The Truth About Functional Capacity Evaluations and Conflicts of Interest

Is it a conflict of interest for a treating professional to perform a Functional Capacity Evaluation (FCE) on a patient they treat?

As treating therapists, we are committed to upholding the highest standards of ethical conduct in our practice. One area that requires careful consideration is the potential for conflicts of interest, particularly when performing a Functional Capacity Evaluation (FCE) on a patient we are already treating.

If a conflict exists, we must determine if we can write an unbiased FCE report.

In this article, we will explore the concept of conflicts of interest in our profession, discuss examples of potential conflicts, outline steps to address such conflicts, and refer to relevant resources from professional associations and scholarly literature.

Defining Conflict of Interest:
A conflict of interest arises when our professional judgment or actions are unduly influenced by personal, financial, or other interests, thereby compromising our ability to act in the best interests of our patients or clients. Specifically, for physical and occupational therapists, conflicts of interest can occur when our roles as evaluators and treatment providers intersect, leading to potential biases in our assessments.

Learn more about FCEs in our FCE certification course: 

Examples of Potential Conflicts of Interest:

1. Financial Incentives: Accepting payment for both evaluation and treatment services from the same patient may create a conflict of interest, as therapists may feel pressured to provide favorable evaluation results to ensure continued treatment.

2. Patient Relationship: Long-standing relationships with patients can cloud judgment during evaluations, as therapists may be inclined to either overestimate or underestimate their capabilities.

3. Employer Expectations: Therapists working within healthcare organizations may face pressure to produce favorable evaluation outcomes to maintain referrals or meet organizational targets, potentially compromising impartiality.

Can we write an unbiased report?

Communication is key. When determining if you can perform the FCE, connect with referral source and consider the following:

Addressing Conflicts of Interest:

When faced with a potential conflict of interest, therapists must take proactive steps to mitigate biases and ensure fair and unbiased evaluations. The following actions can help address conflicts of interest:

1. Disclosure: Transparently disclose any potential conflicts of interest to relevant parties, including patients, employers, and colleagues.

2. Third-Party Evaluation: Consider involving an independent evaluator or colleague who is not involved in the patient's treatment to conduct the evaluation.

3. Ethical Reflection: Reflect on personal biases and interests that may impact the evaluation process and strive to maintain objectivity and impartiality.

4. Professional Boundaries: Establish clear boundaries between evaluation and treatment roles, emphasizing the importance of prioritizing patient welfare above other considerations.

Learn more about the tools used in an FCE

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Professional Association Guidance:
Both the American Physical Therapy Association (APTA) and the American Occupational Therapy Association (AOTA) offer guidance on conflicts of interest and ethical practice. The APTA Code of Ethics emphasizes the importance of integrity, accountability, and impartiality in all aspects of physical therapy practice. Similarly, the AOTA Code of Ethics stresses the ethical responsibility of occupational therapists to prioritize client welfare and avoid conflicts of interest.

1. American Physical Therapy Association. (2019). Code of Ethics for the Physical Therapist. Retrieved from
2. American Occupational Therapy Association. (2020). Occupational Therapy Code of Ethics and Ethics Standards. Retrieved from

Further Reading:
For additional insights into conflicts of interest in physical and occupational therapy practice, consider exploring the following resources:
1. Moyle, K., Lloyd, M., & Murdolo, Y. (2018). Conflicts of interest in the provision of occupational therapy services: A scoping review protocol. JBI Database of Systematic Reviews and Implementation Reports, 16(9), 1833-1839. doi:10.11124/JBISRIR-2017-003931
2. Finucane, P. M., & Marquez, J. S. (2017). Ethical issues in functional capacity evaluations. Physical Medicine and Rehabilitation Clinics of North America, 28(4), 709-719. doi:10.1016/j.pmr.2017.06.010

In conclusion, maintaining ethical integrity in our practice as treating therapists requires careful consideration of conflicts of interest, particularly in the context of conducting Functional Capacity Evaluations. By adhering to professional standards, disclosing potential conflicts, and prioritizing patient welfare, we can uphold the trust and confidence placed in our profession by patients, colleagues, and society at large. Ultimately the question we must answer is: Can we write an unbiased report.

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