Recently, I read a cover letter accompanying a Functional Capacity Evaluation (FCE) signed by a person with an Ed.D., CRC. In the letter, he writes Ms. So & So “never raised her pulse to an acceptable level of aerobic work of which you would expect to see with lifting activities.”
What’s Up With That?
Recently in one case I noticed the Independent Medical Exam (IME) doctor reviewed the same case file material I did, including “opposing FCEs”. In this case, the physical therapist (hired by the defense) specifically pointed out a “flaw” in the opposing PT’s FCE (hired by the claimant.) I saw this “flaw” as significant considering it made sense to me, however the IME doctor didn’t mention it.
Again, Huh? Who’s Missing Something Here?
I decided to do some research…..and contacted a local physical therapist. This PT educated me that heart rate does not have any practical use in determining level of effort on behalf of the claimant during an FCE.
The therapist educated me more by telling me that he has not been able to find any reference to heart rate as a measure of effort aside from the assertion that “minimally” increased heart rate correlates with minimal effort, “moderately” increased heart rate correlates with moderate effort, and “significantly” or “excessively” increased heart rate correlates with maximum effort.
Me? I’m Working to my Maximum!
Many factors other than effort affect heart rate such as stress, physical conditioning, and medication; and that failure to account for these factors makes use of heart rate unusable as an index of effort.
The therapist continues, “These general descriptors lack any sort of scientific support and there is no formula offered for determining what constitutes minimally, moderately, or significantly increased heart rate. While the measurement of heart rate is objective, the interpretation of heart rate by the evaluating therapist and how this correlates to the client’s level of effort is completely subjective. Furthermore, there is a complete lack of published research which correlates heart rate to effort level during functional testing.”
The only way to determine maximum heart rate is to conduct a maximum exercise test under the supervision of a cardiologist. Do you know any PTs who are also cardiologists??
Although measuring physical capacities in an individual is helpful in return to work situation, how about also gathering details about the person’s health condition in general, and how that may or may not relate to a successful return to work?
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My professional rehabilitation counseling practice is focused on helping people find a place in the workforce.
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