FUNCTIONAL CAPACITY ASSESSMENT (FCA)

1. - NITHIN NAIR
• UNDER GUIDANCE OF DR. POTHIRAJ P. (PT)

2. LEARNING OBJECTIVES
After this session students will be able to –
• Explain the outline of Industrial Rehabilitation
• Explain Functional Capacity Assessment in a detailed
manner.

3. PREVENTION
PRIMARY SECONDARY TERTIARY
 RISK ASSESSMENT
 ERGONOMIC
INTERVENTION
 ORGANIZATIONAL
INTERVENTION
 PERSON –
ORIENTED
INTERVENTION
 JOB ANALYSIS
 INJURY
PREVENTION
PROGRAM
 INJURY CARE
 POST INJURY CARE
PHASE : (FUNCTIONAL
CAPACITY ASSESSMENT)
 RETURNING TO
WORK PROGRAM
(WORK CONDITIONING
AND WORK HARDENING)

4. PRIMARY PREVENTION
RISK ASSESSMENT
PROCESS
SYSTEMIC EXAMINATION
OF ALL RISK FACTORS
RAPID UPPER LIMB
ASSESSMENT
RAPID ENTIRE BODY
ASSESSMENT
STRAIN INDEX
OCCUPATIONAL
REPETITIVE ACTIONS
(OCRA) CHECKLIST
ERGONOMIC
INTERVENTIONS
AUTOMATION &
MECHANIZATION
WORK PLACE REDESIGN
ERGONOMIC WORK
EQUIPMENT & TOOLS
PROTECTIVE
EQUIPMENTS
ORGANIZATIONAL
INTERVENTIONS
PRE EMPLOYMENT
SCREENING
WORK PROCESSES
WORK TASKS
ORGANIZATIONAL
DEVELOPMENT
PERSON ORIENTED
INTERVENTIONS
EDUCATION TO WORKERS,
MANAGEMENT AND
EMPLOYERS
HEALTH PROMOTION &
GENERAL FITNESS
PROGRAM

5. SECONDARY PREVENTION
AIM TO IDENTIFY WORKERS AT RISK OF INJURY AND MONITORING THEIR
HEALTH RECOGITION OF RED FLAGS AND YELLOW FLAGS (POTENTIALLY
SERIOUS PHYSICAL OR PSYCHOLOGICAL/PSYCHOSOCIAL RISK FACTORS
FOR DEVELOPMENT OF WMSD.
• TASK ANALYSIS
• PAUSE EXERCISES / WARM UP EXERCISES / STRETCHING EXERCISES
• TARGETED OCCUPATIONAL HEALTH PREVENTIVE CHECK UPS OF
EMPLOYEES WITH PRE-EXISTING CONDITION / EARLIER DISORDERS/
EXPOPSURES WITH REGARD TO PARTICULAR RISK AT WORK PLACE

6. INJURY ACUTE
CARE
FCA
JOB
ANALYSIS
WORK
HARDENING
JOB
MODIFICATION
CONDITIONING
WORK
CONDITIONING
RETURN
TO WORK
EXIT
ASSESSMENT
TERTIARY PREVENTION

7. POST INJURY CARE PHASE
 TAKE THE REFERRAL
 SET UP THE FILE
 SCHEDULE THE CLIENT
 INTAKE INTERVIEW
 ORIENTATION / SIGNING
– FACILITY POLICIES
 AUTHORIZATION –
RELEASE OF
INFORMATION
 CLIENTS RIGHTS LIST
 JOB ANALYSIS OR WORK
INFORMATION REVIEW
 ASSESSMENTS
 FLEXIBILITY /
MOBILITY
 STRENGTHENING
 CONDITIONING
 JOB SIMULATION
 FUNCTIONAL CIRCUIT
 EDUCATION
 VOCATIONAL REHAB
 PSYCHOSOCIAL
 OUTCOMES
 ADMINISTER FCA
 REVIEW MEDICAL HISTORY
 COMPARE FCA RESULTS WITH
JOB REQUIREMENTS
 DEVELOP EXIT GOAL
 IDENTIFY PROGRAM LENGTH
 CONFIRM PROBABILITY OF
REACHING JOB
REQUIREMENTS LEVEL
 IF LOW PROBABILITY – JOB
MODIFICATION
 IDENTIFY STARTING POINT
 IDENTIFY WEEKLY
PROGESSION CHECK
 IDENTIFY BODY MECHANICS
ADAPTATIONS NEEDED
 IDENTIFY EDUCATIONAL
NEEDS
 IDENTIFY EXERCISE NEEDS
 PLAN JOB SIMULATION
ACTIVITIES
 IDENTIFY NEED FOR OUTSIDE
SERVICES.
SCHEDULE IMPLEMENTESTABLISHINTAKE

8. FUNCTIONAL CAPACITY ASSESSMENT IS A PROCESS OF MEASURING, RECORDING,
AND ANALYZING A PERSON’S ABILITY TO SAFELY PERFORM A NUMBER OF JOB-
RELATED FUNCTIONS SUCH AS LIFTING, LOWERING, PUSHING, PULLING AND
CARRYING WEIGHTS, CLIMBING LADDERS AND STAIRS, SITTING, STANDING,
BENDING, STOOPING, CROUCHING, KNEELING, CRAWLING AND GRASPING.
THE ASSESSMENT RESULTS ARE USED AT APPROPRIATE POINTS IN THE WORKER
CARE SPECTRUM TO DETERMINE A WORKER’S SAFE WORKING LEVELS FOR JOB
PLACEMENT, INJURY PREVENTION AND REHABILITATION.
FUNCTIONAL CAPACITY ASSESSMENT

9. OVERALL NEEDS
- MORE OBJECTIVITY & LESS JUDGMENT
- GREATER VALIDITY
- GREATER RELIABILITY
- GREATER PREDICTABILITY
- COST EFFECTIVE
PLACEMENT NEEDS
- MORE OBJECTIVE & ACCURATE
MATCHING OF CAPABILITIES
- MORE PRECISE INPUT INTO JOB
MODIFICATION
- EMPHASIS ON “CAN DO” THAN “SHOULD
NOT DO”
REHABILITATION NEED
- RELIABLE ASSESSMENT OF RTW TIME
FRAMES & CAPABILITIES
- PLANNING & DECISION MAKING
- RELIABLE PRE AND POST COMPARISON
- OBJECTIVE DETECTION OF
MANIPULATION, MAGNIFICATION OR
MALINGERING
- DEPENDABLE ASSESSMENT FOR
TREATMENT OUTCOMES
PREVENTION NEEDS
- ACCURATE IDENTIFICATION – SAFE
CAPABILITIES, LIMITS, AREAS OF RISK
- BETTER INPUT FOR EDUCATIONAL &
CONDITIONING PROGRAM
- RELIABLE DETERMINATION OF SAFE
WORK ENVIRONMENT

10. ASSESSMENT
PRINCIPLES
THERAPIST
OBJECTIVITY
STANDARDIZED
EQUIPMENT
CONSISTENT
METHODOLOGY
STANDARDIZED
PROCESSING
AND REPORTING

11. THERAPIST OBJECTIVITY
 TO MEET LEVEL OF RELIABILITY – 2 DIFFERENT
THERAPISTS TESTING THE SAME PATIENT AT THE
SAME POINT OF TIME SHOULD GET SAME
RESULTS.
 BY INCORPORATING MORE OBJECTIVITY –
THERAPIST EXPOSURE IS REDUCED AND THIS
STRENGHTEN THEIR POSITION IN ANY DISPUTE.
STANDARDIZED PROCESSING AND REPORTING
 BY USING FINAL STATISTICS TO VERIFY
PROTOCOLS AND INTERRELATE DATA THE
RELATIONSHIP BETWEEN FCA RESULTS AND
OUTCOMES BECOME QUANTIFIABLE AND
PREDICTABLE.
 THUS THIS REDUCES THERAPIS’S EXPOSURE
AND STRENGTHEN THEIR POSITION IN LEGAL OR
REIMBURSEMENT DISPUTES.
CONSISTENT METHODOLOGY
 EQUIPMENTS, INSTRUCTIONS, ANALYSIS OR
RECOMENDATIONS SHOULD BE CONSISTENT AND
STANDARDIZED AS IT IS THE BASIS OF RELIABILITY,
VALIDITY, AND REPEATABILITY.
 TESTING DEVICES / PROTOCOL SHOULD BE SAFE,
QUICK AND EASY TO USE.
 INSTRUCTIONS SHOULD BE CLEAR, NEUTRAL,
NONINFLUENCING, NONDEMEANING.
 COMPLETION POINT OF EACH TASK SHOULD BE
DETERMINED OBJECTIVELY AND CONSISTENTLY.
 INFORMATION SHOULD BE ANALYSED AND REPORTED
USING STANDARDIZED METHODS AND REPORTING
FORMATS.
STANDARDIZED EQUIPMENT
 EQUIPMENTS SHOULD HAVE GOOD RELIABILITY
AND VALIDITY.
 EQUIPMENTS SHOULD BE MADE TO
ACCOMMODATE REQUIREMENTS.
 EQUIPMENTS MUST BE FLEXIBLE TO
ACCOMMODATE FUTURE TEST ADDITIONS /
MODIFICATIONS.

12. ASSESSMENT
GUIDELINES
INSTRUCTIONS
THE STOPPING
POINT
DEMONSTRATION
TRANSLATING
RESULTS TO
RECOMMENDATIONS
VALIDITY OF
PARTICIPATION
VERIFYING
FORMULAS
TRAINING

13. INSTRUCTIONS
 GIVE SPECIFIC,CLEARLY DEFINED, OUTCOME
VERIFIED, IDENTICAL INSTRUCTIONS.
 CONSISTENT PROTOCOL.
 TONE OF VOICE SHOULD BE NEUTRAL AND
NONDEMEANING.
 BODY LANGUAGE SHOUULD BE CONTROLLED FOR
CONSISTENCY.
TRANSLATING RESULTS TO RECOMMENDATIONS
 RESULTS HAVE IMPACT ON CLIENT’S LIFE.
 TWO POSSIBILITIES – OVERSTATES CAPABILITIES
(WORKER AT RISK) OR UNDERSTATES
CAPABILITIES (UNABLE TO WORK)
 NEED FOR PROCESS WHICH IS ACCURATE AND
RELIABLE.
 ALGORITHMIC TRANSLATION OF RESULTS TO
RECOMMENDATIONS.
DEMONSTRATION
 WHETHER DEMONSTRATION OF THE ACTIVITY
SHOULD BE PROVIDED BEFORE THE CLIENT
PRODUCES IT ? YES / NO
 1ST SCHOOL OF THOUGHT – IT MIGHT INTERJECT AN
ARTIFICIAL VARIABLE THAT OVERSTATES OR
UNDERSTATES THE CLIENT’S TRUE CAPABILITIES
 2ND SCHOOL OF THOUGHT – ALLOWING THE CLIENT TO
USE SELF SELECTED POSTURES DURING THE
ASSESSMENT YIELDS A MORE RELIABLE TRANSLATION
TO WHAT WILL HAPPEN IN WORK PLACE. HERE
THERAPIST WILL BE ABLE TO OBSERVE AND NOTE THE
CLIENT’S POSTURE WHICH INTURN CAN DETERMINE
WHETHER EDUCATION PROGRAM OE STRENGTHENING
PROGRAM IS ESSENTIAL.
STOPPING POINT
 IT WOULD BE A POINT AT WHICH THE CLIENT IS
ENTERING THE LEVEL OF RISK.
 TWO POSSIBILITIES – STOP THE CLIENT BELOW
TRUE CAPABILITY OR PUSHES THE CLENT BEYOND
SAFE LIMITS
 CURRENTLY NO METHOD AVAILABLE TO
DETERMINE THIS EXACT POINT
 1ST SCHOOL OF THOUGHT – THERAPIST SHOULD
DETERMINE THE STOPPING POINT
 2ND SCHOOL OF THOUGHT – THERAPIST SHOULD
ASSIST THE CLIENT IN REACHING THEIR OWN
STOPPING POINT DETERMINATION.

14. VALID PARTICIPATION: DEMONSTRATED FULL EFFORT RESULTS: SAFE CAPABALITY
INVALID PARTICIPATION: DEMONSTRATED LESS THAN FULL EFFORT (INTENTIONALLY) –
RESULTS: LESS THAN FULL SAFE CAPABILITY
CONDITIONALLY VALID PARTICIPATION: DEMONSTRATED LESS THAN FULL EFFORT
(UNINTENTIONALLY) – RESULTS LESS THAN FULL SAFE CAPABILITY + REPRESENT
CLIENTS OWN PERCEPTION
CONDITIONALLY INVALID PARTICIPATION: DEMONSTRATED BEYOND FULL SAFE
CAPABILITY OVER LONG WORK PERIODS – MORE THAN RECOMMENDED SAFE LEVELS
VALIDITY OF PARTCIPATION
STATISTICAL VALIDATION IS BASED UPON THE PRINCIPLE THAT A PERSON’S ABILITY TO
PERFORM ONE TASK IS AN INDICATOR OF THE RANGE OF CAPBILITY TO PERFORM
ANOTHER.

15. VERIFYING FORMULAS
 FORMULAS CAN BE ESTABLISHED
BASED ON PROTOCOLS OF THE
ASSESSMENT.
 ACCURACY OF THE FORMULAS MUST
BE TESTED.
 IF FOUND INCORRECT – MUST BE
CORRECTED & RETESTED
 AVOID EXTRAPOLATING FORMULAS
FROM WORKS OF OTHERS, UNLESS
TESTING METHODS ARE IDENTICAL.
TRAINING
 FOR CONSISTENCY AND
STANDARDIZATION – ALL POLICIES AND
PROCEDURES SHOULD BE WRITTEN ,
MANUAL PUBLISHED AND TRAINING
PROCESS ESTABLISHED.
 THERAPIST SHOULD BE KNOW THE
PURPOSE OF DATA AND HOW IT WILL BE
UTILIZED.
 FOLLOW RULES MENTIONED DURING
INSTRUCTIONS.
 MUST MASTER THE METHOD OF
DETERMINING THE STOPPING METHOD
 MUST PRACTICE GIVING
DEMONSTRATION WHERE APPROPRIATE
AND WITHHOLD IT WHEN NECESSARY.
 THERAPIST MUST BE OBSERVANT,
ATTENTIVE, AND SHOULD ACCURATELY
RECORD CRITICAL OBSERVATIONS AND
FEEDBACK FROM CLIENT.

16. ASSESSMENTPROCEDURES
SCHEDULING AND
PREPARATION
PROBLEMS TO
ANTICIPATE
GREETING THE
CLIENT
COMPONENTS
SEQUENCING
REPORTING
COMPLETING THE
VISIT

17. SCHEDULING AND PREPARATION
 FCA REFERRALS CAN ORIGINATE FROM MANY SOURCES.
 POLICIES NEED TO BE ESTABLISHED – WHO GETS
AUTHORIZATION FOR PAYMENT.
 FEES SHOULD BE COMMUNICATED CLEARLY.
 FILES MUST BE PREPARED TO COLLECT SCHEDULING
INFORMATION & MEDICAL HISTORY PRIOR TO
ASSESSMENT.
 PREPARE – ANSWERING THE QUESTIONS REFERRING
ABILITY TO READ AND WRITE, PRIMARY LANGUAGE
SPOKEN, LITIGATION STATUS, DATE OF INJURY, PRIMARY
DIAGNOSIS
COMPONENTS
 THREE PRIMARY CATEGORIES OF WORK
 WEIGHTED ACTIVITIES
 POSTURE AND TOLERANCE
 UPPER EXTREMITY ACTIVITY
GREETING THE CLIENT
 CLIENT’S APPREHENSION AND QUESTIONS MUST BE
ADDRESSED
 PROVIDE ORIENTATION OF THE FACILITY, THE SCHEDULED
ACTIVITIES, AND PURPOSE AND USE OF ASSESSMENT
 THERAPIST SHOULD TRY TO -
 ALLEVIATE FEARS
 EXPLAIN OVERALL ASSESSMENT PURPOSE
 ACTIVITIES REVIEW EXPECTED DURATION
 INTRODUCE ANY OVERLYING PHILOSOPHIES
 POINT OUT REFRESHMENT SOURCES
 POINT OUT WHERE BATHROOM ARE
POTENTIAL PROBLEMS TO ANTICIPATE
 CLIENTS SHOW UP LATE
 CLIENTS BRINGING FAMILY MEMBERS
 CLIENTS INFLUENCED BY INSTRUCTIONS FROM ATTORNEY
OR FAMILY MEMBER
 EMOTIONAL RESPONSES
 CLIENTS FRUSTRATION
 CLIENTS RESISTING PARTICIPATION
 CLOSE TO TERM PREGNANCY
 REFERALLS WITH DIAGNOSIS – INAPPROPRIATE FOR FCA’S
 PHYSICIAN’S RESTRICTIONS THAT ARE LOWER THAN
CLIENT’S FULL CAPABILITY
 INAPPROPRIATE ADVANCES
 UNABLE TO FINISH ASSESSMENT
 ALCOHOLIC CLIENTS

18. WEIGHTED ACTIVITIES
• CARRYING
• LIFTING ABOVE
SHOULDER
• LIFTING DESK TO
CHAIR
• LIFTING CHAIR TO
FLOOR
• PULLING
• PUSHING
UPPER EXTREMITY ACTIVITY
• CIRCUIT BOARD
TOLERANCE
• FASTENER BOARD
TOLERANCE
• FINE MANIPULATION
• FIRM GRASPING
• GRIP STRENGTH
• KEY BOARD
TOLERANCE
• SIMPLE GRASPING
• TOOL STATION
TOLERANCE
POSTURE AND TOLERANCE
• BALANCING
• BENDING
• CLIMBING
• CRAWLING
• CROUCHING
• KNEELING
• REPETITIVE FOOT
MOTION
• SITTING
• SQUATING
• STANDING
• STOOPING
• WALKING
• CERVICAL MOBILITY
• WORK DAY
TOLERANCES

19. SEQUENCING
• COMPLETE ENTIRE
ASSESSMENT IN THE
TIME FRAME
DESIGNATED
• SEQUENCE ACTIVITY TO
AVOID FATIGUE
• SEQUENCE THE
COMPONENTS BASED ON
FUNCTION BEING
TESTED AND SEVERITY
OF INJURY
• TAXING ACTIVITY →
LESS TAXING ACTIVITY
(INTERSPACER)
COMPLETING THE VISIT
• REVIEW THE RESULTS
WITH THE CLIENT
• DISCUSS IMPORTANCE OF
WORKING ON BODY
MECHANISM
• WHO WILL RECEIVE THE
COPY OF THE REPORT
AND WHEN
• CONFEDENTIAL
CUSTOMER
SATISFACTION SIGNED
REPORTING
• FCA REPORTS SHOULD BE
CLEAR AND CONSISE
• USE USERS LANGUAGE
• AVOID MEDICAL JARGON
• EG: PRONATION – PALM
DOWN POSITION
• REPORTING RESULTS
SHOULD BE OBJECTIVE

20. FCA
MEET JOB
REQUIREMENTS
RTW
CAPABILTY
BELOW AVERAGE
CONDITIONING &
RTW
DOES NOT MEET
JOB
REQUIREMENTS
VALID
POOR POSTURE &
BODY MECHANICS
TRAINING
MEETS JOB
REQUIREMENTS
RTW
DOES NOT MEET
JOB
REQUIREMENTS
WORK
CONDITIONING
RTW
WORK
CONDITIONING
JOB
MODIFICATION
RTW
JOB
MODIFICATION
RTW
CONDITIONALLY
VALID / INVALID
WORK
HARDENING
RTW
INVALID
FCA RTW
REDUCE OR TERMINATE
WORKERS’
COMPENSATION BENEFITS

22. 1. INDUSTRIAL THERAPY – GLENDA KEY (1ST EDITION)
2. TEXTBOOK OF PREVENTION PRACTICE AND COMMUNITY
PHYSIOTHERAPY (VOLUME: 1) – Dr. BHARATI BELLARE
(1ST EDITION)
3. PHYSIOTHERAPY IN COMMUNITY HEALTH AND
REHABILITATION – WAQAR NAQVI (1ST EDITION)
4. THE ERGONOMICS KIT FOR GENERAL INDUSTRY – DAN
MACLEOD (2ND EDITION)