Pre-employment and Preplacement Screening for Workers to Prevent Occupational Musculoskeletal Disorders

Abstract

As will be discussed in this chapter, functional capacity evaluations (FCEs) are often relied upon by employers, physicians, insurance agencies, and benefits adjudicators to determine an individual’s musculoskeletal capacity to do physical labor, many times with legal and/or occupational consequences. We will also review a number of issues related to FCEs. For example, even though FCEs have been widely used for several decades, scientific, legal, and practical skill concerns remain. Because FCEs are based on a theoretical model of comparing physical job demands to worker capabilities, valid FCE results tend to be optimal when jobs are well defined and present constant, rather than varying, physical demands; work simulation is practical and valid; and serial examinations are employed. Validity of results is questionable when the FCE criteria are unrelated to the job-specific activities or actual job requirements and flexibility are poorly represented. We will also point out that, to date, the evidence concerning the practical reliability of FCE results is limited. Moreover, the evaluation of sincerity of effort, ability to perform complex or variable jobs, and prediction of injury based upon FCE data can also be problematic. Finally, it will be concluded that more research is needed in order to better define the appropriate role for these evaluations in clinical and administrative settings, especially studies linking FCE results to occupational outcomes.