I think arrival notes are one of the most important parts of an FCE.
I think arrival notes are one of the most important parts of an FCE.
This 30-second video is a sped-up patient point-of-view version of what happens before the formal testing even starts. Sitting in the car. Standing in the parking lot. Walking across the lot. Pushing open a door. Pulling another door open. Climbing stairs. Reaching to hang up a jacket. Most of these movements happen before the client even realizes the assessment has already begun.
on the way to an FCE appointment by Kevin Cairns
These are not “gotcha” moments and they should never be treated that way. They are simply functional observations that provide context for the rest of the evaluation. As rehab therapists, we spend a lot of time focusing on standardized testing, force measurements, positional tolerances, and biomechanical analysis. All of that matters. But I also think some of the most valuable observations happen during ordinary movement. How someone gets out of their vehicle. How long they stand before shifting weight. Whether they use the handrail on the stairs. How they manage doors. How naturally they reach overhead. How quickly they walk from the parking lot to the clinic. These observations often occur before the person becomes hyper-focused on “performing” during the evaluation. That is why my greetings during an FCE are usually simple questions: “How was your drive today?” “How was traffic?” “How long did it take you to get here?” “Where did you find parking?” “Was the elevator working today?” To someone outside occupational rehabilitation, this probably sounds like small talk. Clinically, it gives context to the physical demands the person has already completed before testing even begins. If somebody reports they cannot tolerate sitting longer than 15 minutes, but they drove 90 minutes to the clinic, that does not automatically mean they are exaggerating or being deceptive. It means I now have additional information that needs to be explored through clinical reasoning. Maybe they stopped multiple times. Maybe their symptoms increased afterward. Maybe they shifted positions throughout the drive. Maybe they are going to pay for that drive later in the day. The point is not to jump to conclusions. The point is to gather data. A good FCE evaluator looks for consistency across the entire assessment process, not isolated moments. Self-report, movement quality, pacing, biomechanics, physiological response, symptom behavior, and standardized testing all contribute to the overall picture. Arrival notes are just one part of that process, but I think they are an important part because they reflect real-world function. Daily life does not happen inside isolated test stations. People have to walk across parking lots, negotiate doors, climb stairs, carry bags, tolerate sitting, transition positions, and move through unpredictable environments long before they ever lift a crate or push a sled in the clinic. For experienced PTs, OTs, and Kinesiologists, some of the best functional information often comes from simply paying attention to the normal movements happening right in front of you before the formal testing even begins.
