Can you catch the faker?

[fa icon="calendar'] Apr 7, 2022 9:28:35 AM / by Erin Norton


As a clinician, you can use an FCE to “catch the faker,” right?


If FCE vendors are telling you that their FCE can do this…they’re flat out wrong and misrepresenting their product.

You simply cannot infer patient’s motivation from these tests. It is impossible.

A patient may not be giving full or consistent effort for a number of reasons:

  • pain,
  • fear of pain,
  • fear of reinjury,
  • anxiety,
  • depression,
  • lack of understanding of instructions,
  • lack of understanding of the importance of the test

The list goes on, and on…

Sure, secondary financial gain can be a problem…but it’s only one of many possibilities.

And it’s not fair to the patient to automatically assume that their behaviors are for the purpose of exaggerating or fabricating their symptoms to improve the likelihood that they will receive financial remuneration.

So, what can you do that’s objective and fair to the patient?

You can document/describe the extent and type of self-limiting and/or inconsistent behavior without drawing accusatory conclusions.

DO USE - statements that are a more fair and objective representation of the patient’s behavior during testing:Picture2

  • The patient self-limited on ____ % of the tasks of the test.
  • The following unexplained inconsistencies were noted:
  • The patient scored ____ on a formal test of consistent effort.

DO NOT USE – statements that imply motivation:

  • “Faking”
  • “Invalid effort”
  • “Exaggerating pain”

There’s just no research to support these suppositions.

And be careful what you use to formally test consistency of effort.

At ErgoScience we cautiously use the Bell-Shaped Curve and the Rapid Exchange Grip (REG) EXACTLY as it is described by the researchers who developed it. And we combine it with our clinical observations as recommended by the authors (Stokes, 1983, Stokes, 1995).  

Motivation Testing” to avoid…

  • Waddell’s Non-Organic Signs - were not intended for use in detecting sincerity of effort.
  • The coefficient of variation (CV) - 80+ peer-reviewed studies concluded that "there is no evidence that [using] iso-machines [to determine CVs] provides a reliable or valid method to assess effort or to detect if the person is faking.”
  • The correlation of heart rate to pain scores - heart rate does not consistently correlate with pain.

The good news is that it is NOT YOUR DUTY to “catch the faker.”

When performing an FCE, it is your job to objectively evaluate and report the patient’s abilities including consistency and level of effort.

Ready to learn how to perform an objective and defensible FCE, including level and consistency of effort?

CTA Talk to FCE expert

The ErgoScience FCE system is very thorough and objective, with step-by-step methods for objectively and fairly evaluating consistency built into the program.  Case managers, physicians and patients are extremely happy with the reports.  It has really increased our clinic revenue.  

Jon Nettie, PT 

Senior Physical Therapist

 CTA Sincerity of Effort paper


Erin Norton

Written by Erin Norton

Erin help clinics find the best solution to fit their needs from functional capacity evaluations, to job analysis, pre-employment screens or impairment ratings.