My two cents: there is not such thing as 'the validity of the FCE'. An FCE is not a generic commodity; if it is then it is not a Matheson FCE.

Each FCE has its' own internal Safety, Reliability, Validity, Practicality and Utility. Marketing YOUR FCE to physicians should stress that your practice standard requires you to address each of these elements in each, unique FCE.

Many years ago the Key Method said that FCE had become a commodity. I believe this meant that the service could be sold in blocks and that almost anyone could perform one if they followed a secret recipe. When I heard that I knew that we were entering an era of low-value FCE's. Although one can approach evaluation as a non-thinking, recipe driven process the Utility of the outcome is not worth paying for; and it won't assist anyone to close a case.

Over the past couple of years, as the practice of FCE has matured, we have seen several FCE 'system's go out of business. I believe the reason they went out of business was: (1) inability to provide the thinking behind findings, (2) inability to answer unique referral questions, (3) lack of case resolution-oriented information in the report, (4) a reliance on hardware to provide answers to vocational questions.

This business is about answering questions that assist physicians and case managers make decisions about the future on injured workers. Those hawking hardware or secret formuli have never lasted in the business. Think of your FCE as being unique and following the Practice Hierarchy (Safety, Reliability, Validity, Practicality and Utility); it is a great compass.

I empathise with your perdicament. I agree that with influence, comes responsibility, and the physicians that write off restrictions based upon low levels of physical effort do us all a disservice. Comfort comes in knowing I have done the right thing and that there are more readers for what we do than the referring physician. The Deputy Workers' Compensation Commissioner who ends up "hearing" the case sounds like your target audience. I would expect he/she reads your report, and may place more value in it than you know. Have you considered contacting them? Eventually, case managers and insurance companies will value what you do more than the "others", and the referrals will follow.

I would remind your evaluee's of these facts prior to testing. Assure them you are neutral, and are required (and expected) to only report what you see today, and that high levels of physical effort will only benefit them, and low levels of physical effort will only hinder them.

As far as "keeping busy", acknowledge to the MD's that you will make accurate statements regarding Effort and RCR. You will aslo provide them with a detailed report that lists the client's demonstrated abilities, and they can use this data as they see fit. MD's hate filling out tables that ask questions regarding sitting, standing, lifting abilities, etc. They aslo hate spending time interpreting naratives and complex tables. Find out what form they are filling out and use the same terminology to expidite this process for them. I refuse to fill out forms that state or insinuate this is the client's abilities when they have not provided high levels of physical effort. Most of these require the MD's signature anyway.

I would continue to educate case managers, MD's, and client's. I would aslo market towards the attorneys. Your report compaired to the "others" is a much more valueable tool when the settlement process happens. Hope this helps.

Jim

I completely agree with you. I feel that every FCE I've performed is valid. It's physicians or other referral sources that will directly ask me if the test was valid and they seem to confuse a low level of effort with the test being invalid. I also try to avoid the term "valid" for this point because there is so much confusion regarding the term. I have been through other non-Matheson training systems and have learned about those "validity profiles"... the issues of effort and RCR are blurred... and there is no consideration of the psychosocial aspects that go into FCE testing.

As far as closing cases, Iowa is tricky. There is no clear process defined. Much of it is dictated by the physician (MMI) and many of them utilize IMEs and complete "Estimates of Physical Capacities". Any complicated case involves attorneys... eventually it boils down to a monetary settlement that varies with each Deputy Workers' Compensation Commissioner who ends up "hearing" the case. I initially started practicing industrial rehab in WA state and the system out there is much more clearly defined. Per some of my conversations with doctors, they are hesitant to use FCEs because if the client gives a low level of effort and say only lifts 5 lbs... they feel backed into a corner re: permanently restricting them to 5 lbs. My confusion is that it doesn't seem like they should be "stuck" if effort and RCR findings are clearly documented and the test is documented as "valid for safe minimum capacities only". My thought is that is why they get paid the big bucks to make those kind of tough decisions.

Does that help clarify my situation? Thanks for your response.

Validity is a term that gets thrown around a lot, some FCE systems even use a Validty Profile to sound ostentatious. For our purposes, I think every FCE I have ever done has been valid. I am asked to state whether or not they provided high levels of physical effort and whether or not their reports of pain and disability are reliable. My answers to these questions are accurate through testing the day of the test, and therfore valid. I tend to stay away from the use of the word "Valid" due to the confusion associated with it's use, and just stick to my responses regarding Effort and RCRPD.

What do you mean that you are having to explain that the FCE is valid even if the client does not provide high levels of physical effort?

How do your local physicians close cases without some form of testing? If I undertand you question a little more clearly, I'm sure we can come up with a good marketing strategy, and a way to explain how to use what we do. Please reply.

Jim

I find myself having to explain that an FCE is still valid even if the client does not perform with a high level of effort. Physicians in my area are gun shy re: use of FCEs for this reason. They seem to be fearful of getting locked into permanent restrictions, even if the low level of effort, self-limiting, etc is clearly documented in the report. Any suggestions for how to communicate/market with these physicians?