When the barriers to work aren't clear: the value of OT-Led Fitness for Duty Assessments
When concerns arise about an employee's fitness for duty, the factors affecting their capacity to work are not always immediately apparent.
An employee may be experiencing difficulties maintaining consistent attendance, managing the demands of their role or meeting expected performance requirements. Yet, despite these concerns, the primary barriers to work may remain unclear.
For HR professionals and employers, this uncertainty can make it challenging to determine what type of support is appropriate and how best to move forward.
This is where an Occupational Therapy-led Fitness for Duty assessment can provide valuable clarity.
Looking at the whole person
Occupational therapists (OTs) bring a distinctive perspective to the evaluation of work capacity. Their expertise lies in understanding how different aspects of a person's functioning interact with the activities, responsibilities and environments in which they are expected to perform.
Rather than focusing on one area of functioning alone, an OT-led Fitness for Duty assessment can consider three interconnected domains:
Physical functioning: Strength, mobility, endurance, coordination and the physical demands of work.
Cognitive functioning: Attention, memory, information processing, planning, decision-making and the ability to manage competing demands.
Psychosocial functioning: Emotional regulation, interpersonal interactions, behavioural responses, stress tolerance and other psychosocial factors that may influence work participation.
Importantly, these areas do not operate independently.
An employee experiencing fatigue, for example, may also demonstrate difficulties with sustained attention, managing competing priorities or maintaining consistent performance throughout the working day. Understanding how these factors interact can be particularly valuable when the underlying barriers are not readily identifiable.
Why an integrated functional evaluation matters
The value of a comprehensive assessment is not simply in examining multiple areas of functioning. It is in understanding how they interact and what that means for the employee's capacity to meet the specific requirements of their role.
Occupational therapy draws on established frameworks that consider the relationship between the person, their environment and the activities they undertake.
One such framework is the Person–Environment–Occupation–Performance (PEOP) model, which recognises that performance is influenced by the interaction of personal characteristics, environmental conditions and occupational demands.
A 2024 scoping review published in OTJR: Occupation, Participation and Health examined 109 articles applying the PEOP model across different populations and settings. The review highlighted its broad application as a framework for understanding performance, participation and the interaction between personal and environmental factors.
When the primary barriers to work are unclear
For employers, some of the most challenging Fitness for Duty matters are those where concerns are evident, but the reasons for those concerns are not fully understood.
Consider an employee who has experienced intermittent absences and increasing difficulty managing their usual workload. There may be concerns about fatigue, concentration, work pace or the ability to manage competing responsibilities. However, it may not be clear which factors are having the greatest impact, whether several factors are interacting, or what this means for the employee's capacity to perform their role.
An OT-led assessment provides an opportunity to explore these concerns through a structured evaluation of the employee's functioning in relation to their actual work requirements.
Depending on the referral questions and assessment methodology, this may involve clinical interviews, review of relevant information, standardised assessment tools and observation of functional performance.
The aim is to develop a clearer understanding of the employee's functional strengths, limitations and potential barriers, while identifying any areas where further specialist evaluation may be required.
This approach is also reflected in the NSW State Insurance Regulatory Authority's functional assessment practice standards, which recognise the importance of considering physical, psychological, cognitive, social and environmental work demands. The standards emphasise gathering information from multiple sources and examining the relationships between factors affecting work performance.
Although these standards apply within a workers' compensation assessment framework, the principles are relevant to comprehensive work capacity evaluation more broadly.
From uncertainty to clarity: what this means for HR or business leaders
One of the greatest benefits we have observed at Flexiwell from OT-led Fitness for Duty assessments is the clarity they can provide in matters where the employee's functional presentation is complex, or the primary barriers to work have not yet been identified.
For HR professionals, a comprehensive functional evaluation can help answer several important questions:
What are the employee's current functional strengths and limitations?
Which physical, cognitive or psychosocial factors may be influencing their work capacity?
How do these factors interact with the inherent requirements and practical demands of their role?
Are there identifiable barriers that may affect safe, effective or consistent work performance?
Are workplace adjustments or further specialist assessments worth considering?
The answers may not always be straightforward. However, a structured evaluation can help distinguish between areas of established functional capacity, identified limitations and matters requiring further investigation.
Clarity does not necessarily mean having every answer. Sometimes, it means knowing which questions need to be asked next.
For employers navigating complex Fitness for Duty matters, that distinction can be particularly valuable.
Choosing the right assessment approach
Not every Fitness for Duty concern requires a comprehensive OT-led assessment.
Where concerns are clearly defined and relate predominantly to a specific medical, physical or psychological issue, a targeted assessment may be more appropriate.
However, where the presentation is complex, several areas of functioning may be involved, or the primary barriers to work remain uncertain, an OT-led evaluation may offer a particularly useful starting point.
The breadth of the assessment should always be guided by the referral questions, the inherent requirements of the role and the occupational therapist's professional scope of practice.
An OT-led assessment may also identify circumstances where additional medical, psychological or other specialist input is necessary.
Ultimately, selecting the right assessment pathway is about ensuring you receive information that is relevant, appropriately considered and useful for the decisions you need to make.
How Flexiwell can help
Flexiwell Group facilitates independent, Occupational Therapy-led Fitness for Duty assessments designed to help employers better understand an employee's functional capacity in relation to their role.
Our assessments are tailored to the referral questions and the inherent requirements of the position, providing HR professionals and employers with considered functional findings and practical recommendations to support informed workplace decisions.
Not sure which Fitness for Duty assessment is right for your situation?
Contact the Flexiwell team to discuss your concerns and explore the most appropriate assessment pathway.
References
American Occupational Therapy Association. (2020). Occupational Therapy Practice Framework: Domain and Process (4th ed.). Evaluation and Assessment — AOTA.
Bass, J. D., Marchant, J. K., de Sam Lazaro, S. L., & Baum, C. M. (2024). Application of the Person–Environment–Occupation–Performance Model: A Scoping Review. OTJR: Occupation, Participation and Health, 44(3), 521–540. Read the full article.
State Insurance Regulatory Authority, NSW. Functional Assessment Service Sub-stream Practice Standards. Read the practice standards.
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