Functional Assessment for
Adults with Disabilities
Committee on Functional Assessment for Adults with Disabilities
Paul A. Volberding, Carol Mason Spicer, and Jennifer Lalitha Flaubert,
Board on Health Care Services
Health and Medicine Division
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
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This activity was supported by Contract/Task Order No. SS00-13-60048/0009 with the U.S. Social Security Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-48938-6
International Standard Book Number-10: 0-309-48938-5
Digital Object Identifier: https://doi.org/10.17226/25376
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Functional assessment for adults with disabilities. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25376.
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COMMITTEE ON FUNCTIONAL ASSESSMENT FOR ADULTS WITH DISABILITIES
PAUL A. VOLBERDING (Chair), Professor, Department of Medicine; Director, AIDS Research Institute, Co-Director, University of California, San Francisco-Gladstone Institute of Virology and Immunology Center for AIDS Research, University of California, San Francisco
MARÍA P. ARANDA, Associate Professor, School of Social Work, University of Southern California
JACK T. DENNERLEIN, Professor, Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University
LISA DIXON, Professor, Department of Psychiatry, Columbia University; Director, Center for Practice Innovations, Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute
JUDITH GREEN-McKENZIE, Director of Clinical Practice, Associate Residency Director, Associate Professor, Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine
ALLEN W. HEINEMANN, Director, Center for Rehabilitation Outcomes Research; Professor, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
ANDREW J. HOUTENVILLE, Associate Professor, Paul College of Business and Economics; Research Director, Institute on Disability, University of New Hampshire
KURT L. JOHNSON, Director, Center for Technology and Disability Studies; Professor, Department of Rehabilitation Medicine; Head, Division of Rehabilitation Counseling, University of Washington
BARBARA L. KORNBLAU, Adjunct Professor of Occupational Therapy, School of Allied Health Science, Florida A&M University, Coalition for Disability Health Equity
PHILIP JORDAN MARION, Medical Director, Polytrauma Amputation Network Site, Washington, DC, Veterans Affairs Medical Center, Medical Director, Capital Medical Services
SUSAN McGURK, Professor, Department of Occupational Therapy; Senior Researcher, Center for Psychiatric Rehabilitation, Boston University
JUAN I. SANCHEZ, Professor, Knight-Ridder Byron Harless Eminent Chair in Management, College of Business, Florida International University
PAUL SHATTUCK, Associate Professor, A.J. Drexel Autism Institute, Drexel University
LYNNE WARNER STEVENSON, Professor of Medicine and Lisa M. Jacobson Chair in Cardiovascular Medicine, Vanderbilt University Medical School; Director of Cardiomyopathy Program, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center
ROBERT B. WALLACE, Irene Ensminger Stecher Professor of Epidemiology and Internal Medicine, Department of Epidemiology, College of Public Health, The University of Iowa
CAROL MASON SPICER, Study Director
JENNIFER LALITHA FLAUBERT, Associate Program Officer
TOM CARTAXO, Research Assistant
SHARYL NASS, Director, Board on Health Care Services
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by Sara Rosenbaum, The George Washington University, and Elaine Larson, Columbia University School of Nursing. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
The U.S. Social Security Administration (SSA) annually reviews more than 3 million claims from adults requesting a determination of disability for physical or mental health conditions that prevent them from engaging in substantial gainful employment. Assessment of individuals’ functional abilities relevant to work requirements should be an important part of determining whether they are able to meet workplace demands and sustain work performance on a regular and continuing basis. Over the years, many tests, surveys, and instruments have been developed to collect information about individuals’ physical and mental functional abilities. With support from SSA, the Health and Medicine Division (HMD) of the National Academies of Sciences, Engineering, and Medicine convened a committee to identify and describe ways to collect information about individuals’ physical and mental abilities relevant to function in the workplace, to discuss the types of information that support findings of limitations in work-related function, and to provide findings and conclusions about the collection of information and assessment of functional abilities relevant to work requirements.
On behalf of the committee, I sincerely thank the SSA staff who worked closely with the committee to define details of the committee’s task, including Megan Butson, Gina Clemons, Joanna Firmin, Deborah Harkin, Mary Beth Rochowiak, and Melissa Spencer. We also thank the expert and dedicated HMD staff who worked tirelessly to bring together information used in our deliberations. Led by study director Carol Mason Spicer, assisted by Jennifer Lalitha Flaubert (associate program officer) and Tom Cartaxo (research assistant), the committee accomplished a great deal, none of which would have been possible without their hard work, focus, and expertise.
We extend thanks as well to other HMD staff members who played a key role in the production of this report, including Sharyl Nass (senior board director, Board on Health Care Services); Karen Helsing (senior program officer); Patrick Burke, Julie Wiltshire, and Micah Winograd (financial associates). Research assistance was provided by Rebecca Morgan (senior research librarian, the National Academies). We are indebted as well to Rona Brière and Alisa Decatur, who provided exceptional editorial assistance in preparing the final report.
Our thanks go to all of the presenters who shared their time and expertise during the committee’s information-gathering sessions (see Appendix A); to the authors of three papers commissioned by the committee, Laura Ball, Ryan McCreery, Mark Wilkinson, Gislin Dagnelie, and Christopher Johnson; and to the reviewers for their invaluable feedback on an earlier draft of the report.
Finally, I thank the committee itself. As is so often the case, the National Academies are able to bring together experts across a wide range of expertise, each able to contribute to specific aspects of the task we were assigned. But the ability to bring that individual expertise together to a coherent whole demands an openness to learning from each other and a willingness to work as a team. Our committee did that and more. We each learned a great deal and trust that our report will be useful to SSA as it continues to improve in its essential mission.
Paul A. Volberding, Chair
Committee on Functional Assessment for Adults with Disabilities
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Boxes, Figures, and Tables
|ADL||activity of daily living|
|ALS||amyotrophic lateral sclerosis|
|APS||Attending Physician Statement|
|ASD||autism spectrum disorder|
|ASHA||American Speech-Language-Hearing Association|
|BAC||Brief Assessment of Cognition|
|BLS||U.S. Bureau of Labor Statistics|
|CAPS||Clinician-Administered PTSD Scale|
|CAT||computer adaptive testing|
|CCSE||Cognitive Capacity Screening Examination|
|CIDI||Composite International Diagnostic Interview|
|CNSLBP||chronic nonspecific low back pain|
|CPP||Canada Pension Program|
|CPTH||chronic posttraumatic headache|
|DASH||Disabilities of the Arm, Shoulder and Hand Questionnaire|
|DBQ||Disability Benefits Questionnaire|
|DPI||Depression Prognosis Index|
|DSM||Diagnostic and Statistical Manual of Mental Disorders|
|DSP||Disability Support Pension|
|EHR||electronic health record|
|ESII||extended speech intelligibility index|
|EWPS||Endicott Work Productivity Scale|
|FAAM||Foot and Ankle Ability Measure|
|FCE||functional capacity evaluation|
|FGA||Functional Gait Assessment|
|GAD||generalized anxiety disorder|
|GAF||Global Assessment of Functioning|
|GCS||Glasgow Coma Score|
|HAM-D||Hamilton-Depression Rating Scale|
|HAP||Human Activity Profile|
|HHIA||Hearing Handicap Inventory for Adults|
|HPQ||World Health Organization Heath and Work Performance Questionnaire|
|HRQOL||health-related quality of life|
|IADL||instrumental activity of daily living|
|ICC||intraclass correlation coefficient|
|ICF||International Classification of Functioning, Disability|
|IME||independent medical examination|
|IRT||item response theory|
|K10||Kessler Psychological Distress Scale|
|KCCQ||Kansas City Cardiomyopathy Questionnaire|
|L&I||Washington State Department of Labor and Industries|
|LEFS||Lower-Extremity Functional Scale|
|LOC||loss of consciousness|
|MDD||major depressive disorder|
|MHQ||Michigan Hand Outcomes Questionnaire|
|MIRECC||Mental Illness Research, Education and Clinical Center|
|MLHFQ||Minnesota Living with Heart Failure Questionnaire|
|MMI||maximal medical improvement|
|MMSE||Mini-Mental State Exam|
|MoCA||Montreal Cognitive Assessment|
|MRFC||Mental Residual Functional Capacity Assessment|
|NDI||Neck Disability Index|
|Neuro-QoL||Quality of Life in Neurological Disorders|
|NIH||National Institutes of Health|
|NRS||numeric rating scale|
|NYHA||New York Heart Association|
|ODI||Oswestry Disability Index|
|OFS||Occupational Functioning Scale|
|OIS||Occupational Information System|
|OMCT||Short Orientation-Memory-Concentration Test of Cognitive Impairment|
|OMPQ||Orebro Musculoskeletal Pain Questionnaire|
|O*NET||Occupational Information Network|
|ORS||Occupational Requirements Survey|
|PHQ-9||Patient Health Questionnaire-9|
|PREE||Patient-Rated Elbow Evaluation|
|PROMIS||Patient-Reported Outcomes Measurement Information System|
|PRTF||Psychiatric Review Technique Form|
|PRWE||Patient-Rated Wrist Evaluation|
|PSP||Personal and Social Performance Scale|
|PTSD||posttraumatic stress disorder|
|QCL||Quality of Communication Life Scale|
|RFC||residual functional capacity|
|RMDQ||Roland-Morris Disability Questionnaire|
|ROM||range of motion|
|SCL||Symptoms Checklist Depression Scale|
|SF-36||36-Item Short Form Health Survey|
|SGA||substantial gainful activity|
|SII||speech intelligibility index|
|SLOF||Specific Level of Functioning Scale|
|SOFAS||Social and Occupational Functioning Assessment Scale|
|SSA||U.S. Social Security Administration|
|SSDI||Social Security Disability Insurance|
|SSI||Supplemental Security Income|
|SSQ||Speech, Spatial, and Qualities of Hearing Questionnaire|
|TBI||traumatic brain injury|
|UPSA||University of California, San Diego, Performance-Based Skills Assessment|
|VA||U.S. Department of Veterans Affairs|
|VAS||visual analog scale|
|VBA||Veterans Benefits Administration|
|VDS||Vantaa Disability Study|
|VHA||U.S. Veterans Health Administration|
|WAI||Work Ability Index|
|WAIS-IV||Wechsler Adult Intelligence Scale, fourth edition|
|WD-FAB||Work Disability Functional Assessment Battery|
|WHO||World Health Organization|
|WHODAS 2.0||World Health Organization Disability Assessment Schedule 2.0|
|WLQ||Work Limitations Questionnaire|
|WPAI||Work Productivity and Activity Impairment Questionnaire|
|Y-BOCS||Yale-Brown Obsessive Compulsive Scale|