacity is measured both statically and dynamically. Static (isometric) testing is an excellent tool for quickly and safely assessing maximum strength in various work postures. Dynamic lifting is performed utilizing the PILE protocol (Progressive Isoinertial Lifting Evaluation) and has application for both occasional and frequent demand levels of work. Heart rates are measured during static and dynamic lifting, and provide physiological evidence of exertion (reliability of effort) by the client during these tasks. Strength abilities are rated using the standard categories defined in the Dictionary of Occupational Titles published by the U.S. Department of Labor.
Functional Abilities: The ARCON protocol uses Methods-Time-Measurement (MTM) testing to measure a client’s abilities in activities that involve movement, dexterity and/or postural tolerance. MTM utilizes the Industrial Standard (IS) criterion as an objective basis for rating ability levels. The Industrial Standard is defined as the time it takes an average worker (male or female), between 18 and 65 with average skills, to perform a task at a rate that he or she can maintain over an 8-hour workday with appropriate allowance for rest, and without undue stress or fatigue. This method of rating functional abilities is based on an extensive body of research published over the past 70 years. Some functional evaluation systems rely on clinical observation of functional tasks, with the rating of a client's ability based on the evaluator's clinical judgment. With MTM testing, the client’s ability for each of the functional activities is objectively obtained through direct measurement. ARCON MTM results are reliable, valid and not influenced by evaluator judgment or bias.
Cardiovascular Assessment: Another component used to predict a client’s ability to perform work is aerobic capacity. Studies suggest that workers can sustain an energy expenditure rate of 33% of maximum aerobic capacity (VO2 max) over an 8-hour day. The Arcon system offers three sub-maximal aerobic tests that predict VO2 max, and thus sustained work capacity. The Canadian Aerobic Fitness Test and the YMCA Step Test are both simple step tests that can quickly and safely predict aerobic capacity, while the Single Stage Treadmill Test uses a motorized treadmill that some clients find easier to tolerate than a step test. When a client has a job with a significant energy demand, the results of a cardiovascular assessment will indicate if he or she is capable of meeting that demand upon return to work.
Reliability of Effort: Essential to every FCE is an objective assessment of the reliability of effort demonstrated by the client during the evaluation. It is also important to identify symptom complaints and/or behaviors that are inconsistent or exaggerated when compared to objective evidence. Reliability is determined based on evidence collected over the entire evaluation and not simply the results a single test. Observed behaviors are compared and contrasted to the client's perception of abilities and self-reported symptoms. The ARCON system calculates up to 70 independent measures of reliability over the course of an evaluation. These include a statistical consistency of effort and movement, heart rate responses to exertion, quality and speed of movement patterns, force curve analysis and distraction techniques such as isometric horizontal strength changes, rapid exchange grip testing and Waddell’s non-organic signs.
Types of Functional Evaluation
1. Post-Offer of Employment– Used by employers to identify decisions concerning specific job placement based on testing results.
2. Return-To Work Evaluation – designed to identify whether an individual has the physical ability to perform part or all of his or her job tasks.
3. Modified Duties analysis – Is designed to identify modifications to an employee’s pre-injury, which his or her safe and timely return to work.
4. Alternate Duties Analysis – If the employee has residual physical limitations and is not able to return to his pre-injury duties this analysis is designed to identify a safe alternate job while they are still recovering from their injury.
5. Work Simulation Evaluation – designed to identify limitations for the purpose of the work conditioning/hardening program.
6. Disability Evaluation – is a determination of loss of ability to engage in a chosen occupation.
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