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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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Functional Assessment for
Adults with Disabilities

Committee on Functional Assessment for Adults with Disabilities

Paul A. Volberding, Carol Mason Spicer, and Jennifer Lalitha Flaubert,
Editors

Board on Health Care Services

Health and Medicine Division

A Consensus Study Report of

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THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

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
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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.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 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

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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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

Study Staff

CAROL MASON SPICER, Study Director

JENNIFER LALITHA FLAUBERT, Associate Program Officer

TOM CARTAXO, Research Assistant

SHARYL NASS, Director, Board on Health Care Services

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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Reviewers

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:

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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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.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
×

Preface

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.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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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

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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7-1 Alignment of different staging systems to describe heart failure

7-2 Illustration of factors with potential positive and negative effects over time on the trajectory of ability to work

TABLES

2-1 Terms from the Committee’s Conceptual Framework Cross-Linked with Terms and Concepts of the Social Security Administration and the Occupational Requirements Survey

Annex Table 2-1 Examples of Functional Criteria in the Social Security Administration’s Adult Listing of Impairments

5-1 New York Heart Association Functional Classification

5-2 Standard Voice Assessment Procedures, Speech Tasks, and Anticipated Results

Annex Table 5-1 Data Elements on Physical Demands in the Occupational Requirements Survey (ORS)

Annex Table 5-2 Physical Functional Abilities Relevant to Work Requirements

Annex Table 5-3 Selected General Assessments for Physical Function

Annex Table 5-4 Selected Musculoskeletal Assessments

Annex Table 5-5 Selected Cardiovascular Assessments

Annex Table 5-6 Selected Visual Assessments

Annex Table 5-7 Selected Hearing Assessments

Annex Table 5-8 Selected Speech/Fluency and Voice Assessments

Annex Table 5-9 Selected Language Assessments

Annex Table 6-1 Mental Functional Domains Relevant to Work Requirements

Annex Table 6-2 Definitions of Mental Functional Domains

Annex Table 6-3 Selected General Assessments for Mental Function

Annex Table 6-4 Selected Psychological Assessments

Annex Table 6-5 Selected Measures of Disorder Severity and Work-Related Functional Impairment

Annex Table 8-1 Comparison of Selected Benefit Programs

Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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Acronyms and Abbreviations

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
CI confidence interval
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
Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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EHR electronic health record
EKG electrocardiogram
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
and Health
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
MC medical consultant
MDD major depressive disorder
METS metabolic equivalents
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
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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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
OAE otoacoustic emission
OCD obsessive-compulsive disorder
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
PC psychological consultant
PCL PTSD Checklist
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
PTA posttraumatic amnesia
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
SD standard deviation
SF-36 36-Item Short Form Health Survey
SGA substantial gainful activity
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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SII speech intelligibility index
SLOF Specific Level of Functioning Scale
SLP speech-language pathologist
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
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The U.S. Social Security Administration (SSA) provides disability benefits through the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs. To receive SSDI or SSI disability benefits, an individual must meet the statutory definition of disability, which is “the inability to engage in any substantial gainful activity [SGA] by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” SSA uses a five-step sequential process to determine whether an adult applicant meets this definition.

Functional Assessment for Adults with Disabilities examines ways to collect information about an individual’s physical and mental (cognitive and noncognitive) functional abilities relevant to work requirements. This report discusses the types of information that support findings of limitations in functional abilities relevant to work requirements, and provides findings and conclusions regarding the collection of information and assessment of functional abilities relevant to work requirements.

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