What exactly is FCE
 

Functional Capacity Evaluation (FCE). Can anyone give info on this procedure?

Everything is now coming down to the wire and its very difficult. In an earlier post I stated my wife will soon have the opportunity to present her case in front of a judge for her SSDI. To this day we are still trying to show this judge papers received from her work that she had received 6 months sick leave with dates, amounts etc. Even with that info the judge now wants a cover letter from her former employer and stated my wife's time is running out to prove her short term disability pay was just that, not worked performed. Now her doctor, after 3 years, wants to perform a FCE on her. She may refuse to do this test because of her pain, she just wants to be left alone.

I believe saw a guy doing a FCE test when I was at PT a couple of yrs ago-
his was for an electrician trade. He had to twist wires and nut's-bolts at all angles, use screw drivers, tolls of that trade.
he was having to stop and rest and the PT tester took notes and recorded the status of the testee.

here is a snip & link to the full PDF article about FCE - better than I can explain since I only saw the one in process.

[GUIDELINES: OCCUPATIONAL HEALTH PHYSICAL THERAPY: EVALUATING FUNCTIONAL
CAPACITY BOD G10-08-01-01 [Retitled: Occupational Health Guidelines: Evaluating Functional
Capacity, Amended BOD G11-01-07-11; BOD 03-01-16-54; BOD 03-00-25-60; BOD 11-97-16-53]
[Guideline]
1.0 Introduction
A Functional Capacity Evaluation (FCE) is a comprehensive battery of performance based tests that
is used commonly to determine ability for work, activities of daily living, or leisure activities.1
The need for functional evaluation was identified in the 1980s by workers’ compensation systems that
required specific information about worker functional capacities and limitations to expedite the return-
to-work process. Historically, return-to-work decisions were based upon diagnoses and prognoses of
physicians, but did not include objective measurements of worker functional abilities and job match
demands. Physical therapists, whose core competencies include functional evaluation, began to
develop functional capacity tests for comparison to the physical demands of jobs and occupations.
These functional tests initially examined and evaluated the ability of a worker to perform physical job
match conditions as described by the US Department of Labor in Selected Characteristics of
Occupations as Defined in the Revised Dictionary of Occupational Titles2 and The Revised
Handbook for Analyzing Jobs.3 Functional examination/evaluation, combined with diagnoses and
prognoses by physical therapists has emerged as a valid and effective tool to support safe return to
work, activities of daily living or leisure activities after an injury or illness]
http://docs.google.com/viewer?a=v&q=...rJZ-9DxXZUHjMQ

Thanks Jo*mar for the link. I pray this doesn't cause too much stress.:(

Well I broke the news and it isn't good. Has anyone with RSD ever taken this test? Thanks a bunch for any replies.

What a horro story...
 

Jim,

I feel so bad a for your wife and you. I have never heard of it but I am in PT currently and I will ask my PT person and see if I can get any info. for you.

This is truly a nightmare my heart goes out to you guys. But keep plugging you'll get it. One question who ordered this type of test?

Gabbycakes.

I'll post to you later. I won't be home until about 1PM EST.

Gabbycakes

Thanks Gabbycakes. Out of the blue, her doctor. I am extremely freaked about this and my wife is ready to just pack it up and leave everything behind. However, I've explained to her just take this test, we are now pulling all her records from this doctor for the judge and let the chips fall. She's not in good shape, she's in her 50s, her right arm is crippled, legs are swollen etc. she's in constant pain. I truly believe she will win out.

If she shows up for the FCE and the person doing the testing has any brains- they should see & record what her condition is.

All she can to do is try what she can and report to the tester , plus the tester should record what they observe.

Maybe the dr is getting pressured to show some sort of proof that she can not work and this is an independent way of getting that proof????

Is the test being done by an independent provider??

I just filed for disability a couple days ago. Prior to that, I went back to some of my docs to get updates and see if there was anything more I could do.

Two of my docs - my pain doc and my foot specialist said that they would not write letters stating my condition for me to give to SS. They instead said that I should get a FC test. My pain doc said to do only what I can.

Jo*mar, I can't think of where the pressure would be coming from because it's not a WC case, no lawsuits, no moneys coming from anywhere. We lost our insurance so I pay out of pocket. As far as a contractor is concerned I've not thought of that. Her doctor is a board certified pain specialist. What the lawyer provided me seems to indicate my wife's doc will perform it, because the doc told the lawyer to tell my wife to make an appointment for the test at her office. I did read however that this test is used also for SSDI cases.

daylilyfan, This statement "to do only what I can" is pretty much what I told my wife. I told her you can only do what you can do and it aint much so try not to worry. I've explained we have 8 years of medical records indicating the progression of RSD, nothing, not some half hour form indicating whether you can put one foot in front of another would indicate that you'd be a high candidate for employment. I've worked for nearly 40 years and if I were to interview her for a job, she would be turned down, she is and looks to be in pain. Not a good sign to hire especially when attempting to add a very sick girl to one's health insurance rolls.

Just do only what you can.

Maybe the dr wants it for his own records, it sounds like her pain has not been gotten under control , maybe this has to do with that in some way..

I recall seeing posts about her pain control problems, but can't recall the details...

You are correct. I do like this doctor but lately she's had Suzy fill out forms indicating whether she feels better at all and or has "my services as a doctor helped you in anyway". I do feel this doctor is giving up on her. I've told the doc that Suzy's done the best under you, believe it or not, and told her what the positives were and that their is no cure especially a cure for one who received little to no treatment her first 4 years of the disease. In those days she may have slept 2 hours a night for years making her thinking disoriented. Now she does get sleep but her RSD has spread these past 3 years. She is better but her manner with doctors is not the best and never was even when she was a small girl. And she's very shy on top of it all. My wife feels strongly, with everything she's read, that the best thing for her is no evasive proceedures at all and try to rid stress and maximize movement without causing a flare. She wants nothing to do with stimulators, any cutting of bone, skin, nerves etc. She wants nothing to do with physical therepist who do not have a clue. And she's correct, somewhat. She has had ketamine and lidocaine infusions and several of them with no luck. People are different, some will try anything and everything, some just want to be left alone. Suzy just wants to deal with her condition her way and is steadfast about it and it rubs docs the wrong way.

I asked by PT...
 

Hi Jim,

As I said I would ask my PT what this test was all about. He knew what I meant as soon as I said it. What he said is it is a test they use for disability cases, WC, etc. He stressed that they have tests they use that are designed to see if the person is really disabled or not they try and catch the patient doing something they should not be doing or stated they couldn't. He said they get a report of what was stated on the original papers that your wife filled out and go from there. This sounds like a very unfair test. I told him is was for a goverment employer and he said they are the worse. He also stated that not all PT Facilities do it because it is very timely and most don't want to get involved.

I wish you guys all the best with this one.

Gabbycakes

Thanks gabbycakes. Suzy's original report would be several years ago. She wasn't a government employee but a government contractor instead. Either way she can't do much and the stress is a killer for her. I can see what is going to happen even before it begins. I would think a good lawyer with access to 8 years of history with this condition should be able to debunk it. This whole process makes me ill.

I'll also add this doctor has stated my wife has RSD. She has treated my wife's swollen limbs, referred her to major hospitals for infusions etc....on and on and on. It seems this doctor is very disappointed that Suzy has not improved much better than she has. Now, several months ago Suzy did mentioned to the doc she did cut her meds down because of the cost of them at the time (over $1000 a month) in which the doc respond with drug tests. I was not aware of this cutting down but I did notice increased pain with her.

How can a test like this trump everything that was done these past 8 years dealing with a chronic incurable, progressive disease. I'm totally baffled.

If it is the cost of meds that is the reason she is cutting back and no ins - many of the drug companies have programs for discounted or even free meds.

One is called needy meds I believe.
And the manufacturers have programs set up also , so you could contact them directly, if you want to find out more.

found it-
http://www.needymeds.org/

more info on rx help-
http://www.google.com/#hl=en&source=...9d13023017841d

Thanks Jo*mar, we've done just that. Our out of pocket costs with meds have dropped a bunch. In reality our costs are less for her treatment now then when we had BC/BS. I do not have coverage because there is no money to spare. We are now at the wire and if it breaks we will have to sell the house adding more stress to a most stressful situation. If everything turns out ok then we can then spend a little money preparing the house for sale in a better market in my area next spring. I always think ahead and have already contacted a real estate agent just in case.

Yesterday was a great day to end my work week and the beginning of the holiday weekend. Not only did I find out my wife's SSDI hearing may be back on schedule, I talked personnally to my wife's doctor for a half hour yesterday and what a good talk it was! It appears the only reason the doc requested the FCE test was in reaction to the complex form sent to her by my wife's representitive. The doc made a copy of it and it is infact very complex requiring a test of some sort. Her doc's reaction was in order to fill out this form a test needs to be done, not by her but by another PT of our choice. The rep told me all she really needs is a cover letter indicating the progression of her RSD. So, I will talk to the doc and most likely a test will not be necessary at all but a letter instead. It seems all the praying from us, our family and friends and our friends from NeuroTalk are being heard.

I went thru an FCE. After my FCE it was determined that I cannot lift push pull or carry anything more than 10 lbs. It is not a hard test and they said that now with it all hooked up to the computer it is easier to determine if a person is faking everything or not. The test took me about 1 1/2 hrs I think. Don't really remember it was a yr ago almost.

I imagine I will have to go through one of these.

What worries me, is that I can lift up my service dog, who is 42 lbs - but it feels like my muscles are being ripped out. It is not something I do often, but I do put her up on a table to trim her toenails. I help her up - I don't just lift her from the floor. I could probably lift her all the way up if her life depended on it, I could do it once, but I don't think I could do it a second time unless I rested several hours in between.

I carry 12 packs of pop from my car to the house, but have to hold them up close to my body, and I do one, then a couple hours later, I do the second one.

My problem is the PAIN keeps me from doing things. I don't have enough atrophy that I absolutely cannot lift anything - it just hurts so bad, I don't other than in my home PT exercises... then I limit myself to a bag of sugar lifted a few times.

So - my worry is that I have worked hard to keep some strength - but even a gallon of milk causes me a LOT of pain... I could only lift one of those for one or two times, then I usually lay down. In fact, I usually buy milk in half gallons so I don't have to lift a gallon. Laying down does not help the pain - but it keeps my arm from swelling, and any exertion causes me to be very tired.

I am very worried that a test like this will show me to be able to work, when I am not. I have a terrible time doing a few dishes, or doing a couple errands etc.

You hit the nail on the head. My wife's right arm is crippled from RSD. She is right handed. The RSD has spread to her legs and other areas. She knows that if she does not move about her condition will worsen so she does and pays a price. For example, she loves her gardens and was planting today in the heat in which she is not fond of. She rigged a small towl with a small icepack to wrap around her neck to keep the heat down. This pack was very small and not cold but slightly cool. She is now suffering because of this. Not only are her musles and joints sore from simple crouches and bending over but her neck is sore from a towl with 4 icecubes in it. It's not that you can't put one foot infront of another it's the repercussions that come along later that a test like this will never pick up on, jot down and report to one sort of insurance company or another. This test may work for some but to be used in a SSDI hearing, the chance that a gizmo hooked to your appendages spewing data to some knucklehead who then submits to a judge who then dismisses a firm diagnoses and 8 years of recorded suffering for some machine is absolutely too risky to take. Also, this test would be given by someone who has never ever met my wife, knows her condition etc. This test does not see my wife suffer every single day from the least amount of effort like taking a shower.

From seeing the electrician doing his FCE I was noticing that while I would be able to do most of those tasks -except the overhead screwdriver work- I'd have eto keep dropping my arms down to get blood flowing in them again LOL.
Then I would have the delayed pain later or possibly even spasms.

So I wonder how that would show up on the testing?? If at all?

I have no clue how this would be detected. One thing I've noticed is many pain treatment facilities do not do the test anymore because insurance in many cases do not pay for it. I've found 2 places that will do it for cash or charge, close to $1000. Every place I called the first thing they asked "is it a WC case" in which I responded "no, an SSDI case" and then seemed surprised and asked why would you even want this test done? My wife is going to do the test but it just seems another chunk of money down the drain. And more importantly if this test fails to help my wife at all, the feeling that we paid good money so she could go through much pain performing a test that can't gauge much as far as RSD is concerned.

I have to do the FCE test next week...order by SS...they told if I don't go my SSDI case will be closed and not go any further. I took these tests when I was a child because I also have Cerebral Palsy...I did horrible...we'll see what happens....

I too had to take the test years ago, it was done by the w/c Dr., it was a joke. He put me in a room and told me to take my clothes off and put on a gown and he would be back. He came back and I was half done because I happened to have a cast on my foot. This Stupid DR. even questioned if my foot was even broken. He had me try to do things that even people without RSD can't do, so I tried without much success. He even wrote that I could drive while taking Dilaudid,which I was taking back then prior to a surgery. When it came time to go in front of the judge she thru his entire report out, saying that this was ridiculous to even question the foot or to say that I could drive while under the influence of such a strong med. Do what you can and don't push yourself, it's not worth paying for it in pain after the test, just do what you can and leave it at that, your attorney will be with you to protect you from the evil people that make us do these awful things. Good luck my prayers are with you, you will do fine
Your friend Wendy

Thanks cindi1965 and Wendy for your response. cindi, can you explain what you mean "I did horrible"? The reason I ask leads to my answer to Wendy.
Wendy, my wife is freaked about this test. Her doctor and I have told her only do what you can and no more. I've told her not to let this eat at you and try not to get into a flare over it. The other thing about this test is my wife's doctor wants the report on this test not the SSDI judge or her lawyer. The doctor is going to use it to state she can't work.

Thanks again.

Hi Jim and Suzy,

Please tell Suzy not to fret too much over this test. It is electronic and they do pick up on pain signals and anxiety at least that is what my report said. I also scheduled my appt in the afternoon, just to ensure that it was accurate. I did my normal morning routine, which isn't much but is totally exhausting, by noon my pain spikes from the morning routine and that is the main reason I could no longer work. Anyhow, the test, I was capable of sedentary work, with multiple restrictions, but sitting for me is the worse. Bottom line, it was irrelevent due to the damage to my lower extremities. The test only gives a baseline, there are many other factors to weigh in on i.e., age, medication, effects of medication, mental status (does your wife talk to anyone?), anxiety, effects of the pain, etc.

We really need a Robin Hood for this illness, we just should not have to go through this as if we are a criminal. What happened to innocent until proven guilty, we don't even get that. We did nothing wrong. This is just not something anyone can plan for. It is a train wreck to say the least, and it is just so sad to see people, caretakers, families struggling to just cope through a day. I, like many, cannot plan my day ahead I just have to settle for living or should I say coping with each moment. We are surviving. Your wife is shutting down mentally to survive physically, that is what the body does to protect itself. Why doesn't your doctor see that? I will keep you both in my prayers, and I am so sorry for your pain, my husband has been a rock, I don't know where I would be without his love and support. Know that you are appreciated! God Bless

Jeanie

Thanks for the support Wilbyfree. Why doctors don't see alot of things is way over my head. I did ask her once has anyone in your experience ever faked RSD? No, was the reply. If no is the answer then why do folks with RSD get the cold shoulder or the feeling that one is lying to gain something? I'm not too thrilled with American medicine at all. I really truly do not know how it compares with other modern countries.

My wife did talk to the one administering the FCE test and stated she doesn't think this test should be a gauge for those with RSD. WC cases it's primarily for. The other strange thing is on the doctor's prescription it says "EMC on right arm". This is the spot of my wife's injury where RSD first developed and then spread. The administrator thinks this is the wrong test for her but will administer the test anyway. She also said the test does not gauge pain. :confused:

Jim , I am going to be taking a FCE test in the very near future according to my Pain Doc and WC Nurse,Id be guessing but in 2 months or less.

Just wondering if your wife ever did take the test and if she did howd she do ?

DONTTOUCHIT, I wrote a long letter to my wife's pain doctor who wanted this test done after treating my wife and diagnosing her with full body RSD for 3 years and why we think this test is not the right test for her. I presented other doctor's opinion, those doctors who are experts in RSD, in why FCE tests can be misleading to those with RSD. The doctor changed her mind and wrote a letter that she is not able to work (to be submitted to SS). Someone earlier posted that their FCE test was around an 1.5 hours. The test that was going to be administered to my wife was around 4 hours. This test is all over the place it seems.

It appears my test is going to be done Very early in January according to my pain Doc

No, I managed to change the doctor's mind about this test. It would have cost us $1000 out of pocket, was told it may take 3.5 hours to take. The biggest problem we had was the test takers felt Suzy having RSD should not take this test. Also her case was not a Workmans comp case. DONTTOUCHIT, is your situation a WC case?

However, sinse I created this thread things have changed. Last Nov. 2 Suzy was awarded her full benefits from Social Security. :D