Scientific and legal challenges to the functional capacity evaluation in chronic fatigue syndrome

Abstract

Background: Objective measurements of function often form the basis for legal decisions about whether a patient is fit for return to work, or conversely, entitled to disability compensation. The functional capacity evaluation (FCE) is regarded as the gold standard for measuring work capacity in plaintiffs seeking disability benefits. Yet the FCE often fails to link the unremitting fatigue of chronic fatigue syndrome (CFS) to the ability to work. Purpose: To review the legal rationale and scientific evidence related to functional capacity measurements used to establish disability in individuals with CFS. Methods: Narrative review. Results: Several legal cases demonstrate problems with the FCE as determinative of the ability to work in people with CFS. In addition, scientific studies are lacking to support the reliability and validity of the FCE in this population. The putative metabolic pathology of CFS suggests that maximal cardiopulmonary exercise testing, which combines direct measurements of functioning and metabolic status, may be more appropriate to establish ability and disability than the FCE in this population. Conclusion: Utilization of the FCE in legal cases to establish disability in individuals with CFS may yield erroneous findings that can be addressed with the use of alternative validated measurements.

Keywords:

• chronic fatigue syndrome
• functional capacity evaluation
• cardiopulmonary exercise testing
• disability
• medico-legal issues

Acknowledgements

The authors thank Staci R. Stevens, MA for her critical reading and insightful comments on a previous version of this manuscript. The authors affirm they have no commercial/financial associations or conflicts of interest in the subject matter or the materials discussed in this manuscript.

Additional information

Notes on contributors

Margaret E. Ciccolella

Margaret E. Ciccolella is a Professor in the Department of Health, Exercise, and Sports Science at the University of the Pacific. She received an Ed.D.in exercise physiology from Brigham Young University and a J.D. from Humphreys College. Research interests and work focus upon the application of law to health and disability issues.

Todd E. Davenport

Todd E. Davenport serves as Associate Professor with the Department of Physical Therapy at University of the Pacific. He earned his Doctor of Physical Therapy degree from the University of Southern California, and he is a Board-certified specialist in orthopaedic physical therapy. Research and clinical interests involve establishing best practices in clinical physical therapy, including chronic conditions management.