Who Can Benefit From One, and How Does an Occupational Therapist Perform It?

When life throws us a curveball—an injury, illness, or chronic condition—returning to work or daily routines isn’t always straightforward. That’s where a Functional Capacity Evaluation comes in. It’s a powerful, evidence-based tool occupational therapists use to assess a person’s functional abilities in relation to the demands of their job or everyday life.

Whether recovering from an injury, applying for disability benefits, navigating a return-to-work programme, or exploring vocational options, an FCE can provide clarity and direction. It helps answer crucial questions like: Can I go back to work? What kind of work can I do? What accommodations do I need – physically, cognitively, or emotionally? In this blog, we’ll break down what an FCE is, who benefits from it, and how occupational therapists carry out this important and holistic assessment.

What is a Functional Capacity Evaluation?

A Functional Capacity Evaluation is a standardised, objective assessment of an individual’s ability to meet the inherent physical, mental, and emotional demands of a specific job.  While many associate FCEs with physical testing like load handling, sitting, standing or walking, a well-rounded FCE also evaluates cognitive abilities (e.g. attention, memory, problem-solving, processing speed, mental endurance) and psychosocial and behavioural components (motivation, frustration tolerance, interpersonal functioning, stress management, emotional regulation). It offers a snapshot of a person’s performance across multiple domains of function, and can form the foundation for clinical, legal, and vocational decisions.

Why is an FCE Important?

An FCE is valuable for multiple reasons:

• Return-to-Work Decisions: It provides clear evidence of whether someone can return to work full-time or part-time, with or without restrictions.
• Workplace Accommodations: It helps employers understand what physical modifications, cognitive strategies (like task simplification or memory aids) or psychosocial supports (like coaching or reduced social demands) are necessary to support a safe return to work.
• Insurance and Compensation Claims: An FCE is objective evidence for medico-legal cases, workers’ compensation, or disability claims.
• Rehabilitation Planning: It informs treatment and rehabilitation goals by identifying functional deficits and capacities across multiple domains.
• Career Redirection: It assists in vocational planning if someone can no longer perform their previous job.

Ultimately, an FCE bridges the gap between medical recovery and real-world function.

Who Can Benefit From a Functional Capacity Evaluation?

FCEs are incredibly useful for people across various life stages and health conditions. Some of the individuals who may benefit include:

1.                   Injured or Ill Workers

People who have experienced work-related injuries or illnesses and are preparing to return to work often need an FCE to determine if they are physically and mentally fit for duty or require modified duties.

2.                   People with Chronic Illness or Pain

Those living with chronic conditions such as fibromyalgia, rheumatoid arthritis, multiple sclerosis, or chronic back pain may need to understand their safe limits to prevent further injury or burnout. An FCE can inform pacing strategies, emotional coping needs, and safe workload thresholds.

3.                   Post-Surgical or Post-Trauma Patients

After major surgery (e.g., joint replacement or spinal surgery), individuals often need to be assessed to determine when and how to resume daily tasks or employment. Physical trauma can also affect memory, concentration, or confidence; a complete FCE considers the whole picture.

4.                   Insurance and Disability Claimants

When applying for long-term disability or compensation claims, insurers or legal entities may request an FCE as part of the evidence-gathering process.  These evaluations provide objective and holistic insight into the person’s limitations and capacities. 

5.                   Employers and Case Managers

FCEs provide a clear, evidence-based understanding of an individual’s capacity across physical, cognitive, and emotional domains.  This enables informed decisions about duty allocation, workplace accommodations, return-to-work planning, and long-term support needs, which in turn helps promote both employee well-being and organisational safety and productivity.

6.                   Individuals with Mental Health or Neurological Conditions

For those living with anxiety, depression, stroke, TBI, or cognitive decline, an FCE helps quantify unseen limitations and guides support planning.

How Does an Occupational Therapist Perform an FCE?

Occupational therapists (OTs) are uniquely qualified to conduct FCEs because they understand the intricate relationship between physical and mental health, function, environment, and occupation. Here’s a general outline of what the FCE process involves:

1.                   Initial Interview and Review of Medical History

The OT begins by gathering in-depth information: physical and mental health history, current symptoms, detailed job demands, and functional concerns. This provides context and ensures the evaluation is tailored to the client’s needs and circumstances.

2.                   Physical assessment

This may include assessments of:

• Range of motion (ROM)
• Muscle strength
• Posture and body mechanics
• Pain severity and the effects on function
• Cardiovascular endurance
• Functional mobility
• Hand function and grip strength

3.                   Cognitive Assessment

Depending on the client’s needs, the OT may assess: 

• Memory and recall
• Attention span and focus
• Executive function (planning, decision-making, task switching)
• Processing speed and mental endurance

4.                   Psychosocial and Behavioural Observation

Observations or standardised tools can be used to assess:

• Stress tolerance and emotional regulation
• Motivation, frustration thresholds, and coping mechanisms
• Communication and interpersonal engagement.

5.                   Simulated Activities

Performance in simulated activities is measured not only in terms of ability but also how consistently and sustainably a person performs under real-world pressures:

• Physical: load handling, reaching, repetitive tasks
• Cognitive: memory, multitasking, prioritising, responding to interruptions
• Psychosocial: collaborative tasks, managing time pressure or feedback

The person’s execution of each task is closely monitored for performance, biomechanics, endurance, safety, and fatigue. The OT will also watch for consistency of effort, which ensures the accuracy and integrity of the results.

Reporting and Recommendations

Once the evaluation is complete, the occupational therapist compiles the findings into a comprehensive report. This document includes:

• A summary of the individual’s physical, cognitive and psychosocial capacities
• Compatibility with job demands
• Identified limitations and potential risks
• Clear recommendations regarding work capacity, restrictions, or accommodations

The report is often shared with the referring doctor, employer, insurer, or legal representative, depending on the referral pathway.

A Truly Holistic Tool

A Functional Capacity Evaluation is more than just a physical test – it’s a meaningful, whole-person assessment that can help people make informed decisions about their work, health, and daily life. It provides clarity when there’s uncertainty and supports safe, realistic, and empowering outcomes.

For occupational therapists, the FCE is a key tool that aligns with our mission: to help people live fulfilling, functional, and productive lives—regardless of their circumstances. Whether facing recovery, transition, or challenge, an FCE can help shine a light on the path forward.