What type of specialist performs functional capacity testing, such as an occupational medicine physician or a physical medicine and rehabilitation (PM&R) physician?

Specialists Who Perform Functional Capacity Testing

Functional capacity testing is primarily performed by physicians specializing in Physical Medicine and Rehabilitation (PM&R) or Occupational Medicine, with PM&R physicians (physiatrists) being particularly well-qualified due to their expertise in rehabilitation and functional assessment. 1, 2

Types of Specialists Who Perform Functional Capacity Testing

• Physical Medicine and Rehabilitation (PM&R) physicians (physiatrists)

  • Specialize in quality of life, function, ability, and interdisciplinary care 3
  • Have specific training in evaluating and treating disabilities and functional limitations
  • Particularly qualified to interpret functional capacity tests in the context of rehabilitation needs

• Occupational Medicine physicians

  • Focus on work-related health assessment and occupational limitations 2, 4
  • Often perform functional capacity evaluations for return-to-work assessments
  • Evaluate how functional capacity relates to specific job requirements

Testing Environment and Supervision

• Tests are typically conducted in specialized exercise laboratories or rehabilitation facilities
• For low-risk patients, tests may be directly supervised by specially trained personnel (nurses, nurse practitioners, physician assistants, exercise physiologists) working under physician supervision 5
• For higher-risk patients (those with signs/symptoms of cardiovascular/pulmonary disease), direct physician supervision is warranted 5
• The level of supervision is ultimately determined by the physician overseeing the exercise laboratory 5

Types of Functional Capacity Testing

1. Exercise-based testing

   • Typically performed on motorized treadmills or stationary cycle ergometers 5
   • Protocols should be tailored to yield 8-12 minutes of fatigue-limited exercise 5, 1
   • Recommended protocols include Balke and Ware, Naughton, or Ramp protocols 5, 1

2. Work simulation testing

   • Includes material handling tests (lifting low, overhead lifting, carrying) 6
   • Static work tests (overhead working, standing forward bend) 6
   • Often performed by kinesiotherapists under physician supervision 2

Factors Affecting Test Selection and Interpretation

• Patient risk stratification is essential before testing 5
• Test selection should be based on the specific clinical question being addressed 5
• Test results are influenced by multiple factors:
  • Physical factors: muscle strength, gender, body weight, and height 6
  • Psychological factors: self-efficacy, fear of movement 7
  • Self-reported disability levels 7

Clinical Implications

• Functional capacity test results significantly influence physicians' assessment of a patient's work capacity 2
• The addition of functional capacity evaluation data to clinical evaluation can change physician-assigned work capacity levels in the majority of cases (65%) 2
• These tests provide objective data that can improve the accuracy of determining work capacity, especially in patients with chronic pain 2

Common Pitfalls

• Self-reported functional capacity may be inaccurate and should be validated with specific activity questions 1
• Exercise test protocols with large stage-to-stage increments can lead to inaccurate estimation of functional capacity 5, 1
• Handrail support during treadmill testing should be minimized to avoid overestimation of capacity 5, 1
• Orthopedic issues, neurological conditions, or respiratory problems may limit exercise capacity independent of cardiac function 1

When functional capacity testing is needed, a PM&R physician or occupational medicine physician should be consulted, with the choice depending on whether the focus is on rehabilitation potential (PM&R) or specific work-related capacity (occupational medicine).