How to Write an FCE Report That Holds Up: Exertional Levels, Effort Language and the Job Match

Open with the answer

A published US sample FCE report, the OccuPro sample, runs 11 pages and opens with results: the physical demand category the client showed, the job demand match, the percentage of consistent-effort tests, the percentage of reliable pain tests, and the material handling abilities. The narrative comes after. That order is right, because the case manager reading it wants the classification and the match before anything else.

Write your first page so someone with two minutes gets the whole answer: demonstrated physical demand level, the job’s demand level, whether they match, and how reliable the results are. Then show your work.

Use the five federal exertional levels, and quote them

The vocabulary for physical demand level in the US is set by the Social Security Administration at 20 CFR 404.1567, and workers’ compensation systems and employers use the same five words. Quote the definitions in your report so nobody argues about what “medium” means:

• Sedentary: lifting no more than 10 pounds at a time, with occasional lifting or carrying of light articles.
• Light: lifting no more than 20 pounds at a time, with frequent lifting or carrying of objects weighing up to 10 pounds.
• Medium: lifting no more than 50 pounds at a time, with frequent lifting or carrying of objects weighing up to 25 pounds.
• Heavy: lifting no more than 100 pounds at a time, with frequent lifting or carrying of objects weighing up to 50 pounds.
• Very heavy: lifting objects weighing more than 100 pounds at a time, with frequent lifting or carrying of objects weighing 50 pounds or more.

Report tolerances as durations and loads as weights

A tolerance is a number of minutes. A load is a number of pounds. “Good sitting tolerance” is an opinion; “sat for 42 minutes before requesting a position change” is a finding. Write every positional tolerance (sit, stand, walk, reach, bend, squat, kneel, balance, stairs) as a duration and every material-handling result (floor to waist, waist to shoulder, overhead, carry, push and pull) as a weight, with occasional and frequent distinguished, because the exertional definitions above turn on that distinction.

Grip and pinch go in as dynamometer readings. Range of motion, strength and neurological screening go in as measurements. If a test was not administered, say so. A report that names what it did not do is trusted on what it did.

Effort: describe consistency, never motive

This is where FCE reports get excluded. The moment a report says the client “exaggerated,” “magnified symptoms” or “malingered,” the author has stepped out of measurement and into an accusation, and the whole document is open to attack. The defensible move is to report what the consistency measures showed and stop.

Say how many consistency measures you used and how many the client met, in a form like “demonstrated consistent effort on 9 of 10 consistency measures” and “results are considered a reliable representation of current abilities.” If performance was limited by the client’s own pain report rather than by observed capacity, say exactly that. It is a legitimate finding and it is far stronger than any inference about intent.

The words to keep out of the report entirely: malingering, faking, symptom magnification, exaggerated pain behavior, valid or invalid effort, and any statement about what the client intended.

Who performs the FCE, and how long it takes

State boards regulate who may perform an FCE. North Carolina’s board, for example, states that an FCE must be performed by the PT and that a PTA may not perform one independently. Check your own state. Johns Hopkins describes the evaluation as usually taking four hours, with the length varying by occupation. Record the duration and the number of days in your method statement; it is part of what makes the results credible.

A structure that answers every referral question

List the referral questions at the top and answer each one by number at the end. An unanswered referral question is the most common reason an FCE gets sent back. A reliable running order:

• Client and referral details, assessor designation and state license number
• Purpose and the referral questions, listed
• Informed consent statement and documents reviewed
• History, including medications and work history
• Job demands, from a physical demands analysis if one was supplied
• Subjective interview and any questionnaires administered, with scores
• Musculoskeletal examination: posture, range of motion, strength, neurological screen
• Positional tolerances as durations
• Material handling as weights, occasional and frequent
• Grip, pinch and fine motor
• Job simulation where the referral is job-specific
• Consistency of effort and reliability of pain report, as counts
• Results summary and overall exertional classification
• Job match table, only where job demands were supplied
• Conclusions answering each referral question, then recommendations

The job match, and when not to write one

A job match table compares each demonstrated ability against the job’s demand, item by item, and states met or not met. It is the most useful table in the report, and it is only honest when a job demands document was actually supplied. If none was, say that the job match could not be completed and classify against the exertional levels alone. A job match invented from a job title is the kind of thing an attorney enjoys finding.

Where Carearoo fits

Carearoo is building an FCE report drafter for US physical and occupational therapists that leads with the results page, quotes the federal exertional definitions, reports effort as counts of consistency measures and blocks the motive words listed above. It is not live yet, and it will stay that way until it is tested. What is live today for US clinicians is free invoicing. If you also write Medicare progress reports, the progress report guide covers the 10-day rule.

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