Measuring Functional Capacity and Work Requirements Summary of a Workshop (1999) / Chapter Skim
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4 Desired Characteristics of Instruments to Measure Functional Capacity to Work
4 Desired Characteristics of Instruments to Measure Functional Capacity to Work
Pages 45-58
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From page 45... ...
Professor and Dean, Sargeant College of Health and Rehabilitation Sciences, Boston University The principal discussion question for this panel is: What are some of the strengths and limitations of different approaches to measurement self-reports, proxy reports, performance testing, and clinical observation? What criteria should guide the selection of measures of functional capacity?
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From page 46... ...
For example, impairments resulting from a lower extremity fracture include restricted range of motion and diminished muscle strength. Functional limitations or functional incapacities refer to the difficulties the individual has in his or her capacity to perform certain tasks considered normal for everyday living (e.g., walking, handling and grasping objects, climbing stairs, thinking, etch.
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From page 47... ...
Examples of impairment attributes commonly addressed in work-related injury rehabilitation include muscle strength and range of motion. Gait speed, lifting capacity, and bending ability, by contrast, reflect attributes of the individual's performance; thus they are functional limitations.
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From page 48... ...
Existing work disability determination approaches in the relevant literature include the assessment of impairments, functional capacities, or disability and, in some cases, combinations of concepts without regard to any underlying conceptual framework. In the context of this model, SSA is interested in the concept of disability from the point of view of work.
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From page 49... ...
The extent to which this assumption is true can be demonstrated empirically, and this challenge represents a classic validation research question. Once draft protocols are developed for this SSA initiative, empirical testing needs to be conducted to demonstrate the degree to which the chosen protocols validly predict level of work disability in this population.
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From page 50... ...
They identified four different dimensions: self-care, sphincter control, mobility, and cognitive disability. The customary ritual of scientific evaluation when one is considering the use of an assessment approach is to review the existing literature on relevant assessment protocols and obtain documentary evidence comparing empirical evidence of the various protocols.
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From page 51... ...
Professor, Department of Physical Medicine and Rehabilitation, Northwestern University Medical School When identifying measures of functional capacity or any other ability, the measurement ideals must be kept in focus. Measures are needed that are objective, that people can agree on, that are not the result of subjective whim, that are reproducible, and that are not dependent completely on the situation, the occasion, and the circumstances, but say something about the underlying quality of interest work capacity in this case.
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From page 52... ...
The functional capacity items need to be calibrated separately for this subsample of persons with spinal injuries. The same issues may be relevant in the mental impairment field, where issues of the way in which depression results in functional limitations versus schizophrenia versus something else may require subsamples of people to calibrate the measures of functional capacity.
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From page 53... ...
Also, the frequency of disability by the LEAD standard in the population in question must be known, as it has a bearing on error. If the population in question is the universe of people who apply for Social Security Disability Insurance, the frequency of disability is high and error is less (fewer false positives)
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From page 54... ...
If the LEAD standard assessment were applied to every case, the overall cost would be astronomical. As the determination process moves away from the LEAD standard, it costs less but is less accurate.
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From page 55... ...
Ideally, any measure developed should have: superior face validity before any field testing (basically, expert opinion of its ability to measure disability) ; superior concurrent-criterion validity against a LEAD standard in field testing; superior predictive validity, meaning it predicts the course of dis ability over time; and construct validity, such as the practice of validating functional measures against other functional measures (but not a LEAD stan dard)
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From page 56... ...
However, in the population SSA is dealing with, people seeking benefits, there are only true positives or false positives, depending on whether they meet the statutory definition, but there are no true or false negatives. Answers to self-report questions have a lot to do with the extent to which the respondent feels the environment is safe.
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From page 57... ...
The medical environment is recognized in the way the medical listings are tweaked to determine if certain conditions are more or less disabling than they once were. Measuring requirements of jobs in the national economy is a very broad question about the work environment on average in the national economy.
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From page 58... ...
Clearly there is no gold standard, but SSA has to proceed as if there is one and make incremental changes to the current process instead of trying to create something new all at once. The goal of the redesign is to move closer to reality in measuring work capacity (e.g., the medical listings do not tell much about work capacity, so would functional capacity be a better way to determine if someone can worked.
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